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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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Analysis of prognostic factors in men with metastatic prostate cancer. Uro-Oncology Group of Northern Alberta.

https://arctichealth.org/en/permalink/ahliterature24782
Source
J Urol. 1991 Aug;146(2):372-6
Publication Type
Article
Date
Aug-1991
Author
D S Ernst
J. Hanson
P M Venner
Author Affiliation
Cross Cancer Institute, Edmonton, Alberta, Canada.
Source
J Urol. 1991 Aug;146(2):372-6
Date
Aug-1991
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - blood - mortality - therapy
Age Factors
Alberta
Bone Neoplasms - blood - mortality - secondary - therapy
Bone and Bones - radionuclide imaging
Combined Modality Therapy
Follow-Up Studies
Humans
Lung Neoplasms - blood - mortality - secondary - therapy
Male
Neoplasm Staging
Orchiectomy
Prognosis
Proportional Hazards Models
Prostatic Neoplasms - blood - mortality - therapy
Survival Analysis
Testosterone - blood
Abstract
We determined the influence of the extent of disease on bone scan, serum testosterone, patient age, performance status, method of initial diagnosis, Gleason grade, clinical stage at diagnosis, serum acid phosphatase, serum prostate specific antigen (PSA) and primary hormonal treatment on survival. The clinical and hormonal data were obtained when the presence of metastatic disease was established and treatment was to be initiated in 162 men with metastatic prostate cancer. Mean followup was 16 months (range 1 to 105 months). A total of 70 men (43.2%) died of the metastatic disease during the evaluation period. Log rank analysis revealed that only serum testosterone (p = 0.035) and extent of disease on bone scan (p = 0.003) significantly affected over-all survival. A trend (p = 0.068) towards decreased survival was observed with increasing values of PSA. Increasing values of acid phosphatase positively correlated with extent of disease on bone scan but was not a significant independent prognostic factor. Patient age, performance status, clinical stage, method of initial diagnosis, Gleason grade and type of hormonal treatment did not significantly influence survival. Upon using multivariate Cox analysis, only extent of disease on bone scan was significantly correlated with over-all survival (p less than 0.014). PSA may also be influential but longer duration of followup will be necessary. We conclude that extent of disease on bone scan is the most important prognosticator of the analyzed factors and that serum testosterone may be of value.
PubMed ID
1856934 View in PubMed
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Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study.

https://arctichealth.org/en/permalink/ahliterature291221
Source
Eur Urol. 2017 07; 72(1):125-134
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2017
Author
Pär Stattin
Fredrik Sandin
Frederik Birkebæk Thomsen
Hans Garmo
David Robinson
Ingela Franck Lissbrant
Håkan Jonsson
Ola Bratt
Author Affiliation
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden. Electronic address: par.stattin@umu.se.
Source
Eur Urol. 2017 07; 72(1):125-134
Date
07-2017
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Androgen Antagonists - adverse effects - therapeutic use
Antineoplastic Agents, Hormonal - adverse effects - therapeutic use
Databases, Factual
Humans
Kallikreins - blood
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prostate-Specific Antigen - blood
Prostatectomy - adverse effects - mortality
Prostatic Neoplasms - blood - mortality - pathology - therapy
Radiotherapy - mortality
Radiotherapy Dosage
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance.
To investigate the association between radical local treatment and mortality in men with very high-risk PCa.
Semiecologic study of men aged
Notes
CommentIn: Eur Urol. 2017 Apr;71(4):e113-e114 PMID 27717521
CommentIn: Eur Urol. 2017 Apr;71(4):e115-e116 PMID 27720538
PubMed ID
27481175 View in PubMed
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Biochemical control with radiotherapy improves overall survival in intermediate and high-risk prostate cancer patients who have an estimated 10-year overall survival of >90%.

https://arctichealth.org/en/permalink/ahliterature129693
Source
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):22-7
Publication Type
Article
Date
May-1-2012
Author
Christopher Herbert
Mitchell Liu
Scott Tyldesley
W James Morris
Michel Joffres
Mandip Khaira
Winkle Kwan
Vitali Moiseenko
Thomas Pickles
Author Affiliation
Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada. cherbert@bccancer.bc.ca
Source
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):22-7
Date
May-1-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
British Columbia
Disease-Free Survival
Follow-Up Studies
Humans
Life expectancy
Male
Middle Aged
Proportional Hazards Models
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - mortality - pathology - radiotherapy
Radiotherapy Dosage
Testosterone - blood
Abstract
To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled.
A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival.
Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p 90%.
PubMed ID
22079724 View in PubMed
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Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years.

https://arctichealth.org/en/permalink/ahliterature124035
Source
Eur Urol. 2012 Nov;62(5):768-74
Publication Type
Article
Date
Nov-2012
Author
Prasanna Sooriakumaran
Leif Haendler
Tommy Nyberg
Henrik Gronberg
Andreas Nilsson
Stefan Carlsson
Abolfazl Hosseini
Christofer Adding
Martin Jonsson
Achilles Ploumidis
Lars Egevad
Gunnar Steineck
Peter Wiklund
Author Affiliation
Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
Source
Eur Urol. 2012 Nov;62(5):768-74
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Confounding Factors (Epidemiology)
Disease-Free Survival
Follow-Up Studies
Hospitals, University
Humans
Kallikreins - blood
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Staging
Proportional Hazards Models
Prostate-Specific Antigen - blood
Prostatectomy - adverse effects - methods - mortality
Prostatic Neoplasms - blood - mortality - pathology - surgery
Recurrence
Risk assessment
Risk factors
Robotics
Surgery, Computer-Assisted - adverse effects - mortality
Sweden
Time Factors
Treatment Outcome
Abstract
Robot-assisted radical prostatectomy (RARP) is an increasingly commonly used surgical treatment option for prostate cancer (PCa); however, its longer-term oncologic results remain uncertain.
To report biochemical recurrence-free survival (BRFS) outcomes for men who underwent RARP =5 yr ago at a single European centre.
A total of 944 patients underwent RARP as monotherapy for PCa from January 2002 to December 2006 at Karolinska University Hospital, Stockholm, Sweden. Standard clinicopathologic variables were recorded and entered into a secure, ethics-approved database made up of those men with registered domiciles in Stockholm. The median follow-up time was 6.3 yr (interquartile range: 5.6-7.2).
The outcome of this study was biochemical recurrence (BCR), defined as a confirmed prostate-specific antigen (PSA) of =0.2 ng/ml. Kaplan-Meier survival plots with log-rank tests, as well as Cox univariable and multivariable regression analyses, were used to determine BRFS estimates and determine predictors of PSA relapse, respectively.
The BRFS for the entire cohort at median follow-up was 84.8% (95% confidence interval [CI], 82.2-87.1); estimates at 5, 7, and 9 yr were 87.1% (95% CI, 84.8-89.2), 84.5% (95% CI, 81.8-86.8), and 82.6% (95% CI, 79.0-85.6), respectively. Nine and 19 patients died of PCa and other causes, respectively, giving end-of-follow-up Kaplan-Meier survival estimates of 98.0% (95% CI, 95.5-99.1) and 94.1% (95% CI, 90.4-96.4), respectively. Preoperative PSA >10, postoperative Gleason sum =4 + 3, pathologic T3 disease, positive surgical margin status, and lower surgeon volume were associated with increased risk of BCR on multivariable analysis. This study is limited by a lack of nodal status and tumour volume, which may have confounded our findings.
This case series from a single, high-volume, European centre demonstrates that RARP has satisfactory medium-term BRFS. Further follow-up is necessary to determine how this finding will translate into cancer-specific and overall survival outcomes.
Notes
Comment In: Eur Urol. 2012 Nov;62(5):775-6; discussion 777-822790290
PubMed ID
22633365 View in PubMed
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Critical role of prostate biopsy mortality in the number of years of life gained and lost within a prostate cancer screening programme.

https://arctichealth.org/en/permalink/ahliterature120651
Source
BJU Int. 2012 Dec;110(11):1648-52
Publication Type
Article
Date
Dec-2012
Author
Mathieu Boniol
Peter Boyle
Philippe Autier
Alain Ruffion
Paul Perrin
Author Affiliation
International Prevention Research Institute, Lyon Hospices Civils de Lyon, Pierre-Bénite, France. mathieu.boniol@i-pri.org
Source
BJU Int. 2012 Dec;110(11):1648-52
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Biopsy - mortality
Early Detection of Cancer - methods - mortality
Humans
Life expectancy
Male
Middle Aged
Mortality, Premature
Prostate - pathology
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - mortality - pathology
Sweden - epidemiology
Abstract
Study Type--Therapy (data synthesis) Level of Evidence 2b. What's known on the subject? and What does the study add? The efficacy of prostate cancer screening using PSA testing is still being debated, with conflicting results in randomized trials. The study shows that, even using the hypothesis most favourable to prostate cancer screening with PSA, the net number of years of life does not favour screening.
â?¢ To evaluate the impact of the implementation a prostate-specific antigen (PSA) screening programme using the European Randomized Study of Screening for Prostate Cancer (ERSPC) results and taking into account the impact of prostate biopsy and over-treatment on mortality.
â?¢ We used a model based on the number of years of life gained and lost owing to screening, using data reported in the ERSPC. â?¢ We conducted a critical evaluation of the ERSPC results and of the Swedish arm of the study.
â?¢ Accounting for biopsy-specific mortality and for over-treatment, the balance of number of years of life was negative in the ERSPC study, with an estimated loss of 3.6 years of life per avoided death. â?¢ The number of years of life becomes positive (real gain) only when fewer than 666 screened individuals are required to avoid one death. â?¢ We found that in the Swedish arm of the ERSPC there was a biopsy rate of 40% compared with 27% in the ERSPC overall. The over-treatment rate was also greater with 4.1% compared with 3.4% overall. â?¢ For the last 20 years, there has been a marked difference in prostate cancer-specific mortality between Sweden and the rest of Europe: in 2005, for the age group 65-74 the rate was 140 per 100,000 person years in Sweden and ~80 per 100,000 for the rest of Europe.
â?¢ Overall, PSA testing in Europe is associated with a loss in years of life and should thus not be recommended.
Notes
Comment In: BJU Int. 2013 Apr;111(4):E140-123551450
Comment In: BJU Int. 2013 Apr;111(4):E141-223551451
Comment In: BJU Int. 2012 Dec;110(11):165322984891
Comment In: BJU Int. 2013 Mar;111(3):E17-823444934
Comment In: BJU Int. 2013 Mar;111(3):E16-723444933
PubMed ID
22984785 View in PubMed
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Disease-specific outcomes of radical prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time.

https://arctichealth.org/en/permalink/ahliterature104174
Source
BMC Urol. 2014;14:49
Publication Type
Article
Date
2014
Author
Sigve Andersen
Elin Richardsen
Yngve Nordby
Nora Ness
Oystein Størkersen
Khalid Al-Shibli
Tom Donnem
Helena Bertilsson
Lill-Tove Busund
Anders Angelsen
Roy M Bremnes
Author Affiliation
Institute of Clinical Medicine, The Arctic University of Norway, Tromso, Norway. sigve.andersen@uit.no.
Source
BMC Urol. 2014;14:49
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Humans
Male
Middle Aged
Norway
Peripheral Nervous System Neoplasms - mortality
Postoperative Care - statistics & numerical data
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - blood - mortality - surgery
Retrospective Studies
Risk assessment
Survival Analysis
Treatment Outcome
Tumor Markers, Biological - blood
Abstract
Prostate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT).
We conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression.
After a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p
Notes
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PubMed ID
24929427 View in PubMed
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Effect of Comorbidity on Prostate Cancer-Specific Mortality: A Prospective Observational Study.

https://arctichealth.org/en/permalink/ahliterature286843
Source
J Clin Oncol. 2017 Nov 01;35(31):3566-3574
Publication Type
Article
Date
Nov-01-2017
Author
Prabhakar Rajan
Prasanna Sooriakumaran
Tommy Nyberg
Olof Akre
Stefan Carlsson
Lars Egevad
Gunnar Steineck
N Peter Wiklund
Source
J Clin Oncol. 2017 Nov 01;35(31):3566-3574
Date
Nov-01-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Humans
Kallikreins - blood
Male
Middle Aged
Proportional Hazards Models
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - mortality - therapy
Sweden - epidemiology
Abstract
Purpose To determine the effect of comorbidity on prostate cancer (PCa)-specific mortality across treatment types. Patients and Methods These are the results of a population-based observational study in Sweden from 1998 to 2012 of 118,543 men who were diagnosed with PCa with a median follow-up of 8.3 years (interquartile range, 5.2 to 11.5 years) until death from PCa or other causes. Patients were categorized by patient characteristics (marital status, educational level) and tumor characteristics (serum prostate-specific antigen, tumor grade and clinical stage) and by treatment type (radical prostatectomy, radical radiotherapy, androgen deprivation therapy, and watchful waiting). Data were stratified by Charlson comorbidity index (0, 1, 2, or = 3). Mortality from PCa and other causes and after stabilized inverse probability weighting adjustments for clinical patient and tumor characteristics and treatment type was determined. Kaplan-Meier estimates and Cox proportional hazards regression models were used to calculate hazard ratios. Results In the complete unadjusted data set, we observed an effect of increased comorbidity on PCa-specific and other-cause mortality. After adjustments for patient and tumor characteristics, the effect of comorbidity on PCa-specific mortality was lost but maintained for other-cause mortality. After additional adjustment for treatment type, we again failed to observe an effect for comorbidity on PCa-specific mortality, although it was maintained for other-cause mortality. Conclusion This large observational study suggests that comorbidity affects other cause-mortality but not PCa-specific- mortality after accounting for patient and tumor characteristics and treatment type. Regardless of radical treatment type (radical prostatectomy or radical radiotherapy), increasing comorbidity does not seem to significantly affect the risk of dying from PCa. Consequently, differences in oncologic outcomes that were observed in population-based comparative effectiveness studies of PCa treatments may not be a result of the varying distribution of comorbidity among treatment groups.
PubMed ID
28930493 View in PubMed
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Gleason inflation 1998-2011: a registry study of 97,168 men.

https://arctichealth.org/en/permalink/ahliterature261238
Source
BJU Int. 2015 Feb;115(2):248-55
Publication Type
Article
Date
Feb-2015
Author
Daniela Danneman
Linda Drevin
David Robinson
Pär Stattin
Lars Egevad
Source
BJU Int. 2015 Feb;115(2):248-55
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Humans
Logistic Models
Male
Neoplasm Grading
Neoplasm Recurrence, Local - mortality - pathology
Neoplasm Staging
Population Surveillance
Practice Guidelines as Topic
Prognosis
Prostate-Specific Antigen - blood
Prostatectomy - mortality - statistics & numerical data
Prostatic Neoplasms - blood - mortality - pathology
Registries
Sweden - epidemiology
Watchful Waiting
Abstract
To study long-term trends in Gleason grading in a nationwide population and to assess the impact of the International Society of Urological Pathology (ISUP) revision in 2005 of the Gleason system on grading practices, as in recent years there has been a shift upwards in Gleason grading of prostate cancer.
All newly diagnosed prostate cancers in Sweden are reported to the National Prostate Cancer Register (NPCR). In 97?168 men with a primary diagnosis of prostate cancer on needle biopsy from 1998 to 2011, Gleason score, clinical T stage (cT) and serum levels of prostate-specific antigen (s-PSA) at diagnosis were analysed.
Gleason score, cT stage and s-PSA were reported to the NPCR in 97%, 99% and 99% of cases. Before and after 2005, Gleason score 7-10 was diagnosed in 52% and 57%, respectively (P
PubMed ID
24552193 View in PubMed
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The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients.

https://arctichealth.org/en/permalink/ahliterature121501
Source
Eur Urol. 2013 Jul;64(1):19-25
Publication Type
Article
Date
Jul-2013
Author
Julian Mauermann
Vincent Fradet
Louis Lacombe
Thierry Dujardin
Rabi Tiguert
Bernard Tetu
Yves Fradet
Author Affiliation
Department of Surgery, Laval University, Quebec City, QC, Canada.
Source
Eur Urol. 2013 Jul;64(1):19-25
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Androgen Antagonists - therapeutic use
Antigens, Neoplasm - blood
Antineoplastic Agents, Hormonal - therapeutic use
Chi-Square Distribution
GPI-Linked Proteins - blood
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Proteins - blood
Neoplasm Recurrence, Local - blood - mortality - pathology - therapy
Neoplasm Staging
Neoplasm, Residual
Proportional Hazards Models
Prostatectomy - adverse effects - mortality
Prostatic Neoplasms - blood - mortality - pathology - surgery
Prostatic Neoplasms, Castration-Resistant - surgery
Quebec
Retrospective Studies
Risk factors
Salvage Therapy
Time Factors
Treatment Outcome
Abstract
Positive surgical margins (PSMs) increase the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), but their impact on hard clinical end points is a topic of ongoing discussion.
To evaluate the influence of solitary PSMs (sPSMs) and multiple PSMs (mPSMs) on important clinical end points.
Data from 1712 patients from the Centre Hospitalier Universitaire de Québec with pT2-4 N0 prostate cancer (PCa) and undetectable prostate-specific antigen after RP were analyzed.
RP without neoadjuvant or adjuvant treatment.
Kaplan-Meier analysis estimated survival functions, and Cox proportional hazards models addressed predictors of clinical end points.
Median follow-up was 74.9 mo. A total of 1121 patients (65.5%) were margin-negative, 281 patients (16.4%) had sPSMs, and 310 patients (18.1%) had mPSMs. A total of 280 patients (16.4%) experienced BCR, and 197 patients (11.5%) were treated with salvage radiotherapy (SRT). Sixty-eight patients (4.0%) received definitive androgen deprivation therapy, 19 patients (1.1%) developed metastatic disease, and 15 patients (0.9%) had castration-resistant PCa (CRPC). Thirteen patients (0.8%) died from PCa, and 194 patients (11.3%) died from other causes. Ten-year Kaplan-Meier estimates for BCR-free survival were 82% for margin-negative patients, 72% for patients with sPSMs, and 59% for patients with mPSMs (p
Notes
Comment In: Eur Urol. 2013 Jul;64(1):28-923159455
Comment In: Eur Urol. 2013 Jul;64(1):26-822999520
PubMed ID
22901983 View in PubMed
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