Adjuvant therapy in high-risk prostate cancer.

Although the prognosis in patients with localized prostate cancer is positive overall, high-risk localized disease is responsible for significant cancer-related morbidity and mortality following local treatment failure. Despite recent medical advances in advanced prostate cancer, the role of systemic adjuvant therapy has remained relatively stagnant over the last few decades for patients with high-risk disease, consisting of only androgen deprivation therapy. Novel methods of risk stratification, however, based on traditional clinicopathologic features combined with genomic data, will allow investigators to study adjuvant therapy with more precision in high-risk populations. Additionally, the rise of novel hormonal therapies may provide oncologists with more efficacious drugs in the adjuvant setting, potentially leading to effective adjuvant therapy options for clinicians treating men with high-risk localized prostate cancer.

Osteoclast inhibitor treatment among men with metastatic castration-resistant prostate cancer.

BACKGROUND: National Comprehensive Cancer Network guidelines recommend monthly osteoclast inhibitor treatment (OIT) in men with metastatic castration-resistant prostate cancer (mCRPC) to prevent skeletal related events (SREs). We assessed adherence to guidelines by quantifying treatment for SRE prevention in a population-based cohort of men with mCRPC. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men aged >65 with prostate cancer as a primary cause of death during 2006-2010. We assessed OIT during a 12-month period between 15 and 3 months before death and used multivariable negative binomial regression to identify factors associated with treatment. RESULTS: Among 9,634 men who died of prostate cancer, 22% received ≥ 1 OIT, and use increased slightly over time. Men age 75-84 and ≥ 85 were less likely than younger men to be treated (IRR 0.63, 95% CI 0.49-0.78 and IRR 0.34, 95% CI 0.17-0.50, respectively). African American men were less likely than white men to receive OIT (IRR 0.75, 95% CI 0.54-0.95), as were men from areas with lower median income (P=0.014). Compared with men seeing a urologist only, men seeing a medical oncologist and a urologist (IRR 2.52, 95% CI 2.36-2.68) or a medical oncologist alone (IRR 3.82, 95% CI 3.54-4.09) had higher incidence rates of treatment. CONCLUSIONS: Fewer than a quarter of American men dying of prostate cancer received recommended treatment to prevent SREs within the final year of their lives, with particularly low rates of treatment among older men, African American men, and those living in areas with low median income. Visits with a medical oncologist were associated with increased use. Further evaluation of these disparities by age, race and socioeconomic status are necessary to identify interventions to reduce them.