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Sökning: WFRF:(Garmo H) > Lantbruksvetenskap > Association of Radi...

Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study

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
Sandin, F. (författare)
Uppsala University Hospital,Uppsala Univ Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden.
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.
Robinson, D. (författare)
Ryhov County Hospital, Jönköping,Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Hosp, Dept Urol, Jonkoping, Sweden.
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.
Jonsson, Håkan (författare)
Umeå universitet,Umeå University,Umea Univ, Dept Radiat Sci, Umea, Sweden.,Institutionen för strålningsvetenskaper
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.
Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 72:1, s. 125-134
  • Tidskriftsartikel (refereegranskat)
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

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