PURPOSE: To evaluate long-term overall survival (OS), cancer-specific survival (CSS), clinical progression-free survival (cPFS), and health-related quality of life (HRQoL) following definitive radiotherapy (RT) given to T(1-4p)N(0)M(0) prostate cancer patients provided by a single institution between 1989 and 1996. METHODS AND MATERIALS: We assessed outcome among 203 patients who had completed three-dimensional conformal RT (66 Gy) without hormone treatment and in whom staging by lymphadenectomy had been performed. OS was compared with an age-matched control group from the general population. A cross-sectional, self-report survey of HRQoL was performed among surviving patients. RESULTS: Median observation time was 10 years (range, 1-16 years). Eighty-one percent had high-risk tumors defined as T(3-4) or Gleason score (GS) > or =7B (4+3). Among these, 10-year OS, CSS, and cPFS rates were 52%, 66%, and 39%, respectively. The corresponding fractions in low-risk patients (T(1-2) and GS or =7B.
Radical prostatectomy is associated with excellent long-term disease control for localized prostate cancer. Prior studies have suggested an increased risk of short-term complications among older men who underwent radical prostatectomy, but these studies did not adjust for comorbidity.
We examined mortality and complications occurring within 30 days following radical prostatectomy among all 11,010 men who underwent this surgery in Ontario, Canada, between 1990 and 1999 using multivariable logistic regression modeling. We adjusted for comorbidity using two common comorbidity indices. Statistical tests were two-sided.
Overall, 53 men (0.5%) died, and 2195 [corrected] (19.9%[corrected]) had one or more complications within 30 days of radical prostatectomy. In models adjusted for comorbidity and year of surgery, age was associated with an increased risk of 30-day mortality (odds ratio = 2.04 per decade of age, 95% confidence interval [CI] = 1.23 to 3.39). However, the absolute 30-day mortality risk was low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%) for men aged 70-79 years. In adjusted models, age was associated with an increased risk of cardiac (Ptrend
Comment In: J Natl Cancer Inst. 2006 Mar 15;98(6):421; author reply 421-216537836
Erratum In: J Natl Cancer Inst. 2007 Nov 7;99(21):1648
To test the accuracy of life tables (LTs) in predicting survival in men treated with radiotherapy for localized prostate cancer.
We selected the records of 3,176 patients treated with radiotherapy and who had no clinical evidence of disease relapse. Life table-derived life expectancy (LE) was defined for every individual using a population-specific LT. Age, Charlson Comorbidity Index (CCI), and LT-derived LE were then used as predictors of overall mortality in Cox regression models. Predictive accuracy (PA) was estimated with the Harrell's concordance index and was internally validated with 200 bootstrap resamples.
The actuarial median survival was 4.7 years (mean, 6.4 years). At radiotherapy, median age was 70.6 years, median CCI was 2, and median LT-derived LE was 12 years. All variables were statistically significant predictors of overall mortality (all p values
BACKGROUND: The purpose of this study was to determine the incidence, risk factors and prognostic impact of anaemia and thrombocytopenia in patients with bone metastases (BM) from prostate cancer. METHODS: Retrospective cohort study including 51 consecutive patients treated at a community hospital. Twenty-nine patients (57%) received taxotere after diagnosis of BM. RESULTS: Haemoglobin (Hb)
Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii.
Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses.
Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women.
Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.
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The aim of this study was to investigate pre- and post-diagnostic use of antihypertensive drugs on prostate cancer (PCa)-specific survival and the initiation of androgen deprivation therapy (ADT). The cohort investigated 8,253 PCa patients with 837 PCa-specific deaths during the median follow-up of 7.6 years after diagnosis. Information on drug use, cancer incidence, clinical features of PCa, and causes of death was collected from Finnish registries. Hazard ratios with 95% confidence intervals were calculated using Cox regression with antihypertensive drug use as a time-dependent variable. Separate analyses were performed on PCa survival related to pre- and post-diagnostic use of drugs and on the initiation of ADT. Antihypertensive drug use overall was associated with an increased risk of PCa-specific death (Pre-PCa: 1.21 (1.04-1.4), Post-PCa: 1.2 (1.02-1.41)). With respect to the separate drug groups, angiotensin II type 1 receptor (ATr) blockers, were associated with improved survival (Post-PCa: 0.81 (0.67-0.99)) and diuretics with an increased risk (Post-PCa: 1.25 (1.05-1.49)). The risk of ADT initiation was slightly higher among antihypertensive drug users as compared to non-users. In conclusion, this study supports anti-cancer effect of ATr blockers on PCa prognosis and this should be investigated further in controlled clinical trials.
The association between antihypertensive medications and survival in cancer patients remains unclear.
To explore the association between classes of antihypertensive drugs and survival in cancer patients.
Provincial Cancer Registry data was linked with a Provincial Drug Program Information Network (DPIN) for patients with lung (n=4241), colorectal (n=3967), breast (n=4019) or prostate (n=3355) cancer between the years of 2004 and 2008. Cox regression analyses were used to compare survival of patients using beta blockers (BBs), angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARB), calcium channel blockers (CCBs) or thiazide diuretics (TDs) to survival of patients who did not use any of these antihypertensive drugs. Survival of patients using only one class of antihypertensive drugs were compared to each other, with BBs as the reference class.
Compared to the antihypertensive drug non-user cohort, BBs had no effect on survival for any of the cancers. ACEi/ARBs use was weakly associated with increased deaths for breast cancer (HR: 1.22, 95% CI: 1.04-1.44) and lung cancer (HR: 1.11, 95% CI: 1.03-1.21) patients. Deaths were also increased with CCB use in patients with breast cancer (HR: 1.22, 95% CI: 1.02-1.47) and with TD use in lung cancer patients (HR: 1.1, 95% CI: 1.01-1.19). There was strong evidence (p-value
This study evaluated the mortality experience of workers from the styrene-butadiene industry.
The authors added seven years of follow up to a previous investigation of mortality among 17 924 men employed in the North American synthetic rubber industry. Analyses used the standardised mortality ratios (SMRs) to compare styrene-butadiene rubber workers' cause specific mortality (1943-98) with those of the United States and the Ontario general populations.
Overall, the observed/expected numbers of deaths were 6237/7242 for all causes (SMR = 86, 95% CI 84 to 88) and 1608/1741 for all cancers combined (SMR = 92, 95% CI 88 to 97), 71/61 for leukaemia, 53/53 for non-Hodgkin's lymphoma, and 26/27 for multiple myeloma. The 16% leukaemia increase was concentrated in hourly paid subjects with 20-29 years since hire and 10 or more years of employment in the industry (19/7.4, SMR = 258, 95% CI 156 to 403) and in subjects employed in polymerisation (18/8.8, SMR = 204, 95% CI 121 to 322), maintenance labour (15/7.4, SMR = 326, 95% CI 178 to 456), and laboratory operations (14/4.3, SMR = 326, 95% CI 178-546).
The study found that some subgroups of synthetic rubber workers had an excess of mortality from leukaemia that was not limited to a particular form of leukaemia. Uncertainty remains about the specific agent(s) that might be responsible for the observed excesses and about the role of unidentified confounding factors. The study did not find any clear relation between employment in the industry and other forms of lymphohaematopoietic cancer. Some subgroups of subjects had more than expected deaths from colorectal and prostate cancers. These increases did not appear to be related to occupational exposure in the industry.
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We compared survival outcomes in patients of Asian descent treated with curative intent radiation therapy for prostate cancer with that in the nonAsian population in British Columbia, Canada.
Since 1994, 1,872 men treated with curative intent radiotherapy for prostate cancer have been followed prospectively at our provincial institution, where cancer care delivery is coordinated for the province of British Columbia. Patients are treated uniformly based on provincial policies and guidelines. Patients were divided into 63 Asian (3.6%) and 1,804 nonAsian (96.4%) patients by surname with Asian names checked by telephone contact. Three risk groups were defined based on pretreatment prostate specific antigen, biopsy Gleason score and clinical T staging. For the whole cohort and each risk group survival was estimated using the Kaplan-Meier method and comparisons were made between the Asian and nonAsian populations.
The mean age of Asian and nonAsian men was 71.5 and 71 years, respectively. Median prostate specific antigen was 11.4 and 10 ng/ml, respectively (p = 0.7). Median Gleason score was 7 for Asian patients and 6 for nonAsian patients (p = 0.002). There were twice the percentage of Asian patients with Gleason scores 8 or greater than nonAsian (26.5% vs 13.8%, p = 0.003). More Asian patients had stage 3 or 4 disease than nonAsian (44.8% vs 34.9%, p = 0.095). A greater proportion of Asian patients were classified as being at high risk than the nonAsian population (60.3% vs 47.6%, p = 0.04). For the entire cohort, and the low, intermediate and high risk groups there were no differences in time to first failure, or cause specific or overall survival for Asian vs nonAsian men.
A greater proportion of patients of Asian descent present with high risk prostate cancer than nonAsian patients, which could be due to intrinsic biological differences and/or differences in diagnostic patterns. Survival outcomes after radiotherapy are the same for the 2 populations.
For evaluation of occupational mortality in agriculture, age-standardized proportional mortality ratios (PMR) were calculated for 28,032 male farmers with the use of British Columbia (B.C.) death registrations collected from 1950 to 1978. Farmers had significantly elevated risks of death from cancer of the lip (PMR = 191, P = .05), stomach (PMR = 119, P less than .0001), and prostate gland (PMR = 113, P less than .001). In addition, leukemia was higher than expected (PMR = 122, P less than .01), as was aplastic anemia (PMR = 174, P less than .01). The elevated risks were fairly consistent over the 29-year period for stomach, prostate gland, and lip cancer, as well as for leukemia. The PMR for aplastic anemia was highest for the years 1950-59 and declined over the next 19 years. Farmers also showed significant mortality deficits for several important cancer sites, including esophagus (PMR = 59, P less than .0001), colon (PMR = 84, P less than .001), larynx (PMR = 62, P less than .01), and lung (PMR = 66, P less than .0001) for the period 1950-78. More detailed studies in B.C. will be necessary to confirm and extend these cancer-agriculture associations.