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Thread: (F) Treatment Decisions Comparisons Trends

  1. #11
    [#6]
    Information Seeking and Satisfaction with Information Sources Among Spouses of Men with Newly Diagnosed Local-Stage Prostate Cancer
    [2018, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738274/

    Abstract

    Information sources about prostate cancer treatment and outcomes are typically designed for patients. Little is known about the availability and utility of information for partners. The objectives of our study were to evaluate information sources used by partners to understand prostate cancer management options, their perceived usefulness, and the relationship between sources used and satisfaction with treatment experience. A longitudinal survey of female partners of men newly diagnosed with local-stage prostate cancer was conducted in three different geographic regions. Partners and associated patients were surveyed at baseline (after patient diagnosis but prior to receiving therapy) and at 12 months following diagnosis. Information sources included provider, literature, friends or family members, Internet websites, books, traditional media, and support groups. Utility of an information source was defined as whether the partner would recommend it to caregivers of other patients with local-stage prostate cancer. Our study cohort included 179 partner-patient pairs. At diagnosis, partners consulted an average of 4.6 information sources. Non-Hispanic white partners were more likely than others to use friends and family as an information source (OR = 2.44, 95% CI (1.04, 5.56)). More educated partners were less likely to use support groups (OR = 0.31, 95% CI (0.14, 0.71)). At 12-month follow-up, partners were less likely to recommend books (OR = 0.23, 95% CI (0.11, 0.49)) compared to baseline. Partners consulted a large number of information sources in researching treatment options for local-stage prostate cancer and the types of sources accessed varied by race/ethnicity and educational attainment. Additional resources to promote selection of high-quality non-provider information sources are warranted to enable partners to better aid patients in their treatment decision-making process.

  2. #12
    [#7] Understanding Advanced Prostate Cancer Decision Making Utilizing an Interactive Decision Aid [2018, Full Text]

    https://journals.lww.com/cancernursingonline/Fulltext/2018/01000/Understanding_Advanced_Prostate_Cancer_Decision.2. aspx

    Abstract

    Background: Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among men in the United States. Patients with advanced prostate cancer are vulnerable to difficult treatment decisions because of the nature of their disease.

    Objective: The aims of this study were to describe and understand the lived experience of patients with advanced prostate cancer and their decision partners who utilized an interactive decision aid, DecisionKEYS, to make informed, shared treatment decisions.

    Methods: This qualitative study uses a phenomenological approach that included a sample of 35 pairs of patients and their decision partners (16 pairs reflected patients with <6 months since their diagnosis of metastatic castration-resistant prostate cancer; 19 pairs reflected patients with >6 months since their diagnosis of metastatic castration-resistant prostate cancer). Qualitative analysis of semistructured interviews was conducted describing the lived experience of patients with advanced prostate cancer and their decision partners using an interactive decision aid.

    Results: Three major themes emerged: (1) the decision aid facilitated understanding of treatment options; (2) quality of life was more important than quantity of life; and (3) contact with healthcare providers greatly influenced decisions.

    Conclusions: Participants believed the decision aid helped them become more aware of their personal values, assisted in their treatment decision making, and facilitated an interactive patient–healthcare provider relationship.

    Implications for Practice: Decision aids assist patients, decision partners, and healthcare providers make satisfying treatment decisions that affect quality/quantity of life. These findings are important for understanding the experiences of patients who have to make difficult decisions.

  3. #13
    [#8] Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis [2018]

    https://link.springer.com/article/10.1007/s00345-017-2102-9

    Abstract

    Purpose
    Contemporary data regarding the effect of local treatment (LT) vs. non-local treatment (NLT) on cancer-specific mortality (CSM) in elderly men with localized prostate cancer (PCa) are lacking. Hence, we evaluated CSM rates in a large population-based cohort of men with cT1-T2 PCa according to treatment type.

    Methods
    Within the SEER database (2004–2014), we identified 44,381 men ≥ 75 years with cT1-T2 PCa. Radical prostatectomy and radiotherapy patients were matched and the resulting cohort (LT) was subsequently matched with NLT patients. Cumulative incidence and competing risks regression (CRR) tested CSM according to treatment type. Analyses were repeated after Gleason grade group (GGG) stratification: I (3 + 3), II (3 + 4), III (4 + 3), IV (8 ), and V (9-10).

    Results
    Overall, 4715 (50.0%) and 4715 (50.0%) men, respectively, underwent NLT and LT. Five and 7-year CSM rates for, respectively, NLT vs. LT patients were 3.0 and 5.4% vs. 1.5 and 2.1% for GGG II, 4.5 and 7.2% vs. 2.5 and 2.8% for GGG III, 7.1 and 10.0% vs. 3.5 and 5.1% for GGG IV, and 20.0 and 26.5% vs. 5.4 and 9.3% for GGG V patients. Separate multivariable CRR also showed higher CSM rates in NLT patients with GGG II [hazard ratio (HR) 3.3], GGG III (HR 2.6), GGG IV (HR 2.4) and GGG V (HR 2.6), but not in GGG I patients (p = 0.5).

    Conclusions
    Despite advanced age, LT provides clinically meaningful and statistically significant benefit relative to NLT. Such benefit was exclusively applied to GGG II to V but not to GGG I patients.

  4. #14
    [#9] The Diagnosis and Treatment of Prostate Cancer: A Review [2017, JAMA, Full Text rentable]

    https://jamanetwork.com/journals/jama/article-abstract/2633921?redirect=true

    Key Points
    Question What are the optimal methods for the diagnosis and treatment of prostate cancer based on current evidence?

    Findings Improved risk classification methods, imaging techniques, and biomarkers have improved the ability to provide prognostic information to patients with prostate cancer. For the treatment of prostate cancer, monitoring for disease progression followed by local therapy is an accepted strategy for some men. Surgery and radiation techniques continue to evolve as treatment-related adverse effects are better defined. Median survival also has improved for men with metastatic disease and is now 5 years, due to the early administration of docetaxel and new drugs such as abiraterone, enzalutamide, and other agents.

    Meaning With recent advances, prostate cancer can be accurately characterized and more optimally managed according to tumor biology, patient preferences, and survivorship goals.

    Abstract
    Importance Prostate cancer is the most common cancer diagnosis made in men with more than 160 000 new cases each year in the United States. Although it often has an indolent course, prostate cancer remains the third-leading cause of cancer death in men.

    Observations When prostate cancer is suspected, tissue biopsy remains the standard of care for diagnosis. However, the identification and characterization of the disease have become increasingly precise through improved risk stratification and advances in magnetic resonance and functional imaging, as well as from the emergence of biomarkers. Multiple management options now exist for men diagnosed with prostate cancer. Active surveillance (the serial monitoring for disease progression with the intent to cure) appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer, particularly those with a prostate-specific antigen level of less than 10 ng/mL and Gleason score 3 + 3 tumors. Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life. For metastatic disease, chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone. New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy.

    Conclusions and Relevance Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference. Initial treatment with chemotherapy can improve survival compared with androgen deprivation therapy. Abiraterone, enzalutamide, and other agents can improve outcomes in men with metastatic prostate cancer resistant to traditional hormonal therapy.

  5. #15
    [#10]
    Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions
    [2016]

    http://journals.sagepub.com/doi/abs/10.1177/0272989X16662841

    Abstract

    Objective. To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. Methods. We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients’ baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients’ interest in sex. Results. Patients’ initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists’ recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists’ recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients’ interest in sex (<15% of appointments). Conclusions. Patients’ treatment decisions were based largely on urologists’ recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients’ personal views of the relative pros and cons of treatment alternatives.

  6. #16
    [#11]
    Genomic Markers in Prostate Cancer Decision Making
    [2018, Full Text]

    http://www.europeanurology.com/article/S0302-2838(17)30975-2/fulltext

    Abstract

    Context
    Although the widespread use of prostate-specific antigen (PSA) has led to an early detection of prostate cancer (PCa) and a reduction of metastatic disease at diagnosis, PSA remains one of the most controversial biomarkers due to its limited specificity. As part of emerging efforts to improve both detection and management decision making, a number of new genomic tools have recently been developed.

    Objective
    This review summarizes the ability of genomic biomarkers to recognize men at high risk of developing PCa, discriminate clinically insignificant and aggressive tumors, and facilitate the selection of therapies in patients with advanced disease.

    Evidence acquisition
    A PubMed-based literature search was conducted up to May 2017. We selected the most recent and relevant original articles and clinical trials that have provided indispensable information to guide treatment decisions.

    Evidence synthesis
    Genome-wide association studies have identified several genetic polymorphisms and inherited variants associated with PCa susceptibility. Moreover, the urine-based assays SelectMDx, Mi-Prostate Score, and ExoDx have provided new insights into the identification of patients who may benefit from prostate biopsy. In men with previous negative pathological findings, Prostate Cancer Antigen 3 and ConfirmMDx predicted the outcome of subsequent biopsy. Commercially available tools (Decipher, Oncotype DX, and Prolaris) improved PCa risk stratification, identifying men at the highest risk of adverse outcome. Furthermore, other biomarkers could assist in treatment selection in castration-resistant PCa. AR-V7 expression predicts resistance to abiraterone/enzalutamide, while poly(ADP-ribose) polymerase-1 inhibitor and platinum-based chemotherapy could be indicated in metastatic patients who are carriers of mutations in DNA mismatch repair genes.

    Conclusions
    Introduction of genomic biomarkers has dramatically improved the detection, prognosis, and risk evaluation of PCa. Despite the progress made in discovering suitable biomarker candidates, few have been used in a clinical setting. Large-scale and multi-institutional studies are required to validate the efficacy and cost utility of these new technologies.

    Patient summary
    Prostate cancer is a heterogeneous disease with a wide variability. Genomic biomarkers in combination with clinical and pathological variables are useful tools to reduce the number of unnecessary biopsies, stratify low-risk from high-risk tumors, and guide personalized treatment decisions.
    [Emphasis mine]

  7. #17
    [#12]
    Prostate cancer: updates on current strategies for screening, diagnosis and clinical implications of treatment modalities
    [2017]

    https://academic.oup.com/carcin/article-abstract/39/3/307/4690592

    Abstract

    Prostate cancer is the most common cancer in men by way of diagnosis and a leading cause of cancer-related deaths. Early detection and intervention remains key to its optimum clinical management. This review provides the most updated information on the recent methods of prostate cancer screening, imaging and treatment modalities. Wherever possible, clinical trial data has been supplemented to provide a comprehensive overview of current prostate cancer research and development. Considering the recent success of immunotherapy in prostate cancer, we discuss cell, DNA and viruses based, as well as combinatorial immunotherapeutic strategies in detail. Furthermore, the potential of nanotechnology is increasingly being realized, especially in prostate cancer research, and we provide an overview of nanotechnology-based strategies, with special emphasis on nanotheranostics and multifunctional nanoconstructs. Understanding these recent developments is critical to the design of future therapeutic strategies to counter prostate cancer.
    I haven't seen the full text, but since the journal is Carcinogenesis, I'm thinking this article may be aimed at researchers rather than practitioners.

  8. #18
    [#13]
    Cognitive and Affective Representations of Active Surveillance as a Treatment Option for Low-Risk Prostate Cancer
    [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675168/

    Abstract

    Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.
    [Emphasis mine]

  9. #19
    [#14]
    Management and outcomes of Gleason six prostate cancer detected on needle biopsy: A single-surgeon experience over 6 years
    [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693458/

    Abstract

    Objective
    To assess the management and oncological outcomes in men diagnosed with Gleason score (GS) 6 prostate cancer on needle biopsy in a regional centre, as compared with published international data.

    Materials and methods
    A retrospective analysis was conducted of patients who were diagnosed with GS 6 prostate cancer via transrectal ultrasound-guided or transperineal biopsy between June 2009 and September 2015 under the care of a single surgeon. Data were obtained from a prospectively collected database.

    Results
    A total of 166 patients were diagnosed with GS 6 prostate cancer. The mean age was 61 (range 46–79) years, with mean prostate-specific antigen of 6.7 (0.91–26.8 ) ng/mL at diagnosis. Of 166 patients, 117 (70.5%) patients were enrolled into the active surveillance program with 82 (70%) meeting Prostate Cancer Research International Active Surveillance (PRIAS) criteria, 44 patients underwent immediate definitive treatment (88.6% radical prostatectomy and 9.1% radiotherapy) and five watchful waiting. With a median follow-up of 1.8 years, 37 (31.6%) patients on AS had definitive treatment [30 cases (81%) were attributable to disease progression, 4 cases (10.8%) to an abnormal magnetic resonance imaging result and 3 cases (8.1%) for patient preference]. In the 35 patients who underwent radical prostatectomy immediately after diagnosis, the GS was ≥7 in 29 cases (82.9%), and the final pathology was pT3a in 16 (51.6%) and pT3b in one (2.9%). In patients who underwent radical prostatectomy after being on AS, the proportion of GS ≥7 prostate cancer was 29/32 (90.6%), with pT3a in six (18.8%) and pT3b in three (9.4%) cases. Overall, 23.5% of patients had a multiparametric magnetic resonance imaging scan.

    Conclusion
    This single-surgeon cohort of GS 6 prostate cancer patients demonstrates a high proportion of cases managed with active surveillance, with comparable rates to international literature. The majority of cases who underwent immediate definitive treatment had significant disease, indicating that patients are being appropriately selected for active surveillance.
    [Emphasis mine]

  10. #20
    [#15] Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590810/

    Abstract

    Purpose

    The purpose is to evaluate the patterns of care and comparative effectiveness for cause-specific and overall survival of definitive local treatments versus conservatively managed men with a primary or secondary Gleason pattern of 5.

    Methods and materials

    Patients diagnosed from 2004 to 2012 with a primary or secondary Gleason pattern of 5 N0M0 prostate cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox regression analyses were used to estimate the survival.

    Results

    We identified 20,560 men. Median age and follow-up were 68 years and 4.33 years, respectively. At eight years, cause-specific survival (CSS) was 86.6% and 57.4% of those receiving and not receiving definitive local treatments, respectively. For CSS multivariate analysis, the following were significant: age, race, insurance status, total Gleason Score, T-stage, and type or omission of definitive local treatments. Compared to prostatectomy alone, men not undergoing definitive local treatments had the highest risk of death (HR: 6.07; 95% CI: 5.19-7.10). Those undergoing external beam radiotherapy alone (HR: 2.11; 95% CI: 1.80-2.48 ) were also at elevated risk of death. The number needed to treat (NNT) to prevent a prostate cancer death at eight years was three persons.

    Conclusions

    Death from prostate cancer with a primary or secondary Gleason pattern of 5 histology without definitive local treatment is high. In this hypothesis-generating study, we found that men with a limited life expectancy (less than eight years) and non-metastatic Gleason pattern of 5 disease may benefit from definitive local treatments. Given the high mortality in men with a Gleason pattern of 5, combined modality local therapies and consideration of chemotherapies may be warranted.
    [Emphasis mine]

 

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