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Association of Radi...
Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study
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- Stattin, Pär (författare)
- Umeå universitet,Uppsala universitet,Urologkirurgi,Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.,Urologi och andrologi,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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- Sandin, F. (författare)
- Uppsala University Hospital,Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.
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- Thomsen, F. B. (författare)
- University of Copenhagen,Univ Copenhagen, Rigshosp, Dept Urol, Copenhagen Prostate Canc Ctr, Copenhagen, Denmark.
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- Garmo, H. (författare)
- King's College London,Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.;Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Grp, London, England.
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- Robinson, D. (författare)
- Ryhov County Hospital, Jönköping,Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
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- Franck-Lissbrant, Ingela, 1969 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Sahlgrenska Academy,Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden.
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- Jonsson, Håkan (författare)
- Umeå universitet,Umeå University,Umea Univ, Dept Radiat Sci, Umea, Sweden.,Institutionen för strålningsvetenskaper
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- Bratt, Ola (författare)
- Lund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,Urological cancer, Malmö,Lund University Research Groups,University of Cambridge,Lund Univ, Div Urol Canc, Dept Translat Med, Lund, Sweden.;Cambridge Univ Hosp, Dept Urol, CamPARI Clin, Cambridge, England.
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(creator_code:org_t)
- Elsevier BV, 2017
- 2017
- Engelska.
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 72:1, s. 125-134
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Abstract
Ämnesord
Stäng
- Background: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. Objective: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. Design, setting, and participants: Semiecologic study of men aged < 80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200 ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level < 50 ng/ml, any N, and M0) were used as positive controls. Intervention: Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis. Outcome measurements and statistical analysis: PCa and all-cause mortality rate ratios (MRRs). Results and limitations: Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposurewere in agreement with results fromrandomized trials (PCaMRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity. Conclusions: The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective. Patient summary: Menwith very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality. (C) 2016 European Association of Urology. Published by Elsevier B.V.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- LANTBRUKSVETENSKAPER -- Veterinärmedicin -- Klinisk vetenskap (hsv//swe)
- AGRICULTURAL SCIENCES -- Veterinary Science -- Clinical Science (hsv//eng)
Nyckelord
- Prostate cancer
- Very high-risk
- Radical
- Treatment
- Semiecologic
- Nationwide
- Population-based
- androgen-deprivation therapy
- death certificates
- plus orchiectomy
- nccn
- guidelines
- cohort profile
- sweden
- radiotherapy
- register
- outcomes
- trial
- Urology & Nephrology
- PCBaSe
- Prostate cancer
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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