Prostate cancer outcomes for men who present with symptoms at diagnosis

Kerri R. Beckmann, Michael O'Callaghan, Rasa Ruseckaite, Ned Kinnear, Caroline Miller, Sue Evans, David M. Roder, Kim Moretti, South Australian Prostate Cancer Clinical Outcomes Collaborative

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)

Abstract

Objective: To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. Patients and Methods: This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Results: Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [CI] 0.61–0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56–0.75) and less radiotherapy (IR 0.86, CI: 0.77–0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16–1.47), disease-specific mortality (HR 1.42, CI: 1.13–1.77) and risk of metastases (HR 1.36, CI: 1.13–1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ (HR 0.90, CI: 0.74–1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3–8.8), those aged >70 years (HR 1.4, CI: 1.0–1.8), men receiving private treatment (HR 2.1, CI: 1.3–3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0–1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2–2.7). Conclusion: Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.
Original languageEnglish
Pages (from-to)862–871
Number of pages10
JournalBJU International
Volume119
Issue number6
DOIs
Publication statusPublished - Jun 2017

Keywords

  • lower urinary tract symptoms
  • oncological outcomes
  • prostate cancer

Cite this

Beckmann, K. R., O'Callaghan, M., Ruseckaite, R., Kinnear, N., Miller, C., Evans, S., ... South Australian Prostate Cancer Clinical Outcomes Collaborative (2017). Prostate cancer outcomes for men who present with symptoms at diagnosis. BJU International, 119(6), 862–871. https://doi.org/10.1111/bju.13622
Beckmann, Kerri R. ; O'Callaghan, Michael ; Ruseckaite, Rasa ; Kinnear, Ned ; Miller, Caroline ; Evans, Sue ; Roder, David M. ; Moretti, Kim ; South Australian Prostate Cancer Clinical Outcomes Collaborative. / Prostate cancer outcomes for men who present with symptoms at diagnosis. In: BJU International. 2017 ; Vol. 119, No. 6. pp. 862–871.
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title = "Prostate cancer outcomes for men who present with symptoms at diagnosis",
abstract = "Objective: To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. Patients and Methods: This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Results: Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95{\%} confidence interval [CI] 0.61–0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56–0.75) and less radiotherapy (IR 0.86, CI: 0.77–0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16–1.47), disease-specific mortality (HR 1.42, CI: 1.13–1.77) and risk of metastases (HR 1.36, CI: 1.13–1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ (HR 0.90, CI: 0.74–1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3–8.8), those aged >70 years (HR 1.4, CI: 1.0–1.8), men receiving private treatment (HR 2.1, CI: 1.3–3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0–1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2–2.7). Conclusion: Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.",
keywords = "lower urinary tract symptoms, oncological outcomes, prostate cancer",
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Beckmann, KR, O'Callaghan, M, Ruseckaite, R, Kinnear, N, Miller, C, Evans, S, Roder, DM, Moretti, K & South Australian Prostate Cancer Clinical Outcomes Collaborative 2017, 'Prostate cancer outcomes for men who present with symptoms at diagnosis', BJU International, vol. 119, no. 6, pp. 862–871. https://doi.org/10.1111/bju.13622

Prostate cancer outcomes for men who present with symptoms at diagnosis. / Beckmann, Kerri R.; O'Callaghan, Michael; Ruseckaite, Rasa; Kinnear, Ned; Miller, Caroline; Evans, Sue; Roder, David M.; Moretti, Kim; South Australian Prostate Cancer Clinical Outcomes Collaborative.

In: BJU International, Vol. 119, No. 6, 06.2017, p. 862–871.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Prostate cancer outcomes for men who present with symptoms at diagnosis

AU - Beckmann, Kerri R.

AU - O'Callaghan, Michael

AU - Ruseckaite, Rasa

AU - Kinnear, Ned

AU - Miller, Caroline

AU - Evans, Sue

AU - Roder, David M.

AU - Moretti, Kim

AU - South Australian Prostate Cancer Clinical Outcomes Collaborative

PY - 2017/6

Y1 - 2017/6

N2 - Objective: To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. Patients and Methods: This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Results: Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [CI] 0.61–0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56–0.75) and less radiotherapy (IR 0.86, CI: 0.77–0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16–1.47), disease-specific mortality (HR 1.42, CI: 1.13–1.77) and risk of metastases (HR 1.36, CI: 1.13–1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ (HR 0.90, CI: 0.74–1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3–8.8), those aged >70 years (HR 1.4, CI: 1.0–1.8), men receiving private treatment (HR 2.1, CI: 1.3–3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0–1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2–2.7). Conclusion: Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.

AB - Objective: To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer (PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen (PSA) level. Patients and Methods: This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Results: Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [CI] 0.61–0.81 for high vs low risk), fewer radical prostatectomies (IR 0.64, CI: 0.56–0.75) and less radiotherapy (IR 0.86, CI: 0.77–0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [HR] 1.31, CI: 1.16–1.47), disease-specific mortality (HR 1.42, CI: 1.13–1.77) and risk of metastases (HR 1.36, CI: 1.13–1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ (HR 0.90, CI: 0.74–1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy (HR 3.4, CI: 1.3–8.8), those aged >70 years (HR 1.4, CI: 1.0–1.8), men receiving private treatment (HR 2.1, CI: 1.3–3.3), those diagnosed via biopsy (HR 1.3, CI: 1.0–1.7) and those diagnosed before 2006 (HR 1.6, CI: 1.2–2.7). Conclusion: Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted.

KW - lower urinary tract symptoms

KW - oncological outcomes

KW - prostate cancer

U2 - 10.1111/bju.13622

DO - 10.1111/bju.13622

M3 - Article

VL - 119

SP - 862

EP - 871

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 6

ER -