PURPOSE: To evaluate the primary causes of death in low-risk (low-risk), intermediate-risk (intermediate-risk), and high-risk (high-risk) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. METHODS AND MATERIALS: From April 1995 through November 2004, a total of 1,354 consecutive patients underwent prostate brachytherapy. All patients underwent brachytherapy >3 years before analysis. Of the patients, 532 (39.3%) received androgen deprivation therapy and 703 (51.9%) received supplemental radiation therapy. The median follow-up was 5.4 years. Multiple parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. RESULTS: The 10-year cause-specific survival was 97.0% (99.7%, 99.0%, and 90.1% for low-risk, intermediate-risk, and high-risk patients). Overall survival was 76.7% (82.5%, 78.3%, and 67.6% for low-, intermediate-, and high-risk patients, respectively). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3%, and 19.8% for low-, intermediate-, and high-risk patients). The death rate from second malignancies (nonprostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0%, and 10.8% for low-, intermediate-, and high-risk patients. In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group, whereas death from cardiovascular disease, nonprostate cancer, and all other causes were most closely related to patient age and tobacco use. CONCLUSIONS: Although cardiovascular mortality was the predominant cause of death, prostate cancer was responsible for approximately 10% of all deaths. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients primarily resulted from an excess of cardiovascular deaths. Changes in lifestyle to improve cardiovascular health may improve overall survival in patients with clinically localized prostate cancer.
PURPOSE: To evaluate the primary causes of death in low-risk (low-risk), intermediate-risk (intermediate-risk), and high-risk (high-risk) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. METHODS AND MATERIALS: From April 1995 through November 2004, a total of 1,354 consecutive patients underwent prostate brachytherapy. All patients underwent brachytherapy >3 years before analysis. Of the patients, 532 (39.3%) received androgen deprivation therapy and 703 (51.9%) received supplemental radiation therapy. The median follow-up was 5.4 years. Multiple parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. RESULTS: The 10-year cause-specific survival was 97.0% (99.7%, 99.0%, and 90.1% for low-risk, intermediate-risk, and high-risk patients). Overall survival was 76.7% (82.5%, 78.3%, and 67.6% for low-, intermediate-, and high-risk patients, respectively). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3%, and 19.8% for low-, intermediate-, and high-risk patients). The death rate from second malignancies (nonprostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0%, and 10.8% for low-, intermediate-, and high-risk patients. In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group, whereas death from cardiovascular disease, nonprostate cancer, and all other causes were most closely related to patient age and tobacco use. CONCLUSIONS: Although cardiovascular mortality was the predominant cause of death, prostate cancer was responsible for approximately 10% of all deaths. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients primarily resulted from an excess of cardiovascular deaths. Changes in lifestyle to improve cardiovascular health may improve overall survival in patients with clinically localized prostate cancer.
Authors: Alana M Rojewski; Stephen Baldassarri; Nina A Cooperman; Ellen R Gritz; Frank T Leone; Megan E Piper; Benjamin A Toll; Graham W Warren Journal: Nicotine Tob Res Date: 2016-01-17 Impact factor: 4.244
Authors: Erica N Peters; Essie Torres; Benjamin A Toll; K Michael Cummings; Ellen R Gritz; Andrew Hyland; Roy S Herbst; James R Marshall; Graham W Warren Journal: J Clin Oncol Date: 2012-06-11 Impact factor: 44.544
Authors: Graham W Warren; James R Marshall; K Michael Cummings; Michael A Zevon; Robert Reed; Pat Hysert; Martin C Mahoney; Andrew J Hyland; Chukwumere Nwogu; Todd Demmy; Elisabeth Dexter; Maureen Kelly; Richard J O'Connor; Teresa Houstin; Dana Jenkins; Pamela Germain; Anurag K Singh; Jennifer Epstein; Katharine A Dobson Amato; Mary E Reid Journal: Cancer Date: 2013-10-25 Impact factor: 6.860
Authors: Nelson A Morales; Michelle A Romano; K Michael Cummings; James R Marshall; Andrew J Hyland; Alan Hutson; Graham W Warren Journal: Cancer Causes Control Date: 2013-04-04 Impact factor: 2.506
Authors: Erin P Balogh; Carolyn Dresler; Mark E Fleury; Ellen R Gritz; Thomas J Kean; Matthew L Myers; Sharyl J Nass; Brenda Nevidjon; Benjamin A Toll; Graham W Warren; Roy S Herbst Journal: Oncologist Date: 2013-12-04
Authors: Benjamin A Toll; Thomas H Brandon; Ellen R Gritz; Graham W Warren; Roy S Herbst Journal: Clin Cancer Res Date: 2013-04-09 Impact factor: 12.531