Metastatic Prostate Cancer Declined from 1988 to 2003 by ProQuest


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									10 Renal & Urology News                                 FEBRUARY 2010               

                                                                                                                                                                                                      LVI Predicts
Metastatic Prostate Cancer                                                                                                                                                                            Worse
Declined from 1988 to 2003                                                                                                                                                                            Outcomes
                                                                                                                                                                                                      LYMPHOVASCULAR invasion (LVI)
The age-adjusted incidence dropped by an average of 6.4% a year                                                                                                                                       independently predicts both recur-
                                                                                                                                                                                                      rence-free survival and cancer-specific
METASTATIC prostate cancer con-                                                 and 12.5%, respectively, for men diag-                                     Furthermore, the study showed that         survival in patients undergoing radical
tinues to decline in incidence, but the                                         nosed during 1998-2003.                                                  older age (71 years or older), black race,   nephroureterectomy (RNU) for urothe-
proportion of cases being diagnosed in                                            During the study period, five-year                                      higher tumor grade, and lack of radical      lial carcinoma of the upper urinary
younger men is increasing, according                                            relative survival increased from 41.6%                                   prostatectomy generally conferred a          tract, researchers concluded.
to a study.                                                                     to 62.3%. Men diagnosed at youn-                                         poorer prognosis, “most likely reflect-         At nine centers in European, Asia,
  Researchers analyzed population-                                              ger ages or with moderately to well-                                     ing differences between subgroups of         and Canada, investigators studied 762
based cancer registry data from 24,251                                          differentiated tumors had particularly                                   patients with respect to biological fac-     patients treated with RNU for upper
cases of stage IV prostate cancer                                               dramatic improvements in survival.                                       tors related to survival, access to care,    tract urothelial carcinoma (UTUC)
diagnosed from 1988 to 2003. They                                                 For men aged 35-50 years, rela -                                       nature and extent of comorbiditiy, and       without neoadjuvant chemotherapy
obtained data from the Surveillance,                                            tive five-year survival rose from                                        response to available treatments.”           and without pathologic slide review.
Epidemiology, and End Results (SEER)                                            33.0% in 1988-1992 to 64.8% in                                             The proportion of stage IV tumors that     The researchers, led by Shahrokh
Program. Overall, the age-adjusted                                              1998-2001; for men aged 51-60 years,                                     were poorly differentiated at diagnosis      F. Shariat, MD, of Memorial Sloan-
                                                                                                                                                         rose significantly from 42.7% during the      Kettering Cancer Center in New York,
                                                                                                                                                         period 1988 to 1992 to 48.8% during          found LVI in 148 patients (19.4%). At
  Stage IV Prostate Cancer Decreasing                                                                                                                    1998 to 2003, and the percentage of          a median follow-up of 34 months, dis-
  The overall age-adjusted incidence, in cases per 100,000 population, of stage IV prostate                                                              those of lower grades decreased.             ease recurred in 23.5% of subjects and
  cancer and the incidence of patients with distant metastases at diagnosis decreased from                                                                                                            19.8% died from UTUC. The five-year
  1988 to 2003, a study showed.                                                                                                                          Treatment trends                             recurrence-free survival and cancer-
                                                                                                                                                         The proportion of men who received           specific survival rates were 79.3% and
         30%                                                                                                                                             radiation as part of first-line therapy       82.1%, respectively, in the absence of
                                                                        Overall incidence                                                                increased slightly during the study          LIV compared with 45.1% and 45.8%,
         25%                   28.1%
                                                                        Incidence of distant metastases at diagnosis                                     period, primarily among men with             respectively, in the presence of LVI, Dr.
         20%                                                                                                                                             distant metastases, but more than 75%        Shariat’s group reported in European
         15%                                           18.4%                                                                                             of patients did not receive any form         Urology (2010; published online ahead
                                                                                                                                                         of radiation, the authors reported.          of print).
         10%                                                                                12.3%                                                          In addition, the researchers, led            LVI was associated with a 3.3 times
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