Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23002.X
R. Pruthi
{"title":"Prostate specific antigen kinetics: A review of prostate specific antigen doubling times and half-lives in patients with treated and untreated prostate cancer","authors":"R. Pruthi","doi":"10.1046/J.1525-1411.2000.23002.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23002.X","url":null,"abstract":"","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"64 1","pages":"111-115"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78317691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23011.X
T. Stamey, M. Raimondo, C. Yemoto, J. McNeal, I. Johnstone
Objectives: Autopsy studies show that prostate cancer begins in the 4th and 5th decade of life. We sought to determine if increasing age at the time of diagnosis is related to morphologic and clinical predictors of cancer progression. Materials and Methods: We examined 7 morphologic variables known to impact progression of prostate cancer plus clinical stage and serum PSA in relation to increasing age. 981 untreated men undergoing radical prostatectomy were divided into 5 increasing age groups. Prostate size, which is known to increase with age, was used as a positive control. We compared the median and inter-quartile range for each grouping. Results: Increase in prostate weight was highly significant at all age differences. The % Gleason grade 4/5 cancer and cancer volume showed the most statistically significant changes with ageing, followed by non-organ confined cancer and capsular penetration both of which are highly correlated with cancer volume. Serum PSA was significant at 12, 17, and 22 years of age differences, but may be related more to prostate size than to increasing cancer volume. The presence of positive lymph nodes, seminal vesicle invasion, and palpable cancer were unrelated to increasing age. Conclusions: With the exception of increasing prostate size, % Gleason grade 4/5 cancer and cancer volume are the most significantly related variables to increasing age. Since % Gleason grade 4/5 cancer and cancer volume are also the primary determinants of failure to cure prostate cancer by radical prostatectomy, these age related changes suggest that detection of prostate cancer later in life will be accompanied by increased amounts of high grade cancer and larger tumor volumes. They also explain why, in so many younger men (age 45–60), the largest prostate cancer is often clinically insignificant (< 0.5 cc) at the time of radical prostatectomy.
{"title":"Effect of Ageing on Morphologic and Clinical Predictors of Prostate Cancer Progression","authors":"T. Stamey, M. Raimondo, C. Yemoto, J. McNeal, I. Johnstone","doi":"10.1046/J.1525-1411.2000.23011.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23011.X","url":null,"abstract":"Objectives: Autopsy studies show that prostate cancer begins in the 4th and 5th decade of life. We sought to determine if increasing age at the time of diagnosis is related to morphologic and clinical predictors of cancer progression. \u0000 \u0000 \u0000 \u0000Materials and Methods: We examined 7 morphologic variables known to impact progression of prostate cancer plus clinical stage and serum PSA in relation to increasing age. 981 untreated men undergoing radical prostatectomy were divided into 5 increasing age groups. Prostate size, which is known to increase with age, was used as a positive control. We compared the median and inter-quartile range for each grouping. \u0000 \u0000 \u0000 \u0000Results: Increase in prostate weight was highly significant at all age differences. The % Gleason grade 4/5 cancer and cancer volume showed the most statistically significant changes with ageing, followed by non-organ confined cancer and capsular penetration both of which are highly correlated with cancer volume. Serum PSA was significant at 12, 17, and 22 years of age differences, but may be related more to prostate size than to increasing cancer volume. The presence of positive lymph nodes, seminal vesicle invasion, and palpable cancer were unrelated to increasing age. \u0000 \u0000 \u0000 \u0000Conclusions: With the exception of increasing prostate size, % Gleason grade 4/5 cancer and cancer volume are the most significantly related variables to increasing age. Since % Gleason grade 4/5 cancer and cancer volume are also the primary determinants of failure to cure prostate cancer by radical prostatectomy, these age related changes suggest that detection of prostate cancer later in life will be accompanied by increased amounts of high grade cancer and larger tumor volumes. They also explain why, in so many younger men (age 45–60), the largest prostate cancer is often clinically insignificant (< 0.5 cc) at the time of radical prostatectomy.","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"25 1","pages":"157-162"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87887674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23004.X
Q. Le, V. Weinberg, J. Ryu, P. Lewis, M. Roach
Objectives: The objectives of this study are the following: (1) to determine the outcome of patients with at least two unfavorable prognostic factors, as defined in the literature (tumor Stage ≤T2c, pretreatment PSA level >10 ng/ml, Gleason score ≥7); and (2) to define the impact of conformal radiotherapy (CRT), whole pelvic radiation, and hormonal therapy in the treatment of these patients. Materials and Methods: Between January 1, 1987, and December 31, 1995, 594 evaluable patients were treated with definitive radiotherapy for localized prostate carcinoma at the University of California, San Francisco and associated institutions. One hundred eighty-two patients had clinically localized high-risk prostate carcinomas defined as having at least two of the following adverse risk features: (1) tumor Stage ≥T2c; (2) pretreatment PSA level >10 ng/ml; and (3) Gleason score ≥7. One hundred sixty-four patients had >12 months of PSA follow-up and formed the cohort of this study. Fifty-eight percent of the patients had pretreatment PSA levels >20 ng/ml, 31% had Gleason scores of 8–10, and 60% had Stage T3 disease. Radiotherapy was delivered at 1.8 Gy/fraction/day, 5 days/week. The maximum tumor dose ranged from 60 to 82.4 Gy (median 73.7 Gy). Sixty-two percent of the group had elective whole-pelvic radiotherapy (WPRT), and 34% had androgen suppression therapy (AST). The median PSA follow-up was 39 months. PSA failure was defined by the consensus definition of the American Society for Therapeutic Radiotherapy and Oncology. Results: The 4-year estimate of biochemical freedom from relapse of the 164 patients with clinically localized high-risk prostate cancer was 39%. The median time to PSA failure was 18 months. The 4-year estimate of PSA control was 51% for patients with two adverse risk factors and 16% for those with three adverse risk factors. On univariate analysis, the number of adverse risk factors (p = 0.004) and WPRTs (p = 0.04) were significant prognostic factors for PSA control. The use of CRT (p = 0.08) and AST (p = 0.10) were of borderline significance. On multivariate analysis, the most significant independent prognostic factor for PSA control was the number of risk factors present (favoring two factors, p = 0.002). Treatment with WPRT (p = 0.03) was the next independent predictor. AST was of borderline significance (p = 0.10). Eight percent of patients (14 of 164) had Grade 1–2 cystitis and proctitis. There was no Grade 3–4 toxicity. Conclusions: The combination of pretreatment PSA level, Gleason score, and disease stage could reliably predict the prognosis of patients with localized high-risk prostate carcinoma treated with definitive radiotherapy. The use of prophylactic WPRT improved PSA control in patients with clinical Stage N0 disease who are at high-risk for nodal involvement. Patients with three adverse risk factors (PSA level >10 ng/ml, Gleason Score ≥7, and tumor Stage ≥2c) had a very poor prognosis when treated w
{"title":"An Analysis of Patients with Clinically Localized High‐Risk Prostate Carcinoma","authors":"Q. Le, V. Weinberg, J. Ryu, P. Lewis, M. Roach","doi":"10.1046/J.1525-1411.2000.23004.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23004.X","url":null,"abstract":"Objectives: The objectives of this study are the following: (1) to determine the outcome of patients with at least two unfavorable prognostic factors, as defined in the literature (tumor Stage ≤T2c, pretreatment PSA level >10 ng/ml, Gleason score ≥7); and (2) to define the impact of conformal radiotherapy (CRT), whole pelvic radiation, and hormonal therapy in the treatment of these patients. \u0000 \u0000 \u0000 \u0000Materials and Methods: Between January 1, 1987, and December 31, 1995, 594 evaluable patients were treated with definitive radiotherapy for localized prostate carcinoma at the University of California, San Francisco and associated institutions. One hundred eighty-two patients had clinically localized high-risk prostate carcinomas defined as having at least two of the following adverse risk features: (1) tumor Stage ≥T2c; (2) pretreatment PSA level >10 ng/ml; and (3) Gleason score ≥7. One hundred sixty-four patients had >12 months of PSA follow-up and formed the cohort of this study. Fifty-eight percent of the patients had pretreatment PSA levels >20 ng/ml, 31% had Gleason scores of 8–10, and 60% had Stage T3 disease. Radiotherapy was delivered at 1.8 Gy/fraction/day, 5 days/week. The maximum tumor dose ranged from 60 to 82.4 Gy (median 73.7 Gy). Sixty-two percent of the group had elective whole-pelvic radiotherapy (WPRT), and 34% had androgen suppression therapy (AST). The median PSA follow-up was 39 months. PSA failure was defined by the consensus definition of the American Society for Therapeutic Radiotherapy and Oncology. \u0000 \u0000 \u0000 \u0000Results: The 4-year estimate of biochemical freedom from relapse of the 164 patients with clinically localized high-risk prostate cancer was 39%. The median time to PSA failure was 18 months. The 4-year estimate of PSA control was 51% for patients with two adverse risk factors and 16% for those with three adverse risk factors. On univariate analysis, the number of adverse risk factors (p = 0.004) and WPRTs (p = 0.04) were significant prognostic factors for PSA control. The use of CRT (p = 0.08) and AST (p = 0.10) were of borderline significance. On multivariate analysis, the most significant independent prognostic factor for PSA control was the number of risk factors present (favoring two factors, p = 0.002). Treatment with WPRT (p = 0.03) was the next independent predictor. AST was of borderline significance (p = 0.10). Eight percent of patients (14 of 164) had Grade 1–2 cystitis and proctitis. There was no Grade 3–4 toxicity. \u0000 \u0000 \u0000 \u0000Conclusions: The combination of pretreatment PSA level, Gleason score, and disease stage could reliably predict the prognosis of patients with localized high-risk prostate carcinoma treated with definitive radiotherapy. The use of prophylactic WPRT improved PSA control in patients with clinical Stage N0 disease who are at high-risk for nodal involvement. Patients with three adverse risk factors (PSA level >10 ng/ml, Gleason Score ≥7, and tumor Stage ≥2c) had a very poor prognosis when treated w","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"52 1","pages":"146-156"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81082042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23005.X
A. Zisman, M. Herbert, S. Strauss, H. Manor, Dan Liebovici, A. Lindner
Treatment for cure is reserved for patients with organ-confined prostate cancer. The clinical staging of prostate cancer lacks accuracy regarding local extension. The results of a transrectal ultrasound-guided staging biopsy (TGSB), performed in addition to routine sextant biopsies (RSBs) of the prostate, is defined as being positive when tumor cells are shown to invade extraprostatic loci and, thus, would certainly differentiate between organ-confined and locally advanced disease. Seventy-seven RSB + TGSB procedures were compared to 223 routine sextant prostate TRGBs. Prostate cancer (CaP) was detected in 24 patients (31%) and 60 patients (27%), respectively. In four RSB + TGSB procedures, local extension of CaP was depicted, and as a result radical prostatectomy was withheld. In six of seven patients undergoing radical prostatectomy (86%), the specimen analysis result was in agreement with the results of the preoperative TGSB. There were no extra complications associated with the performance of staging biopsies. We conclude that TGSB is safe and efficacious and that it should be performed in candidates for radical prostatectomy.
{"title":"Preoperative Detection of Locally Advanced Prostate Cancer by Using Transrectal Ultrasound‐Guided Staging Prostate Biopsy","authors":"A. Zisman, M. Herbert, S. Strauss, H. Manor, Dan Liebovici, A. Lindner","doi":"10.1046/J.1525-1411.2000.23005.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23005.X","url":null,"abstract":"Treatment for cure is reserved for patients with organ-confined prostate cancer. The clinical staging of prostate cancer lacks accuracy regarding local extension. The results of a transrectal ultrasound-guided staging biopsy (TGSB), performed in addition to routine sextant biopsies (RSBs) of the prostate, is defined as being positive when tumor cells are shown to invade extraprostatic loci and, thus, would certainly differentiate between organ-confined and locally advanced disease. Seventy-seven RSB + TGSB procedures were compared to 223 routine sextant prostate TRGBs. Prostate cancer (CaP) was detected in 24 patients (31%) and 60 patients (27%), respectively. In four RSB + TGSB procedures, local extension of CaP was depicted, and as a result radical prostatectomy was withheld. In six of seven patients undergoing radical prostatectomy (86%), the specimen analysis result was in agreement with the results of the preoperative TGSB. There were no extra complications associated with the performance of staging biopsies. We conclude that TGSB is safe and efficacious and that it should be performed in candidates for radical prostatectomy.","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"98 1","pages":"130-136"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81213690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23001.X
D. Reese, E. Small
{"title":"Therapy of Advanced Prostate Cancer: Part I: Antiandrogen Withdrawal, Androgen Receptor Mutations, and Secondary Hormonal Manipulations","authors":"D. Reese, E. Small","doi":"10.1046/J.1525-1411.2000.23001.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23001.X","url":null,"abstract":"","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"67 1","pages":"116-122"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82854235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-01DOI: 10.1046/J.1525-1411.2000.23010.X
S. Pandian, S. Heys, K. Wahle, S. McClinton
{"title":"Dietary fat and prostate cancer: A review","authors":"S. Pandian, S. Heys, K. Wahle, S. McClinton","doi":"10.1046/J.1525-1411.2000.23010.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.23010.X","url":null,"abstract":"","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"33 1","pages":"123-129"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77343924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1046/J.1525-1411.2000.22001.X
Shivapriya Ramaswamy, W. Sellers
{"title":"PTEN: A Prostate Cancer Tumor‐Suppressor Gene","authors":"Shivapriya Ramaswamy, W. Sellers","doi":"10.1046/J.1525-1411.2000.22001.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.22001.X","url":null,"abstract":"","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"12 1","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84552057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1046/J.1525-1411.2000.22005.X
W. H. Williams, F. Critz, J. Benton, K. Levinson, W. Falconer, E. Harrison, C. Holladay, D. Holladay
Objectives: Reportedly, African American men (AAM) with prostate cancer present with more advanced disease and have worse outcomes than white men (WM). We evaluate this concept in our series of men with prostate cancer treated with modern simultaneous irradiation in a busy private practice. Materials and Methods: From 1993 to 1998, 1270 men with clinical stage T1T2N0 prostate cancer were treated by ultrasound-guided transperineal implantation of I-125 in the prostate and seminal vesicle (median dose 12,000 cGy) followed by external-beam radiation therapy (4500 cGy) including an additional 750 cGy seminal vesicle boost in men with adverse prognostic factors. None received neoadjuvant or adjuvant hormone therapy. The median pretreatment prostate specific antigen (PSA) level for 141 AAM and 1129 WM was 8.6 ng/ml and 7.1 ng/ml, respectively, a significant difference (p = 0.0001). Disease freedom is defined as achievement and maintenance of a PSA nadir of ≤ 0.2 ng/ml. The median follow-up is 24 months (range 12–66 months). Results: Disease-free survival for the entire group is 89% (± 3%) at 5 years. Overall, or when analyzed by stage, Gleason score, or age, AAM present with higher pretreatment PSA levels than WM. However, according to pretreatment PSA groups of ≤ 4.0 ng/ml, 4.1–10.0 ng/ml, 10.1–20.0 ng/ml, and > 20.0 ng/ml, the 5-year disease-free survival rates for AAM and WM in these groups are 100% and 95%, 85% and 92%, 67% and 80%, 76% and 83%, respectively. No significant difference in disease freedom is observed within the above PSA groups or by analysis of Gleason score or stage. With disease freedom as an end point, race is not a significant factor on multivariate analysis. Conclusions: AAM present with higher pretreatment PSA levels than WM both overall and when stratified by stage, Gleason score, or age. In this series, however, disease-free survival rates of AAM and WM are not significantly different overall or according to pretreatment variables. Thus, race does not appear to be an adverse prognostic factor after simultaneous irradiation.
{"title":"African American Men with Prostate Cancer Treated by Simultaneous Irradiation","authors":"W. H. Williams, F. Critz, J. Benton, K. Levinson, W. Falconer, E. Harrison, C. Holladay, D. Holladay","doi":"10.1046/J.1525-1411.2000.22005.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.22005.X","url":null,"abstract":"Objectives: Reportedly, African American men (AAM) with prostate cancer present with more advanced disease and have worse outcomes than white men (WM). We evaluate this concept in our series of men with prostate cancer treated with modern simultaneous irradiation in a busy private practice. \u0000 \u0000 \u0000 \u0000Materials and Methods: From 1993 to 1998, 1270 men with clinical stage T1T2N0 prostate cancer were treated by ultrasound-guided transperineal implantation of I-125 in the prostate and seminal vesicle (median dose 12,000 cGy) followed by external-beam radiation therapy (4500 cGy) including an additional 750 cGy seminal vesicle boost in men with adverse prognostic factors. None received neoadjuvant or adjuvant hormone therapy. The median pretreatment prostate specific antigen (PSA) level for 141 AAM and 1129 WM was 8.6 ng/ml and 7.1 ng/ml, respectively, a significant difference (p = 0.0001). Disease freedom is defined as achievement and maintenance of a PSA nadir of ≤ 0.2 ng/ml. The median follow-up is 24 months (range 12–66 months). \u0000 \u0000 \u0000 \u0000Results: Disease-free survival for the entire group is 89% (± 3%) at 5 years. Overall, or when analyzed by stage, Gleason score, or age, AAM present with higher pretreatment PSA levels than WM. However, according to pretreatment PSA groups of ≤ 4.0 ng/ml, 4.1–10.0 ng/ml, 10.1–20.0 ng/ml, and > 20.0 ng/ml, the 5-year disease-free survival rates for AAM and WM in these groups are 100% and 95%, 85% and 92%, 67% and 80%, 76% and 83%, respectively. No significant difference in disease freedom is observed within the above PSA groups or by analysis of Gleason score or stage. With disease freedom as an end point, race is not a significant factor on multivariate analysis. \u0000 \u0000 \u0000 \u0000Conclusions: AAM present with higher pretreatment PSA levels than WM both overall and when stratified by stage, Gleason score, or age. In this series, however, disease-free survival rates of AAM and WM are not significantly different overall or according to pretreatment variables. Thus, race does not appear to be an adverse prognostic factor after simultaneous irradiation.","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"27 1","pages":"80-87"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82314178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1046/J.1525-1411.2000.22006.X
Simon P. Kim, E. Moran, E. Bowes, Adam G. Tennant, C. Bennett
Objectives: Financial and nonfinancial barriers affect the care of prostate cancer patients. In this study, we evaluated whether financial considerations were a primary reason for lower income veterans with prostate cancer to transfer their care to Veterans Affairs (VA) Hospitals, and if so, which aspects of medical care were most affected by these considerations. Materials and Methods: Interviews with 106 veterans with prostate cancer were undertaken after the transfer of their care to the VA medical system. Respondents provided information about the primary reasons they shifted their care. Results: Although 64.2% of the patients had private health insurance before their initial visit to the VA, only 26.4% retained their private health insurance at the time of the interview, and 53.8 % transferred their entire medical care to the VA after the diagnosis of prostate cancer. Reasons for transferring care to the VA included the costs of oral anti-androgen therapy (34.9%), copayment costs for physician visits (30.2%), a feeling that medical care would be better in the VA system (26.4%), and copayment costs of luteinizing hormone-releasing hormone analogs (8.5%). Reasons for transfer varied with stage of disease at diagnosis (p < 0.05). The most common reasons for transfer were anti-androgen therapy costs among metastatic patients and, among patients with localized cancer, physician copayments and a feeling that care would be of higher quality in the VA system. Conclusions: Our findings suggest that there is a phenomenon, termed the “anti-androgen transfer,” that leads veterans with metastatic prostate cancer to transfer to the VA setting. The enactment of a comprehensive pharmaceutical benefit to the Medicare program will affect transfers of metastatic prostate cancer patients to the VA medical system.
{"title":"The Anti‐Androgen Transfer","authors":"Simon P. Kim, E. Moran, E. Bowes, Adam G. Tennant, C. Bennett","doi":"10.1046/J.1525-1411.2000.22006.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.22006.X","url":null,"abstract":"Objectives: Financial and nonfinancial barriers affect the care of prostate cancer patients. In this study, we evaluated whether financial considerations were a primary reason for lower income veterans with prostate cancer to transfer their care to Veterans Affairs (VA) Hospitals, and if so, which aspects of medical care were most affected by these considerations. \u0000 \u0000 \u0000 \u0000Materials and Methods: Interviews with 106 veterans with prostate cancer were undertaken after the transfer of their care to the VA medical system. Respondents provided information about the primary reasons they shifted their care. \u0000 \u0000 \u0000 \u0000Results: Although 64.2% of the patients had private health insurance before their initial visit to the VA, only 26.4% retained their private health insurance at the time of the interview, and 53.8 % transferred their entire medical care to the VA after the diagnosis of prostate cancer. Reasons for transferring care to the VA included the costs of oral anti-androgen therapy (34.9%), copayment costs for physician visits (30.2%), a feeling that medical care would be better in the VA system (26.4%), and copayment costs of luteinizing hormone-releasing hormone analogs (8.5%). Reasons for transfer varied with stage of disease at diagnosis (p < 0.05). The most common reasons for transfer were anti-androgen therapy costs among metastatic patients and, among patients with localized cancer, physician copayments and a feeling that care would be of higher quality in the VA system. \u0000 \u0000 \u0000 \u0000Conclusions: Our findings suggest that there is a phenomenon, termed the “anti-androgen transfer,” that leads veterans with metastatic prostate cancer to transfer to the VA setting. The enactment of a comprehensive pharmaceutical benefit to the Medicare program will affect transfers of metastatic prostate cancer patients to the VA medical system.","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"7 1","pages":"88-93"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81413507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1046/J.1525-1411.2000.22004.X
Ping L. Zhang, G. Bubley, M. Upton, A. Morgentaler, W. DeWolf, S. Rosen
Objectives: Androgen therapy in hypogonadal men with low free testosterone levels (< 1.5 ng/dl) is potentially dangerous because exogenous androgen may stimulate occult prostatic adenocarcinoma (PA). Our previous study reported occult PA (14% incidence) in hypogonadal men with normal prostate specific antigen (PSA) levels and normal findings on digital rectal examination (DRE). The purpose of the current study was to examine the extent and nature of PA in prostatectomy specimens of hypogonadal patients. Materials and Methods: PA in these14 patients (the hypogonadal group) was compared to a control group of patients (n = 14). The two groups of patients were matched with similar mean ages, Gleason scores, and percentage of core involvement by PA. Subsequently, PA in prostatectomy specimens was analyzed in the two groups with additional comparison of immunohistochemical sections for androgen receptors, PSA, and prostatic acid phosphatase. Results: As expected, patients in the hypogonadal group had significantly lower levels of PSA and free testosterone than those in the control group (PSA 2.32 ± 0.60 ng/ml versus 8.06 ± 1.17 ng/ml, respectively; free testosterone 1.17 ± 0.09 ng/dl versus 1.74 ± 0.20 ng/dl, respectively). Prostatectomy specimens in hypogonadal patients (n = 9) showed a less extensive PA (0% positive margins, 11% perineural invasion, 78% unilateral tumor, and 22% bilateral tumor) compared to control prostatectomy specimens (n = 14) (21% positive margins, 42% perineural invasion, 21% unilateral tumor, and 58% bilateral tumor). However, immunohistochemical studies using anti-androgen receptor, anti-PSA and anti-prostatic acid phosphatase antibodies showed that carcinoma cells stained with equivalent intensity in both groups. Conclusions: PA in hypogonadal patients who had normal DREs and PSA levels appears to be less extensive but otherwise is not morphologically different than usual and should be treated in the same manner. The high incidence of occult PA in these hypogonadal patients makes screening prostate biopsies important before the androgen replacement therapy.
{"title":"Pathologic Features of Occult Prostatic Carcinoma in Hypogonadal Men","authors":"Ping L. Zhang, G. Bubley, M. Upton, A. Morgentaler, W. DeWolf, S. Rosen","doi":"10.1046/J.1525-1411.2000.22004.X","DOIUrl":"https://doi.org/10.1046/J.1525-1411.2000.22004.X","url":null,"abstract":"Objectives: Androgen therapy in hypogonadal men with low free testosterone levels (< 1.5 ng/dl) is potentially dangerous because exogenous androgen may stimulate occult prostatic adenocarcinoma (PA). Our previous study reported occult PA (14% incidence) in hypogonadal men with normal prostate specific antigen (PSA) levels and normal findings on digital rectal examination (DRE). The purpose of the current study was to examine the extent and nature of PA in prostatectomy specimens of hypogonadal patients. \u0000 \u0000 \u0000 \u0000Materials and Methods: PA in these14 patients (the hypogonadal group) was compared to a control group of patients (n = 14). The two groups of patients were matched with similar mean ages, Gleason scores, and percentage of core involvement by PA. Subsequently, PA in prostatectomy specimens was analyzed in the two groups with additional comparison of immunohistochemical sections for androgen receptors, PSA, and prostatic acid phosphatase. \u0000 \u0000 \u0000 \u0000Results: As expected, patients in the hypogonadal group had significantly lower levels of PSA and free testosterone than those in the control group (PSA 2.32 ± 0.60 ng/ml versus 8.06 ± 1.17 ng/ml, respectively; free testosterone 1.17 ± 0.09 ng/dl versus 1.74 ± 0.20 ng/dl, respectively). Prostatectomy specimens in hypogonadal patients (n = 9) showed a less extensive PA (0% positive margins, 11% perineural invasion, 78% unilateral tumor, and 22% bilateral tumor) compared to control prostatectomy specimens (n = 14) (21% positive margins, 42% perineural invasion, 21% unilateral tumor, and 58% bilateral tumor). However, immunohistochemical studies using anti-androgen receptor, anti-PSA and anti-prostatic acid phosphatase antibodies showed that carcinoma cells stained with equivalent intensity in both groups. \u0000 \u0000 \u0000 \u0000Conclusions: PA in hypogonadal patients who had normal DREs and PSA levels appears to be less extensive but otherwise is not morphologically different than usual and should be treated in the same manner. The high incidence of occult PA in these hypogonadal patients makes screening prostate biopsies important before the androgen replacement therapy.","PeriodicalId":22947,"journal":{"name":"The open prostate cancer journal","volume":"84 1","pages":"74-79"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83946651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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