Comorbidity and the Receipt of Curative Therapy for Favorable-risk Prostate Cancer Prior to and Following the Publication of PIVOT.

Autor: Mihalcik SA; Harvard Radiation Oncology Program, Boston, MA, USA. Electronic address: smihalcik@partners.org., Chen MH; Department of Statistics, University of Connecticut, Storrs, CT, USA., Braccioforte MH; Prostate Cancer Foundation of Chicago, Westmont, IL, USA., Moran BJ; Prostate Cancer Foundation of Chicago, Westmont, IL, USA., D'Amico AV; Department of Radiation Oncology, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, MA, USA.
Jazyk: angličtina
Zdroj: European urology focus [Eur Urol Focus] 2018 Jan; Vol. 4 (1), pp. 64-67. Date of Electronic Publication: 2016 Mar 03.
DOI: 10.1016/j.euf.2016.02.007
Abstrakt: The publication of the randomized Prostate Cancer Intervention Versus Observation Trial (PIVOT) in July 2012, in which men with favorable-risk prostate cancer (PCa) were not found to benefit from radical prostatectomy, had the potential to shift PCa practice patterns. Using a prospectively assembled database of 5398 men with low-risk or favorable intermediate-risk PCa selected for curative treatment with brachytherapy in the years preceding and the year following the publication of PIVOT, we evaluated the odds of receiving curative treatment after adjusting for risk group (favorable intermediate vs low), race (black, Hispanic, or other), number of cardiometabolic comorbidities, and age. Following publication, the receipt of curative treatment was significantly lower (adjusted odds ratio [AOR]: 0.40; 95% confidence interval [CI], 0.16-0.99; p=0.05) among men with at least two cardiometabolic comorbidities, in contrast to the increasing trend (p=0.02) noted prior to PIVOT. Among black men, a subgroup at risk for occult high-grade disease, the odds of receiving curative treatment increased after PIVOT (AOR: 1.55; 95% CI, 1.06-2.26; p=0.02). These observations suggest that PIVOT's publication appropriately contributed to decreasing the use of curative treatment in men unlikely to benefit.
Patient Summary: The Prostate Intervention Versus Observation Trial (PIVOT) showed that radical prostatectomy did not benefit men with favorable-risk prostate cancer. Following the publication of PIVOT, the selection of men with multiple medical issues for curative treatment declined, whereas treatment of men at high risk of having aggressive prostate cancer increased.
(Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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