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Leaning D, Kaur G, Morgans AK, Ghouse R, Mirante O, Chowdhury S. Treatment landscape and burden of disease in metastatic castration-resistant prostate cancer: systematic and structured literature reviews. Front Oncol 2023; 13:1240864. [PMID: 37829336 PMCID: PMC10565658 DOI: 10.3389/fonc.2023.1240864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose Metastatic castration-resistant prostate cancer (mCRPC) is a lethal disease that imposes a major burden on patients and healthcare systems. Three structured literature reviews (treatment guidelines, treatment landscape, and human/clinical/patient burden) and one systematic literature review (economic burden) were conducted to better understand the disease burden and unmet needs for patients with late-stage mCRPC, for whom optimal treatment options are unclear. Methods Embase®, MEDLINE®, MEDLINE® In-Process, the CENTRAL database (structured and systematic reviews), and the Centre for Reviews and Dissemination database (systematic review only) were searched for English-language records from 2009 to 2021 to identify mCRPC treatment guidelines and studies related to the treatment landscape and the humanistic/economic burden of mCRPC in adult men (aged ≥18 years) of any ethnicity. Results In total, six records were included for the treatment patterns review, 14 records for humanistic burden, nine records for economic burden, three records (two studies) for efficacy, and eight records for safety. Real-world treatment patterns were broadly aligned with treatment guidelines and provided no optimal treatment sequencing beyond second line other than palliative care. Current post-docetaxel treatments in mCRPC are associated with adverse events that cause relatively high rates of treatment discontinuation or disruption. The humanistic and economic burdens associated with mCRPC are high. Conclusion The findings highlight a lack of treatment options with novel mechanisms of action and more tolerable safety profiles that satisfy a risk-to-benefit ratio aligned with patient needs and preferences for patients with late-stage mCRPC. Treatment approaches that improve survival and health-related quality of life are needed, ideally while simultaneously reducing costs and healthcare resource utilization.
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Affiliation(s)
- Darren Leaning
- Department of Radiology and Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom
| | - Gagandeep Kaur
- Parexel Access Consulting, Parexel International, Mohali, Punjab, India
| | - Alicia K. Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Ray Ghouse
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Osvaldo Mirante
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Simon Chowdhury
- Department of Urological Cancer, Guy’s, King’s, and St. Thomas’ Hospitals, and Sarah Cannon Research Institute, London, United Kingdom
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Kanesvaran R, Chia PL, Chiong E, Chua MLK, Ngo NT, Ow S, Sim HG, Tan MH, Tay KH, Wong ASC, Wong SW, Tan PH. An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:135-148. [PMID: 38904491 DOI: 10.47102/annals-acadmedsg.2022372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction There has been a rapid evolution in the treatment strategies for metastatic castration-resistant prostate cancer (mCRPC) following the identification of targetable mutations, making genetic testing essential for patient selection. Although several international guidelines recommend genetic testing for patients with mCRPC, there is a lack of locally endorsed clinical practice guidelines in Singapore. Method A multidisciplinary specialist panel with representation from medical and radiation oncology, urology, pathology, interventional radiology, and medical genetics discussed the challenges associated with patient selection, genetic counselling and sample processing in mCRPC. Results A clinical model for incorporating genetic testing into routine clinical practice in Singapore was formulated. Tumour testing with an assay that is able to detect both somatic and germline mutations should be utilised. The panel also recommended the "mainstreaming" approach for genetic counselling in which pre-test counselling is conducted by the managing clinician and post-test discussion with a genetic counsellor, to alleviate the bottlenecks at genetic counselling stage in Singapore. The need for training of clinicians to provide pre-test genetic counselling and educating the laboratory personnel for appropriate sample processing that facilitates downstream genetic testing was recognised. Molecular tumour boards and multidisciplinary discussions are recommended to guide therapeutic decisions in mCRPC. The panel also highlighted the issue of reimbursement for genetic testing to reduce patient-borne costs and increase the reach of genetic testing among this patient population. Conclusion This article aims to provide strategic and implementable recommendations to overcome the challenges in genetic testing for patients with mCRPC in Singapore.
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Affiliation(s)
| | - Puey Ling Chia
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, Singapore
- Department of Surgery, National University of Singapore, Singapore
| | | | - Nye Thane Ngo
- Division of Pathology, Singapore General Hospital, Singapore
| | - Samuel Ow
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Hong Gee Sim
- Ravenna Urology Clinic, Gleneagles Medical Centre, Singapore
| | | | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiation, Singapore General Hospital, Singapore
| | | | | | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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3
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Kanesvaran R, Castro E, Wong A, Fizazi K, Chua MLK, Zhu Y, Malhotra H, Miura Y, Lee JL, Chong FLT, Pu YS, Yen CC, Saad M, Lee HJ, Kitamura H, Prabhash K, Zou Q, Curigliano G, Poon E, Choo SP, Peters S, Lim E, Yoshino T, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with prostate cancer. ESMO Open 2022; 7:100518. [PMID: 35797737 PMCID: PMC9434138 DOI: 10.1016/j.esmoop.2022.100518] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of prostate cancer was published in 2020. It was therefore decided, by both the ESMO and the Singapore Society of Oncology (SSO), to convene a special, virtual guidelines meeting in November 2021 to adapt the ESMO 2020 guidelines to take into account the differences associated with the treatment of prostate cancer in Asia. These guidelines represent the consensus opinions reached by experts in the treatment of patients with prostate cancer representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with prostate cancer across the different regions of Asia.
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Affiliation(s)
- R Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore.
| | - E Castro
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Málaga, Malaga, Spain
| | - A Wong
- Division of Medical Oncology, National University Cancer Institute, Singapore, Singapore
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - M L K Chua
- Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Y Zhu
- Department of Urology, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - H Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, India
| | - Y Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - J L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - F L T Chong
- Department of Radiotherapy and Oncology, Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | - Y-S Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Yen
- Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - M Saad
- Department of Clinical Oncology, University of Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - H J Lee
- Department of Medical Oncology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - H Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Q Zou
- Department of Urology, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - G Curigliano
- European Institute of Oncology, IRCCS and University of Milano, Milan, Italy
| | - E Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - S P Choo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Medical Oncology, Curie Oncology, Singapore, Singapore
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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4
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Treatment of Metastatic Hormone-Sensitive Prostate Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shih HJ, Chang SC, Hsu CH, Lin YC, Hung CH, Wu SY. Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer. Cancers (Basel) 2021; 13:cancers13235986. [PMID: 34885096 PMCID: PMC8656593 DOI: 10.3390/cancers13235986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary That the definitive optimal treatments for relatively young men (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC) are radical prostatectomy (RP) or radiation plus antiandrogen therapy (RT-ADT) is controversial. To the best of our knowledge, our study is the first and largest to examine biochemical failure (BF), all-cause death, locoregional recurrence, and distant metastasis in relatively young men with HR/VHR-LPC as defined by National Comprehensive Cancer Network risk strata. After head-to-head propensity score matching was used to balance the potential confounders, a multivariable Cox proportional hazards regression model was used to analyze oncologic outcomes. In relatively young men with HR/VHR-LPC, RP and RT-ADT yielded similar oncologic outcomes and RP reduced the risk of BF compared with RT-ADT. Abstract That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.
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Affiliation(s)
- Hung-Jen Shih
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Recreation and Holistic Wellness, MingDao University, Changhua 500, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shyh-Chyi Chang
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
| | - Chia-Hao Hsu
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
| | - Yi-Chu Lin
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
| | - Chu-Hsuan Hung
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 242062, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan 262307, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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6
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Bonfill X, Martinez-Zapata MJ, Vernooij RWM, Sánchez MJ, Morales-Suárez-Varela M, Emparanza JI, Ferrer M, Pijoan JI, Palou J, Madrid E, Abraira V, Zamora J. Follow-up care over 12 months of patients with prostate cancer in Spain: A multicenter prospective cohort study. Medicine (Baltimore) 2021; 100:e27801. [PMID: 34964747 PMCID: PMC8615301 DOI: 10.1097/md.0000000000027801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
The therapeutic approach is crucial to prostate cancer prognosis. We describe treatments and outcomes for a Spanish cohort of patients with prostate cancer during the first 12 months after diagnosis and identify the factors that influenced the treatment they received.This multicenter prospective cohort study included patients with prostate cancer followed up for 12 months after diagnosis. Treatment was stratified by factors such as hospital, age group (<70 and ≥70 years), and D'Amico cancer risk classification. The outcomes were Eastern Cooperative Oncology Group (ECOG) performance status, adverse events (AEs), and mortality. The patient characteristics associated with the different treatment modalities were analyzed using multivariate logistic regression.We included 470 men from 7 Spanish tertiary hospitals (mean (standard deviation) age 67.8 (7.6) years), 373 (79.4%) of which received treatment (alone or in combination) as follows: surgery (n = 163; 34.7%); radiotherapy (RT) (n = 149; 31.7%); and hormone therapy (HT) (n = 142; 30.2%). The remaining patients (n = 97) were allocated to no treatment, that is, watchful waiting (14.0%) or active surveillance (5.7%). HT was the most frequently administered treatment during follow-up and RT plus HT was the most common therapeutic combination. Surgery was more frequent in patients aged <70, with lower histologic tumor grades, Gleason scores <7, and lower prostate-specific antigen levels; while RT was more frequent in patients aged ≥70 with histologic tumor grade 4, and higher ECOG scores. HT was more frequent in patients aged ≥70, with histologic tumor grades 3 to 4, Gleason score ≥8, ECOG ≥1, and higher prostate-specific antigen levels. The number of fully active patients (ECOG score 0) decreased significantly during follow-up, from 75.3% at diagnosis to 65.1% at 12 months (P < .001); 230 (48.9%) patients had at least 1 AE, and 12 (2.6%) patients died.Surgery or RT were the main curative options. A fifth of the patients received no treatment. Palliative HT was more frequently administered to older patients with higher tumor grades and higher Gleason scores. Close to half of the patients experienced an AE related to their treatment.
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Affiliation(s)
- Xavier Bonfill
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
- Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María José Martinez-Zapata
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - María José Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Barcelona, Spain
| | - María Morales-Suárez-Varela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - José Ignacio Emparanza
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Clinical Epidemiology Unit, Hospital Universitario Donostia, BioDonostia, San Sebastian, Spain
| | - Montse Ferrer
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José Ignacio Pijoan
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Clinical Epidemiology Unit, Hospital, Universitario Cruces, Biocruces, Barakaldo, Spain
| | | | - Eva Madrid
- Cochrane Centre Universidad de Valparaíso, Chile, Interdisciplinary Centre for Health Studies CIESAL, Department of Public Health - School of Medicine - Universidad de Valparaíso, Chile
| | - Víctor Abraira
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Javier Zamora
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Tian Z, Meng L, Wang X, Wang X, Ma T, Wang M, Zhong Q, Zhang Y, Liu M. Survival in Patients With Metastatic Prostate Cancer Undergoing Radiotherapy: The Importance of Prostate-Specific Antigen-Based Stratification. Front Oncol 2021; 11:706236. [PMID: 34178701 PMCID: PMC8224529 DOI: 10.3389/fonc.2021.706236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore the effectiveness of radiotherapy in mPCa patients with different PSA stratifications based on the cancer database of a large population. BACKGROUND Screening criteria for patients with metastatic prostate cancer, who are candidates for radiotherapy, are rarely reported. PATIENTS AND METHODS We identified 22,604 patients with metastatic prostate cancer in the Surveillance, Epidemiology, and End Results database and divided them into a radiotherapy group and a control group. Patients with metastatic prostate cancer were divided into subgroups according to their levels of prostate-specific antigen to evaluate the efficacy of radiotherapy. They were also divided into six subgroups according to their prostate-specific antigen levels. We used multivariate Cox analysis to evaluate overall survival and cancer-specific survival. After 1:1 propensity score matching, Kaplan-Meier analysis was used to explore the difference in overall survival and cancer-specific survival in the radiotherapy and control group. RESULTS In all, 5,505 patients received radiotherapy, compared to 17,099 in the control group. In the multivariate Cox analysis, radiotherapy improved overall survival (hazard ratio [HR]: 0.730, 95% confidence interval [CI]: 0.636-0.838; P<0.001) and cancer-specific survival (HR: 0.764, 95% CI: 0.647-0.903; P=0.002) in patients with a PSA level of 4-10 ng/mL. Similar results were obtained by Kaplan-Meier analysis after 1:1 propensity score matching. In patients with prostate-specific antigen levels between 4-10 ng/mL, the overall survival (P<0.001) and cancer-specific survival (P<0.05) in the radiotherapy group was significantly better than those in the control group. CONCLUSION The result of this large population-based study shows that rigorous selection of appropriate metastatic prostate cancer patients for radiotherapy can benefit prognosis significantly. This can be the basis for future prospective trials.
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Affiliation(s)
- Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianming Ma
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiuzi Zhong
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaqun Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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8
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Okoye JO. High mortality risk of prostate cancer patients in Asia and West Africa: A systematic review. Avicenna J Med 2020; 10:93-101. [PMID: 32832424 PMCID: PMC7414604 DOI: 10.4103/ajm.ajm_19_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Globally, prostate cancer (PCa) is the second most preponderant cancer in men. It contributes to the high mortality-to-incidence ratio reported in West Africa and Asia largely due to low screening. The mortality risk is determined or predicted based on the prevalence of high-risk or aggressive PCa using a scoring or grading system such as Gleason score (GS), Gleason grade (GG), and prostate-specific antigen (PSA) level. In this review, peer-reviewed articles found on databases such as Google Scholar, Scopus, Web of Science, PubMed Central and, EMBASE were selected based on adherence to clinical guidelines for the classification of PCa. In West Africa and Asia, the result revealed that the frequency of high-risk PCa was 42% and 51.2% based on GS, 48.8% and 25.3% based on GG pattern, and 87.5% and 44.3% based on PSA level >10 ng/mL, respectively. Data revealed a high prevalence of high-risk PCa both in West Africa and Asia when compared with developed countries. However, the prevalence of high-risk PCa is higher in West Africa than in Asia. Studies have shown that high-risk PCas are associated with germline mutations and such mutations are prevalent in blacks and Asians than in whites. Thus, testing for germline mutations in patients with GS of ≥ 7, GG ≥ 3, high prostate density, low prostate volume, and PSA levels of >4.0 ng/mL may identify those at risk of developing lethal PCa and could reduce the mortality rates in Asia and West Africa.
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Affiliation(s)
- Jude O Okoye
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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9
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Akakura K, Bolton D, Grillo V, Mermod N. Not all prostate cancer is the same - patient perceptions: an Asia-Pacific region study. BJU Int 2020; 126 Suppl 1:38-45. [PMID: 32521568 DOI: 10.1111/bju.15129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore the perceptions of patients living with different stages of prostate cancer across the Asia-Pacific (APAC) region, as while extensive quantitative research has been undertaken into outcomes of treatments for prostate cancer, little in the way of qualitative research has been performed looking at subjective perceptions of patients in regard to their perceived deficits in the treatment of this condition and such research is particularly lacking in reference to the APAC region. PATIENTS AND METHODS Initial 45-min qualitative research interrogatory interviews were conducted with 12 patients from Australia, China and Japan to identify themes that were significant to patients in the management of prostate cancer. Thereafter, 150 patients with different stages of prostate cancer underwent 30-min online (Australia) or computer-assisted/personal interviews categorised on the five key themes identified, in order to more fully clarify the nature of patient perceptions of how their prostate cancer had been treated and the issues they felt could be more fully addressed in order to improve the management of this condition. RESULTS Interviews indicated common challenges and unmet needs among patients, including: (i) patients' feelings and emotional state change during their disease journey, (ii) patients lack of knowledge about prostate cancer and disease progression prior to diagnosis, (iii) patients felt shared decision-making was uncommon, (iv) patients have misperceptions about surgery, and (v) patients have unmet needs for greater information and support to manage their condition. CONCLUSIONS These patient perceptions of unmet needs in prostate cancer management stand in contrast to patient awareness of other common diseases such as heart failure and diabetes. Such unmet needs vary across disease stages and between different nationalities. Patients with prostate cancer in the APAC region appear to have gaps in knowledge about their disease and wish for greater information, support and public awareness about prostate cancer.
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Affiliation(s)
- Koichiro Akakura
- Department of Urology, Japan Community Health-care Organization (JCHO), Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Damien Bolton
- Department of Urology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Vince Grillo
- Health Division, Kantar, Singapore City, Singapore
| | - Naomi Mermod
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Asia Pacific, Beerse, Belgium
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Hall ME, Huelster HL, Luckenbaugh AN, Laviana AA, Keegan KA, Klaassen Z, Moses KA, Wallis CJD. Metastatic Hormone-sensitive Prostate Cancer: Current Perspective on the Evolving Therapeutic Landscape. Onco Targets Ther 2020; 13:3571-3581. [PMID: 32431511 PMCID: PMC7201221 DOI: 10.2147/ott.s228355] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/07/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The treatment landscape for patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed dramatically in the past five years, despite little change in the preceding 20 years. Such rapid change can make it difficult for clinicians to remain abreast of the current literature and synthesize the relevant data to inform evidence-based treatment decisions. METHODOLOGY We performed a narrative, comprehensive review of treatment options for patients with mHSPC as of December 31, 2019. Specifically, we focused on phase II and III randomized controlled trials assessing the role of chemotherapy, novel androgen axis targeting agents, local-(prostate) directed therapy, and metastasis-directed therapy. RESULTS The data support a survival benefit with the addition of four different agents to androgen deprivation among men with newly diagnosed prostate cancer-docetaxel, abiraterone acetate, enzalutamide, and apalutamide. While not directly compared, the efficacy of these agents appears similar. That said, there are differences in their toxicity profiles and notable differences in cost between agents. Although analyses encompassing men with low- and high-volume metastases failed to demonstrate a significant survival benefit for radiotherapy treatment to the prostate, new data demonstrates a benefit for men with low-volume metastatic disease. Ongoing trials will assess whether this applies to local surgical treatment. Similarly, metastasis-directed therapy appears beneficial among carefully selected patients. CONCLUSION Treatment options for patients with mHSPC are rapidly changing following years of stagnation. A number of systemic therapies offer benefit without significant clinical differences between them. The role for local treatment of the prostate as well as metastatic sites continues to evolve.
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Affiliation(s)
- Mary E Hall
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA,Correspondence: Mary E Hall Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr, Suite 3823, Nashville, TN 37232, USA Email
| | - Heather L Huelster
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron A Laviana
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk A Keegan
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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