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Peter R Carroll

Publications and source records attributed to Peter R Carroll.

At least 73 records · Page 4Linked to original sources
PubMed2004

Distribution of a single nucleotide polymorphism on codon 211 of the androgen receptor gene and its correlation with human renal cell cancer in Japanese patients.

The human androgen receptor (AR) gene contains a single nucleotide polymorphism (SNP) on codon 211 and two polymorphic short tandem repeats of CAG and GGC in the N-terminal domain that may influence transcription efficiency of AR gene. We previously reported that the lengths of the CAG and GGC repeats are inversely and linearly related to AR activity and associated with several cancers. However, little is known about this SNP on codon 211 of the AR gene in human renal cell cancer. The cause of renal cell cancer is not well understood although several factors such as chemical carcinogens and hormones have been implicated. AR has been identified in human and animal renal cell cancer. We hypothesize that the SNP on codon 211 is associated with human renal cell cancer. To test this hypothesis, the genetic distribution of the SNP on codon 211 of AR gene was investigated in renal cell cancer patients (211 cases) and healthy controls (200 cases). The allelic and genotypic distributions were determined by PCR-RFLP and direct DNA sequencing techniques. The chi2 test for these data revealed that the distribution of this SNP was not different between renal cell cancer patients as compared to normal healthy controls. The findings suggest that the SNP on codon 211 in the AR gene may not have an important role in the carcinogenesis of human renal cell cancers.

Adult↗
PubMed2004

Age-dependent methylation of ESR1 gene in prostate cancer.

The incidence of prostate cancer increases dramatically with age and the mechanism underlying this association is unclear. Age-dependent methylation of estrogen receptor alpha (ESR1) gene has been previously implicated in other cancerous and benign diseases. We evaluated the age-dependent methylation of ESR1 in prostate cancer. The methylation status of ESR1 in 83 prostate cancer samples from patients aged 49 to 77 years (mean age at 67.4 years) was examined using the bisulfite genomic sequencing technique. The samples were divided into three age groups: men aged 60 years and under (n = 14), men aged 61-70 years (n = 40), and men aged over 70 years (n = 29). Overall, ESR1 promoter methylation was detected in 54 out of 83 (65.1%) prostate samples. The methylation rate of ESR1 increased dramatically with age from 50.0% in patients aged 60 years and under to 89.7% for patients aged 70 years and over. Logistic regression analyses revealed that age and Gleason score were the only variables that affect incidence of ESR1 methylation; other clinical factors such as prostate-specific antigen level and clinical stage did not. We also calculated ESR1 methylation density (the percentage of methylated CpGs among all CpGs within the analyzed region) and severity (the percentage of methylated CpG alleles) for each sample analyzed. Multiple regression analyses showed a positive correlation between age and methylation density (beta, 0.35; P, 0.012; 95% CI, 0.26-2.01); while Gleason score was positively associated with methylation severity (beta, 0.45; P, 0.018; 95% CI, 1.04-4.26). These findings suggest that methylation of ESR1 is both age-dependent and tumor differentiation-dependent and age-dependent methylation of ESR1 may represent a mechanism linking aging and prostate cancer.

Aged↗
PubMed2004

The changing face of low-risk prostate cancer: trends in clinical presentation and primary management.

PURPOSE: Early intervention for prostate cancer is associated with excellent long-term survival, but many affected men, especially those with low-risk disease characteristics, might not experience adverse impact to survival or quality of life were treatment deferred. We sought to characterize temporal trends in clinical presentation and primary disease management among patients with low-risk prostate cancer. METHODS: Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 8,685 men with various stages of prostate cancer. Included were 2,078 men who were diagnosed between 1989 and 2001 and had a serum prostate specific antigen </= 10 ng/mL, Gleason sum </= 6, and clinical T stage </= 2a. Trends in risk distribution, tumor characteristics, and primary treatment were evaluated. RESULTS: The proportion of patients with low-risk tumor characteristics rose from 29.8% in 1989 to 1992, to 45.3% in 1999 to 2001 (P <.0001). There have been sharp increases in the use of brachytherapy and androgen deprivation monotherapy, from 3.1% and 3.1%, to 12.0% and 21.7%, respectively. Utilization rates for prostatectomy, external-beam radiotherapy, and observation have fallen accordingly, from 63.8%, 16.1%, and 13.8%, to 51.6%, 6.8%, and 7.9% (P <.0001 for all except prostatectomy [P =.0019]). Age and socioeconomic status were significantly associated with treatment selection, but overall, the treatment trends were echoed on subgroup analysis of patients 75 years or older. CONCLUSION: Low-risk features characterize a growing proportion of prostate cancer patients, and there have been significant shifts in the management of low-risk disease. Overtreatment may be a growing problem, especially among older patients.

Aged↗
PubMed2004

Whole genome scanning identifies genotypes associated with recurrence and metastasis in prostate tumors.

Prostate cancer is the most commonly diagnosed non-cutaneous neoplasm among American males and is the second leading cause of cancer-related death. Prostate specific antigen screening has resulted in earlier disease detection, yet approximately 30% of men will die of metastatic disease. Slow disease progression, an aging population and associated morbidity and mortality underscore the need for improved disease classification and therapies. To address these issues, we analyzed a cohort of patients using array comparative genomic hybridization (aCGH). The cohort comprises 64 patients, half of whom recurred postoperatively. Analysis of the aCGH profiles revealed numerous recurrent genomic copy number aberrations. Specific loss at 8p23.2 was associated with advanced stage disease, and gain at 11q13.1 was found to be predictive of postoperative recurrence independent of stage and grade. Moreover, comparison with an independent set of metastases revealed approximately 40 candidate markers associated with metastatic potential. Copy number aberrations at these loci may define metastatic genotypes.

Biomarkers, Tumor↗
PubMed2004

Intermediate end point for prostate cancer-specific mortality following salvage hormonal therapy for prostate-specific antigen failure.

BACKGROUND: Whether the prostate-specific antigen (PSA) response to salvage hormonal therapy can act as an intermediate end point for prostate cancer-specific mortality (PCSM) remains unclear. Therefore, we evaluated whether PSA response, defined as the absolute value of the ratio of the rate of PSA change after salvage hormonal therapy to the rate of PSA change before salvage therapy, is associated with the time to PCSM following salvage hormonal therapy. METHODS: A single-institution and two pooled multi-institution databases containing baseline, treatment, and follow-up information on men who received salvage hormonal therapy for PSA failure following surgery or radiation therapy from January 1, 1988, to January 1, 2002, formed the study (n = 199) and validation cohorts (n = 1255), respectively. The ability of PSA response and its constituents (i.e., pre-salvage hormonal therapy PSA slope and post-salvage hormonal therapy PSA slope) to predict time to PCSM following salvage hormonal therapy was assessed using Cox regression analysis. For illustrative purposes, PSA response was analyzed as a dichotomous variable with a breakpoint for the ratio of PSA response of 1. All statistical tests were two-sided. RESULTS: PSA response was statistically significantly associated with time to PCSM following salvage hormonal therapy in both the study (P(Cox) =.0014) and validation (P(Cox)<.001) cohorts; however, its constituents were not (pre-salvage hormonal therapy PSA slope: P(Cox-study) =.97, P(Cox-validation) =.57; post-salvage hormonal therapy PSA slope: P(Cox-study) =.27, P(Cox-validation) =.31). Patients with a PSA response that was less than or equal to 1 had a statistically significantly shorter time to PCSM than patients with a PSA response of greater than 1 in both the study (hazard ratio [HR] = 3.6, 95% confidence interval [CI] = 1.3 to 10.3; P(Cox) =.01) and validation (HR = 12.8, 95% CI = 6.2 to 26.3; P(Cox)<.001) cohorts. CONCLUSION: The PSA response to salvage hormonal therapy can serve as an intermediate end point for PCSM in patients with a rising PSA level following surgery or radiation therapy.

Adult↗
PubMed2004

Genetic aberrations in prostate carcinoma detected by comparative genomic hybridization and microsatellite analysis: association with progression and angiogenesis.

BACKGROUND: In spite of increasing knowledge about the tumor biology of prostate cancer (PC), molecular events involved in tumor progression are not well characterized. There is evidence that a number of genetic alterations play a role in tumor progression and in addition, angiogenesis also contributes. In this study, comparative genomic hybridization (CGH), a sensitive method for detecting regional DNA copy number abnormalities, and microsatellite analysis was used to identify frequent genome changes in PC. Correlation of these data with microvessel density (MVD) and clinical follow-up data was performed to determine genetic alterations that are associated with angiogenesis and subsequent tumor progression. METHODS: Fifty-seven paraffin embedded radical prostatectomy (RP) specimens were microdissected. DNA from the microdissected PC tissue was amplified by degenerate oligonucleoitide primed (DOP)-polymerase chain reaction (PCR), and CGH was performed on the PCR product. Quantitative analyses of the CGH profiles were performed using a t-statistic. Additionally, a microsatellite analysis of chromosome 13q was performed on a subgroup of 31 of the tumors. Using a polyclonal antibody against factor VIII, MVD was determined for all RP specimens. The results of CGH and microsatellite analysis were correlated with the clinical data of the patients and with MVD. RESULTS: Forty-two of the tumors (75%) showed one or more gains while 39 (70%) showed one or more losses per tumor. The most frequent DNA copy number gains were on chromosome 3, 4, 7, 8, 10, 11, 12, 13, and X. The most frequent losses were on chromosomes 2, 5, 6, 8, 10, 13, 15, and 16. Cancer recurrence occurred in 15 patients. The total number of DNA copy number losses was significantly higher in patients with this progression (86%) than without (52%) (P < 0.001). There was no significant difference in the number of gains in patients with or without progression. Contingency table analysis showed a significant correlation between progression and losses in regions of chromosomes 6q and 13q and a gain of chromosome 7q. In multivariate analysis, only loss of chromosome 6 was independently prognostic. The gains that correlated most closely with MVD > 35 were on chromosomes 2q, 7q, and Xq, while the losses most closely associated with MVD > 35 were on chromosomes 8q, 10q, and 13q. However, only the association between loss of chromosome 13q and MVD > 35 was statistically significant. Microsatellite analysis revealed a statistically significant correlation between MVD and instability of locus 171. CONCLUSIONS: This study indicates that the frequency of genetic alterations in PC as detected by CGH correlates with clinical outcome, and that losses of DNA from chromosomes 6q and 13q are important events that correlate with tumor progression, with loss of 13q, especially instability of locus 171, also associated with angiogenesis.

Chromosome Aberrations↗
PubMed2004

Patterns of practice in the United States: insights from CaPSURE on prostate cancer management.

The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10,000 patients with prostate cancer treated at 31 primarily community-based sites across the country. The database tracks oncologic and health-related quality-of-life outcomes. Because the urologists participating in the project treat according to their usual practices, CaPSURE facilitates the study of trends in disease-management strategies, offering a reflection of "real world" practice patterns. This review highlights key studies during the past several years that document downward risk migration, validates widely used prognostic nomograms, establishes prostate-specific antigen doubling time as a surrogate endpoint for disease-specific mortality, assesses the impact of treatment on patient-reported quality of life, and presents national trends in imaging test use and primary treatment strategies for localized disease.

Humans↗
PubMed2004

Lifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention?

This article provides a foundation for clinicians willing to provide lifestyle change recommendations for the prevention of prostate cancer. In part II, more general and specific lifestyle recommendations will be provided. It is imperative to provide patients with realistic and practical recommendations that are not only consistent in the medical literature, but will improve overall compliance.

Aged↗
PubMed2004

Lifestyle recommendations to prevent prostate cancer, part II: time to redirect our attention?

This article provides a foundation for men who want to incorporate lifestyle changes to reduce their risk for prostate cancer and, more importantly, impact all-cause mortality. Table 1 summarizes some of these lifestyle changes that can be recommended to patients in most settings. Minimal time is required to suggest these changes, and a copy of Table 1 can be provided as a reminder to patients. Although these recommendations may seem simple, past studies of men have demonstrated that few (less than 5%) adhere to numerous healthy behaviors simultaneously. It seems to be more common to follow one healthy change in excess than to make multiple changes in moderation. This may be the result of past studies focusing on one lifestyle change to affect disease risk; poor compliance; lack of attention, time, or understanding to this detail; or lack of motivation on the part of the health professional and the patient. Clinical trials of combined moderate lifestyle changes, however, demonstrate that the total effort to make healthy lifestyle changes is more important than one or two behavioral changes in affecting cardiovascular markers, cancer, and all-cause mortality. Recommending a pill is an easy answer, but few supplements for prostate-cancer prevention or total mortality reduction can be recommended, and long-term compliance is a concern with any agent. Additionally, the potential for supplements to increase the risk for prostate cancer or interfere with conventional treatment continues to be a concern, and no dietary supplement has come close to matching the reduction in all-cause mortality observed in clinical trials of lifestyle changes. The time seems ripe to redirect our attention regarding lifestyle changes and prostate cancer risk. What is heart-healthy is prostate-healthy, which makes it more likely that any man concerned about the risk for prostate cancer will make healthy lifestyle changes.

Aged↗
PubMed2004

Laparoscopic partial nephrectomy with temporary arterial occlusion: description of technique and renal functional outcomes.

OBJECTIVES: To report our laparoscopic partial nephrectomy experience and the impact of temporary arterial occlusion during laparoscopic partial nephrectomy on postoperative renal function. Laparoscopic partial nephrectomy is increasingly popular but remains technically challenging. METHODS: Laparoscopic partial nephrectomy was performed in 27 patients, with arterial occlusion in 15 cases. Postoperative renal function was evaluated with serum creatinine in all patients and postoperative technetium-99m mercaptoacetyl triglycine renal scans in a subset of patients after arterial occlusion. RESULTS: The group with arterial occlusion (n = 15) did not differ from those without arterial occlusion (n = 12) with respect to age, body mass index, American Society of Anesthesiologists score, lesion size, operative time, blood loss, or complications. In patients undergoing arterial occlusion, the mean warm ischemia time was 43 +/- 10 minutes (range 25 to 65). The preoperative and postoperative serum creatinine levels were unchanged in patients with (1.07 +/- 0.4 to 1.15 +/- 0.4 ng/dL; P = 0.24) and without (0.96 +/- 0.22 to 1.07 +/- 0.27 ng/dL; P = 0.14) arterial occlusion. The tumor size on imaging correlated with postoperative serum creatinine (r2 = 0.450, P = 0.04). Nuclear renography was performed in 9 patients (60%) after renal artery occlusion. The mean differential renal function of the operated kidney (49%) was similar to that of the contralateral kidney (51%) and was not associated with warm ischemic time or tumor size. CONCLUSIONS: Temporary arterial occlusion during laparoscopic partial nephrectomy does not appear to affect short-term renal function adversely. We believe that this technique can be safely performed when significant bleeding or entry into the collecting system is anticipated. Additional study is warranted to identify the maximal time of warm ischemia and ways to reduce potential renal injury.

Adenoma, Oxyphilic↗
PubMed2004

Evaluation of the patient with hematuria.

There is little controversy regarding whether gross or visible hematuria requires complete upper and lower urinary tract evaluation. With regard to microscopic hematuria, investigators have disagreed on precisely which patients require a complete work-up. Most agree that older patients (> 40 years), patients with a history of cigarette use, and those with occupational exposure or history of chronic phenacetin use should absolutely undergo upper tract imaging, cystourethroscopy, and cytologic examination of the urine in addition to a thorough history and physical examination. A multidisciplinary group of oncologists, radiologists, urologists, and internists has published its recommendations as part of the American Urological Association best practice policy. The formal guidelines, which were distributed, rereviewed, and modified following a nationwide survey of clinicians, recommend complete urologic evaluation for all patients with microscopic hematuria who are over 40 years of age, and younger patients with a history suspicious for urologic disease. This identifies those at highest risk for malignancy while minimizing the number of evaluations in patients unlikely harboring significant disease.

Algorithms↗
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

The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry.

PURPOSE: The epidemiology and treatment of prostate cancer have changed dramatically in the prostate specific antigen era. A large disease registry facilitates the longitudinal observation of trends in disease presentation, management and outcomes. MATERIALS AND METHODS: The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10000 men with prostate cancer accrued at 31 primarily community based sites across the United States. Demographic, clinical, quality of life and resource use variables are collected on each patient. We reviewed key findings from the data base in the last 8 years in the areas of disease management trends, and oncological and quality of life outcomes. RESULTS: Prostate cancer is increasingly diagnosed with low risk clinical characteristics. With time patients have become less likely to receive pretreatment imaging tests, less likely to pursue watchful waiting and more likely to receive brachytherapy or hormonal therapy. Relatively few patients treated with radical prostatectomy in the database are under graded or under staged before surgery, whereas the surgical margin rate is comparable to that in academic series. CaPSURE data confirm the usefulness of percent positive biopsies in risk assessment and they have further been used to validate multiple preoperative nomograms. CaPSURE results strongly affirm the necessity of patient reported quality of life assessment. Multiple studies have compared the quality of life impact of various treatment options, particularly in terms of urinary and sexual function, and bother. CONCLUSIONS: The presentation and management of prostate cancer have changed substantially in the last decade. CaPSURE will continue to track these trends as well as oncological and quality of life outcomes, and will continue to be an invaluable resource for the study of prostate cancer at the national level.

Biomedical Research↗
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

Treatment and outcome of invasive bladder cancer in patients after renal transplantation.

PURPOSE: Optimal management and clinical outcome of bladder cancer in renal transplant recipients are not well-defined. We analyzed single institution treatment strategies and outcomes of these patients. MATERIALS AND METHODS: We retrospectively reviewed the University of California, San Francisco transplant database which contains information on 6,288 renal transplants performed between 1964 and 2002. The United Network for Organ Sharing database and Israel Penn International Transplant Tumor Registry were also queried to characterize the global nature of bladder cancer in renal transplant recipients. RESULTS: The United Network for Organ Sharing database (1986 to 2001) contained information on 31 patients who were found to have bladder cancer (0.024% prevalence) and the Israel Penn International Transplant Tumor Registry (1967 to 2001) contained information on 135 patients representing 0.84% of all reported malignancies. We identified 7 renal transplant recipients with bladder cancer at our institution. Invasive transitional cell carcinoma developed in 5 patients at a median of 2.8 years after transplant. Three patients underwent uncomplicated radical cystectomy and preservation of the renal allograft. Overall survival at 48 months was 60%. CONCLUSIONS: Bladder cancer after renal transplantation is not common. For patients who present with invasive disease, traditional extirpative surgery should be considered. Moreover, the allograft is rarely the source of transitional cell carcinoma and can be preserved. In our experience the cancer and urinary outcomes compare favorably with nontransplant patient outcomes after treatment.

Adult↗
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↗
PubMed2004

Watchful waiting and health related quality of life for patients with localized prostate cancer: data from CaPSURE.

PURPOSE: Watchful waiting is an alternative to active treatment for men with low risk prostate cancer but it is unclear how health related quality of life (HRQoL) may change over time for men who select this option. We report on HRQoL in men with localized prostate cancer who selected watchful waiting. MATERIALS AND METHODS: HRQoL outcomes were reviewed for 310 men diagnosed with prostate cancer from 1990 to 2001 within Cancer of the Prostate Strategic Urological Research Endeavor who chose watchful waiting. The UCLA Prostate Cancer Index and RAND 36-Item Health Survey were completed at enrollment and approximately every 6 months. A random slopes model was developed to assess time trends in HRQoL for up to 5 years after diagnosis, adjusting for age at diagnosis and specific comorbidities. RESULTS: Significant decreases with time were observed in 7 domains of the RAND 36-Item Health Survey and 4 of the UCLA Prostate Cancer Index scales. CONCLUSIONS: Men with prostate cancer who chose watchful waiting in the current study had better or similar HRQoL outcomes compared to men without prostate cancer at the start of the study. Many of these scores were significantly affected by increasing age and decreased with time. The physical domain scores as well as sexual function scores decreased more than expected from the aging process alone.

Aged↗