THE "NEW" PROSTATE CANCER INFOLINK

Today’s news reports deal with:

• Physician trust, continuity of care, and prostate cancer
• Predictive tools in prostate cancer risk and care
• Outcomes after brachytherapy for patients with T1-2 disease

Carpenter et al. have investigated issues such as patients’ usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in prostate cancer screening. Interviews were carried out with 1,031 African-American men and Caucasian-American men ≥ 50 years of age in North Carolina and Louisiana within weeks of their prostate cancer diagnosis. Their medical records were also examined. Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically taking advantage of prostate cancer testing services. Seeing the same physician for regular care was associated with greater trust and use of prostrate cancer testing. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior prostate cancer testing than other men. Additional comments on this study are available in a media release from Roswell Park Cancer Institute.

A review by Jeldres et al. has emphasized the increasing value of nomograms and other predictive tools in planning prostate cancer care compared to “physician opinion.” They point out that clinicians need the most accurate estimates of life expectancy in situations in which there is uncertainty regarding the need for aggressive local therapy; that the accuracy of clinician-derived life expectancy prediction is relatively modest; and that clinicians may benefit from assisted life expectancy prediction by using life tables and statistical tools in their daily practice. The “New” Prostate Cancer InfoLink reminds readers that there are dozens of such tools now available on line. Indeed, for Canadian patients in particular, Prostate Cancer Canada offers a set of 22 specific tools developed using Canadian patients.

Hinnen et al. have reported data on a single institution series of 921 patients in the Netherlands, all treated with permanent interstitial brachytherapy alone, using iodine-125 seeds, between 1989 and 2004 for clinical stage ≤ T2c prostate cancer with no known evidence of positive lymph nodes or gross metastasis. Eighty-five patients with a gland volume ≥ 50 cm³ received 6 months of antiandrogen therapy before treatment. Patients were classified into risk groups with 232 defined as having low-risk, 369 as having intermediate-risk, and as having 320 high-risk disease. The median follow-up was 69 months (range, 4 to 186 months) and the mean age of the patients was 67 years. The overall median 5- and 10-year rates of biochemical recurrence-free survival (BRFS) were 79 and 57 percent, respectively. Average 10-year rates of BRFS by risk group were 88 percent for low-risk, 61 percent for intermediate-risk, and 30 percent for high-risk patients. The median 10-year overall and disease-specific survival rates were 59 and 82 percent, respectively. Ten-year overall and disease-specific survival rates by risk group were, respectively, 68 and 96 percent for low-risk patients, 64 and 87 percent for intermediate-risk patients, and 49 and 69 percent for high-risk disease.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment Tagged: | brachytherapy, continuity of care, nomograms, outcomes, predictive tools, trust