O Abdel-Rahman1,2. 1. Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. omar.abdelsalam@ahs.ca. 2. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, T2N4N1, Canada. omar.abdelsalam@ahs.ca.
Abstract
OBJECTIVE: To assess the outcomes of active monitoring (active surveillance or watchful waiting) as an initial management approach compared to upfront definitive local treatments (prostatectomy or radiation therapy) in a cohort of clinically localized prostate cancer patients. METHODS: Patients with clinically localized prostate cancer registered within the Surveillance, Epidemiology and End Results (SEER) watchful waiting database from 2010-2015 were reviewed. Kaplan-Meier analysis was used to compare overall survival outcomes between patients treated with different initial therapeutic approaches. Multivariate Cox regression analysis (stratified by the risk group) was used to assess potential factors affecting prostate cancer-specific survival. RESULTS: Using Kaplan-Meier analysis, prostatectomy was associated with better overall survival compared to radiation therapy and active monitoring (P < 0.001). Multivariate Cox regression analysis was then employed to evaluate different factors affecting prostate cancer-specific survival. Among patients with low-risk disease, the following factors were predictive of better prostate cancer-specific survival: younger age (hazard ratio for patients ≥ 70 years versus patients 40-69 years: 2.081; 95% CI 1.277-3.390; P = 0.003), white race (hazard ratio for black race versus white race: 2.575; 95% CI 1.538-4.311; P < 0.001), non-Hispanic ethnicity (hazard ratio versus Hispanic ethnicity: 0.472; 95% CI 0.244-0.910; P = 0.025), and initial treatment with prostatectomy (hazard ratio for prostatectomy versus active monitoring: 0.551; 95% CI 0.371-0.818; P = 0.003). CONCLUSIONS: Active monitoring seems to be at least as effective as upfront radiation therapy in the management of low-risk disease. Radical prostatectomy is associated with better overall and prostate cancer-specific survival compared to either radiation therapy or active monitoring.
OBJECTIVE: To assess the outcomes of active monitoring (active surveillance or watchful waiting) as an initial management approach compared to upfront definitive local treatments (prostatectomy or radiation therapy) in a cohort of clinically localized prostate cancerpatients. METHODS:Patients with clinically localized prostate cancer registered within the Surveillance, Epidemiology and End Results (SEER) watchful waiting database from 2010-2015 were reviewed. Kaplan-Meier analysis was used to compare overall survival outcomes between patients treated with different initial therapeutic approaches. Multivariate Cox regression analysis (stratified by the risk group) was used to assess potential factors affecting prostate cancer-specific survival. RESULTS: Using Kaplan-Meier analysis, prostatectomy was associated with better overall survival compared to radiation therapy and active monitoring (P < 0.001). Multivariate Cox regression analysis was then employed to evaluate different factors affecting prostate cancer-specific survival. Among patients with low-risk disease, the following factors were predictive of better prostate cancer-specific survival: younger age (hazard ratio for patients ≥ 70 years versus patients 40-69 years: 2.081; 95% CI 1.277-3.390; P = 0.003), white race (hazard ratio for black race versus white race: 2.575; 95% CI 1.538-4.311; P < 0.001), non-Hispanic ethnicity (hazard ratio versus Hispanic ethnicity: 0.472; 95% CI 0.244-0.910; P = 0.025), and initial treatment with prostatectomy (hazard ratio for prostatectomy versus active monitoring: 0.551; 95% CI 0.371-0.818; P = 0.003). CONCLUSIONS: Active monitoring seems to be at least as effective as upfront radiation therapy in the management of low-risk disease. Radical prostatectomy is associated with better overall and prostate cancer-specific survival compared to either radiation therapy or active monitoring.
Authors: Anna Bill-Axelson; Lars Holmberg; Hans Garmo; Kimmo Taari; Christer Busch; Stig Nordling; Michael Häggman; Swen-Olof Andersson; Ove Andrén; Gunnar Steineck; Hans-Olov Adami; Jan-Erik Johansson Journal: N Engl J Med Date: 2018-12-13 Impact factor: 91.245
Authors: Peter R Carroll; J Kellogg Parsons; Gerald Andriole; Robert R Bahnson; Erik P Castle; William J Catalona; Douglas M Dahl; John W Davis; Jonathan I Epstein; Ruth B Etzioni; Thomas Farrington; George P Hemstreet; Mark H Kawachi; Simon Kim; Paul H Lange; Kevin R Loughlin; William Lowrance; Paul Maroni; James Mohler; Todd M Morgan; Kelvin A Moses; Robert B Nadler; Michael Poch; Chuck Scales; Terrence M Shaneyfelt; Marc C Smaldone; Geoffrey Sonn; Preston Sprenkle; Andrew J Vickers; Robert Wake; Dorothy A Shead; Deborah A Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2016-05 Impact factor: 11.908
Authors: M Bolla; D Gonzalez; P Warde; J B Dubois; R O Mirimanoff; G Storme; J Bernier; A Kuten; C Sternberg; T Gil; L Collette; M Pierart Journal: N Engl J Med Date: 1997-07-31 Impact factor: 91.245
Authors: J L Donovan; F C Hamdy; J A Lane; D E Neal; M Mason; C Metcalfe; E Walsh; J M Blazeby; T J Peters; P Holding; S Bonnington; T Lennon; L Bradshaw; D Cooper; P Herbert; J Howson; A Jones; N Lyons; E Salter; P Thompson; S Tidball; J Blaikie; C Gray; P Bollina; J Catto; A Doble; A Doherty; D Gillatt; R Kockelbergh; H Kynaston; A Paul; P Powell; S Prescott; D J Rosario; E Rowe; M Davis; E L Turner; R M Martin Journal: N Engl J Med Date: 2016-09-14 Impact factor: 91.245
Authors: Freddie C Hamdy; Jenny L Donovan; J Athene Lane; Malcolm Mason; Chris Metcalfe; Peter Holding; Michael Davis; Tim J Peters; Emma L Turner; Richard M Martin; Jon Oxley; Mary Robinson; John Staffurth; Eleanor Walsh; Prasad Bollina; James Catto; Andrew Doble; Alan Doherty; David Gillatt; Roger Kockelbergh; Howard Kynaston; Alan Paul; Philip Powell; Stephen Prescott; Derek J Rosario; Edward Rowe; David E Neal Journal: N Engl J Med Date: 2016-09-14 Impact factor: 91.245
Authors: Kenneth G Nepple; Andrew J Stephenson; Dorina Kallogjeri; Jeff Michalski; Robert L Grubb; Seth A Strope; Jennifer Haslag-Minoff; Jay F Piccirillo; Jay P Ciezki; Eric A Klein; Chandana A Reddy; Changhong Yu; Michael W Kattan; Adam S Kibel Journal: Eur Urol Date: 2013-03-13 Impact factor: 20.096
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: Maxine Sun; Jesse D Sammon; Andreas Becker; Florian Roghmann; Zhe Tian; Simon P Kim; Alexandre Larouche; Firas Abdollah; Jim C Hu; Pierre I Karakiewicz; Quoc-Dien Trinh Journal: BJU Int Date: 2013-08-13 Impact factor: 5.588