scholarly journals Radiotherapeutic Strategies in the Management of Low-Risk Prostate Cancer

2010 ◽  
Vol 10 ◽  
pp. 1854-1869 ◽  
Author(s):  
Kevin S. Choe ◽  
Stanley L. Liauw
Keyword(s):  
Prostate Cancer ◽  
Tumor Imaging ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
The United States ◽  
Low Risk ◽  
Image Guided Radiotherapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Prostate cancer is the most common nonskin malignancy among men in the United States. Since the introduction of screening with prostate-specific antigen (PSA), most patients are being diagnosed at an early stage with low-risk disease. For men with low-risk prostate cancer, there exists an array of radiotherapeutic strategies that are effective and well tolerated, such as external-beam radiotherapy and brachytherapy. In recent years, there have been tremendous advances in the field of radiation oncology that have transformed the way radiation is used to treat prostate cancer, such as intensity-modulated radiotherapy, image-guided radiotherapy, and stereotactic radiotherapy. It is now feasible to deliver high doses of radiation to the target volume with improved precision and spare more of the neighboring tissues from potentially damaging radiation. Disease outcomes are generally excellent in low-risk prostate cancer. Improvements are expected with further integration of innovative technologies in radiation delivery, tumor imaging, and target localization.

Overtreatment of low-risk prostate cancer in the United States: Incidence, cost, complications, and implications for the screening debate.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Ayal A. Aizer ◽  
Xiangmei Gu ◽  
Toni K. Choueiri ◽  
Neil E. Martin ◽  
Jim C. Hu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Life Expectancy ◽  
Specific Antigen ◽  
Expectant Management ◽  
The United States ◽  
Low Risk ◽  
Definitive Treatment ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

161 Background: The National Comprehensive Cancer Network (NCCN) recommends active surveillance as the sole option for men with low-risk prostate cancer (LRPC) and a life expectancy <10 years. We sought to describe the incidence, risk factors, cost, and morbidity related to overtreatment of LRPC within the United States. Methods: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare Program to identify 11,744 men ≥66 years with LRPC diagnosed from 2004-2007. Expected survival was estimated using the 2007 Social Security Life Table and was increased and decreased by 50% in men in the upper and lower quartiles of comorbidity, respectively, as specified by the NCCN. Overtreatment was definitive treatment in men with LRPC and life expectancy <10 years. Costs were the amount paid by Medicare in the year following minus the year prior to diagnosis. Toxicities were defined as relevant Medicare diagnoses or interventions. Results: Of 3001 men with LRPC and a life expectancy <10 years, 2011 (67%) were treated definitively. On multivariable logistic regression, men overtreated for prostate cancer were more likely to be younger (p<.001), white (vs black, OR 1.44, 95% CI 1.03-2.02, p=.03), married (OR 1.30, 95% CI 1.05-1.61, p=.02), urban (trend, OR 1.40, 95% CI 0.98-2.00, p=.06), have higher Elixhauser comorbidity (p<.001), and have a higher clinical stage (T2 vs T1, OR 1.57, 95% CI 1.19-2.07, p=.001) and prostate-specific antigen level (OR 1.02, 95% CI 1.02-1.02, p<.001). Relative to expectant management, the mean added cost per definitive treatment was $15,308. When extrapolated nationally the cumulative net cost of overtreatment in men ≥66 years is $32 million per annum. Long-term urinary, erectile, and bowel toxicity occurred in 59.2% and 50.0%, 47.9% and 19.7%, and 7.1% and 17.8% of prostatectomy and radiation patients, respectively. Conclusions: Overtreatment of prostate cancer is partially driven by sociodemographic factors and occurs in a high percentage of men with LRPC and limited life expectancy, with marked impact on patient quality of life and health care costs. Efforts to enhance appropriate management of LRPC would reduce the harms associated with screening.

scholarly journals The Changing Face of Low-Risk Prostate Cancer: Trends in Clinical Presentation and Primary Management

2004 ◽  
Vol 22 (11) ◽  
pp. 2141-2149 ◽  
Author(s):  
Matthew R. Cooperberg ◽  
Deborah P. Lubeck ◽  
Maxwell V. Meng ◽  
Shilpa S. Mehta ◽  
Peter R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Presentation ◽  
External Beam Radiotherapy ◽  
Temporal Trends ◽  
Specific Antigen ◽  
Low Risk ◽  
Tumor Characteristics ◽  
Term Survival ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Purpose Early intervention for prostate cancer is associated with excellent long-term survival, but many affected men, especially those with low-risk disease characteristics, might not experience adverse impact to survival or quality of life were treatment deferred. We sought to characterize temporal trends in clinical presentation and primary disease management among patients with low-risk prostate cancer. Methods Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 8,685 men with various stages of prostate cancer. Included were 2,078 men who were diagnosed between 1989 and 2001 and had a serum prostate specific antigen ≤ 10 ng/mL, Gleason sum ≤ 6, and clinical T stage ≤ 2a. Trends in risk distribution, tumor characteristics, and primary treatment were evaluated. Results The proportion of patients with low-risk tumor characteristics rose from 29.8% in 1989 to 1992, to 45.3% in 1999 to 2001 (P < .0001). There have been sharp increases in the use of brachytherapy and androgen deprivation monotherapy, from 3.1% and 3.1%, to 12.0% and 21.7%, respectively. Utilization rates for prostatectomy, external-beam radiotherapy, and observation have fallen accordingly, from 63.8%, 16.1%, and 13.8%, to 51.6%, 6.8%, and 7.9% (P < .0001 for all except prostatectomy [P = .0019]). Age and socioeconomic status were significantly associated with treatment selection, but overall, the treatment trends were echoed on subgroup analysis of patients 75 years or older. Conclusion Low-risk features characterize a growing proportion of prostate cancer patients, and there have been significant shifts in the management of low-risk disease. Overtreatment may be a growing problem, especially among older patients.

scholarly journals Cost Implications and Complications of Overtreatment of Low-Risk Prostate Cancer in the United States

2015 ◽  
Vol 13 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Ayal A. Aizer ◽  
Xiangmei Gu ◽  
Ming-Hui Chen ◽  
Toni K. Choueiri ◽  
Neil E. Martin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
The United States ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Cost Implications

scholarly journals The Role of Targeted Focal Therapy in the Management of Low-Risk Prostate Cancer: Update on Current Challenges

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Daniel W. Smith ◽  
Diliana Stoimenova ◽  
Khadijah Eid ◽  
Al Barqawi
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Specific Antigen ◽  
Three Dimensional ◽  
Focal Therapy ◽  
The United States ◽  
Psa Testing ◽  
Three Dimensional Mapping ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Prostate cancer is one of the most prevalent cancers among men in the United States, second only to nonmelanomatous skin cancer. Since prostate-specific antigen (PSA) testing came into widespread use in the late 1980s, there has been a sharp increase in annual prostate cancer incidence. Cancer-specific mortality, though, is relatively low. The majority of these cancers will not progress to mortal disease, yet most men who are diagnosed opt for treatment as opposed to observation or active surveillance (AS). These men are thus burdened with the morbidities associated with aggressive treatments, commonly incontinence and erectile dysfunction, without receiving a mortality benefit. It is therefore necessary to both continue investigating outcomes associated with AS and to develop less invasive techniques for those who desire treatment but without the significant potential for quality-of-life side effects seen with aggressive modalities. The goals of this paper are to discuss the problems of overdiagnosis and overtreatment since the advent of PSA screening as well as the potential for targeted focal therapy (TFT) to bridge the gap between AS and definitive therapies. Furthermore, patient selection criteria for TFT, costs, side effects, and brachytherapy template-guided three-dimensional mapping biopsies (3DMB) for tumor localization will also be explored.

Lifelong Yearly Prostate Specific Antigen Surveillance is Not Necessary for Low Risk Prostate Cancer Treated With Radical Prostatectomy

2010 ◽  
Vol 184 (3) ◽  
pp. 925-929 ◽  
Author(s):  
Matthew K. Tollefson ◽  
Michael L. Blute ◽  
Laureano J. Rangel ◽  
R. Jeffrey Karnes ◽  
Igor Frank
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

External Beam Radiotherapy for Low-Risk Prostate Cancer

2012 ◽  
pp. 709-717
Author(s):  
Gert O. De Meerleer ◽  
Piet Ost ◽  
Geert M. Villeirs ◽  
Nicolaas Lumen ◽  
Valérie Fonteyne
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Low Risk ◽  
External Beam ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer
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