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PMID- 28890245
OWN - NLM
STAT- Publisher
LR  - 20170911
IS  - 1873-7560 (Electronic)
IS  - 0302-2838 (Linking)
DP  - 2017 Sep 7
TI  - Efficacy of Local Treatment in Prostate Cancer Patients with Clinically Pelvic
      Lymph Node-positive Disease at Initial Diagnosis.
LID - S0302-2838(17)30697-8 [pii]
LID - 10.1016/j.eururo.2017.08.011 [doi]
AB  - BACKGROUND: There is limited evidence supporting the use of local treatment (LT) 
      for prostate cancer (PCa) patients with clinically pelvic lymph node-positive
      (cN1) disease. OBJECTIVE: To examine the efficacy of any form of LT+/-androgen
      deprivation therapy (ADT) in treating these individuals. DESIGN, SETTING, AND
      PARTICIPANTS: Using the National Cancer Database (2003-2011), we retrospectively 
      identified 2967 individuals who received LT+/-ADT versus ADT alone for cN1 PCa.
      Only radical prostatectomy (RP) and radiation therapy (RT) were considered as
      definitive LT. INTERVENTION: LT+/-ADT versus ADT alone. OUTCOME MEASUREMENTS AND 
      STATISTICAL ANALYSIS: Instrumental variable analyses (IVA) were performed using a
      two-stage residual inclusion approach to compare overall mortality (OM)-free
      survival between patients who received LT+/-ADT versus ADT alone. The same
      methodology was used to further compare OM-free survival between patients who
      received RP+/-ADT versus RT+/-ADT. RESULTS AND LIMITATIONS: Overall, 1987 (67%)
      and 980 (33%) patients received LT+/-ADT and ADT alone, respectively. In the
      LT+/-ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP+/-ADT and
      RT+/-ADT, respectively. In IVA, LT+/-ADT was associated with a significant
      OM-free survival benefit (hazard ratio=0.31, 95% confidence interval
      [CI]=0.13-0.74, p=0.007), when compared with ADT alone. At 5 yr, OM-free survival
      was 78.8% (95% CI: 74.1-83.9%) versus 49.2% (95% CI: 33.9-71.4%) in the LT+/-ADT 
      versus ADT alone groups. When comparing RP+/-ADT versus RT+/-ADT, IVA showed no
      significant difference in OM-free survival between the two treatment modalities
      (hazard ratio=0.54, 95% CI=0.19-1.52, p=0.2). Despite the use of an IVA, our
      study may be limited by residual unmeasured confounding. CONCLUSIONS: Our
      findings show that PCa patients with clinically pelvic lymph node-positive
      disease may benefit from any form of LT+/-ADT over ADT alone. While not
      necessarily curative by itself, the use of RP or RT could be the first step in a 
      multi-modality approach aiming at providing the best cancer control outcomes for 
      these individuals. PATIENTS SUMMARY: We examined the role of local treatment for 
      clinically pelvic lymph node-positive prostate cancer. We found that the delivery
      of radical prostatectomy or radiation therapy may be associated with an overall
      mortality-free survival benefit compared with androgen deprivation therapy alone.
CI  - Copyright (c) 2017 European Association of Urology. Published by Elsevier B.V.
      All rights reserved.
FAU - Seisen, Thomas
AU  - Seisen T
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA; Division of Urological
      Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital,
      Harvard Medical School, Boston, MA, USA.
FAU - Vetterlein, Malte W
AU  - Vetterlein MW
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA; Division of Urological
      Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital,
      Harvard Medical School, Boston, MA, USA.
FAU - Karabon, Patrick
AU  - Karabon P
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Jindal, Tarun
AU  - Jindal T
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Sood, Akshay
AU  - Sood A
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Nocera, Luigi
AU  - Nocera L
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical
      School, Boston, MA, USA.
FAU - Choueiri, Toni K
AU  - Choueiri TK
AD  - Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical
      School, Boston, MA, USA.
FAU - Trinh, Quoc-Dien
AU  - Trinh QD
AD  - Division of Urological Surgery and Center for Surgery and Public Health, Brigham 
      and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Menon, Mani
AU  - Menon M
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Abdollah, Firas
AU  - Abdollah F
AD  - Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology
      Institute, Henry Ford Health System, Detroit, MI, USA. Electronic address:
      [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170907
PL  - Switzerland
TA  - Eur Urol
JT  - European urology
JID - 7512719
OTO - NOTNLM
OT  - Castration
OT  - Lymph nodes
OT  - Prostate neoplasms
OT  - Prostatectomy
OT  - Radiotherapy
EDAT- 2017/09/12 06:00
MHDA- 2017/09/12 06:00
CRDT- 2017/09/12 06:00
PHST- 2016/12/26 00:00 [received]
PHST- 2017/08/11 00:00 [accepted]
PHST- 2017/09/12 06:00 [entrez]
PHST- 2017/09/12 06:00 [pubmed]
PHST- 2017/09/12 06:00 [medline]
AID - S0302-2838(17)30697-8 [pii]
AID - 10.1016/j.eururo.2017.08.011 [doi]
PST - aheadofprint
SO  - Eur Urol. 2017 Sep 7. pii: S0302-2838(17)30697-8. doi:
      10.1016/j.eururo.2017.08.011.