68: Intermediate-Risk Prostate Cancer, Androgen Deprivation Therapy and the Risk of Death
Notice bibliographique
Résumé
Purpose: Intermediate-risk prostate cancer comprises a heterogenous group, whose management includes external radiation (EBRT), brachytherapy (brachy), or surgery.Androgen deprivation therapy (ADT) has been shown to improve survival in IR prostate cancer when combined with standard dose EBRT (RTOG 9408).Its role with brachy is unclear, but appears to add 10-15% absolute improvement in biochemical control (as presented at CARO 2015).In our practice the use of ADT in this context has declined from 91% in 1990 to 21% in 2015, because of uncertainty of its role, and concerns of toxicity.The aim of this study was to examine the effect of ADT on subsequent survival of men treated for IR with brachy.Methods and Materials: Men treated for IR prostate cancer 1998-2011 were prospectively followed in an outcomes database.They were risk grouped using the ProCars scheme into low-and high-IR.Endpoints were biochemical control (bNED, by the Phoenix, nadir + 2 definition) and survival.Death information was obtained from the provincial cancer registry.Cause of death was ascribed to prostate cancer, cardiovascular disease, other cause, or unknown.bNED and survival were calculated using the Kaplan-Meier method with log-rank statistics, and multivariable analysis performed.Results: 2232 men form the study cohort.Eighty-seven percent had low-IR cancer, and 13% high-IR.Six months of neoadjuvant and concurrent ADT was used in 50%.Ninety-nine percent received 125I low dose rate permanent brachytherapy monotherapy (144 Gy) and 1% received 115 Gy plus pelvic EBRT, (46 Gy).Median follow up for bNED is five years (range 0-17) and for survival seven years (4-17, with 23% followed for more than 10 years).Actuarial biochemical control at 10 years is 74% without, and 88% with ADT (p < 0.001), and both low-IR (77% versus 86%) and high-IR (68% versus 83% at six years) show this improvement.Overall survival is 89% without ADT and 85% with ADT at 10 years (p = 0.041).Cardiovascular deaths were significantly increased with ADT (5% versus 2.3% at 10 years, p = 0.015), and contribute to the decreased overall survival observed.Prostate cancer deaths occurred in 0.5% and 1.5% without and with ADT, at 10 years.Multivariable analysis shows that the excess cardiac deaths are due to comorbidity and age.Conclusions: Although bNED is improved by the addition of six months of ADT, overall survival is worse when examined in a mature dataset.This detriment is due to excess non-prostate causes, including cardiovascular deaths.The main drivers of the latter appear to be presence of cardiac risk factors, other comorbidity, and age.The use of ADT may be a particular concern in patients with such risk factors.Benefits, risks, and patient preference should be considered when determining the addition of ADT with BT for IR prostate cancer.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».