Biomedical subjects

David J Pasta

Publications and source records attributed to David J Pasta.

At least 19 recordsLinked to original sources

PubMed2007

Quality of life for men receiving a second treatment for prostate cancer.

PURPOSE: We assessed the impact of second treatment on health related quality of life for men with prostate cancer. This issue is important because second treatment resulting from prostate specific antigen recurrence has the potential to further negatively impact health related quality of life and affect the overall value of treatment. We compared differences in health related quality of life before and after second treatment for men who had asymptomatic prostate specific antigen recurrence with those who did not have biochemical failure. MATERIALS AND METHODS: Men in this analysis (897) had localized disease, initially underwent radical prostatectomy monotherapy, and completed at least 1 health related quality of life questionnaire before and after radical prostatectomy. In this cohort 175 men underwent second treatment (nonadjuvant). The Medical Outcomes Survey Short Form-36 and UCLA Prostate Cancer Index were used to measure health related quality of life. Associations between patient groups and time on health related quality of life were analyzed using repeated measures. RESULTS: Men who received a second treatment presented with more severe disease before radical prostatectomy and had worse general health related quality of life. Although health related quality of life differed significantly with time for the 2 groups, most domains for the second treatment group improved or remained stable until 15 months before second treatment, at which point they declined. Scores in the sexual functioning and role-physical domains showed clinically and statistically significant patterns of decreasing with time. CONCLUSIONS: Health related quality of life is affected following second treatment but starts to decline approximately 1 year before second treatment. Not all aspects of health related quality of life decreased at the same rate, so patients should be counseled that certain domains may be affected more by additional treatment.

Aged↗

PubMed2006

Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy.

BACKGROUND: The University of California, San Francisco (UCSF) Cancer of the Prostate Risk Assessment (CAPRA) is a novel preoperative index which predicts the risk of biochemical recurrence after radical prostatectomy. The performance of the index is at least as good as the best available instruments based on clinical variables, and the 0 to 10 score is simple to calculate for both clinical and research purposes. This study used a large external dataset to validate CAPRA. METHODS: Data were abstracted from the Shared Equal Access Regional Cancer Hospital (SEARCH) database, a registry of men who underwent radical prostatectomy at 4 Veterans Affairs and 1 active military medical center. Of 2096 men in the database, 1346 (64%) had full data available to calculate the CAPRA score. Performance of the CAPRA score was assessed with proportional hazards regression, survival analysis, and the concordance (c) index. RESULTS: Of the studied patients, 41% were non-Caucasian, and their mean age was 62 years. Twenty-six percent suffered recurrence; median follow-up among patients who did not recur was 34 months. The hazard ratio (HR) for each 1-point increase in CAPRA was 1.39 (95% CI [confidence interval], 1.31-1.46). The 5-year recurrence-free survival rate ranged from 86% for CAPRA 0-1 patients to 21% for CAPRA 7-10 patients. Increasing CAPRA scores were significantly associated with increasing risk of adverse pathologic outcomes. The c-index for CAPRA for the validation set was 0.68, compared with 0.66 for the original development set. CONCLUSIONS: The UCSF-CAPRA accurately predicted both biochemical and pathologic outcomes after radical prostatectomy among a large, diverse, cohort of men. These results validated the effectiveness of this powerful and straightforward instrument.

Adult↗

PubMed2006

Early coronary revascularization diminishes the risk of ischemic stroke with acute myocardial infarction.

BACKGROUND AND PURPOSE: Ischemic stroke is an uncommon but devastating complication of myocardial infarction (MI). It is possible that delay in the acute revascularization of these patients influences the risk of peri-MI ischemic stroke independent of size of infarction or residual ventricular function. The influence of the timing and type of revascularization on risk of ischemic stroke in the patient with MI has not previously been assessed. METHODS: We used the National Registry of Myocardial Infarction 3 and 4 databases to identify 45,997 subjects who received thrombolytic therapy and 47,876 patients who were treated with primary percutaneous transluminal coronary angioplasty for MI. In-hospital ischemic stroke occurred in 248 (0.54%) and 150 (0.31%) patients in the two groups, respectively. Patients were stratified based on time from presentation to initial therapy. RESULTS: A statistically significant linear relationship between time to revascularization therapy and risk of in-hospital ischemic stroke was seen on univariate analysis. A multivariate model incorporating 26 other variables showed thrombolytic therapy within 15 minutes was associated with a lower risk of ischemic stroke (odds ratio, 0.58; 95% CI, 0.36-0.94). Primary angioplasty within 90 minutes of arrival was associated with a nonsignificant trend toward lower stroke risk (odds ratio, 0.68; 95% CI, 0.41-1.12). Interestingly, his benefit of early reperfusion therapy did not appear to be related to improvements in left ventricular function. CONCLUSIONS: Risk of in-hospital ischemic stroke with MI is closely tied to the time to revascularization with both thrombolytic and percutaneous transluminal coronary angioplasty therapies. Early revascularization is independently predictive of a lower risk of ischemic stroke, but the mechanism of this does not appear to be related to improved cardiac function. The records of 45,997 subjects who received thrombolytic therapy and 47,876 patients who were treated with primary percutaneous transluminal coronary angioplasty for myocardial infarction were analyzed to determine the relationship between time to revascularization and the occurrence of ischemic stroke. A statistically significant linear relationship between time to revascularization therapy and risk of in-hospital ischemic stroke was seen on univariate analysis. A multivariate model incorporating 26 other variables showed thrombolytic therapy within 15 minutes of presentation was associated with a lower risk of ischemic stroke, and angioplasty within 90 minutes was similarly associated with a nonsignificant trend toward lower stroke risk.

Aged↗

PubMed2006

Correlation of thyroid stimulating hormone (TSH) level with pregnancy outcome in women undergoing in vitro fertilization.

OBJECTIVE: The aim of this study was to determine if pregnancy outcome for women undergoing in vitro fertilization is correlated with pre-conception thyroid-stimulating hormone level. STUDY DESIGN: We performed a retrospective cohort study of in vitro fertilization cycles in our private practice with an initial positive serum human chorionic gonadotropin level and thyroid-stimulating hormone level available (n = 364). We examined whether or not birth outcome differed between cycles in which the thyroid-stimulating hormone was > 2.5 mIU/L compared with cycles with a thyroid-stimulating hormone level of < or = 2.5 mIU/L. Logistic regression was used to determine the association between thyroid-stimulating hormone level and spontaneous abortion rate. RESULTS: Delivery outcome was available for 195 cycles, 36% of which had a thyroid-stimulating hormone level > 2.5. The gestational age at delivery was higher in cycles with a thyroid-stimulating hormone < or = 2.5 than for cycles with a thyroid-stimulating hormone > 2.5 (38.5 vs 38.0 weeks for singletons, 36.0 vs 34.6 weeks for twins, overall P = .012 for thyroid-stimulating hormone level). The mean birth weight for cycles with a thyroid-stimulating hormone < or = 2.5 was higher than for cycles with a thyroid-stimulating hormone > 2.5 (7.33 vs 6.78 lbs for singletons, P = .024 and 5.36 vs 4.83 lbs for twins, P = .023). Restricting analysis to cycles where the woman was not taking thyroid replacement did not change the overall conclusions. There was a trend toward increasing risk of miscarriage with increasing thyroid-stimulating hormone level in nondonor cycles, controlling for age and day 3 follicle-stimulating hormone level, but this trend did not reach statistical significance. CONCLUSION: A pre-conception thyroid-stimulating hormone level > 2.5 mIU/L is associated with a lower gestational age at delivery and lower birth weight in women undergoing in vitro fertilization.

Abortion, Spontaneous↗

PubMed2006

Impact of pregnancy on women with cystic fibrosis.

BACKGROUND: Improvements in the health and survival of patients with cystic fibrosis (CF) have led to increasingly normal lifestyles, including successful pregnancies in women with CF. Concern exists among care providers about the impact of pregnancy on the health of women with CF. STUDY OBJECTIVES: We examined data from a large longitudinal observational study, the Epidemiologic Study of Cystic Fibrosis (ESCF), to characterize health outcomes and CF-related therapies in women who became pregnant. DESIGN: This analysis was conducted using ESCF data from 1995 to 2003. PATIENTS: A total of 216 women, aged 15 to 38 years, who met the criteria for a qualifying pregnancy, were compared with a matched group of never-pregnant women during three time periods (ie, baseline, during pregnancy, and follow-up). INTERVENTIONS: None. RESULTS: The baseline pulmonary function (FEV(1)) values were 74.5% and 66.4% predicted, respectively, in the pregnant and nonpregnant women. Declines in FEV(1) values of 6.8% and 4.7%, respectively, were observed from baseline to follow-up in the pregnant and nonpregnant women (p = 0.61). During pregnancy, outpatient visits were 33% more frequent compared to baseline and 62% more frequent than in the nonpregnant group (7.19 vs 4.45, respectively, visits annually). Annual rates of respiratory exacerbation and hospitalization were similar at baseline but increased during pregnancy. The prevalence of treatment for diabetes more than doubled, from 9.3% at baseline to 20.6% during pregnancy, and was 14.4% at follow-up. In contrast, 18.7% of the never-pregnant women were being treated for diabetes at baseline, rising to 25.2% at follow-up. CONCLUSIONS: These findings suggest that, over the same time period, women with CF who become pregnant experienced similar respiratory and health trends as nonpregnant women. However, pregnant women use a greater number of therapies and receive more intense monitoring of their health. These findings have implications for clinicians providing prepregnancy counseling for women with CF.

Adolescent↗

PubMed2005

Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.

CONTEXT: Early mechanical revascularization in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock is a therapeutic strategy that reduces mortality. It has been a class I recommendation in guidelines from the American College of Cardiology and the American Heart Association since 1999 for patients younger than 75 years. However, little is known about implementation of these guidelines in practice. OBJECTIVES: To assess trends in early revascularization and mortality for patients with cardiogenic shock complicating AMI and to determine whether the national guidelines affect revascularization rates. DESIGN, SETTING, AND PATIENTS: Prospective, observational study of 293,633 patients with ST-elevation myocardial infarction (25,311 [8.6%] had cardiogenic shock; 7356 [29%] had cardiogenic shock at hospital presentation) enrolled in the National Registry of Myocardial Infarction (NRMI) from January 1995 to May 2004 at 775 US hospitals with revascularization capability (defined as the capability to perform cardiac catheterization, percutaneous coronary intervention [PCI], and open-heart surgery). MAIN OUTCOME MEASURES: Management patterns and in-hospital mortality rates. RESULTS: There was an increase in primary PCI rates from 27.4% to 54.4% (P<.001) in hospitals with revascularization capability that paralleled the change in PCI for ST-elevation myocardial infarction. There was no significant change in rates of immediate coronary artery bypass graft surgery (from 2.1% to 3.2%). Propensity-adjusted multivariable analyses demonstrated that primary PCI was associated with a decreased odds of death during hospitalization (odds ratio, 0.46; 95% confidence interval, 0.40-0.53). There were no differences in the rates of change in revascularization rates based on the date when the guidelines were released regardless of patient age. Overall in-hospital cardiogenic shock mortality decreased from 60.3% in 1995 to 47.9% in 2004 (P<.001). CONCLUSIONS: The use of PCI for patients with cardiogenic shock was associated with improved survival in a large group of hospitals with revascularization capability. The American College of Cardiology and American Heart Association guidelines had no detectable temporal impact on revascularization rates. These findings support the need for increased adherence to these guidelines.

Aged↗

PubMed2005

Impact of obesity on prostate cancer recurrence after radical prostatectomy: data from CaPSURE.

OBJECTIVES: To determine the association between obesity and prostate cancer recurrence after primary treatment with radical prostatectomy. METHODS: Data were abstracted from CaPSURE, a disease registry of 10,018 men with prostate cancer. We included 2131 men who had undergone radical prostatectomy between 1989 and 2003 and had body mass index (BMI) information available. Recurrence was defined as two consecutive prostate-specific antigen (PSA) levels of 0.2 ng/mL or greater or any second treatment. Patients were risk stratified using the PSA level, Gleason grade, and clinical T stage. RESULTS: Patients were followed up for a median of 23 months. Of the 2131 patients, 251 (12%) developed recurrence at a median of 13 months (range 1 to 107); 183 (9%) of these men had PSA failure and 68 (3%) received a second treatment. After adjusting for risk group, ethnicity, age, and comorbidities, a significant association was found between an increasing BMI and disease recurrence (P = 0.028). Very obese patients (BMI 35 kg/m2 or more) were 1.69 times more likely to have recurrence relative to men of normal weight (BMI less than 25.0 kg/m2; 95% confidence interval [CI] 1.01 to 2.84). An increasing PSA level (P <0.0001) and Gleason grade (P <0.0001) were also associated with recurrence. Ethnicity was not significantly associated with either BMI or PSA recurrence (P = 0.685 and P = 0.068, respectively). CONCLUSIONS: The results of our study have shown that obesity is an independent predictor of prostate cancer recurrence. Because of the increased comorbidities and greater rates of recurrence, obese individuals undergoing radical prostatectomy need vigilant follow-up care.

Adult↗

PubMed2005

Obesity and prostate cancer clinical risk factors at presentation: data from CaPSURE.

PURPOSE: We investigated the association of obesity with prostate cancer case demographics and clinical disease features at presentation. MATERIALS AND METHODS: Data were abstracted from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor), a disease registry of 10,018 men with prostate cancer. A total of 2,952 men were included who were treated between 1989 and 2002, and had complete body mass index (BMI) information. BMI classes were defined as normal (less than 25 kg/m), overweight (25 to 29.9 kg/m), obese (30 to 34.9 kg/m) or very obese (35 kg/m or greater). Patients were categorized as having low, intermediate or high risk disease based on the D'Amico classification. Associations among BMI, risk and demographics were analyzed using univariate and multivariate models. RESULTS: Of the patients 29% had a normal BMI, 51% were overweight, 16% were obese and 5% were very obese. Patients who were overweight or obese were more likely to be young, have hypertension and diabetes, and have a lower education level. The overweight group had a lower serum prostate specific antigen (p = 0.010) and lower stage disease (p = 0.030) at diagnosis, but there was no association between Gleason score and obesity (p = 0.57). However, among men with a BMI of 25 kg/m or greater there was a positive correlation between increasing BMI and risk of being in a worse prognostic group at diagnosis (p = 0.018). CONCLUSIONS: Overweight and obese patients are more likely to be young at diagnosis and have multiple comorbidities. Men in the overweight and obese groups presented with lower risk prostate cancer at diagnosis. This may be due to earlier disease detection secondary to more frequent interaction with the medical community. Among overweight and obese patients increased obesity is associated with a slightly increased chance of having high risk prostate cancer at diagnosis.

Adenocarcinoma↗

PubMed2005

The impact of obesity on health related quality of life before and after radical prostatectomy (data from CaPSURE).

PURPOSE: Health related quality of life (HRQOL) is an important measure of outcomes among patients with prostate cancer due to disease related and treatment related effects on physical and emotional health. We determined if there are differences in the HRQOL of obese men at diagnosis and after radical prostatectomy compared to the HRQOL of men with normal body mass index (BMI). MATERIALS AND METHODS: Data were abstracted from Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), a disease registry of 10,018 men with prostate cancer. A total of 1,884 men were included in study who were treated with radical prostatectomy between 1989 and 2002, had BMI information available and had completed 1 initial HRQOL questionnaire. Of these men 672 who completed at least 2 followup questionnaires were assessed further. RESULTS: The BMI (kg/m) distributions were 24% normal (less than 24.9 kg/m), 56% overweight (25 to 29.9), 16% obese (30 to 34.9) and 4% very obese (greater than 35 kg/m). Higher BMI was associated with worse physical function, bodily pain, general health, vitality and role physical, but better bowel bother at diagnosis independent of race. Higher BMI was also associated with worse HRQOL after radical prostatectomy for physical function, general health and vitality, but better bowel bother. HRQOL differences between BMI groups were similar among times for all measured variables. Compared to the normal group, the higher BMI groups had similar HRQOL after radical prostatectomy. CONCLUSIONS: In the majority of domains men with higher BMI had lower HRQOL at diagnosis than men of normal BMI. Obese men have a similar recovery pattern of HRQOL after radical prostatectomy, with minimal additive long-term impairment in HRQOL relative to men of normal weight.

Activities of Daily Living↗

PubMed2005

The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy.

PURPOSE: Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We devised a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood. MATERIALS AND METHODS: We studied 1,439 men diagnosed between 1992 and 2001 who had undergone radical prostatectomy and were followed in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a longitudinal, community based disease registry of patients with prostate cancer. Disease recurrence was defined as prostate specific antigen (PSA) 0.2 ng/ml or greater on 2 consecutive occasions following prostatectomy or a second cancer treatment more than 6 months after surgery. The University of California, San Francisco-Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score was developed using preoperative PSA, Gleason score, clinical T stage, biopsy results and age. The index was developed and validated using Cox proportional hazards and life table analyses. RESULTS: A total of 210 patients (15%) had recurrence, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0 to 4 points), Gleason score (0 to 3), T stage (0 to 1), age (0 to 1) and percent of biopsy positive cores (0 to 1). The UCSF-CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a UCSF-CAPRA score of 0 to 1 (95% CI 73%-92%) to 8% for a score of 7 to 10 (95% CI 0%-28%). The concordance index for the UCSF-CAPRA score was 0.66. CONCLUSIONS: The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies.

Adenocarcinoma↗

PubMed2005

Demographics, insurance coverage, and utilization of medical services in newly diagnosed prostate cancer: data from caPSURE.

This study was conducted to identify factors that might influence access to medical services by patients with prostate cancer. The sample comprised 1882 patients who underwent radical prostatectomy and received at least six months of posttreatment follow-up. The investigators found that the type of insurance coverage significantly influenced the number of visits to general practitioners, mental health professionals, and oncologists. However, visits to urologists, nurse practitioners, or alternative-therapy providers were not influenced by type of insurance coverage. Moreover, race, risk profile, and education were significantly correlated with utilization of health services by these patients. The influence of demographic features and insurance coverage on health care utilization by patients with prostate cancer should be further explored.

Aged↗

PubMed2004

Longitudinal assessment of changes in sexual function and bother in patients treated with external beam radiotherapy or brachytherapy, with and without neoadjuvant androgen ablation: data from CaPSURE.

PURPOSE: To evaluate the effects of external beam radiotherapy (EBRT), with or without brachytherapy (BT) boost or brachytherapy monotherapy with and without short-term androgen ablation (<==6 months; STAD) on sexual function (SF) and sexual bother (SB) in men treated for localized prostate cancer. METHODS AND MATERIALS: A total of 992 men with newly diagnosed prostate cancer enrolled in the Cancer of the Prostate Strategic Urological Research Endeavor database were studied to assess treatment-related changes in SF and SB. Six treatment subgroups (EBRT - STAD, EBRT + STAD, BT - STAD, BT + STAD, EBRT + BT - STAD, EBRT + BT + STAD) were compared. RESULTS: The greatest reported changes in SF occurred during the first 2 posttreatment years. Patients receiving BT reported greater SF and the least change in SF overall; those receiving EBRT + BT reported the greatest decline in SF. SF scores associated with STAD were initially lower than in patients without STAD; however by 1 year no statistically significant difference in SF or SB was noted. CONCLUSION: Each treatment for prostate cancer can negatively affect SF and SB. Initial differences among treatment subgroups exist, but diminish with time. SF changes associated with EBRT +/- BT were statistically significant and those for BT were not. STAD appeared to confer only temporary and recoverable impairment of erectile function.

Aged↗

PubMed2004

Medical care expenditures and earnings losses of persons with arthritis and other rheumatic conditions in the United States in 1997: total and incremental estimates.

OBJECTIVE: To provide estimates of the total medical care expenditures and earnings losses associated with arthritis and other rheumatic conditions (AORC), as well as the increment in such costs specifically attributable to these conditions, in the US in 1997. METHODS: The estimates were derived from the 1997 Medical Expenditures Panel Survey (MEPS), a national probability sample of 14,147 households including 34,551 persons, of whom 4,776 self-reported arthritis. After weighting, those who self-reported AORC represent 38.4 million persons. We tabulated all medical care expenditures of the adult MEPS respondents, stratified by arthritis and comorbidity status, and then used regression techniques to estimate the increment in health care expenditures attributable to AORC, after taking comorbidity, demographic characteristics, and insurance status into account. Using the same methods, we also estimated the magnitude of the earnings losses sustained by persons of working ages (18-64 years) who had AORC. RESULTS: Persons with AORC incurred mean total medical care expenditures of 4,865 dollars (total 186.9 billion dollars). The largest components of these expenditures were inpatient care (39%), ambulatory care (29%), and prescriptions (14%). The mean increment in medical care expenditures specifically attributable to AORC among those ages 18 years and older was 1,391 dollars(total approximately 51.1 billion dollars). Persons with AORC ages 18-64 years earned 3,812 dollars less on average than did other persons of these ages (total 82.4 billion dollars). Of this average, 1,579 dollars was attributable to the AORC (total 35.1 billion dollars). CONCLUSION: In 1997, persons with AORC incurred direct and indirect costs of 269.3 billion dollars, of which 86.2 billion dollars was attributable to these conditions.

Adult↗

PubMed2004

Obstructive lower urinary tract symptoms correlate with erectile dysfunction.

OBJECTIVES: To examine whether the severity of lower urinary tract symptoms (LUTS), when controlled for other factors, is related to erectile dysfunction (ED) in the male veteran population. Early evidence suggests that LUTS may be associated with ED in men. METHODS: A total of 181 male veterans were prospectively entered into the study. They completed the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires. Of the 181 men, 144 also underwent uroflowmetry, including determination of the postvoid residual urine volume. Demographic and medical history data were recorded. Pearson correlation coefficients and multiple linear regression analysis were used to examine the relationship between LUTS and ED, as well as the effects of age and comorbidities. RESULTS: The correlation coefficient (r) for the SHIM score with the total IPSS was -0.17 (P = 0.023); with the obstructive IPSS, it was -0.20 (P = 0.006); and with the irritative IPSS, -0.05 (P = 0.492). Age was the only other factor with a statistically significant correlation with the SHIM score (r = -0.23, P = 0.002). Multiple linear regression modeling showed obstructive IPSS (P = 0.001) and depression (P = 0.017) to be the only statistically significant predictors of the SHIM score. A consistent negative correlation was found between obstructive IPSS and the SHIM score across age groups, with the strongest effect for men aged 60 to 70 years (r = -0.412, P = 0.003). CONCLUSIONS: Obstructive LUTS correlated with, and were predictive of, ED, even after controlling for age and comorbidities. Although age correlated with ED, it did not add to the power of the multiple linear regression model composed of obstructive IPSS and depression.

Adult↗

PubMed2004

A framework for modelling fertility motivation in couples.

We present a theoretical framework that organizes individual-level fertility motivations into a couple-level model. One feature of this framework is the Traits-Desires-Intentions-Behaviour (TDIB) sequence through which the fertility motivations of individuals produce instrumental behaviours that are designed to promote or prevent childbearing. A second feature of this framework is the cognitive capacity of individuals to perceive a partner's motivational structure. We combine these two features into a dyad-level model that addresses interactions between partners at each step of the motivational sequence. We elaborate this model first with respect to the perception of partner's motivational structure and second with respect to the combination of partner's and own motivational structure. In the process we consider how couple-level processes of communication, influence, and disagreement can be measured and studied through these interactions. We conclude with a summary discussion of the framework and a consideration of the implications it has for a theory of reproductive psychology, population surveys, and family planning services.

Female↗

PubMed2004

Patterns of secondary cancer treatment for biochemical failure following radical prostatectomy: data from CaPSURE.

PURPOSE: Biochemical failure after definitive treatment for localized prostate cancer may occur in a substantial number of patients. The pattern and type of treatment offered to such patients have been poorly documented. We determined second treatment patterns in patients with biochemical failure following radical prostatectomy (RP). MATERIALS AND METHODS: A total of 303 patients treated with RP who had biochemical failure were identified from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor, Tap Pharmaceutical Products, Inc., Lake Forest, Illinois), a national longitudinal registry of men with prostate cancer. Failure was defined as 2 or more prostate specific antigen (PSA) values 0.2 or greater following RP. The timing and type of secondary cancer treatment were determined. Cox proportional hazards regression analysis was conducted to determine significant predictors of time to secondary treatment, and logistic regression was used to determine predictors of the type of secondary treatment (androgen deprivation versus radiation). RESULTS: Of the 303 patients with biochemical failure 102 (33.7%) received second treatment a mean of 12 months after failure was documented. Second treatments were divided between androgen deprivation (57%) and radiation (43%). On multivariate analysis predictors of second treatment were clinical stage, biopsy Gleason score and PSA at failure. Patients with higher PSA at diagnosis and seminal vesicle invasion were more likely to receive androgen deprivation than radiation as second treatment. CONCLUSIONS: Second treatment timing and type after biochemical failure for patients initially treated with RP were documented. Clinical characteristics, such as PSA, Gleason score and clinical stage, can be used to determine which patients are at highest risk for second treatment after RP and can help guide subsequent treatment decisions.

Databases, Factual↗

PubMed2004

Predicting quality of life after radical prostatectomy: results from CaPSURE.

PURPOSE: We investigated the usefulness of patient and tumor characteristics in predicting continence, potency, and physical and mental health 1 year after radical prostatectomy. MATERIALS AND METHODS: We studied 372 men drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, longitudinal cohort, who underwent radical prostatectomy alone for localized prostate cancer. Health related quality of life (HRQOL) was assessed before and 12 months after (range 9 to 15) surgery with the Physical and Mental Component Summaries of the RAND 36-Item Health Survey and the Sexual and Urinary Function scales of the UCLA Prostate Cancer Index. Covariates included clinical T stage, prostate specific antigen Gleason sum, age, race, income, education, relationship status, comorbidity and overall health self-rating. Chi-square and backward stepwise multivariate analysis identified differences between men who did and did not return to baseline HRQOL postoperatively. Return to baseline HRQOL score was set at 90% or greater for physical and mental health, 80% for continence and 75% for potency. RESULTS: After 1 year 63%, 20%, 80% and 86% returned to baseline continence, potency, physical health and mental health, respectively. Men younger than 65 years were more likely to return to baseline continence, potency, and physical but not mental health. Univariate analyses also revealed several other characteristics to predict (p <0.05) better outcomes including household income greater than 30,000 US dollars (potency, physical health), fewer comorbidities (potency, physical health), and excellent or very good health self-rating (mental health). In multivariate analyses subjects younger than 65 years were more likely to return to baseline urinary (OR 1.8, p <0.01), sexual (OR 2.5, p <0.01) and physical health (OR 1.8, p = 0.03). Furthermore, subjects with no comorbidities were more likely to return to baseline physical health (OR 2.5, p = 0.01), while those with an excellent or very good baseline health self-rating were more likely to return to baseline mental health (OR 2.3, p = 0.01). Clinical T stage, prostate specific antigen and Gleason sum did not predict return to baseline HRQOL. CONCLUSIONS: Younger patient age (less than 65) is associated with a greater likelihood of returning to baseline continence, potency and physical health after radical prostatectomy. In addition, patients who underwent radical prostatectomy without comorbidities and those with high health self-ratings are more likely to return to baseline physical and mental health, respectively. Preoperative tumor characteristics do not appear to be associated with regaining baseline HRQOL, suggesting that factors not measured in this model may be important in optimizing quality of life after radical prostatectomy.

Aged↗

PubMed2004

Validation of the Kattan preoperative nomogram for prostate cancer recurrence using a community based cohort: results from cancer of the prostate strategic urological research endeavor (capsure).

PURPOSE: The Kattan preoperative nomogram combines preoperative prostate specific antigen (PSA), biopsy Gleason grade and clinical stage to estimate disease recurrence after radical prostatectomy. Several studies using patient data from academic centers have validated the nomogram. We assessed the performance of the Kattan nomogram using the Cancer of the Prostate Strategic Urological Research Endeavor database, a national, largely community based observational disease registry. MATERIALS AND METHODS: From the Cancer of the Prostate Strategic Urological Research Endeavor database we identified 1701 men with clinically localized prostate cancer undergoing radical prostatectomy with sufficient pretreatment information and PSA followup after surgery. Disease recurrence was defined as 2 consecutive PSA values 0.2 ng/ml or greater, or a second cancer treatment more than 6 months after prostatectomy. A concordance index was used to evaluate the performance of the nomogram compared to observed 5-year recurrence-free survival (Kaplan-Meier). Kattan nomogram scores were calculated for each patient and stratified into 6 groups for analysis. RESULTS: In our cohort of 1701 men 413 (24%) had evidence of disease recurrence. Median followup in these patients was 2.3 years. Kattan nomogram scores were 17% to 99% (mean 79%). The overall concordance index was 0.68. Varying the definition of recurrent disease and excluding patients with imputed data did not substantially alter nomogram performance (concordance index 0.65 to 0.70). The Kattan nomogram tended to overestimate 5-year freedom from recurrence in patients with scores of 65% and higher. CONCLUSIONS: We noted the reasonable performance of the Kattan nomogram for predicting cancer outcomes after radical prostatectomy using a community based population. Although concordance is lower than in previous validation studies and the nomogram overestimates recurrence-free survival in patients at lower risk, the model is fairly robust and it provides important information when counseling patients regarding treatment options in the community setting. Further refinements in pretreatment estimation of disease-free survival and ultimately overall survival are needed.

Cohort Studies↗