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Peter R Carroll

Publications and source records attributed to Peter R Carroll.

At least 109 records · Page 6Linked to original sources
PubMed2003

Impact of patient educational level on treatment for patients with prostate cancer: data from CaPSURE.

OBJECTIVES: To examine the effect of a patient's educational level on treatment selection for patients with newly diagnosed prostate cancer. A patient's educational level may impact a patient's understanding and perception of the risks and benefits of the treatment options for prostate cancer. METHODS: We examined 3484 patients in CaPSURE with prostate cancer between 1992 and 2001. Chi-square and multinomial logistic regression analyses were performed to determine the role of education level in primary treatment received relative to other pretreatment predictors (age, race, insurance status, prostate cancer risk, comorbidity). Prostate cancer risk stratification was determined by serum prostate-specific antigen level and tumor stage and grade. RESULTS: The mean patient age was 67.7 +/- 8.3 years, and the mean prostate-specific antigen level was 13.0 +/- 18.7 ng/mL. Of the 3484 patients, 16.7% had less than a high school education, 27.0% had completed high school or technical school, 19.5% had had some college, 18.0% had graduated from college, and 18.6% had had some graduate education. In bivariate analysis, the factors predictive of treatment selection were patient age, race, education, insurance status, risk group, and patient comorbidity (all P <0.001). In multinomial regression analysis, the factors predicting treatment received were age, race, cancer risk group, and comorbidity. For patients older than 75 years, those with a higher education level received more aggressive treatment (radiotherapy versus hormonal therapy) than did those with less education. CONCLUSIONS: Patient age, race, cancer risk group, comorbidity, and, for men older than 75 years, education level are the factors predictive of the primary treatment received by men with newly diagnosed prostate cancer.

Adenocarcinoma↗
PubMed2003

Imaging clinically localized prostate cancer.

At this time there is no highly sensitive and specific widespread radiographic test for local staging of prostate cancer. Future developments will likely require a combination of imaging modalities with utilization guided by risk-stratification models (Table 4). Staging data for all imaging tests discussed in this article are summarized in Tables 5 and 6. Clinically, conventional gray-scale TRUS remains the most frequently used tool because of its utility in guiding prostatic biopsies. Modifications of TRUS--including power and color Doppler, 3D imaging, and new ultrasound contrast agents and elastography--show promise in increasing the accuracy of ultrasound. Endorectal MRI may have some value for staging selected patients. The addition of prostatic MRS, which images the differential activity of metabolites, may increase the specificity of MRI. Newer techniques with finer voxel resolution may prove to be clinically useful. A large well-designed study evaluating the utility of MRI/MRS is currently being planned. Cross-sectional imaging of the pelvis with either MRI or CT should be used selectively as should radionuclide bone scans. Similarly, ProstaScint scans should be ordered selectively, either before or after primary therapy, rather than routinely in all patients.

Antibodies, Monoclonal↗
PubMed2003

Health related quality of life significance of single pad urinary incontinence following radical prostatectomy.

PURPOSE: Continence outcomes after radical prostatectomy are frequently reported as the proportion of men using 1 urinary pad or less daily. We postulated that under appreciated health related quality of life (HRQOL) differences may exist between patients requiring 1 pad daily and those who do not require pads. MATERIALS AND METHODS: A total of 168 patients who underwent radical prostatectomy performed by a single surgeon in a 2-year period were surveyed at a mean of 75 +/- 30 weeks postoperatively using the urinary function and bother scales of the University of California-Los Angeles Prostate Cancer Index (PCI), the American Urological Association symptom index and a question assessing satisfaction. To establish patient groups the levels of the PCI question assessing pad use were redefined to 0, 1, or 2 or greater pads daily. The remaining 4 urinary function questions were used to calculate the summary function score. RESULTS: Of the patients 146 (86.9%) reported no pad use and 20 (11.9%) used 1 pad daily. The mean function score +/-SD was 81.7 +/- 19.5 and 51.5 +/- 26.5 for the no and 1 pad groups, respectively (p <0.0001). The mean bother score was 86.8 +/- 18.8 and 54.2 +/- 30.0 (p <0.0001). There were sharp differences between the 2 groups for each of the individual PCI questions and for the satisfaction question but no differences in American Urological Association symptom index scores. CONCLUSIONS: We noted significant differences in urinary HRQOL between patients who do not require urinary pads after surgery and those who use a single pad daily across several domains of urinary function and bother. We believe that these findings underscore the need for more comprehensive HRQOL assessment in urinary outcome assessment after prostatectomy.

Humans↗
PubMed2003

Sociodemographic and clinical risk characteristics of patients with prostate cancer within the Veterans Affairs health care system: data from CaPSURE.

PURPOSE: Veterans Affairs (VA) health care system investigators perform large clinical trials in prostate cancer treatment but potential differences between VA and other patient cohorts have not been explored systematically. MATERIALS AND METHODS: Cancer of the Prostate Strategic Urologic Research Endeavor is an ongoing observational database of men with prostate cancer, comprising 7,202 patients treated at 35 sites across the United States. Three sites that together contribute 241 patients are VA medical centers. Demographic and clinical characteristics were compared between all VA and nonVA patients in the database and a multivariate model was used to explore the interactions between ethnicity and VA status for predicting clinical characteristics. RESULTS: VA patients were 4 times as likely as nonVA patients to be black. They had lower income, less education and more co-morbidity at presentation (all comparisons p <0.0001). VA patients had higher risk disease. Mean serum prostate specific antigen at diagnosis was 20.1 vs 15.3 ng/ml for nonVA patients (p = 0.003). Mean Gleason score was 6.4 for VA patients vs 6.0 for nonVA patients (p <0.0001). Differing ethnic distributions explained the differences in prostate specific antigen between VA and nonVA patients. However, VA status, socioeconomic level and ethnicity independently predicted Gleason score. VA patients were more likely to undergo watchful waiting or primary hormonal therapy and less likely to receive definitive local treatment (p <0.0001). CONCLUSIONS: Significant sociodemographic and clinical differences exist between VA and nonVA patients, which should be borne in mind when extrapolating the results of VA clinical trials to the general population. These observations require validation in larger patient cohorts.

Adenocarcinoma↗
PubMed2003

Health related quality of life patterns in patients treated with interstitial prostate brachytherapy for localized prostate cancer--data from CaPSURE.

PURPOSE: We measured the impact brachytherapy monotherapy (BMT) has on general and disease specific health related quality of life (HRQOL) compared to patients treated with radical prostatectomy (RP). MATERIALS AND METHODS: We studied 419 men with newly diagnosed prostate cancer who enrolled in CaPSURE (Cancer of the Prostate Strategic Urological Research Endeavor) data base whose primary treatment was brachytherapy monotherapy (92) or radical prostatectomy (327). The validated RAND 36-Item Health Survey and the UCLA Prostate Cancer Index were used to measure HRQOL before treatment and at 6-month intervals during the first 2 years after treatment. RESULTS: Patients treated with BMT or RP did not differ greatly in general HRQOL after treatment. Both treatment groups showed early functional impairment in most general domains with scores returning to or approaching baseline in most domains 18 to 24 months after treatment. Patients treated with BMT had significantly higher urinary function scores at 0 to 6 months after treatment (84.5, SD 18.7) than patients treated with RP (63.3, SD 26.6). Urinary bother scores at 0 to 6 months after treatment were not significantly different between patients treated with BMT (67.7, SD 31.2) and those treated with RP (67.4, SD 29.1). Both treatment groups had decreases in sexual function that did not return to pretreatment levels. CONCLUSIONS: Overall BMT and RP are well tolerated procedures that cause mild changes in general HRQOL. Disease specific HRQOL patterns are different in patients treated with BMT or RP. Baseline and serial HRQOL measurements after treatment can provide valuable information regarding expected quality of life outcome after treatment for localized prostate cancer.

Aged↗
PubMed2003

Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CaPSURE.

PURPOSE: Watchful waiting (WW) is one option for men with clinically localized prostate cancer. We examined temporal trends in the use of WW, as well as sociodemographic and clinical profiles of men who choose this form of management. MATERIALS AND METHODS: The Cancer of the Prostate Strategic Urologic Research Endeavor is a national registry of patients with various stages of prostate cancer. Between 1989 and 2000, 5,365 men in the database were diagnosed with localized disease and elected either WW or active treatment within 9 months of diagnosis. Of these men 402 elected WW as initial disease management. We analyzed time trends in WW use, and sociodemographic and clinical predictors of WW using chi-square tests and multivariate logistical regression. RESULTS: In examining 3-year intervals, use of WW increased from 7.5% in 1989 to 1991 to 9.5% in 1992 to 1994, and then decreased during the next 6 years to 5.5% in 1998 to 2000 (p = 0.001). With time there was a significant increase in the proportion of WW patients with T1 disease and prostate specific antigen of 10 ng/ml or less. Compared to patients choosing active treatment, patients opting for WW were more likely to have low risk disease. After controlling for clinical factors WW patients were also more likely to be 75 years old or older, to have Medicare insurance and to have greater comorbidity. CONCLUSIONS: During the prostate specific antigen era rates of WW for the initial treatment of prostate cancer have been decreasing despite considerable downward stage migration. We expect that as prostate cancer risk assessment and surveillance strategies continue to improve, more patients may benefit from this approach to management.

Adenocarcinoma↗
PubMed2003

Predictors of treatment after initial surveillance in men with prostate cancer: results from CaPSURE.

PURPOSE: Expectant management of prostate cancer or watchful waiting (WW) is a reasonable option for some men with clinically localized prostate cancer. We identified predictors of eventual prostate cancer treatment in a cohort of men initially choosing WW. MATERIALS AND METHODS: We identified 457 men in the Cancer of the Prostate Strategic Urologic Research Endeavor data base selecting WW as initial management without subsequent treatment for at least 6 months. A subset of these men eventually received active treatment for prostate cancer. These groups were compared with respect to baseline clinical, sociodemographic characteristics and followup prostate specific antigen (PSA) characteristics using Kaplan-Meier life tables and Cox proportional hazards models to determine predictors of active treatment after WW. RESULTS: Of the 457 men initially on WW 188 (41%) went on to active treatment at a median of 1.7 years after diagnosis. Baseline characteristics associated with progression to active treatment included younger age, higher level of formal education, higher PSA and higher Gleason grade. Actuarial freedom from treatment (that is continued WW) was 74% at 2, 63% at 3 and 49% at 5 years with androgen deprivation the most common form of therapy (72%). Men progressing to treatment had higher baseline and followup PSA as well as a significantly greater PSA change that those remaining on WW (7.2 vs -0.4 ng/ml). Other measures of PSA dynamics also predicted eventual active treatment. These observations persisted in multivariate models. CONCLUSIONS: WW is an appropriate and common form of treatment in many men with prostate cancer and about half remain on WW at 5 years. Our analysis of national practice patterns identified demographic, clinical and PSA characteristics associated with men who continue with this modality. Conversely these factors may help determine which men (for example higher risk/PSA) ultimately receive active treatment despite initial treatment preference and allow investigation of the effects of these interventions on cancer outcomes and quality of life.

Adenocarcinoma↗
PubMed2003

Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE).

PURPOSE: Many instruments designed to predict prostate cancer risk use a combination of clinical T stage, biopsy Gleason score and serum prostate specific antigen (PSA). We designed a study to characterize time trends in these parameters and their impact on patient risk stratification. MATERIALS AND METHODS: Data were abstracted from CaPSURE (Cancer of the Prostate Strategic Urological Research Endeavor), a disease registry of 8,685 men with prostate cancer. The 6,260 men diagnosed since 1989 who had complete clinical information reported were categorized into low, intermediate or high risk groups based on established parameters for T stage, Gleason score and PSA. RESULTS: Between 1989 to 1990 and 2001 to 2002 the proportion of patients presenting with high, intermediate and low risk disease changed from 40.9%, 28.0% and 31.2% to 14.8%, 37.5% and 47.7%, respectively (p <0.0001). The incidence of T1 tumors increased from 16.7% to 48.5% and that of T3-4 tumors decreased from 11.8% to 3.5%, respectively (p <0.0001). The incidence of Gleason 2 to 6 tumors decreased from 77.1% to 66.4%, while that of Gleason 7 tumors increased from 12.9% to 24.8%, respectively (p = 0.0030). PSA levels 10 ng/ml or less increased from 43.6% to 77.7%, respectively, while PSA 10 to 20 and greater than 20 ng/ml decreased accordingly (p <0.0001). These trends were mirrored in subset analysis of black patients. CONCLUSIONS: A significant downward risk migration has occurred over time. Gleason score is now more likely and PSA less likely than previously to drive risk assignment. This shift is most likely attributable to changes in practice patterns with respect to screening and pathological grading. These changes should be considered when applying nomograms derived from earlier datasets to contemporary cases.

Adenocarcinoma↗
PubMed2002

Mental health in men treated for early stage prostate carcinoma: a posttreatment, longitudinal quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor.

BACKGROUND: The current study was conducted to assess posttreatment changes in the mental components of health related quality of life in prostate carcinoma patients during the two years following diagnosis and management with radical prostatectomy, pelvic irradiation, or watchful waiting. METHODS: The authors studied the mental domains of general health related quality of life in 452 men recently diagnosed with early stage prostate carcinoma and treated with radical prostatectomy, pelvic radiation, or watchful waiting. Outcomes were assessed with the RAND 36-Item Health Survey, a validated health-related quality of life instrument that includes four mental domains. To minimize the influence of potentially confounding factors, the authors adjusted for age, comorbidity, prostate specific antigen (PSA) at diagnosis, and biopsy Gleason score. All subjects were drawn from CaPSURE, a national, longitudinal cohort. RESULTS: By 6-12 months after treatment, the active treatment groups began to show differences in mental health and vitality. By 15 months, surgery and radiation patients scored differently in all four mental domains. Over time, the gaps between mental domain scores grew wider among the treatment groups, with surgery patients performing the best, radiation patients performing the worst, and watchful waiting patients falling in between. CONCLUSIONS: The mental health profiles differ for patients undergoing surgery, radiation, or watchful waiting for early stage prostate carcinoma. Men with more serious disease, as evidenced by higher PSA levels or more aggressive histology, tended to worry more about it. Older men performed better, while sicker men performed worse, even though the older men tended to be sicker.

Aged↗
PubMed2002

Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy?

PURPOSE: Prostate cancer incidence and mortality are higher in black than in white American men. We determined whether ethnicity is an independent predictor of disease recurrence in men undergoing radical prostatectomy. MATERIALS AND METHODS: We studied 1,468 patients who underwent radical prostatectomy at the University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor database, a longitudinal disease registry of patients with prostate cancer. Preoperative characteristics, including age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage, biopsy Gleason score and percent positive prostate biopsies at diagnosis were determined in each patient. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment at least 6 months after surgery. Cox proportional hazards analysis was performed to determine independent predictors of time to disease recurrence. To control for pretreatment disease characteristics simultaneously patients were assigned to previously described risk groups based on clinical tumor stage, PSA at diagnosis and biopsy Gleason score. The likelihood of disease recurrence per risk group stratified according to ethnicity was determined using the Kaplan-Meier method and compared using the log rank test. Additional multivariate analysis was performed in the subset of patients enrolled in Cancer of the Prostate Strategic Urological Research Endeavor on whom education and income information was available. RESULTS: Disease recurred in 304 of the 1,468 patients (21%). Black ethnicity, serum PSA at diagnosis, biopsy Gleason score and percent positive prostate biopsies were independent predictors of recurrence on multivariate analysis. Black ethnicity remained an independent predictor of disease recurrence in the multivariate model after stratifying patients into risk groups (p = 0.0007). Ethnicity was most important in patients at high risk, in whom estimated 5-year disease-free survival was 65% and 28% in white and black men, respectively. Education, income and ethnicity correlated highly. When education and income were entered into the multivariate model, ethnicity was no longer an independent predictor of outcome after prostatectomy. CONCLUSIONS: Ethnicity appears to be an independent predictor of disease recurrence after adjusting for pretreatment measures of disease extent in patients undergoing radical prostatectomy. It appears to be particularly important in those with high risk disease characteristics. However, black ethnicity, education and income are highly correlated variables, suggesting that sociodemographic factors may contribute to the poorer outcomes in black patients even after adjusting for differences in pretreatment disease characteristics.

Black or African American↗
PubMed2002

Neoadjuvant therapy before radical prostatectomy for clinical T3/T4 carcinoma of the prostate: 5-year followup, Phase II Southwest Oncology Group Study 9109.

PURPOSE: Several investigators have examined the role of hormonal therapy before definitive local therapy for locally advanced prostate cancer to improve outcome. We evaluated the resectability rate and clinical response rate to 16 weeks of total androgen blockage therapy for clinically locally prostate cancer before radical prostatectomy, and progression-free survival in this multi-institutional study. MATERIALS AND METHODS: Southwest Oncology Group 9109 was a phase II feasibility study designed to treat patients with clinical stage C prostate cancer (T3, T4, N0 and M0). Cases were classified by stage T3 versus T4 and bulky (greater than 4 cm.) versus nonbulky (or less 4 cm.) disease. The neoadjuvant agents used were goserelin and flutamide before radical prostatectomy. RESULTS: A total of 62 patients were accrued to the study and 1 patient was ineligible. There were 2 protocol deviations and these patients refused to undergo prostatectomy after hormonal therapy. Four patients went off protocol treatment because they were not considered surgical candidates. The racial distribution was 72% white, 20% black, 7% Hispanic and 2% Asian. Clinical stage at diagnosis was T3 in 97% and T4 in 3% of cases. Of the patients 39% were diagnosed with bulky disease. Of the 61 eligible patients 55 (90%) underwent a prostatectomy. The 5-year progression-free survival estimate was 70% (24 of 61 cases failed) and the 5-year survival estimate was 90% (11 of 61 deaths). Most of the patients in this trial would have been considered inoperable and referred to radiation oncology. CONCLUSIONS: Neoadjuvant hormonal therapy followed by radical prostatectomy is reasonable and appropriate for clinical stage T3 prostate cancer. A progression-free and overall 5-year survival of 70% and 90%, respectively, compares favorably to Radiation Therapy Oncology Group neoadjuvant trial outcomes for this stage of prostate cancer.

Aged↗
PubMed2002

Sociodemographic characteristics and health related quality of life in men attending prostate cancer support groups.

PURPOSE: Prostate cancer can be associated with anxiety, depression and fears of recurrence and side effects of treatment. Support groups may help meet the needs of patients with cancer by providing treatment information and emotional support. We describe men in prostate cancer support groups and compare them to a national registry. METHODS AND METHODS: Men attending prostate cancer support groups in the San Francisco Bay area completed a questionnaire including sociodemographic and clinical characteristics, health related quality of life items, satisfaction with treatment, relief of prostate cancer symptoms and bother from perceived side effects of treatment. Patients in support groups were compared to men enrolled in a national prostate cancer registry (Cancer of the Prostate Strategic Urological Research Endeavor). RESULTS: Men attending support groups had higher annual income and education levels, lower median serum prostate specific antigen and higher cancer grades than men in Cancer of the Prostate Strategic Urological Research Endeavor. Clinical stage was comparable for the 2 groups. Men in support groups were satisfied with treatment and alleviation from symptoms. Adjusting for ethnicity, marital status, age and type of treatment, sexual function scores were higher in men who attended support groups (p = 0.001). There was no statistically significant difference in bowel and urinary function between groups, although urinary function approached statistical significance at p = 0.05. Sexual and bowel bother scores indicated less bother for men in support groups (p < or = 0.025). CONCLUSIONS: Men enrolled in support groups have unique sociodemographic characteristics. Their health related quality of life appears to be better than that of other men with prostate cancer. Whether this is related to support group participation is not known. Additional studies are required to determine whether routine support group participation improves outcomes in men with prostate cancer.

Aged↗
PubMed2002

Thrombospondin-1 expression in patients with pathologic stage T3 prostate cancer undergoing radical prostatectomy: association with p53 alterations, tumor angiogenesis, and tumor progression.

OBJECTIVES: To investigate thrombospondin-1 (TSP) expression in patients with prostate cancer undergoing radical prostatectomy. TSP is a p53-dependent inhibitor of tumor angiogenesis. Previous studies have demonstrated that TSP expression is significantly associated with the microvessel density (MVD) count, p53 expression, and disease-specific and overall survival in patients with invasive bladder cancer undergoing radical cystectomy. METHODS: Radical prostatectomy specimens from 85 patients with pathologic Stage T3 disease were analyzed for TSP expression, p53 nuclear reactivity, and MVD using antigen-retrieval immunohistochemistry. The median follow-up after surgery was 10.6 years (range 1.8 to 15.4). Disease recurrence was defined as a prostate-specific antigen level of 0.2 ng/mL or greater on two consecutive occasions after surgery. TSP expression was graded as present or absent on the basis of the immunoreactivity in the extracellular matrix by persons unaware of the clinical outcome. Specimens were considered p53 positive (altered) if more than 10% of the tumor cells demonstrated nuclear reactivity. The chi-square test was used to determine whether the associations were significant between the pathologic tumor characteristics and the immunohistochemical findings. The log-rank test was used to determine the associations between the immunohistochemical findings and disease recurrence. RESULTS: TSP and p53 were graded as positive in 21 (26%) and 16 (19%) tumors, respectively. The median MVD count was 111.5. No significant associations were found among p53 status, TSP expression, and MVD. Seminal vesicle invasion and Gleason pattern 4 or 5 disease were significant predictors of disease recurrence. A trend was noted toward a higher rate of disease recurrence for patients with altered p53 expression (p53 positive) or increased MVD. TSP expression was not associated with disease recurrence. CONCLUSIONS: We found no significant association between TSP expression and p53 status, MVD count, or outcome after radical prostatectomy for patients with pathologic Stage T3 prostate cancer. Our data suggest that p53 and MVD may be associated with outcome in these patients. Additional studies are needed to identify reliable molecular markers of outcome for patients with this disease.

Adenocarcinoma↗
PubMed2002

Predicting disease recurrence in intermediate and high-risk patients undergoing radical prostatectomy using percent positive biopsies: results from CaPSURE.

OBJECTIVES: To determine whether percent positive biopsies could be used to predict the probability of disease recurrence in contemporary patients undergoing radical prostatectomy in community-based practice settings. Previous studies have demonstrated the importance of systematic prostate biopsy results in the risk assessment for newly diagnosed patients with prostate cancer. METHODS: We studied 1265 patients enrolled in CaPSURE (a longitudinal registry of patients with prostate cancer) who underwent radical prostatectomy as definitive local treatment of their prostate cancer. Preoperative characteristics, including age, race, prostate-specific antigen (PSA) level at diagnosis, clinical T stage, biopsy Gleason score, and percent positive prostate biopsies at the time of diagnosis, were determined for each patient. Disease recurrence was defined as PSA level of 0.2 ng/mL or greater on two consecutive occasions after radical prostatectomy or the occurrence of a second cancer treatment more than 6 months after surgery. Cox proportional regression analysis was performed to determine the significant independent predictors of disease recurrence. Patients were assigned to previously described risk groups on the basis of clinical tumor stage, PSA at diagnosis, and biopsy Gleason score. The likelihood of disease recurrence for each risk group, stratified according to the percentage of positive biopsies (0% to 33%, 34% to 66%, and more than 66%), was determined using the Kaplan-Meier method and compared using the log-rank test. RESULTS: The median follow-up was 3.3 years after surgery. The serum PSA level at diagnosis, biopsy Gleason score, percent positive biopsies, and ethnicity were significant independent predictors of disease recurrence. The percentage of positive prostate biopsies was a significant predictor of disease recurrence for low, intermediate, and high-risk patients. For patients with high-risk disease, the likelihood of disease recurrence 5 years after surgery was 24%, 34%, and 59% for patients with 0% to 33%, 34% to 66%, and more than 66% positive biopsies, respectively. CONCLUSIONS: Serum PSA, biopsy Gleason score, and percent positive biopsies were significant predictors of disease recurrence in this population. The percent positive biopsies may be useful in identifying high-risk patients suitable for definitive local therapy.

Biopsy, Needle↗
PubMed2002

Utility of intraoperative frozen section analysis of surgical margins in region of neurovascular bundles at radical prostatectomy.

OBJECTIVES: To report our experience with intraoperative frozen section (IFS) analysis in patients who are potential candidates for nerve-sparing surgery. Potency can be maintained in select patients who undergo radical prostatectomy using a nerve-sparing approach. However, extracapsular disease extension in the area of the neurovascular bundles may compromise adequate surgical margins in some patients undergoing such surgery. METHODS: We reviewed the pathologic results from 101 patients who underwent either unilateral or bilateral nerve-sparing radical prostatectomy in whom IFS analysis was performed. The clinical disease stage was T1 in 20 patients and T2 in 81 patients. The mean serum prostate-specific antigen level before surgery was 7.2 ng/mL. Of the 101 patients, 62, 28, and 11 had a biopsy Gleason score of 2 to 6, 7, and 8 to 10, respectively. IFS analysis was performed on the surgical margin thought to be at risk of tumor involvement as determined by the results of systematic prostate biopsy, transrectal ultrasonography, or intraoperative inspection. If the frozen section was positive, additional tissue, including the neurovascular bundle, was subsequently removed to establish clear surgical margins. IFS results were compared with those on the final, permanent tissue section, as well as with the status of the additionally resected tissue. RESULTS: The IFS results were identical to those obtained on the final, permanent section in 92 (91%) of the 101 cases. The IFS results showed positive margins in 15 (15%) of 101 patients. Of these cases, 11 demonstrated positive margins on the final permanent sections. Of the 86 patients with negative frozen section diagnosis, 5 had positive surgical margins on permanent sections at the site of the IFS. The positive and negative predictive value for the IFS technique was 73% and 94%, respectively. Of the 15 patients with positive IFS, 12 (80%) had no evidence of tumor in the additionally resected tissue. Prostate-specific antigen recurrence was noted in 7% of the study population. The risk of recurrence in patients with either positive or negative IFS findings was similar. CONCLUSIONS: IFS at the time of radical prostatectomy can reliably predict the final surgical margin status in most carefully selected high-risk patients when there are concerns about the margin status.

Adult↗
PubMed2002

Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer.

Although once reserved for the management of metastatic prostate cancer, androgen deprivation therapy (ADT) is being used increasingly to treat lower stages of disease. We sought to assess patterns of ADT use in a contemporary cohort of men newly diagnosed with prostate cancer. Men with newly diagnosed prostate cancer who had > or =12 months of follow-up evaluation were identified in a national disease registry of patients with prostate cancer. The patterns of ADT use, both primary and secondary, were characterized and stratified by risk according to prostate-specific antigen levels, clinical stage, and Gleason score. In a cohort of 1485 men, 46% underwent ADT at some point during their treatment: 41% as primary therapy (either sole therapy or neoadjuvant therapy), and 5% as secondary therapy. In all, 50% of men receiving initial ADT had low- or intermediate-risk disease characteristics. Among patients treated with radical prostatectomy and radiation therapy, neoadjuvant ADT was administered in 20% and 48% of patients, respectively. Secondary hormonal manipulation was observed in 5% and 7% of patients treated initially with surgery or radiation, respectively. ADT is commonly used to treat men with prostate cancer. Much of the use of ADT is in men with low- and intermediate-risk disease characteristics. The appropriateness of such therapy requires further study, including its effect, not only on disease endpoints, but also on resource utilization and health-related quality of life.

Androgen Antagonists↗