The epidemiology of high-risk prostate cancer
ABSTRACT PURPOSE OF REVIEW: Concern for over and under-treatment of men with prostate cancer has led to an increased focus on the identification and selective treatment of men with high-risk features. The purpose of this review is to summarize the epidemiology, risk factors, and treatment trends of men with high-risk prostate cancer. RECENT FINDINGS: Findings from recent trials on prostate-specific antigen-based screening suggest that screening has substantially reduced the incidence of high-risk prostate cancer. Men with high-risk disease tend to be older at diagnosis than those with low-risk disease. There is marked variation in the treatment of men with high-risk features; contemporary studies favor multimodal therapy, but high-risk disease is often under-treated with androgen deprivation alone, particularly among older men. SUMMARY: Variations in the incidence, mortality, and treatment of men with high-risk prostate cancer may reflect heterogeneity among studies in the definition of high-risk disease. Future research should attempt to standardize definitions of high-risk prostate cancer to allow better comparison between studies and provide a more homogeneous assessment of natural history.
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ABSTRACT: This pilot study investigates the role of DOC-2/DAB2 Interacting Protein (DAB2IP) and enhancer of zeste homolog 2 (EZH2) as prognostic biomarkers in high-risk prostate cancer patients receiving definitive radiation therapy.International journal of radiation oncology, biology, physics 05/2014; 89(4). DOI:10.1016/j.ijrobp.2014.03.035 · 4.18 Impact Factor
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ABSTRACT: Introduction: Despite a rapid dissemination of robot-assisted radical prostatectomy (RARP) over open RP (ORP), to date no study compared perioperative outcomes between the two approaches in patients with high-risk prostate cancer (PCa). The aim of our study was to evaluate the safety and feasibility of RARP in this setting. Patients and Methods: Overall, 1,512 patients with high-risk PCa within the Surveillance Epidemiology and End Results (SEER) Medicare-linked database diagnosed between 2008 and 2009 were abstracted. Patients were treated with RARP or ORP. Postoperative complications, blood transfusions, prolonged length of hospital stay (pLOS), positive surgical margins, and additional cancer therapy rates were compared. Propensity-score matched analyses and logistic regression models fitted with generalized estimating equations for clustering among hospitals were performed. Results: Overall, 706 (46.7%) and 806 (53.3%) patients underwent ORP and RARP, respectively. Following propensity-matched analyses, 706 patients remained. No differences were observed in complications (P=0.6), positive surgical margins (P=0.4), and additional therapy after surgery (P=0.2) between patients treated with RARP and ORP. However, RARP was associated with lower rates of transfusions and shorter hospitalization (all P<0.001). In multivariable analyses, patients undergoing RARP were less likely to receive a blood transfusion (P=0.002) and to experience a pLOS (P<0.001) compared to men treated with ORP. Conclusions: RARP and ORP have comparable complications, positive surgical margins, and additional cancer therapy rates in high-risk PCa. RARP is associated with lower rates of blood transfusions and shorter LOS. These findings suggest that RARP is safe and feasible even in this clinical scenario.Journal of endourology / Endourological Society 02/2014; DOI:10.1089/end.2013.0774 · 2.10 Impact Factor
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ABSTRACT: Purpose High-risk prostate cancer (PC) has poor outcomes due to therapeutic resistance to conventional treatments, which include prostatectomy, radiation, and hormone therapy. Previous studies suggest that anticoagulant (AC) use may improve treatment outcomes in PC patients. We hypothesized that AC therapy confers a freedom from biochemical failure (FFBF) and overall survival (OS) benefit when administered with radiotherapy in patients with high-risk PC. Materials and Methods Analysis was performed on 74 high-risk PC patients who were treated with radiotherapy from 2005 to 2008 at UT Southwestern. Of these patients, 43 were on AC including aspirin (95.6%), clopidogrel (17.8%), warfarin (20%), and multiple ACs (31.1%). Associations between AC use and FFBF, OS, distant metastasis, and toxicity were analyzed. Results Median follow-up was 56.6 mo for all patients. For patients taking any AC compared with no AC, there was improved FFBF at 5 years of 80% vs. 62% (P = 0.003), and for aspirin the FFBF was 84% vs. 65% (P = 0.008). Aspirin use was also associated with reduced rates of distant metastases at 5 years (12.2% vs. 26.7%, P = 0.039). On subset analysis of patients with GS 9-10 histology, aspirin resulted in improved 5-year OS (88% vs. 37%, P = 0.032), which remained significant on multivariable analysis (P<0.05). Conclusions AC use was associated with a FFBF benefit in high-risk PC which translated into an OS benefit in the highest risk PC patients with GS 9-10, who are most likely to experience mortality from PC. This hypothesis-generating result suggests AC use may represent an opportunity to augment current therapy.Cancer biology & therapy 03/2014; 15(6). DOI:10.4161/cbt.28554 · 3.63 Impact Factor