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10-year experience with I-125 prostate brachytherapy at the Princess Margaret Hospital: results for 1,100 patients.

https://arctichealth.org/en/permalink/ahliterature141809
Source
Int J Radiat Oncol Biol Phys. 2011 Aug 1;80(5):1323-9
Publication Type
Article
Date
Aug-1-2011
Author
Juanita Crook
Jette Borg
Andrew Evans
Ants Toi
E P Saibishkumar
Sharon Fung
Clement Ma
Author Affiliation
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada. jcrook@bccancer.bc.ca
Source
Int J Radiat Oncol Biol Phys. 2011 Aug 1;80(5):1323-9
Date
Aug-1-2011
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - blood - mortality - pathology - radiotherapy
Aged
Aged, 80 and over
Brachytherapy - adverse effects - methods
Disease-Free Survival
Humans
Iodine Radioisotopes - therapeutic use
Male
Middle Aged
Neoadjuvant Therapy - methods
Neoplasm Staging
Ontario
Penile Erection - physiology
Proportional Hazards Models
Prospective Studies
Prostate
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - mortality - pathology - radiotherapy
Radiotherapy Dosage
Urination Disorders - drug therapy
Abstract
To report outcomes for 1,111 men treated with iodine-125 brachytherapy (BT) at a single institution.
A total of 1,111 men (median age, 63) were treated with iodine-125 prostate BT for low- or intermediate-risk prostate cancer between March 1999 and November 2008. Median prostate-specific antigen (PSA) level was 5.4 ng/ml (range, 0.9-26.1). T stage was T1c in 66% and T2 in 34% of patients. Gleason score was 6 in 90.1% and 7 or 8 in 9.9% of patients. Neoadjuvant hormonal therapy (2-6 months course) was used in 10.1% of patients and combined external radiotherapy (45 Gy) with BT (110 Gy) in 4.1% (n = 46) of patients. Univariate and multivariate Cox proportional hazards were used to determine predictors of failure.
Median follow-up was 42 months (range, 6-114), but for biochemical freedom from relapse, a minimum PSA test follow-up of 30 months was required (median 54; n = 776). There were 27 failures, yielding an actuarial 7-year disease-free survival rate of 95.2% (96 at risk beyond 84 months). All failures underwent repeat 12-core transrectal ultrasound -guided biopsies, confirming 8 local failures. On multivariate analysis, Gleason score was the only independent predictor of failure (p = 0.001; hazard ratio, 4.8 (1.9-12.4). Median International Prostate Symptom score from 12 to 108 months ranged between 3 and 9. Of the men reporting baseline potency, 82.8% retained satisfactory erectile function beyond 5 years.
Iodine-125 prostate BT is a highly effective treatment option for favorable- and intermediate-risk prostate cancer and is associated with maintenance of good urinary and erectile functions.
PubMed ID
20675072 View in PubMed
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Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.

https://arctichealth.org/en/permalink/ahliterature271603
Source
Scand J Urol. 2015 Feb;49(1):43-50
Publication Type
Article
Date
Feb-2015
Author
Frederik B Thomsen
Kasper D Berg
M Andreas Røder
Peter Iversen
Klaus Brasso
Source
Scand J Urol. 2015 Feb;49(1):43-50
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - economics - utilization
Biopsy, Large-Core Needle - adverse effects - economics - statistics & numerical data
Cohort Studies
Denmark
Disease Management
Disease Progression
Health Resources - economics - utilization
Hospitalization - economics - statistics & numerical data
Humans
Kallikreins - blood
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - pathology - therapy
Transurethral Resection of Prostate
Watchful Waiting - economics - statistics & numerical data
Abstract
Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa.
In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost.
The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction).
AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.
PubMed ID
25363612 View in PubMed
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Active surveillance for prostate cancer: a review.

https://arctichealth.org/en/permalink/ahliterature143951
Source
Curr Urol Rep. 2010 May;11(3):165-71
Publication Type
Article
Date
May-2010
Author
Laurence Klotz
Author Affiliation
Division of Urology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, #MG408, Toronto, ON, M4N 3M5, Canada. Laurence.klotz@sunnybrook.ca
Source
Curr Urol Rep. 2010 May;11(3):165-71
Date
May-2010
Language
English
Publication Type
Article
Keywords
Biopsy - methods
Canada - epidemiology
Humans
Male
Mass Screening - methods
Morbidity
Population Surveillance - methods
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - diagnosis - epidemiology
Risk Assessment - methods
Risk factors
United States - epidemiology
Abstract
Active surveillance is a solution to the widely acknowledged problem of overdiagnosis and overtreatment of clinically insignificant disease which accompanies early detection of prostate cancer using prostate-specific antigen (PSA) and biopsy. It is an approach to the management of favorable-risk prostate cancer which uses the opportunity provided by the long natural history of the disease to incorporate a period of initial observation into patient management. The basic concept is that most men diagnosed with low-grade, small-volume disease are not destined to have any clinical manifestations of the condition during their lifetime. However, a subset of patients with favorable-risk prostate cancer is at risk, due to either the presence of higher-risk disease not apparent at diagnosis or progression to a more aggressive phenotype over time. These patients can be identified with reasonable accuracy by close follow-up, including serial PSAs and biopsies, and treated effectively in most cases. The rationale, patient selection, method of follow-up, triggers for intervention, and recent results of this approach will be reviewed.
PubMed ID
20425623 View in PubMed
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Active surveillance: the Canadian experience with an "inclusive approach".

https://arctichealth.org/en/permalink/ahliterature117780
Source
J Natl Cancer Inst Monogr. 2012 Dec;2012(45):234-41
Publication Type
Article
Date
Dec-2012
Author
Laurence Klotz
Author Affiliation
Sunnybrook Health Sciences Centre, Division of Urology, University of Toronto, 2075 Bayview Ave, Toronto, Ontario. Laurence.klotz@sunnybrook.ca
Source
J Natl Cancer Inst Monogr. 2012 Dec;2012(45):234-41
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Canada
Cohort Studies
Disease Progression
Humans
Male
Neoplasm Grading
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - diagnosis - mortality - therapy
Risk
Survival
Survival Analysis
Watchful Waiting
Abstract
Active surveillance has evolved to become a standard of care for favorable-risk prostate cancer. This is a summary of the rationale, method, and results of active surveillance beginning in 1995 with the first prospective trial of this approach. This was a prospective, single-arm cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression. Survival analysis and Cox proportional hazard model were applied to the data. Since November 1995, 450 patients have been managed with active surveillance. The cohort included men under 70 with favorable-risk disease and men of age more than 70 with favorable- or intermediate-risk cancer (Gleason score 3+4 or PSA 10-15). Median follow-up is 6.8 years (range 1-16 years). Overall survival is 78.6%. Ten-year prostate cancer actuarial survival is 97.2%. Five of 450 patients (1.1%) have died of prostate cancer. Thirty percent of patients have been reclassified as higher-risk patients and offered definitive therapy. The commonest indication for treatment was a PSA doubling time less than 3 years (48%) or Gleason upgrading (26%). Of 117 patients treated radically, the PSA failure rate was 50%. This represents 13% of the total cohort. Most PSA failures occurred early; at 2 years, 44% of the treated patients had PSA failure. The hazard ratio for non-prostate cancer mortality to prostate cancer mortality was 18.6 at 10 years. In conclusion, we observed a very low rate of prostate cancer mortality in an intermediate time frame. Among the one-third of patients who were reclassified as higher risk and retreated, PSA failure was relatively common. However, other-cause mortality accounted for almost all of the deaths. Further studies are warranted to improve the identification of patients who harbor more aggressive disease in spite of favorable clinical parameters at diagnosis [reproduced from Klotz (1) with permission from Wolters Kluwer Health].
Notes
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PubMed ID
23271779 View in PubMed
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Advanced prostate cancer treated with intermittent or continuous androgen deprivation in the randomised FinnProstate Study VII: quality of life and adverse effects.

https://arctichealth.org/en/permalink/ahliterature121987
Source
Eur Urol. 2013 Jan;63(1):111-20
Publication Type
Article
Date
Jan-2013
Author
Arto J Salonen
Kimmo Taari
Martti Ala-Opas
Jouko Viitanen
Seppo Lundstedt
Teuvo L J Tammela
Author Affiliation
Department of Urology, Kuopio University Hospital, Finland. arto.salonen@kuh.fi
Source
Eur Urol. 2013 Jan;63(1):111-20
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Androgen Antagonists - administration & dosage - adverse effects
Antineoplastic Agents, Hormonal - administration & dosage - adverse effects
Chi-Square Distribution
Drug Administration Schedule
Finland
Goserelin - administration & dosage - adverse effects
Humans
Kallikreins - blood
Male
Neoplasm Grading
Neoplasm Staging
Neoplasms, Hormone-Dependent - blood - drug therapy - pathology
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - drug therapy - pathology
Quality of Life
Questionnaires
Testosterone - antagonists & inhibitors - blood
Time Factors
Treatment Outcome
Abstract
Intermittent dosing may reduce the adverse events (AEs) of androgen-deprivation therapy (ADT).
To compare intermittent androgen deprivation (IAD) and continuous androgen deprivation (CAD) with regard to health-related quality of life (QoL).
A total of 852 men with advanced prostate cancer (PCa) were enrolled to receive goserelin acetate 3.6 mg every 28 d for 24 wk. A total of 554 patients whose prostate-specific antigen (PSA) decreased to 20 ng/ml or above baseline.
QoL was monitored with a validated Cleary 30-item questionnaire and analysed by the Mann-Whitney U test, 0.5 standard deviation rule, and repeated measures analysis of variance. AEs and adverse drug reactions (ADRs) were analysed by the chi-square test.
Median follow-up was 65 mo. Significant differences in QoL emerged in activity limitation, physical capacity, and sexual functioning, favouring IAD. No significant differences emerged in the prevalence of AEs: 87 patients in the IAD arm (31.8%) and 95 in the CAD arm (33.9%) had cardiovascular (CV) AEs (p=0.59), with 25 (9.1%) and 29 (10.4%) withdrawn (p=0.62), and 21 (7.7%) and 24 (8.6%) dying because of a CV event (p=0.70), respectively; bone fractures occurred in 19 (6.9%) and 15 (5.4%) patients (p=0.44), respectively. Hot flushes or night sweats were the most common ADRs (47.1% vs 50.4%; p=0.44). Erectile dysfunction (15.7% vs 7.9%; p=0.042) and depressed mood (2.2 vs 0%; p=0.032) were more common in the IAD arm.
IAD showed benefits in the treatment of advanced PCa with respect to QoL. The prevalence of AEs was not significantly lower with IAD.
ClinicalTrials.gov, NCT00293670.
Notes
Comment In: Eur Urol. 2013 Jan;63(1):121-2; discussion 123-422921963
PubMed ID
22857983 View in PubMed
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Age-specific reference values for serum prostate-specific antigen in a community-based population of healthy Swedish men.

https://arctichealth.org/en/permalink/ahliterature22087
Source
Scand J Clin Lab Invest. 1997 May;57(3):225-32
Publication Type
Article
Date
May-1997
Author
O. Löfman
T. Lindahl
E. Varenhorst
Author Affiliation
Centre for Public Health Sciences, University Hospital, Linköping, Sweden.
Source
Scand J Clin Lab Invest. 1997 May;57(3):225-32
Date
May-1997
Language
English
Publication Type
Article
Keywords
Aged
Aging - blood
Analysis of Variance
Humans
Logistic Models
Male
Middle Aged
Normal Distribution
Prostate-Specific Antigen - blood
Random Allocation
Reference Values
Statistics, nonparametric
Sweden
Abstract
To establish normal reference values for prostate-specific antigen (PSA) in a Swedish population we investigated 878 healthy men, 56-75 years of age. They were randomly selected from a population of 9171 males in this group. Cancer of the prostate was excluded by digital rectal examination. When digital rectal examination was suspicious for carcinoma of the prostate and/or serum PSA > 4 micrograms l-1, fine-needle aspiration biopsy was performed. Central values, values of variance and reference limits were defined by a non-parametric method in four age groups. A strong positive correlation between PSA values and age was found and the variance increased with age. The relationship between PSA value and age was non-linear. For the age group 56-60 the upper reference limit (95th percentile) was 4.6 micrograms l-1 (confidence interval, CI: 3.9-5.5). For the age groups 61-65, 66-70 and 71-75 the corresponding values were 4.4 (3.8-5.2), 7.6 (6.5-8.9) and 8.4 micrograms l-1 (7.2-9.8) respectively. For the age groups studied the increment over time of the PSA value was 2-8% per year depending on age, with an average increment per year over 15 years of 4.3%. Overall, 11% of our reference sample had a serum PSA level > 4 micrograms l-1. We consider our study population to be representative for a normal Swedish male population in these age groups.
PubMed ID
9238758 View in PubMed
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Allopurinol and the risk of prostate cancer in a Finnish population-based cohort.

https://arctichealth.org/en/permalink/ahliterature310695
Source
Prostate Cancer Prostatic Dis. 2019 09; 22(3):483-490
Publication Type
Journal Article
Date
09-2019
Author
Ville Kukko
Antti Kaipia
Kirsi Talala
Kimmo Taari
Teuvo L J Tammela
Anssi Auvinen
Teemu J Murtola
Author Affiliation
University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland. kukko.ville.t@student.uta.fi.
Source
Prostate Cancer Prostatic Dis. 2019 09; 22(3):483-490
Date
09-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Allopurinol - therapeutic use
Databases, Factual - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Finland - epidemiology
Follow-Up Studies
Gout - drug therapy
Gout Suppressants - therapeutic use
Humans
Incidence
Male
Mass Screening - statistics & numerical data
Middle Aged
Neoplasm Grading
Prostate-Specific Antigen - blood
Prostatic Neoplasms - diagnosis - epidemiology - prevention & control
Risk assessment
Time Factors
Abstract
Allopurinol reduces oxidative stress and may thus have an anti-inflammatory effect. Previous studies suggest that allopurinol use might decrease the risk of prostate cancer (PCa) among gout patients. We studied the association between allopurinol use and PCa incidence.
The cohort consists of 76,874 men without prevalent PCa, originally identified for the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). The follow-up started at entry to the trial. We excluded men using allopurinol in the year before entry (wash-out). PCa cases detected during 1996-2015 were identified from the Finnish Cancer Registry. Information on tumor Gleason score and TNM stage were obtained from medical files. Information on PSA level was obtained from screening samples for men in the FinRSPC screening arm and from laboratory databases for men in the control arm. Information on BMI was based on a questionnaire sent to men in the FinRSPC screening arm in 2004-2008. Drug purchase information were obtained from the national prescription database. We used Cox regression (adjusted for age, FinRSPC trial arm, PCa family history and use of other medication) to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of PCa risk by allopurinol use. We analyzed medication as a time-dependent variable to minimize immortal time bias.
There were 9062 new PCa diagnoses in the cohort. Follow-up time did not differ by allopurinol use (median 17?yr; IQR 11-19 vs median 17?yr; IQR 12.33-19). The risk of PCa did not differ by allopurinol use (multivariable adjusted HR 1.03; 95% CI 0.92-1.16). Allopurinol use did not associate with the risk of high-grade or metastatic cancer. Cumulative duration or average yearly dose of allopurinol use showed no association with PCa risk. No delayed risk associations were observed in the lag-time analyses.
We observed no difference in the PCa risk by allopurinol use.
PubMed ID
30696944 View in PubMed
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Androgen therapy: testing before prescribing and monitoring during therapy.

https://arctichealth.org/en/permalink/ahliterature160341
Source
Can Fam Physician. 2007 Nov;53(11):1936-42
Publication Type
Article
Date
Nov-2007
Author
Alan Katz
Anne Katz
Charles Burchill
Author Affiliation
408-727 McDermot Ave, Winnipeg, MB. Alan_Katz@cpe.umanitoba.ca
Source
Can Fam Physician. 2007 Nov;53(11):1936-42
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Blood Chemical Analysis
Cohort Studies
Drug Utilization
Family Practice
Follow-Up Studies
Hormone Replacement Therapy - adverse effects - methods
Humans
Male
Manitoba
Middle Aged
Monitoring, Physiologic
Prostate - drug effects - metabolism
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - physiopathology
Retrospective Studies
Risk factors
Testosterone - administration & dosage - metabolism
Abstract
To explore the extent to which biochemical testing is used to diagnose androgen deficiency before initiating treatment and to learn whether recommendations for clinical monitoring of men taking androgen therapy are being followed.
Population-based retrospective cohort study.
Winnipeg, Man.
A total of 902 men who filled at least 2 prescriptions for androgen therapy.
Whether men had had baseline prostate-specific antigen (PSA) and testosterone testing before initiation of therapy and whether men had been monitored during the first year of treatment.
Of the 902 men who filled first-time prescriptions during the study period, only 475 (52.7%) had ever had PSA or testosterone tests. Before starting therapy, 315 men (34.9%) had had PSA tests, and 152 men (16.9%) had had testosterone tests. Less than 1% of the entire sample had had 3 or more tests during the year following initiation of therapy.
Indications for androgen therapy in this population appear to be based on clinical symptoms rather than on demonstrated biochemical androgen deficiency. Recommendations for clinical monitoring of men taking androgen therapy are not followed consistently.
Notes
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PubMed ID
18000271 View in PubMed
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An estimate of prostate cancer prevalence for a demographically similar workforce population.

https://arctichealth.org/en/permalink/ahliterature201923
Source
W V Med J. 1999 May-Jun;95(3):116-22
Publication Type
Article
Author
C S Westra
A M Ducatman
M. Niewiadomska-Bugaj
G R Hobbs
Author Affiliation
Kimberly Clark Corporation, Neenah, Wisc., USA.
Source
W V Med J. 1999 May-Jun;95(3):116-22
Language
English
Publication Type
Article
Keywords
Aged
Canada
Humans
Male
Mass Screening - economics
Middle Aged
Occupational Health Services - economics
Practice Guidelines as Topic
Prevalence
Prostate-Specific Antigen - blood
Prostatic Neoplasms - epidemiology - prevention & control
United States
Abstract
To obtain an estimate of prostate cancer prevalence when screening is applied to a workforce, we conducted a search of the English world literature from West Virginia University. Thirty-one papers which met selection criteria for screening were followed by histopathologic diagnosis. Publications using Prostate Specific Antigen (PSA) as a screening test were reviewed. The data from these papers were combined. Population characteristics were then selected to represent the demographics of a working population. Prostate cancer prevalence estimates for the demographics of a working population were calculated using a weighted mean after relevant studies lacked homogeneity and therefore failed meta-analysis. The expected prevalence of prostate cancer in a workplace surveillance population is 2.03% (95% C.I. from 1.69% to 2.37%). This information is useful to entities considering workplace surveillance. Selection bias, geographic location, and uncertainty in prediction of a representative workforce population may strongly influence estimates.
PubMed ID
10352569 View in PubMed
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299 records – page 1 of 30.