Years For Prostate Cancer Research Articles

Age at diagnosis for lung, colon, breast and prostate cancers: An international comparative study.

Differences in the average age at cancer diagnosis are observed across countries. We therefore aimed to assess international variation in the median age at diagnosis of common cancers worldwide, after adjusting for differences in population age structure. We used IARC's Cancer Incidence in Five Continents (CI5) Volume XI database, comprising cancer diagnoses between 2008 and 2012 from population-based cancer registries in 65 countries. We calculated crude median ages at diagnosis for lung, colon, breast and prostate cancers in each country, then adjusted for population age differences using indirect standardization. We showed that median ages at diagnosis changed by up to 10 years after standardization, typically increasing in low- and middle-income countries (LMICs) and decreasing in high-income countries (HICs), given relatively younger and older populations, respectively. After standardization, the range of ages at diagnosis was 12 years for lung cancer (median age 61-Bulgaria vs 73-Bahrain), 12 years for colon cancer (60-the Islamic Republic of Iran vs 72-Peru), 10 years for female breast cancer (49-Algeria, the Islamic Republic of Iran, Republic of Korea vs 59-USA and others) and 10 years for prostate cancer (65-USA, Lithuania vs 75-Philippines). Compared to HICs, populations in LMICs were diagnosed with colon cancer at younger ages but with prostate cancer at older ages (both pLMICS-vs-HICs < 0.001). In countries with higher smoking prevalence, lung cancers were diagnosed at younger ages in both women and men (both pcorr < 0.001). Female breast cancer tended to be diagnosed at younger ages in East Asia, the Middle East and Africa. Our findings suggest that the differences in median ages at cancer diagnosis worldwide likely reflect population-level variation in risk factors and cancer control measures, including screening.

Age at Diagnosis for Lung, Colon, Breast, and Prostate Cancers: An International Comparative Study

PURPOSE Differences in the age at diagnosis for lung, colon, breast, and prostate cancers have been reported between low- and middle-income countries (LMICs) and high-income countries (HICs). However, this may be influenced by differences in the population age distributions across countries. We aimed to compare the median age at diagnosis for these cancers after adjusting for population age differences. METHODS We analyzed data from the Cancer Incidence in 5 Continents (CI5) Volume XI database. It includes information on cancer diagnoses during 2008 to 2012 from cancer registries in 66 countries. We calculated crude median ages at diagnosis for each cancer in each country, and then performed indirect standardization using the age-specific UN world population estimate to remove the influence of population age structure. RESULTS Overall, the adjustment for population age structure tended to increase the median ages at diagnosis in LMICs which have younger populations, and decrease them in HICs which have older populations. After standardization, differences between the youngest and oldest median ages of diagnosis across cancer sites were: 11 years for lung cancer (youngest median age observed was 61 in Bulgaria v 71 in Bahrain), 10 years for colon cancer (59 in Iran v 69 New Zealand), 10 years for breast (49 in Algeria v 59 Iceland), and 8 years for prostate cancer (65 in USA v 73 in the Philippines). LMICs had younger ages at diagnosis for colon cancer but older ages at diagnosis for prostate cancer as compared with HICs. Countries with higher smoking prevalence had younger ages at lung cancer diagnosis ( P value Pearson correlation = 0.0025). CONCLUSION For lung, colon, breast, and prostate cancers, the differences across countries in the median age at diagnosis range from 8 to 11 years after adjusting for population age distribution. These differences likely reflect population-level variation in risk factors and screening.

Dietary Acrylamide Intake and the Risks of Renal Cell, Prostate, and Bladder Cancers: A Japan Public Health Center-Based Prospective Study.

Acrylamide can be carcinogenic to humans. However, the association between the acrylamide and the risks of renal cell, prostate, and bladder cancers in Asians has not been assessed. We aimed to investigate this association in the Japan Public Health Center-based Prospective Study data in 88,818 Japanese people (41,534 men and 47,284 women) who completed a food frequency questionnaire in the five-year follow-up survey in 1995 and 1998. A validated food frequency questionnaire was used to assess the dietary acrylamide intake. Cox proportional hazard regression models were used to estimate hazard ratios and 95% confidence intervals (CIs). During a mean follow-up of 15.5 years (15.2 years of prostate cancer), 208 renal cell cancers, 1195 prostate cancers, and 392 bladder cancers were diagnosed. Compared to the lowest quintile of acrylamide intake, the multivariate hazard ratios for the highest quintile were 0.71 (95% CI: 0.38–1.34, p for trend = 0.294), 0.96 (95% CI: 0.75–1.22, p for trend = 0.726), and 0.87 (95% CI: 0.59–1.29, p for trend = 0.491) for renal cell, prostate, and bladder cancers, respectively, in the multivariate-adjusted model. No significant associations were observed in the stratified analyses based on smoking. Dietary acrylamide intake was not associated with the risk of renal cell, prostate, and bladder cancers.

Temporal Trends in Population-Level Cure of Cancer: The Australian Context.

With the improvements in cancer diagnosis and treatment, more patients with cancer are surviving for longer periods than before. This study aims to quantify the proportion cured and median survival time for those who are not cured for major cancers in Australia. Australian population-based cohort of 2,164,172 cases, ages 15 to 89 years, whose first cancer diagnosis between 1982 and 2014 was one of 22 leading cancers, were followed up to December 2014. Flexible parametric cure models were used to estimate the proportion cured and median survival time for those uncured by age, sex, and spread of disease, and temporal trends in these measures. Cure estimates could be generated for 19 of the 22 cancer types. The unadjusted proportion cured ranged from 5.0% for pancreatic cancer to 90.0% for melanoma. Median survival time for those uncured ranged from 0.35 years for pancreatic cancer to 6.05 years for prostate cancer. Cancers were divided into four groups according to their proportion cured in the 1980s and the degree of improvement over 28 years. Esophageal, stomach, pancreatic, liver, gallbladder, lung, and brain cancer had lower proportion cured and smaller improvements over time. For cancers with poor survival in which little has changed over time either in prolonging life or achieving statistical cure, efforts should be focused on reducing the prevalence of known risk factors and earlier detection, thereby enabling more effective treatment. Cure models provide unique insights into whether survival improvements are due to prolonging life or through curing the disease.

Characteristics of cancer patients with a history of solid organ transplantation: Analysis of a patient cohort reporting to a large cancer center.

1558 Background: Solid organ transplant recipients have a 2-4-fold elevated risk of developing cancer compared to the general population due to immunosuppressive therapy. Cancer patients with a history of organ transplantation (TPx) may or may not have a cancer attributed to immunosuppression. Here we report on a cohort of cancer patients of the Charité, diagnosed with the first occurrence of a solid cancer in 2010-2014 and a history of TPx. Methods: The cancer registry database of the Charité Comprehensive Cancer Center was queried for patients diagnosed with the first occurrence of solid cancer between 2010 and 2014 and a previous solid organ transplantation. General tumor and patient characteristics as well as outcome were analyzed. Results: A total of 226 patients (151 male, 75 female) were identified and included in the analysis. Transplanted organs included kidney in 148 patients, liver in 63, and heart, lung or a combination of both in 15. The median age at transplantation and initial tumor diagnosis was 54.7 years and 63.4 years respectively. Median interval between organ transplantation and diagnosis of the cancer was 8.1 years, range 0 - 39 years. 60.6% of cancers developed &gt; 10 years after TPx. The interval between TPx and development of cancer inversely correlated to patient age at TPx, with a median of 17.9 years (age group 18-34), 13.0 years (35-49), 6.7 years, (50-64), and 5.3 years, (65+ years). The majority of cancers occurred within the first 10 years after TPx, however especially for the age group 35-49 cancer diagnoses peaked 20-25 years after transplantation. The most common cancer types where non-melanoma skin cancer (34%), followed by kidney (15%), lung (13%) prostate (8.61% of all male patients) and colorectal (4.87%). Median survival of all patients after tumor diagnosis was 4.6 years, with 1.0 years for lung cancer, 4.6 years for colorectal cancer, 5.7 years for prostate cancer respectively. The median OS was not yet reached for non-melanoma skin cancer and kidney cancer. Conclusions: Our data support the necessity of long- term follow up and cancer screening in patients after organ transplantation beyond the commonly practiced 10 years post transplantation screening.

Estimation of population-based cancer-specific potential years of life lost in Belgium.

The potential years of life lost (PYLL) observed in a cohort of cancer patients cannot be fully assigned to the cancer as both cancer-related and non-cancer-related deaths contribute. A method is presented to decompose the observed all-cause PYLL into cancer mortality and population background mortality fractions when cause of death information is not available. Furthermore, the association of cancer-specific PYLL with cancer-specific mortality and mean age at diagnosis is explored and the impact of the follow-up window length is examined. The framework of the actuarial relative survival and the Ederer II method is applied to estimate the population background mortality contribution, PYLL*. The fraction (PYLL-PYLL*)/PYLL is then attributed to the cancer. The method is applied to cancer incidence in Belgium 2004-2014, about 631 300 cancer patients. The cancer-specific PYLL divided by the number of cancer patients, mean PYLL, in the Belgian cancer population ranges from 0.4 years for prostate cancer to 15 years for tumours of the central nervous system. The cancer-specific mean PYLL increases with both increasing cancer-specific mortality and decreasing age at diagnosis. Longer follow-up periods yield larger cancer-specific mean PYLL until statistical cure of cancer is achieved. The mean PYLL results, obtained by dividing the PYLL by the number of cancer patients, are visualized in combination with cancer incidence and mean age and mean life expectancy at diagnosis, providing an elegant summary to rank and compare cancer sites in terms of incidence, relative survival and PYLL.

C15 - Over the years change in prostate cancer management through the multidisciplinary team at a community hospital

Background: A multidisciplinary approach to the patient affected by prostate cancer is crucial to optimize the treatment in all stages of the disease, from active surveillance (AS) candidates to those be offered palliative care only. In fact surgery, radiotherapy (RT), brachytherapy, endocrine therapy (HT), chemotherapy, radionuclide metabolic therapy as well as AS, watchful waiting (WW) and best supportive care are all equally involved in the management of these patients. Material and methods: Our aim was to record and analyze data coming from our institutional experience of multidisciplinary roundtable focused on genitourinary cancers, held by oncologists, urologists and radiotherapists, to verify how this approach was able to modify therapeutic choices during the years for prostate cancer in particular. Results: We compared the results of multidisciplinary discussion regarding patients affected by prostate cancer, between 2014 and 2015. In 2014, our genitourinary team discussed 136 cases of prostate cancer patients vs. 172 in 2015. In 2014, 63 patients were considered fit for surgery, 6 patients were assigned to WW or best supportive care and 19 to AS. Also 22 patients were managed with RT + HT and 11 patients were assigned to oncologists because affected by metastatic disease. In 2015, even though we discussed more cases overall, fewer patients were assigned to surgery (n = 56), while more patients were managed with WW (n = 12) and AS (n = 32), 33 patients were treated with RT plus HT, and 22 patients referred to oncology unit. Fifteen and 17 patients referred to another center respectively in 2014 and 2015. Conclusions: Multidisciplinary discussion is the best modality to share decision about how to handle patients affected by prostate cancer in each setting of disease and allows to avoid too many aggressive procedures (as surgery where not clearly indicated) responsible for significant morbidities and unnecessary costs.Table: C15Active surveillanceBSC o watchful waiting/follow upSurgeryRTSystemic therapy aloneOther hospital2014 (n = 136)N = 19N = 6N = 63N = 22N = 11N = 152015 (n = 172)N = 32N = 12N = 56N = 33N = 22N = 17 Open table in a new tab

Psychosocial Adjustment of Men During the First Year of Prostate Cancer

The psychosocial dimension of prostate cancer has received increased attention over the past 2 decades. The objectives of the study were to investigate the men's psychosocial adjustment over the course of the first year of prostate cancer and to examine the sense of coherence, couple cohesion and adaptability, sexual and urinary symptoms, and mood disturbance as predictors of their adjustment. There were 81, 69, and 61 men visited at home prior to treatment (T1), 3 months later (T2), and 1 year after the first visit (T3), respectively. Repeated-measures analyses of variance were used to examine adjustment over time. Multiple regressions determined whether the predictors were associated with the adjustment domains. Sexual relationship deteriorated and social environment improved between T1 and T2. Between T1 and T3, sexual, domestic, and family relationships deteriorated, whereas social environment improved. Mood disturbance, sense of coherence, couple cohesion, and couple adaptability were predictors of psychological, vocational, and domestic domains at T1. At T2, mood disturbance and sexual functioning were predictors of healthcare, vocational, social, psychological, and family domains. At T3, couple cohesion and adaptability and urinary functioning were predictors to vocational, domestic, social, and psychological adjustment. During the first year of prostate cancer, men showed deterioration in sexual, close-family, and extended-family relationship domains. Sexuality is an important topic, and spousal communication should be encouraged throughout the first year following diagnosis. Preparedness for the changes associated with prostate cancer along with continuing support to couples, rather than to patients only, might be the strongest approach to enhancing men's adjustment.

Recording, Interpreting, and Updating the Family History of Cancer

EVIDENCE-BASED GUIDELINES RECOMMEND THAT PERsons at elevated risk of cancer begin cancer screening at a younger age than the general population and consider more sensitive screening tests. A family history of cancer contains powerful information for cancer risk stratification. Because most common cancers are diagnosed in older age, the prevalence of a family history of cancer increases throughout adulthood. However, agespecific data based on detailed family history have only recently become available. In this issue of JAMA, Ziogas and coinvestigators from the Cancer Genetics Network (CGN) report prospective and retrospective data from a populationbased registry to illustrate the extent to which family history relevant for cancer prevention increases with age. What are the implications for preventive care? Family history is an integral part of medical history and decision making yet has not, until recently, been standardized or widely recorded in structured fashion. Thus, little high-quality evidence is available to confirm the health benefits of generally screening family history in primary care. However, precise family history of an array of cancers is the basis for state-of-the-art cancer risk assessment. An Agency for Healthcare Research and Quality (AHRQ) expert panel concluded that systematic family history collection tools, some self-administered, are likely to improve on usual practice in primary care. The panel recommended recording a patient’s family history of several cancers at the initial visit (including ethnicity, lineage, and age at diagnosis of each affected relative). Relevant family history also may include the family member’s tumor pathology and genotype. Family history may be more consistently discussed with new patients than with established patients. To optimize the use of clinical time and resources, it is important to know when (at what ages and how often) to update the family history of common cancers. Knowing this, health information systems can be designed to accomplish this task. Furthermore, estimating the age-specific prevalence of increased familial risk is important for planning risk-appropriate cancer prevention services. The study by Ziogas et al presents longitudinal data from the population-based CGN registry that show changes in self-reported family history of cancer through adult life, increasing most steeply before age 50 years for breast and colorectal cancer and before age 60 years for prostate cancer. The authors found a 5% chance that an individual’s colorectal cancer screening recommendation would change between the ages of 30 and 50 years based on new family history and a 4% chance that women would be newly identified candidates for breast magnetic resonance imaging. The CGN study found age-specific prevalences of “clinically relevant” family histories of colon, breast, and prostate cancer that are similar to cross-sectional population-based data obtained from the California Health Interview Survey, lending confidence that these estimates could reasonably be extrapolated to the general population. The CGN investigators recommend updating family history of cancer every 5 to 10 years between ages 30 and 60 years. In current practice, updates likely occur either when patients present to clinicians with concerns about cancer (especially a relative or friend with a recent diagnosis), or for preventive care. Although primary care clinicians generally order cancer screening, it is easy to think of circumstances when updating the family history of cancer would be relevant for surgeons, gastroenterologists, urologists, radiologists, oncologists, gynecologists, and other clinicians. Having all clinicians and patients participate in reviewing and recording family history will become more feasible as electronic health records (EHRs) compile information from all who care for a patient, and as EHRs and personal health records eventually include structured family medical history data.

Spontaneous Smoking Cessation Before Lung Cancer Diagnosis

We have observed that many patients with lung cancer stop smoking before diagnosis, usually before clinical symptoms, and often without difficulty. This led us to speculate that spontaneous smoking cessation may be a presenting symptom of lung cancer. Patients from the Philadelphia Veterans Affairs Medical Center with lung cancer and for comparison, prostate cancer and myocardial infarction underwent a structured interview about their smoking habits preceding diagnosis. Severity of nicotine addiction was graded using the Fagerström Test for Nicotine Dependence. Among former smokers, dates of cessation, onset of symptoms, and diagnosis were recorded. Difficulty quitting was rated on a scale of 0 to 10. Distributions of intervals from cessation to diagnosis were compared between groups. All 115 patients with lung cancer had been smokers. Fifty-five (48%) quit before diagnosis, and only six of these (11%) were symptomatic at quitting. Patients with lung cancer who quit were as dependent on nicotine, when smoking the most, as those who continued to smoke, unlike the other groups. Despite this, 31% quit with no difficulty. The median interval from cessation to diagnosis was 2.7 years for lung cancer, 24.3 years for prostate cancer, and 10.0 years for patients with myocardial infarction. These results challenge the notion that patients with lung cancer usually quit smoking because of disease symptoms. The hypothesis that spontaneous smoking cessation may be a presenting symptom of lung cancer warrants further investigation.

Do men and their wives see it the same way? Congruence within couples during the first year of prostate cancer

The purpose of this study was to determine the psychosocial adjustment congruence within couples through the first year of prostate cancer experience, and to explore the personal variables that could predict congruence within couples. Eighty-one couples were interviewed at the time of diagnosis; 69 participated at 3 months and 61 at 12 months. Paired t-tests were used to examine dyadic congruence on seven domains of psychosocial adjustment. Repeated Measures ANOVAs were used to examine the congruence over time. Multiple regressions were used to determine whether mood disturbance, urinary and sexual bother, sense of coherence, and social support were predictors of congruence within couples on each of the adjustment domains. At time 1, couples had incongruent perceptions in 3 of 7 domains: health care, psychological, and social adjustment. Three months later, health care, psychological, and sexual domains showed incongruence within couples. One year after the diagnosis, there were incongruent perceptions only in sexual and psychological domains. There was little variation of the congruence within couples over time. Husbands and wives' mood disturbance, urinary and sexual bother, sense of coherence, and social support accounted for 25-63% of variance in couple congruence in the adjustment domains in the study periods. The findings suggested that there is couple congruence. Domains in which incongruence was observed are important targets for clinical interventions. Greater attention needs to be directed to assisting couples to recognize the differences between their perceptions, especially the ones related to the sexual symptoms and psychological distress.

Association of cigarette smoking with extraprostatic prostate cancer in young men.

A few recent studies have revealed that cumulative or recent smoking is associated with death from prostate cancer suggesting that smoking may influence progression to more advanced disease. We evaluate the association of cigarette smoking with extraprostatic and/or Gleason sum 7 or greater prostate cancer in young men. The study included men who underwent radical prostatectomy before age 55 years for prostate cancer between 1992 and 1999. A survey soliciting cigarette smoking history and other exposures was mailed to 498 eligible men. The response rate was 73%. Cases were defined as men with Gleason sum 7 or greater, extraprostatic or Gleason sum 7 or greater/extraprostatic disease based on pathologic analysis. All remaining participants were considered noncases for each case definition. We used logistic regression modeling to estimate the odds ratio (OR) for Gleason sum 7 or greater, extraprostatic and Gleason sum 7 or greater/extraprostatic disease with cigarette smoking. Of the 352 respondents with a cigarette smoking history 5.4% were current smokers and 44.6% were former smokers at the time of surgery. The odds ratios of extraprostatic and Gleason sum 7 or greater/extraprostatic disease were 3.85 (95% CI 1.44-10.33) and 3.17 (95% CI = 1.13-8.85), respectively, for current smokers compared to men who never smoked. Evidence of an association of smoking with Gleason sum 7 or greater disease was limited. Risk of extraprostatic (p = 0.005) and Gleason sum 7 or greater/extraprostatic (p = 0.003) disease increased with increasing cumulative pack-years smoked. Higher cumulative smoking in the 10 years before surgery was associated with an increased risk of extraprostatic (p = 0.004) and Gleason sum 7 or greater/extraprostatic (p = 0.005) disease. Cigarette smoking may influence the risk of extraprostatic prostate cancer in young men.

Association of Cigarette Smoking with Extraprostatic Prostate Cancer in Young Men

Association of Cigarette Smoking with Extraprostatic Prostate Cancer in Young Men

A survey to evaluate patients’ perspective concerning e-mail in an oncology practice

Purpose: Use of e-mail to improve physician-patient communication is becoming increasingly widespread, however, little research has been done to evaluate patients’ interest and concerns regarding this technology. The goals of this study were to (1) evaluate the effectiveness of e-mail for communication between patients and their oncologist and (2) assess from the perspective of the patient the accessibility and usefulness of e-mail to facilitate medical treatment and advice as compared to conventional mail and telephone. E-mail as a clinical tool is a new trend in medicine that is growing quickly, however, there are few reports to date that evaluate the patients’ perspective concerning e-mail usage. The use of e-mail in doctor-patient communication is potentially faster and more efficient than conventional mail and may reduce “telephone tag”. E-mail initiated by the physician also allows for potential follow-up after treatment. Our study evaluated the types of transactions (personal medical questions, referrals, etc.) for which patients’ preferred using e-mail in place of conventional communication methods. Materials and Methods: A self-administered survey (8 pages; 50 items) was mailed to 65 patients who were treated within the previous three years for prostate cancer in a radiation oncology practice. This survey explored the opinions and behaviors of patients with regard to online communication about general healthcare issues. The items included: patients’ interest in e-mail, comfort in using e-mail, concerns about confidentiality, and access to e-mail. Patients’ interest in using e-mail for specific situations were also evaluated, such as, making appointments, following up on treatment, or asking general health related questions. Patients’ concerns about using email to communicate with healthcare organizations also were assessed. Results: The response rate to the survey was 63%, with a median age of 68 years (range 53-82), and the majority of respondents were white (94%) with 6% African American. Sixty-four percent or respondents had access to an e-mail account at home or work. Among these e-mail users, 66% were between the ages of 58-68, and 34% were more than 68 years old. Eight-one percent of email users had completed some or all of college, and 19 % had completed some or all of high school. The majority of patients indicated that the benefits of e-mail were to eliminate phone calls (70%), to increase the timeliness of a message (81%), to arrange appointments (73%), to ask a physician health related questions (79%), to refill prescriptions (64 %). Only one-third of patients felt e-mail to be appropriate to ask urgent health questions. Most patients (72%) felt comfortable responding to health questions sent by their doctor by e-mail. When controlling for age within this group 57% of patients who preferred e-mail were under 68 years old and 43% of patients were over 68 years old. When evaluating education level, 64% of the patients that preferred using email had a college or graduate degree and 36% had completed some or all of high school. More than half of respondents (61%) felt comfortable answering questions via e-mail that were posed to them by someone in their doctor’s office, such as, a nurse, or physician’s assistant. Patients were evenly divided when asked about confidentiality (56% unconcerned). Conclusion: This study demonstrated that patients were interested in using e-mail in non-urgent situations and to improve the timeliness of communication. Patients preferred e-mail for increased convenience and efficiency regarding minor health problems and did not prefer it for answers to more urgent health questions. Patients with at least a college degree were inclined to use e-mail over those who had completed some or all of high school. Patients who were not currently using e-mail responded favorably to the notion of communicating via e-mail with their physician and/or physician’s staff. Our survey revealed that patient’s may prefer using email for some aspects of communication with their physician. E-mail has the potential to be integrated into a radiation oncology practice.

Headache and Transient Blindness in a 53-Year-Old Woman

of a transient episode of blindness. She had been in good health until July of 1989, when she underwent hemicolectomy with anastomosis for a colon carcinoma (Duke's stage C). The patient did well postoperatively. One year later, however, on the day of admission, she experienced acute onset of bilateral blindness, with associated aphasia and amnesia. These symptoms resolved within 2 hours but were followed by a severe global headache. The patient denied nausea, vomiting, stiff neck, fever, rash, photophobia, seizures, diarrhea, or melena. In addition to the colon carcinoma, the patient's medical history included a colonoscopy 9 months postoperatively, with normal findings. Maxillary infection 5 years previously had led to extraction of all of her upper teeth. Her most recent dental work had been done >1 year earlier. Her father had died at the age of 72 years of prostate cancer, and her sister had a history of uterine cancer. The patient had returned 6 months earlier from a 2-month trip to Israel, where she had spent time primarily in Jerusalem. She had not left Los Angeles since that time. She had emigrated from Israel 20 years previously. She denied exposure to animals or pets. Her diet was strictly kosher, with no exposure to unusual raw foods or milk. The woman lived with her husband and did not work outside the home. She