Other-cause mortality in incidental prostate cancer.
SEER
TURP
active surveillance
death
survival
Journal
The Prostate
ISSN: 1097-0045
Titre abrégé: Prostate
Pays: United States
ID NLM: 8101368
Informations de publication
Date de publication:
20 Mar 2024
20 Mar 2024
Historique:
revised:
07
02
2024
received:
09
01
2024
accepted:
01
03
2024
medline:
20
3
2024
pubmed:
20
3
2024
entrez:
20
3
2024
Statut:
aheadofprint
Résumé
In incidental prostate cancer (IPCa), elevated other-cause mortality (OCM) may obviate the need for active treatment. We tested OCM rates in IPCa according to treatment type and cancer grade and we hypothesized that OCM is significantly higher in not-actively-treated patients. Within the Surveillance, Epidemiology, and End Results database (2004-2015), IPCa patients were identified. Smoothed cumulative incidence plots as well as multivariable competing risks regression models were fitted to address OCM after adjustment for cancer-specific mortality (CSM). Of 5121 IPCa patients, 3655 (71%) were not-actively-treated while 1466 (29%) were actively-treated. Incidental PCa not-actively-treated patients were older and exhibited higher proportion of Gleason sum (GS) 6 and clinical T1a stage. In smoothed cumulative incidence plots, 5-year OCM was 20% for not-actively-treated versus 8% for actively-treated patients. Conversely, 5-year CSM was 5% for not-actively-treated versus 4% for actively-treated patients. No active treatment was associated with 1.4-fold higher OCM, even after adjustment for age, cancer characteristics, and CSM. According to GS, OCM reached 16%, 27%, and 35% in GS 6, 7, and 8-10 not-actively-treated IPCa patients, respectively and exceeded CSM recorded for the same three groups (2%, 6%, and 28%, respectively). Our results quantified OCM rates, confirming that in not-actively-treated IPCa patients OCM is indeed significantly higher than in their actively-treated counterparts (HR: 1.4). These observations validate the use of no active treatment in IPCa patients, in whom OCM greatly surpasses CSM (20% vs. 5%).
Sections du résumé
BACKGROUND
BACKGROUND
In incidental prostate cancer (IPCa), elevated other-cause mortality (OCM) may obviate the need for active treatment. We tested OCM rates in IPCa according to treatment type and cancer grade and we hypothesized that OCM is significantly higher in not-actively-treated patients.
METHODS
METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2015), IPCa patients were identified. Smoothed cumulative incidence plots as well as multivariable competing risks regression models were fitted to address OCM after adjustment for cancer-specific mortality (CSM).
RESULTS
RESULTS
Of 5121 IPCa patients, 3655 (71%) were not-actively-treated while 1466 (29%) were actively-treated. Incidental PCa not-actively-treated patients were older and exhibited higher proportion of Gleason sum (GS) 6 and clinical T1a stage. In smoothed cumulative incidence plots, 5-year OCM was 20% for not-actively-treated versus 8% for actively-treated patients. Conversely, 5-year CSM was 5% for not-actively-treated versus 4% for actively-treated patients. No active treatment was associated with 1.4-fold higher OCM, even after adjustment for age, cancer characteristics, and CSM. According to GS, OCM reached 16%, 27%, and 35% in GS 6, 7, and 8-10 not-actively-treated IPCa patients, respectively and exceeded CSM recorded for the same three groups (2%, 6%, and 28%, respectively).
CONCLUSION
CONCLUSIONS
Our results quantified OCM rates, confirming that in not-actively-treated IPCa patients OCM is indeed significantly higher than in their actively-treated counterparts (HR: 1.4). These observations validate the use of no active treatment in IPCa patients, in whom OCM greatly surpasses CSM (20% vs. 5%).
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243-262. doi:10.1016/j.eururo.2020.09.042
Adolfsson J. The management of category T1a-T1b (incidental) prostate cancer: can we predict who needs treatment? Eur Urol. 2008;54(1):16-18. doi:10.1016/j.eururo.2008.03.099
Scheipner L, Incesu RB, Morra S, et al. Characteristics of incidental prostate cancer in the United States. Prostate Cancer Prostatic Dis. 2023. doi:10.1038/s41391-023-00742-7
Capogrosso P, Capitanio U, Vertosick EA, et al. Temporal trend in incidental prostate cancer detection at surgery for benign prostatic hyperplasia. Urology. 2018;122:152-157. doi:10.1016/j.urology.2018.07.028
Capitanio U, Autorino R, Bandini M, et al. Incidental prostate cancer (cT1a-cT1b) is a relevant clinical and research entity and should be fully discussed in the international prostate cancer guidelines. Eur Urol Oncol. 2022;5(2):256-258. doi:10.1016/j.euo.2021.03.005
Cause of death recode: SEER recodes. SEER. Accessed October 30, 2023. https://seer.cancer.gov/codrecode/index.html
Cheng BKC, Castellani D, Chan ISH, et al. Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol. 2022;40(1):87-101. doi:10.1007/s00345-021-03756-9
Luzzago S, Piccinelli ML, Marvaso G, et al. Active surveillance for prostate cancer: comparison between incidental tumors vs. tumors diagnosed at prostate biopsies. World J Urol. 2022;40(2):443-451. doi:10.1007/s00345-021-03864-6
Herden J, Schwarte A, Boedefeld EA, Weissbach L. Active surveillance for incidental (cT1a/b) prostate cancer: long-term outcomes of the prospective noninterventional HAROW study. Urol Int. 2021;105(5-6):428-435. doi:10.1159/000512893
Capitanio U, Scattoni V, Freschi M, et al. Radical prostatectomy for incidental (stage T1a-T1b) prostate cancer: analysis of predictors for residual disease and biochemical recurrence. Eur Urol. 2008;54(1):118-125. doi:10.1016/j.eururo.2008.02.018
Herden J, Eminaga O, Wille S, Weissbach L. Treatment of incidental prostate cancer by active surveillance: results of the HAROW study. Urol Int. 2015;95(2):209-215. doi:10.1159/000431024
Alba C, Zheng Z, Wadhera RK. Changes in health care access and preventive health screenings by race and ethnicity. JAMA Health Forum. 2024;5(2):e235058. doi:10.1001/jamahealthforum.2023.5058
Chierigo F, Flammia RS, Sorce G, et al. Racial/ethnic disparities in the distribution and effect of type and number of high-risk criteria on mortality in prostate cancer patients treated with radiotherapy. Arab J Urol. 2023;21(3):135-141. doi:10.1080/2090598X.2022.2148867
Wenzel M, Nocera L, Collà Ruvolo C, et al. Racial/ethnic disparities in tumor characteristics and treatments in favorable and unfavorable intermediate risk prostate cancer. J Urol. 2021;206(1):69-79. doi:10.1097/JU.0000000000001695