SAN FRANCISCO, CA USA (UroToday.com) - Dr. Inger L. Rosner, MD, presented two studies in this session.
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The first study looked at the utilization of robotic prostatectomy and intensity-modulated radiation therapy (IMRT) in patients diagnosed with low-risk prostate cancer (Jacobs BL, et al., JAMA (2013) 309(24):2587-95). Using SEER data, the study found an increase in the use of IMRT and robotic prostatectomy in patients with low-risk prostate cancer between 2004 and 2009. Conversely the use of previous standard therapies (i.e., open radical prostatectomy and EBRT) decreased over the same time period in these patients. A similar trend was seen in patients with high- risk disease as well. The authors also found that overall treatment of prostate cancer over the time period remained stable, and that the rates of observation did not increase over time. This study highlights the fact that patients with indolent disease, least likely to benefit from treatment of their prostate cancer, are still being treated at a high rate, and with therapeutic strategies that are more costly than prior standards or treatment. Dr. Rosner discussed the need to identify patients most likely to benefit from treatment with these advanced technologies in order to avoid overtreatment and to cut back on the increased financial burden these treatments represent.
The second study presented by Dr. Rosner looked at differences in functional outcomes after treatment for localized prostate cancer (Resnick MJ, et al., N Engl J Med (2013) 368(5):436-45). This study looked at the long term effects of radical prostatectomy and EBRT on urinary, bowel, and sexual function using data from the Prostate Cancer Outcomes Study (PCOS). Baseline functional scores were obtained 6 months after diagnosis via recall, and patients were contacted 1, 2, 5, and 15 years after diagnosis for updates on functional scores. As expected, the study found higher rates of urinary incontinence and sexual dysfunction early on in patients undergoing radical prostatectomy, however, by 15 years there was no significant difference in either of these functional domains when compared with radiation therapy. Radiotherapy was found to result in higher rates of short-term bowel dysfunction but by 15 years, again, no significant difference was seen with regards to bowel dysfunction when compared to prostatectomy patients. The study concluded that at 15 years, no significant differences in functional outcomes were seen between patients undergoing radical prostatectomy and radiation therapy. While this study is important in that is provides functional data at very long-term follow-up, there is some question about whether these findings would be the same if the study were repeated comparing robotic prostatectomy and IMRT.
Highlights of a presentation by Inger L. Rosner, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
Walter Reed Army Medical Center, Washington, DC USA
Written by Timothy Ito, MD, medical writer for UroToday.com
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