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Androgen-deprivation therapy as primary treatment for localized prostate cancer: data from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE).
Cancer 2006; 106(8):1708-14C

Abstract

BACKGROUND

Prostate cancer is largely an androgen-sensitive disease. Androgen-deprivation therapy (ADT) generally has been used for patients with advanced disease. However, ADT is used increasingly as monotherapy for patients with clinically localized disease. The objective of the current report was to describe the characteristics of patients who underwent ADT for the management of localized disease.

METHODS

Cancer of the Prostate Strategic Urologic Endeavor (CaPSURE), which is a national disease registry of men with prostate cancer, was screened to identify patients who received treatment with primary ADT (PADT) between 1989 and 2002 for clinically localized disease (T1-T3,Nx/N0,Mx/M0). Clinical data (including Gleason score, prostate-specific antigen [PSA] level, and T classification) and sociodemographic data (including age, race, education, income, and insurance coverage) were analyzed with chi-square statistical tests. Time to failure data were analyzed using log-rank tests, the Kaplan-Meier method, and Cox proportional hazards regression analyses.

RESULTS

Of 7045 men, 993 patients (14.1%) with clinically localized disease received primary ADT. Compared with patients who underwent standard treatment, patients who received PADT had higher risk disease (as defined by PSA level, T classification, and Gleason score) and had more comorbidities. Patients who underwent PADT were older, less educated, had lower income, and were more likely to have Medicare than private insurance. The dominant forms of hormone therapy were luteinizing hormone-releasing hormone (LHRH) monotherapy (48.6%) and combined androgen blockade (LHRH agonist and antiandrogens; 38.8%). At 5 years after the initiation of PADT, 67.3% of patients still were receiving treatment with only androgen deprivation, 103 patients (13.8%) had gone on to receive definitive second treatment (radical prostatectomy, external beam radiotherapy, brachytherapy, or cryotherapy), 27 patients (3.9%) underwent second-line therapy (chemotherapy or alternative hormone-deprivation therapy), 22 patients (4.1%) died of prostate cancer, and 146 patients (19%) died of all causes.

CONCLUSIONS

The use of PADT therapy appeared to control disease in the majority of patients who received it, at least for an intermediate period. However, such patients appeared to be unique based on sociodemographic characteristics, comorbidity status, and risk factors compared with patients who received other forms of therapy. The impact of PADT on quality of life needs to be compared with standard therapy, and its long-term durability should be assessed better in patients with prostate cancer.

Authors+Show Affiliations

Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, University of California-San Francisco Cancer Center, San Francisco, California 94115-1711, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16544313

Citation

Kawakami, Jun, et al. "Androgen-deprivation Therapy as Primary Treatment for Localized Prostate Cancer: Data From Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE)." Cancer, vol. 106, no. 8, 2006, pp. 1708-14.
Kawakami J, Cowan JE, Elkin EP, et al. Androgen-deprivation therapy as primary treatment for localized prostate cancer: data from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Cancer. 2006;106(8):1708-14.
Kawakami, J., Cowan, J. E., Elkin, E. P., Latini, D. M., DuChane, J., & Carroll, P. R. (2006). Androgen-deprivation therapy as primary treatment for localized prostate cancer: data from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Cancer, 106(8), pp. 1708-14.
Kawakami J, et al. Androgen-deprivation Therapy as Primary Treatment for Localized Prostate Cancer: Data From Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Cancer. 2006 Apr 15;106(8):1708-14. PubMed PMID: 16544313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Androgen-deprivation therapy as primary treatment for localized prostate cancer: data from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). AU - Kawakami,Jun, AU - Cowan,Janet E, AU - Elkin,Eric P, AU - Latini,David M, AU - DuChane,Janeen, AU - Carroll,Peter R, AU - ,, PY - 2006/3/18/pubmed PY - 2006/5/25/medline PY - 2006/3/18/entrez SP - 1708 EP - 14 JF - Cancer JO - Cancer VL - 106 IS - 8 N2 - BACKGROUND: Prostate cancer is largely an androgen-sensitive disease. Androgen-deprivation therapy (ADT) generally has been used for patients with advanced disease. However, ADT is used increasingly as monotherapy for patients with clinically localized disease. The objective of the current report was to describe the characteristics of patients who underwent ADT for the management of localized disease. METHODS: Cancer of the Prostate Strategic Urologic Endeavor (CaPSURE), which is a national disease registry of men with prostate cancer, was screened to identify patients who received treatment with primary ADT (PADT) between 1989 and 2002 for clinically localized disease (T1-T3,Nx/N0,Mx/M0). Clinical data (including Gleason score, prostate-specific antigen [PSA] level, and T classification) and sociodemographic data (including age, race, education, income, and insurance coverage) were analyzed with chi-square statistical tests. Time to failure data were analyzed using log-rank tests, the Kaplan-Meier method, and Cox proportional hazards regression analyses. RESULTS: Of 7045 men, 993 patients (14.1%) with clinically localized disease received primary ADT. Compared with patients who underwent standard treatment, patients who received PADT had higher risk disease (as defined by PSA level, T classification, and Gleason score) and had more comorbidities. Patients who underwent PADT were older, less educated, had lower income, and were more likely to have Medicare than private insurance. The dominant forms of hormone therapy were luteinizing hormone-releasing hormone (LHRH) monotherapy (48.6%) and combined androgen blockade (LHRH agonist and antiandrogens; 38.8%). At 5 years after the initiation of PADT, 67.3% of patients still were receiving treatment with only androgen deprivation, 103 patients (13.8%) had gone on to receive definitive second treatment (radical prostatectomy, external beam radiotherapy, brachytherapy, or cryotherapy), 27 patients (3.9%) underwent second-line therapy (chemotherapy or alternative hormone-deprivation therapy), 22 patients (4.1%) died of prostate cancer, and 146 patients (19%) died of all causes. CONCLUSIONS: The use of PADT therapy appeared to control disease in the majority of patients who received it, at least for an intermediate period. However, such patients appeared to be unique based on sociodemographic characteristics, comorbidity status, and risk factors compared with patients who received other forms of therapy. The impact of PADT on quality of life needs to be compared with standard therapy, and its long-term durability should be assessed better in patients with prostate cancer. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/16544313/Androgen_deprivation_therapy_as_primary_treatment_for_localized_prostate_cancer:_data_from_Cancer_of_the_Prostate_Strategic_Urologic_Research_Endeavor__CaPSURE__ L2 - https://doi.org/10.1002/cncr.21799 DB - PRIME DP - Unbound Medicine ER -