Prostate Cancer Treatment Selection Research Articles

Medication-based Comorbidity Measures and Prostate Cancer Treatment Selection

IntroductionWe aimed to assess the association between comorbidities and prostate cancer management. Patients and methodsWe studied 12,603 South Australian men diagnosed with prostate cancer between 2003 and 2019. Comorbidity was measured one year prior to prostate cancer diagnosis using a medication-based comorbidity index (Rx-Risk). Binomial logistic regression analyses were used to assess the association between comorbidities and primary treatment selection (active surveillance, radical prostatectomy (RP), external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT), brachytherapy, ADT alone, and watchful waiting (WW)). Certain common comorbidities within Rx-Risk (cardiac disorders, diabetes, chronic airway diseases, depression and anxiety, thrombosis, and chronic pain) were also assessed. All models were adjusted for sociodemographic and tumor characteristics. ResultsLikelihood of receiving RP was lower among men with Rx-Risk score ≥3 (odds ratio (OR) 0.62, 95%CI:0.56-0.69) and Rx-Risk 2 (OR 0.80, 95%CI:0.70-0.92) compared with no comorbidity (Rx-Risk ≤0). Men with high comorbidity (Rx-Risk ≥3) were more likely to have received ADT alone (OR 1.76, 95%CI:1.40-2.21), EBRT (OR 1.30, 95%CI:1.17-1.45) or WW (OR 1.49, 95%CI:1.19-1.88) compared with Rx-Risk ≤0. Pre-existing cardiac and respiratory disorders, thrombosis, diabetes, depression and anxiety, and chronic pain were associated with lower likelihood of selecting RP and higher likelihood of EBRT (except chronic airway disease) or WW (except diabetes and depression and anxiety). Cardiac disorders and thrombosis were associated with higher likelihood of selecting ADT alone. Furthermore, age had greater effect on treatment choice than the level of comorbidity. ConclusionHigh comorbidity burden was associated with primary treatment choice, with significantly less RP and more EBRT, WW and ADT alone among men with higher levels of comorbidity. Each of the individual comorbid conditions also influenced treatment selection.

Income level and treatment selection in prostate cancer: analysis of a North Carolina population-based cohort.

Disparities in treatment selection based on socioeconomic status for prostate cancer exist. However, the association between patient-level income with treatment selection priorities and treatment received has not been studied. A population-based cohort of 1382 individuals with newly diagnosed prostate cancer was enrolled throughout North Carolina prior to treatment. Patients self-reported household income and were asked about the importance of 12 factors contributing to their treatment decision-making process. Diagnosis details and primary treatment received were abstracted from medical records and cancer registry data. Patients with lower income were diagnosed with more advanced disease (P < .01). Cure was deemed to be "very important" by more than 90% of patients at all income levels. However, patients with lower vs higher household income were more likely to rate factors beyond cure as "very important" such as cost (P < .01), effect on daily activities (P = .01), duration of treatment (P < .01), recovery time (P < .01), and burden on family and friends (P < .01). On multivariable analysis, high vs low income was associated with increased utilization of radical prostatectomy (odds ratio = 2.01, 95% confidence interval = 1.33 to 3.04; P < .01) and decreased use of radiotherapy (odds ratio = 0.48, 95% confidence interval = 0.31 to 0.75; P < .01). New insights from this study on the association between income and treatment decision-making priorities provide potential avenues for future interventions to reduce disparities in cancer care.

Quality of life in patients who underwent robot‐assisted radical prostatectomy compared with those who underwent low‐dose‐rate brachytherapy

To compare the quality of life (QOL) in patients who underwent robot-assisted radical prostatectomy (RARP) or low-dose-rate brachytherapy (LDR-BT) for prostate cancer. We enrolled patients who underwent LDR-BT (LDR-BT alone [n = 540] or LDR-BT plus external beam radiation therapy [n = 428]) and RARP (n = 142). QOL was evaluated using the International Prostate Symptom Score, Expanded Prostate Cancer Index Composite (EPIC), Sexual Health Inventory for Men (SHIM), and 8-item Short Form (SF-8) health survey. The two groups were compared using propensity score matching analysis. At 24 months after treatment, the number of patients with worsened urinary QOL in the urinary domain of EPIC compared with baseline was 78/111 (70%) and 63/137 (46%) in the RARP and LDR-BT groups, respectively (p < 0.001). In the urinary incontinence and function domain, this number was higher in the RARP group versus the LDR-BT group. However, in the urinary irritative/obstructive domain, the number of patients with improved urinary QOL at 24 months compared with baseline was 18/111 (16%) and 9/137 (7%), respectively (p = 0.01). Regarding the SHIM score, sexual domain of EPIC, and mental component summary of SF-8, there were more number of patients with worsened QOL in the RARP group than in the LDR-BT group. In the EPIC bowel domain, the number of patients with worsened QOL was lower in the RARP group versus the LDR-BT group. The differences in QOL observed between patients treated with RARP and LDR-BT could assist in treatment selection for prostate cancer.

Trends in primary treatment for localized prostate cancer according to the availability of treatment modalities and the impact of introducing robotic surgery.

We aimed to investigate the effect of available treatment modalities on primary treatment selection in patients with localized prostate cancer and that of introducing robotic surgery. We retrospectively studied 12 061 patients diagnosed with localized prostate cancer between 2004 and 2018 from 21 institutions. These institutions were divided into five groups according to the availability of surgery and radiotherapy. Differences in primary treatment selection between the institutions were investigated, and the predictive factors involved in the selection were explored. Surgery, radiotherapy, androgen deprivation therapy, and active surveillance/watchful waiting were selected as primary treatment in 4115, 3621, 3188, and 821 patients, respectively, while the remaining 316 patients selected other modalities. The number of patients, particularly young patients, was much higher in institutions with both surgery and radiotherapy. With the introduction of robotic surgery, open radical prostatectomy has decreased, and robotic surgery made up approximately 70% of all prostatectomies. Institutions with both surgery and radiotherapy tended to treat patients with very low or low risk by surgery or radiotherapy, while institutions without surgery and radiotherapy tended to select active surveillance or watchful waiting. Multivariate analysis revealed that primary treatment selection for prostate cancer was affected not only by clinical factors, but also by the available modalities in each institution. Differences in available treatment modalities affect the selection of primary treatment for localized prostate cancer. Introduction of robotic surgery also has a strong influence on the number of patients in each institution.

The Association between Income Status and Treatment Selection for Prostate Cancer in a Universal Health Care System: A Population-Based Analysis.

Treatment selection for localized prostate cancer is guided by risk stratification and patient preferences. While socioeconomic status (SES) disparities exist for access to care, less is known about the effect of SES on treatment decision-making. We sought to evaluate whether income status was associated with the treatment selected (radical prostatectomy [RP] vs radiation therapy [RT]) for nonmetastatic prostate cancer in a universal health care system. All men from Manitoba, Canada who were diagnosed with nonmetastatic prostate cancer between 2005 and 2016 and subsequently treated with RP or RT were identified using a provincial cancer database. SES was defined as neighborhood income by postal code and divided into income quintiles (Q1-Q5, with Q1 the lowest quintile and Q5 the highest). Multivariable logistic regression nested models were used to compare whether SES was associated with treatment type received. We identified 3,966 individuals who were diagnosed with nonmetastatic prostate cancer and were treated with RP (2,354) or RT (1,612). After adjusting for demographic and clinicopathological characteristics, as income quintile increased, men were incrementally more likely to undergo RP than RT (range Q2 vs Q1: adjusted OR 1.40, 95% CI 1.01-1.93; Q5 vs Q1: adjusted OR 2.30, 95% CI 1.70-3.12). As income levels increased there was a stepwise incremental increase in the odds of receiving RP over RT for localized prostate cancer. These results may inform initiatives to better understand the values, priorities and barriers that patients experience when making treatment decisions in a universal health care system.

The cyclin-dependent kinases pathway as a target for prostate cancer treatment: rationale and future perspectives.

The rapidly expanding scenario of treatment options for patients affected by prostate cancer (PC) is leading to improved outcomes; however, PC still represents one of the most frequent causes of male mortality. Thus, while translational research is trying to unravel the molecular landscape underlying carcinogenesis, disease progression and treatment resistance, several clinical trials are evaluating novel options to further expand therapeutic options. The cyclin-dependent kinases (CDK)-pathway represents a promising therapeutic target for different cancer types; due to the pivotal role of this pathway in the regulation of PC cell cycle, three CDK4/6-inhibitors (abemaciclib, palbociclib and ribociclib) are currently being investigated in several clinical trials. In this paper, we review the current knowledge on CDK-pathway and the mechanism of action of CDK-inhibitors; we discuss the biological rationale for their use in PC and the state of the art of clinical trials focused on the demonstration of their potential role in early or advanced stage, in hormone-sensitive and castration-resistant state. Finally, the potential application of precision oncology for treatment selection in PC is discussed.

Deep learning for automatic Gleason pattern classification for grade group determination of prostate biopsies

Histopathologic grading of prostate cancer using Gleason patterns (GPs) is subject to a large inter-observer variability, which may result in suboptimal treatment of patients. With the introduction of digitization and whole-slide images of prostate biopsies, computer-aided grading becomes feasible. Computer-aided grading has the potential to improve histopathological grading and treatment selection for prostate cancer. Automated detection of GPs and determination of the grade groups (GG) using a convolutional neural network. In total, 96 prostate biopsies from 38 patients are annotated on pixel-level. Automated detection of GP 3 and GP ≥ 4 in digitized prostate biopsies is performed by re-training the Inception-v3 convolutional neural network (CNN). The outcome of the CNN is subsequently converted into probability maps of GP ≥ 3 and GP ≥ 4, and the GG of the whole biopsy is obtained according to these probability maps. Differentiation between non-atypical and malignant (GP ≥ 3) areas resulted in an accuracy of 92% with a sensitivity and specificity of 90 and 93%, respectively. The differentiation between GP ≥ 4 and GP ≤ 3 was accurate for 90%, with a sensitivity and specificity of 77 and 94%, respectively. Concordance of our automated GG determination method with a genitourinary pathologist was obtained in 65% (κ = 0.70), indicating substantial agreement. A CNN allows for accurate differentiation between non-atypical and malignant areas as defined by GPs, leading to a substantial agreement with the pathologist in defining the GG.

Prostate cancer presentation, treatment selection, and outcomes among men with HIV/AIDS: A clinical, stage, and age-matched analysis.

245 Background: The clinical presentation, oncologic outcomes and the optimal management of prostate cancer (PC) among human immunodeficiency virus-seropositive (HIV+) men are poorly described. Our objective was to compare the clinical characteristics, treatment decisions and oncologic outcomes in a contemporary series of HIV+ and HIV negative (HIV-) men with PC. Methods: Clinical data for 3135 men treated for PC at Cook County Hospital (2000-16) were reviewed. HIV+ patients (N = 46) were matched 1:2-3 by age and clinical stage to HIV-negative controls (N = 137). Clinicopathologic features, primary treatment, and oncologic outcomes were compared with Kaplan Meier and Cox proportional hazards analyses. Results: HIV- and HIV+ patients were similar with respect to median age (58.2 vs. 57.2 years, p = 0.2), initial PSA (10.6 vs. 10.5 ng/mL, p = 1), clinical stage (94% cT1/2 vs. 88%, p = 0.4), 8% cN1 vs. 6.5%, p = 1; 10.9% cM1 vs. 10.9%, p = 1), ECOG performance status (0-1 in 99% vs. 100%, p = 1). Among HIV+ men, 67.4% had a history of AIDS, and 91.3% were on HAART at diagnosis with median viral load and CD4+ count of 40 copies/mL and 400 cells/mm3. Median time from HIV diagnosis to PC diagnosis was 8.6 years. Among men with localized disease (N = 153), HIV+ men (N = 37) were more likely to receive radiation therapy (59.5% vs. 44.8%) or no therapy at all (13.5% vs. 4.3%) and less likely to receive surgery (16.2% vs. 30.2%), or to initiate active surveillance (10.8% vs. 16.4%; p = 0.04 overall) than HIV-. There were no differences in rates of biochemical recurrence (Hazard ratio [HR] 0.79; p = 0.6), clinical progression (HR 0.89, p = 0.8), castration resistance (HR 0.71, p = 0.1), or PC-death (HR 3, p = 0.1). However, HIV+ status was associated with an increased risk of all-cause death (HR 2.89, p = 0.04) with median follow-up of 4.2 years (range 0-14). Conclusions: Matched by age and stage, HIV+ men with localized PC were observed to receive surgery and definitive treatment overall at significantly lower rates than HIV- controls. Oncologic outcomes were similar between HIV+ and HIV- men. Further research is necessary to define optimal PC treatment selection in men with HIV.

Luminal and basal subtyping of prostate cancer.

3 Background: There is a clear need to develop a clinically relevant molecular subtyping approach for prostate cancer. We hypothesized that prostate cancer can be subtyped based on luminal versus basal lineage. Methods: We applied the PAM50 classifier, which is used clinically to identify luminal and basal cancers in breast cancer, to subtype a total of 3,782 prostate cancer samples using a high-density microarray platform run in a CLIA-certified laboratory. We examined the associations of these subtypes and clinical outcomes. Results: We demonstrate that PAM50 segregates prostate cancer into three reproducible subtypes in both retrospective cohorts and on prospective validation: luminal A (33.3%-34.3%), luminal B (28.5%-32.6%), and basal (34.1%-37.1%). Luminal B prostate cancers exhibited the worst clinical prognoses, followed by basal and luminal A subtypes (10-year biochemical recurrence-free survival: 29/39/41%; distant metastasis-free survival: 53/73/73%; prostate cancer-specific survival: 78/86/89%; overall survival: 69/80/82% respectively) on both univariable and multivariable analyses accounting for standard clinicopathologic prognostic factors. Known luminal lineage markers, such as NKX3.1 and KRT18, and the basal lineage CD49f signature, were enriched in luminal- and basal-like cancers respectively, demonstrating the connection between these subtypes and established prostate cancer biology. While both luminal-like subtypes were associated with increased AR expression and signaling, only luminal B prostate cancers were significantly associated with post-operative response to androgen deprivation therapy (ADT) in a subset analysis matching patients based on clinicopathologic variables (interaction p = 0.006, luminal B 10-year metastasis: 33% (treated) vs. 55% (untreated), non-luminal B: 37% (treated) vs. 21% (untreated)). Conclusions: These findings contribute novel insight into the biology of prostate cancer, and provide translatable clinical tools for personalizing post-operative ADT for patients with prostate cancer. Similar to breast cancer, these findings suggest that luminal/basal subtyping may be useful in treatment selection in prostate cancer.

Urinary quality of life outcomes in men who were treated with image-guided intensity-modulated radiation therapy for prostate cancer

PurposeQuality of life (QoL) outcomes play a major role in the treatment selection for prostate cancer (CaP). We evaluated the urinary QoL outcomes in men who were treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for CaP. Methods and materialsWe enrolled men who were diagnosed with CaP and underwent IG-IMRT in a large urological group practice into a prospectively maintained database. The typical radiation treatment dosage to prostates and seminal vesicles was 8100 cGy in 45 fractions. Urinary QoL was self-assessed using the standardized incontinence grade and International Prostate Symptom Score (IPSS) at baseline and at each follow-up visit. We evaluated the cumulative incidence of urinary incontinence and changes in both continence and IPSS over time. ResultsOf the 3602 men who were eligible for analysis, 3086 (85.7%) had no urinary incontinence; 479 (13.3 %) had minimal incontinence (no requirement for pads), and 37 (1.0 %) had significant urinary incontinence that required the use of pads or interfered with activities of daily living, at baseline. After a median follow-up of 24 months (range: 12.0-41.0 months), these numbers were 80.6%, 17.4%, and 2.0%, respectively. Radiation therapy appeared to have a beneficial effect on some men: 54.1% of men with minimal incontinence became completely continent of urine during follow-up. Of those with significant urinary incontinence, 29.7% reported resolution and 27.0% reported improved symptoms with no requirement for pads. Of the 1276 men with moderate IPSS, the mean IPSS decreased from 12 to 9.8 at the time of the last follow-up (P < .001). Similarly, of the 233 men with severe IPSS, the mean IPSS decreased from 24 to 13 at the time of the last follow-up (P < .001). ConclusionIG-IMRT for clinically localized CaP is associated with a relatively low incidence of urinary incontinence. Although unexplained, IG-IMRT seems to improve symptoms in some men with baseline urinary incontinence and moderate-to-severe IPSS.

CHROMOGRANIN-A IN THE DIAGNOSIS OF PROSTATE CANCER

The principal marker of neuroendocrine differentiation (NED) is chromogranin A (HGA). The purpose of this work is to determine the role of NED in diseases of the prostate gland by the level of HGA. Materials and methods. The study included 304 men with various diseases of the prostate: BPH - 20; chronic prostatitis (CP) - 22; BPH and prostatic low-grade intraepithelial neoplasia (BPH+LDPIN) - 50; BPH and high degree PIN (BPH+HGPIN) - 32; localized prostate cancer (LPC) - 80; locally advanced PCA (LAPC) - 21; CRPC - 51. The last group United in patients LPC, LAPC and metastatic prostate cancer. All these groups of patients were performed blood sampling fasting with further definition of the level of HGA in serum by enzyme immunoassay. The reference values of HGA for this method are ranged from 0 to 3 nmol/L. Results. During the analyzing of the results of the study they revealed a general trend of increasing of mean values of HGA of serum with the growth stage of prostate cancer, with a maximum of patients with CRPC. According to the analysis they revealed no significant correlation between age and HGA (r = 0,05) among all study groups. They noted the persistent correlation (r = 0,32; p <0,001) between HGA and PSA levels among all studied groups of patients. They traced some relationship between the amount of points Gleason and HGA (r = 0,19; p <0,05) in cases of LPC, LAPC and CRPC. Defining the relationship between HGA and stage of prostate cancer (LPC, LAPC and CRPC), we also found a correlation (r = 0,31, p <0,005) among these groups of patients. Conclusions. HGA is a high interest for the early detection CRPC. Also with the help of HGA it seem to be quite promising to discover the most aggressive forms of prostate cancer. Definition of NED-tumor may be necessary for the analysis of a comprehensive approach to prostate cancer treatment selection.

A meta-analysis of health-related quality of life after primary treatment for prostate cancer as measured by the Expanded Prostate Cancer Index Composite.

39 Background: Health-related quality of life (HRQoL) outcomes are important in treatment selection for prostate cancer. The Expanded Prostate Cancer Index Composite (EPIC) is a validated and widely-utilized HRQoL survey which accounts for newer radiotherapeutic, surgical, and hormonal treatment methods. We present a meta-analysis of patient reported HRQoL outcomes collected with EPIC and compare HRQoL trends with radiation therapy, surgery, or active surveillance as primary treatment. Methods: The PubMed database was systematically searched for all studies which presented data directly derived from the use of EPIC on patients with prostate cancer prior to 07/09/2014. All eligible studies were selected for either inclusion and analysis or exclusion based on pre-determined criteria. The data from included studies was compiled and a simulation-based estimation method using Approximate Bayesian Computation was performed to obtain missing standard deviation estimate. A longitudinal meta-analysis was conducted to estimate EPIC-profiles for each component using Bayesian p-spline method. Results: Over 4,000 studies were searched, 152 were deemed eligible, and 39 were included. The calculated mean summary score estimates are shown in the attached table. Conclusions: In the urinary domain, radical prostatectomy (RP) has lower acute scores than active surveillance (AS) or radiation therapy (RT) without long-term difference. In the bowel domain, RT has lower scores than AS or RP acutely and long-term. In the sexual domain, RT and RP have lower acute scores than AS. RP has lower scores than RT without long-term difference. In the hormonal domain, little difference was noted between modalities. [Table: see text]

Mean Per-Core Biopsy Volume as a Predictor of Failure for Gleason 7 Prostate Cancer Patients Undergoing High-dose-rate Brachytherapy (HDR)

Purpose/Objective(s): The objective of this study was to assess relationships between race, treatment, and cause-specific mortality for prostate cancer. Materials/Methods: The Surveillance, Epidemiology and End Results (SEER) database yielded 328,151 prostate cancer patients diagnosed between 1990 and 2007 including 5,129 Japanese-American, 50,717 Black-American, and 282,305 White-American men. Japanese-American men were selected as they have the lowest incidence of prostate cancer and best treatment outcomes. Cox proportional-hazards regression analysis was used to assess association of race with prostate-cancer specific mortality before and after adjusting for age, health, and treatment. To assess impact of race on treatment selection, we compared mean incidence of treatment type [external beam radiation therapy (EBRT), brachytherapy, and surgery] by race using one-way ANOVA and post-testing with Bonferroni correction. Results: Race significantly impacted survival after prostate cancer treatment. Blacks had the highest (HR Z 1.198; 95% CI: 1.159 to 1.239, p < 0.001) and Japanese the lowest (HR Z .618; 95% CI: .560 to .682, p < 0.001) mortality hazard compared to Whites. Tumor grade was the strongest predictor of survival (p < 0.001). Treatment was also significant: Brachytherapy had the lowest mortality hazard for radiation treatments and surgery was associated with lower mortality hazard compared to no surgery. A total of 37.8%, 44.1%, and 29.1% of Blacks, Whites, and Japanese-Americans underwent surgery (p < 0.05), 27.3%, 23.8%, and 38.2% of Blacks, Whites, and Japanese-Americans underwent EBRT, (p < 0.05), and 4.9%, 6.7%, and 4.7% of Blacks, Whites, and JapaneseAmericans underwent brachytherapy, with Whites significantly different from the other groups(p < 0.05). Conclusions: SEER database analysis revealed race impacts prostate cancer survival. Treatment selection for prostate cancer differs among racial groups and race is associated with differential treatment outcomes. Comparisons between treatments must be viewed with caution, as confounding variables likely exist not accounted for in the SEER database. Future research on race, treatment, and socioeconomic impact on cancerspecific mortality is warranted. Author Disclosure: C. Duarte: None. N. Sarkisian: None. E. Garroutte: None. P. Nguyen: None. M. Hurwitz: None.

Impact of Race on Prostate Cancer Treatment Selection and Cause-specific Mortality: A SEER Database Analysis

Impact of Race on Prostate Cancer Treatment Selection and Cause-specific Mortality: A SEER Database Analysis

Impact of race on prostate cancer selection and cause-specific mortality: A SEER database analysis.

248 Background: The objective of this study was to assess relationships between race, treatment, and cause-specific mortality for prostate cancer. Methods: The Surveillance, Epidemiology and End Results (SEER) database yielded 328,151 prostate cancer patients diagnosed between 1990–2007 including 5,129 Japanese-American, 50,717 Black-American, and 282,305 White-American men. Japanese-American men were selected as they have the lowest incidence of prostate cancer and best treatment outcomes. Cox proportional-hazards regression analysis was used to assess association of race with prostate-cancer specific mortality before and after adjusting for age, health, and treatment. To assess impact of race on treatment selection, we compared mean incidence of treatment type [external beam radiation therapy (EBRT), brachytherapy, and surgery] by race using one-way ANOVA and post-testing with Bonferroni correction. Results: Race significantly impacted survival after prostate cancer treatment. Blacks had the highest (HR= 1.198; 95% CI: 1.159 to 1.239, p&lt; .001) and Japanese the lowest (HR= .618; 95% CI: .560 to .682, p&lt; .001) mortality hazard compared to Whites. Tumor grade was the strongest predictor of survival (p&lt; .001). Treatment was also significant: Brachytherapy had the lowest mortality hazard for radiation treatments and surgery was associated with lower mortality hazard compared to no surgery. 37.8%, 44.1%, and 29.1% of Blacks, Whites, and Japanese-Americans underwent surgery (p&lt; .05), 27.3%, 23.8%, and 38.2% of Blacks, Whites, and Japanese-Americans underwent EBRT, (p&lt; .05), and 4.9%, 6.7%, and 4.7% of Blacks, Whites, and Japanese-Americans underwent brachytherapy, with Whites significantly different from the other groups( p&lt;.05). Conclusions: SEER database analysis revealed race impacts prostate cancer survival. Treatment selection for prostate cancer differs among racial groups and race is associated with differential treatment outcomes. Comparisons between treatments must be viewed with caution as confounding variables likely exist not accounted for in the SEER database. Future research on race, treatment, and socioeconomic impact on cancer-specific mortality is warranted.

Prostate Cancer Treatment Selection after Counseling in a Multidisciplinary Prostate Cancer Clinic

Prostate Cancer Treatment Selection after Counseling in a Multidisciplinary Prostate Cancer Clinic

Appropriate Use of Nomograms to Guide Prostate Cancer Treatment Selection

For decades physicians have attempted to accurately predict post-treatment outcomes before performing prostate cancer interventions. Use of basic clinical factors, such as clinical T-stage, biopsy Gleason sum, and pretreatment prostate specific antigen, has allowed some level of prediction of pathologic and clinical outcomes. However, these basic tables and risk stratification schema provide a broad range of potential outcomes. The rapid growth of retrospective research in prostate cancer has yielded an abundance of additional potential prognostic factors that may influence outcomes of interest; however, incorporating and understanding the significance of these ever-expanding factors is difficult for even the most experienced physicians. Nomograms incorporate these factors (including treatment-specific) and assign them relative weights to provide a probability of the outcome of interest on a graphical scale. They distill large numbers of data into a manageable format and provide the probability of outcomes on a continuous scale rather than in categoric groups. However, because they require a computation to generate a probability, they are not amenable to memorization, which decreases ease of use. Furthermore, these numbers still have associated confidence intervals and the models are largely derived from retrospective data, which have inherent drawbacks. Clinicians and patients should still exercise due diligence when interpreting the results of these nomograms, and these prediction tools should not serve as a stand-alone substitute for clinical decision-making.

Assessment of patient concern and adequacy of informed consent regarding infertility resulting from prostate cancer treatment

Objectives To address in a questionnaire-based study the frequency at which fertility is a concern for men when they consider their prostate cancer treatment options. A secondary aim was to assess the rate at which men were informed of the fertility implications of prostate cancer treatment by their physician before their selection of a treatment option. Methods Two questionnaires were used. One questionnaire was distributed to men with localized prostate cancer who had undergone treatment within the past year. These questions addressed whether continence, erectile function, and fertility were discussed with them by their physician during the prostate cancer treatment selection process. The second questionnaire was distributed to men with newly diagnosed prostate cancer and queried their level of concern about the effects of prostate cancer treatment on sexual function, urinary function, and fertility. Results All patients receiving the first questionnaire stated that they were informed of the incontinence and impotence side effects of prostate cancer treatments, but only 8.7% stated that they were informed of the effect that prostate cancer treatments would have on their future fertility. Of the patients completing the second questionnaire, 53.7% responded that incontinence was the side effect of prostate cancer treatment that caused them the most concern, 42.6% stated that erectile dysfunction was the most concerning, and 3.7% listed fertility as the major concern. Conclusions Urologists should consider approaching the topic of infertility when discussing the pros and cons of various prostate cancer therapies with their younger patients.

Decision making and prostate cancer treatment selection: a review.

To review the issues surrounding decision making regarding prostate cancer treatment. Journal articles, abstracts, and selected findings from one prospective grounded theory research study. Multiple factors are involved in the selection of prostate cancer treatment, such as individual disease-specific data, age, personal values, vicarious and personal cancer experiences, and the physician-patient relationship. Accurate information regarding each treatment option delivered by experts in their respective fields is necessary for informed decision making. A more multidisciplinary approach regarding discussion of treatment options is needed. Nurses play a pivotal role in facilitating discussion among family members and assisting patients to make a decision that balances their personal values with accurate information regarding treatment outcomes.

From Two Perspectives to One Choice: Blending Couple and Individual Views of Prostate Cancer Treatment Selection

Prostate cancer is a leading public health concern. Despite advances leading to early detection, the scientific community is at odds as to whether such early detection is beneficial in terms of improved survival and quality of life. Currently available treatment options carry significant side effects such as incontinence, impotence, and impaired bowel functioning. A theoretical basis for guiding decision making from the patient/family perspective is now emerging. This article details the methodological decisions made by one research team in its efforts to examine the prostate cancer treatment selection process as experienced by older couples. Selected findings are presented as they illuminate the process by which couples moved from their individual perspectives of cancer treatment options to one negotiated couple choice.