Metastasis, Mortality, and Quality of Life for Men With NCCN High and Very High Risk Localized Prostate Cancer After Surgical and/or Combined Modality Radiotherapy
| Autor: | Dennis C. Shrieve, Kristine E. Kokeny, Neeraj Agarwal, Nia Z. Sherar, Kenneth M. Boucher, Shane Lloyd, Samir Courdy, Tyler Farr, Jonathan D. Tward, Rachel Petragallo, Andrew Hofer, Isaac Kunz, Donald M. Cannon, Robert A. Stephenson, Brock O'Neil, Christopher Dechet, William T. Lowrance |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Oncology medicine.medical_specialty Urology medicine.medical_treatment Brachytherapy 030232 urology & nephrology Metastasis Androgen deprivation therapy 03 medical and health sciences Prostate cancer 0302 clinical medicine Internal medicine medicine Humans Patient Reported Outcome Measures Prospective Studies Watchful Waiting Aged Retrospective Studies Prostatectomy business.industry Prostatic Neoplasms Androgen Antagonists Retrospective cohort study Multimodal therapy Middle Aged Prognosis medicine.disease Combined Modality Therapy Survival Rate Radiation therapy 030220 oncology & carcinogenesis Quality of Life business Follow-Up Studies |
| Zdroj: | Clinical Genitourinary Cancer. 18:274-283.e5 |
| ISSN: | 1558-7673 |
| DOI: | 10.1016/j.clgc.2019.11.023 |
| Popis: | To compare metastasis-free survival, overall survival, and patient-reported quality of life (QOL) of men with National Comprehensive Cancer Network high or very high risk prostate cancer after definitive surgery and/or multimodal radiotherapy (RT).We studied a retrospective cohort study of 586 patients treated between the years 2000 and 2017 receiving radical prostatectomy with or without postoperative RT, external-beam RT (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy (Brachy) boost + ADT. Patient-reported QOL for urinary, bowel, sexual, and overall physical and mental functioning was assessed using the American Urological Association symptom scale, the Sexual Health Inventory in Men, the Rectal-Function Assessment Scale, the Expanded Prostate Cancer Index Composite, and the Veterans RAND 12-Item Health Survey.Median follow-up for survival was 5 years. No significant differences between the treatments were observed for overall survival or metastasis-free survival at the P .05 threshold. The propensity-adjusted 5-year metastasis-free survival estimates for EBRT + ADT, EBRT + Brachy + ADT, and surgery were 74.6%, 94.8%, and 83.1%, respectively. The EBRT + Brachy + ADT and surgery cohorts had significantly worse mean American Urological Association symptom scores at 6 months than the EBRT + ADT cohort, which resolved by 1 year. Surgical patients had better rectal function scores than EBRT + ADT patients at years 1 to 3, but similar function thereafter. Adjuvant or salvage RT resulted in significant declines in various Expanded Prostate Cancer Index Composite urinary, sexual, and bowel domains, and Veterans RAND 12-Item Health Survey physical but not mental domains.Men with very and/or high-risk localized prostate cancer are likely to require multimodal therapy. The overall differences in survival and long-term QOL are similar for men choosing surgical versus RT pathways. |
| Databáze: | OpenAIRE |
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