A Cost-Effectiveness and Quality of Life Analysis of Different Approaches to the Management and Treatment of Localized Prostate Cancer

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50–69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate ca...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research

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ABSTRACT Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018. Materials and Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤ 2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were rec...
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
ABSTRACT Introduction: Androgen deprivation therapy (ADT) is the mainstay of therapy for advanced prostate cancer. Studies addressing the efficacy of different depot formulations of long acting luteinizing hormone releasing hormone agonists in the Brazilian population are lacking. We aimed to compare the efficacy of three schedules of leuprolide acetate in lowering PSA in a real world population. Materials and Methods: We reviewed the medical records of patients with prostate cancer seen at our institution between January 2007 and July 2018. We analyzed patients treated with long-acting leuprolide acetate and grouped these...
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
Conclusion: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
Conclusion: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
ABSTRACT Purpose: To compare perioperative outcomes, complications and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy (RC) with modified Wallace anastomotic technique versus traditional ileal conduit. Materials and methods: Study enrolled 180 patients, of whom 140 were randomized and underwent RC; seventy were randomized to group I and the seventy to the group II. For the primary objective, we hypothesized that the rate of ureteroenteric strictures would be at least 20 % lower in the second group. Secondary end points included rate of anastomotic leak, surgical time, d...
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
ABSTRACT Purpose: To compare perioperative outcomes, complications and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy (RC) with modified Wallace anastomotic technique versus traditional ileal conduit. Materials and methods: Study enrolled 180 patients, of whom 140 were randomized and underwent RC; seventy were randomized to group I and the seventy to the group II. For the primary objective, we hypothesized that the rate of ureteroenteric strictures would be at least 20 % lower in the second group. Secondary end points included rate of anastomotic leak, surgical time, d...
Source: International Braz J Urol - Category: Urology & Nephrology Source Type: research
Oral androgen receptor inhibitor (ARi) Nubeqa ® (darolutamide) approved for the treatment of men with non-metastatic castration-resistant prostate cancer (nmCRPC), who are at high risk of developing metastatic disease / Approval is based on Phase III ARAMIS trial results showing a statistically significant improvement in metastasis-free surviv al (MFS) for darolutamide plus androgen deprivation therapy (ADT) versus placebo plus ADT, and a favorable safety profile
Source: Bayer Company News - Category: Pharmaceuticals Source Type: news
The Florida Legislature has passed a bill designed to better protect its firefighters from cancer-causing contaminants, including toxic asbestos. By approving the legislation, Florida joined a growing number of states that have passed laws in recent years to help firefighters combat occupational hazards they face every day. The Firefighter Cancer Decontamination Equipment Grant Program in Florida will provide funding for departments to procure supplies, equipment and add additional training that should reduce exposure to hazardous pollutants. It includes all fire departments across the state, from large municipal entities...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
Journal of Medicinal ChemistryDOI: 10.1021/acs.jmedchem.9b02031
Source: Journal of Medicinal Chemistry - Category: Chemistry Authors: Source Type: research
by James Y. Dai, Xiaoyu Wang, Bo Wang, Wei Sun, Kristina M. Jordahl, Suzanne Kolb, Yaw A. Nyame, Jonathan L. Wright, Elaine A. Ostrander, Ziding Feng, Janet L. Stanford Genome-wide association studies have identified more than 100 SNPs that increase the risk of prostate cancer (PrCa). We identify and compare expression quantitative trait loci (eQTLs) and CpG methylation quantitative trait loci (meQTLs) among 147 established PrCa risk SNPs in primary prostate tumo rs (n = 355 from a Seattle-based study and n = 495 from The Cancer Genome Atlas, TCGA) and tumor-adjacent, histologically benign samples (n = 471 from a Mayo Cli...
Source: PLoS Genetics - Category: Genetics & Stem Cells Authors: Source Type: research
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