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3. Eisenberg DM, Kessler RC, Van Rompay MI et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001;135(5):344-351. 4. Tasaki K, Maskarinec G, Shumay DM, Tatsumura Y, Kakehi Y. Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives. Psychooncology 2002;11(3):212-220. 5. Schofield P, et al. Effectively discussing complementary and alternative medicine in a conventional oncology setting: Communication recommendations for clinicans. Patient Educ Couns (2009) doi:10 1016/j pec 2009 07 038. In press. 6. Steginga SK, Occhipinti S, Gardiner RA, Yaxley J, Heathcote P. A prospective study of the use of alternative therapies by men with localized prostate cancer. Patient Educ Couns 2004;55(1):70-77. 7. Kemper KJ, Cassileth B, Ferris T. Holistic pediatrics: a research agenda. Pediatrics 1999;103(4 Pt 2):902-909. 8. Oh WK, Kantoff PW, Weinberg V et al. Prospective, multicenter, randomized phase II trial of the herbal supplement, PC-SPES, and diethylstilbestrol in patients with androgen-independent prostate cancer. J Clin Oncol 2004;22(18):3705-3712. 9. Ansari MS, Gupta NP. A comparison of lycopene and orchidectomy vs orchidectomy alone in the management of advanced prostate cancer. BJU Int 2003;92(4):375-378. 10. Reddy GK, Tyagi PT. Clinical Prostate Cancer: Highlights from ASCO May 2005 and 2005 ASCO Prostate Cancer Symposium. Interim Results of the Phase ll Randomised ASCENT Trial of High-Dose Calcitriol and Docetaxel in patients with Androgen Independent Prostate Cancer. 2005. 11. Beer TM. ASCENT: The androgen-independent prostate cancer study of calcitriol enhancing taxotere. BJU Int 2005;96(4):508-513. 12. Trial terminated as indicated on website. www.marketwire.com/press-release/Novacea- NASDAQ-NOVC-788553.html. Novacea, 2009. 13. Falsaperla M, Morgia G, Tartarone A, Ardito R, Romano G. Support ellagic acid therapy in patients with hormone refractory prostate cancer (HRPC) on standard chemotherapy using vinorelbine and estramustine phosphate. Eur Urol 2005;47(4):449-454. 14. Kranse R, Dagnelie PC, van Kemenade MC et al. Dietary intervention in prostate cancer patients: PSA response in a randomized double-blind placebo-controlled study. Int J Cancer 2005;113(5):835-840. 15. Ma RW, Chapman K. A systematic review of the effect of diet on prostate cancer prevention and treatment. J Hum Nutr Diet Jun 22(3):187-99. quiz 2001-2. E pub 2009 Apr 1 16. National Prescribing Service (NPS). Review of the Quality of Complementary Medciines Information Resources: Summary Report. National Prescribing Service. March 2009. http://www.nps.org.au/__data/assets/pdf_file/0005/69656/CMsInfoSummary.pdf. 109 Complementary and alternative therapies
9 SOCIO-ECONOMIC ASPECTS OF ADVANCED PROSTATE CANCER 9.1 Introduction Adverse social and economic circumstances are well-recognised determinants of access to and use of health care. Less affluent or socially disadvantaged people live shorter lives and suffer more illness than those who are well off. 1 Guideline development needs to consider how issues such as income, education, occupation or employment, ethnicity, indigenous status, literacy, and place of residence affect risk factors, use of health care services and outcomes of care. There is growing evidence that socio-economic status (SES) is associated with prostate cancer outcomes, particularly participation in PSA testing, patterns of care for localised disease and with survival and mortality outcomes. Most of this evidence is based on American or European studies. Randomised controlled trials rarely report whether trial selection is associated with social class or whether interventions for advanced prostate cancer are confounded by SES. The relationships between SES and prostate cancer incidence, mortality and survival in Australia are poorly understood and even less is known about the association between SES and advanced prostate cancer. 9.2 Socio-economic status A number of studies have demonstrated a higher risk of diagnosis of prostate cancer in men from higher SES groups. This is likely to be related to higher prevalence of prostate cancer testing in those with higher education, income and health-seeking behaviours. In New South Wales between 2002 and 2006, the incidence of prostate cancer was 15% higher than average in men resident in the highest socio-economic status areas, compared to an 8% lower risk in the lowest SES group. However there was no significant difference in mortality rates by SES groups. 2 Hall, using linked administrative data from Western Australia, found higher three-year mortality from prostate cancer in more socioeconomically disadvantaged groups (relative risk=1.34, 95% CI=1.10 to 1.64), whereas those admitted to a private hospital (relative risk=0.77, 95% CI=0.71 to 0.84) or with private health insurance (relative risk=0.82, 95% CI=0.76 to 0.89) fared better. 3 International studies have shown that men with localised disease with lower incomes are less likely to be treated at all, and if treated for localised cancer they are less likely to have prostatectomy and more likely to have radiation therapy. 4,5 A number of studies have shown that men with higher incomes and private health insurance status are more likely to have aggressive treatment, better quality of life and lower mortality from prostate cancer. 6–9 The role of income, education and health insurance in the determination of advanced prostate cancer outcomes in Australia has never been explored. 9.3 Accessibility Coory and Baade 10 , using administrative data for the whole of Australia, found a statistically significant and increasing excess risk for prostate cancer mortality in regional and rural areas. In 2000–2002, the excess (compared with capital cities) was 21% (95% CI=14% to 29%). The authors suggested that this was likely related to lower rates of screening with PSA tests and treatment with radical prostatectomy in rural and regional Australia. 10 Western Australia data indicate that the three-year mortality rate for prostate cancer was greater with a first admission to a rural hospital (relative risk=1.22, 95% CI=1.09 to 1.36) compared to non-rural hospitals. 3 A survival analysis comparing rural and remote residents of NSW found a more than three-fold relative excess risk of death by five years in men from rural and remote NSW (relative risk=3.38, 95% CI=2.21 to 5.16). This was partly driven by later stage of disease at diagnosis in men from rural and remote areas. 11 An analysis of linked data for NSW for the period 1993–2002 also showed associations between SES and rural/urban areas of residence and the type of treatment received. Prostate cancer patients from less accessible Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer 110
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Clinical Practice Guidelines for th
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4 Biochemical relapse .............
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FOREWORD The management of prostate
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SUMMARY OF CLINICAL PRACTICE RECOMM
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SUMMARY OF RECOMMENDATIONS Chapter
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Chapter Recommendations Grade Refs
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1 INTRODUCTION 1.1 Natural history
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2 PSYCHOSOCIAL CARE The diagnosis a
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2.2 Effect of psychological and cog
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Evidence summary Level References T
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Recommendation Men with advanced pr
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An Australian cross-sectional study
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10. Dunn J, et al. A review of peer
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41. Sharpley CF, Christie DRH. An a
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different treatments from different
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Evidence summary Level References I
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Evidence summary Level References F
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Despite these reservations and the
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For non-metastatic disease there we
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Evidence summary Level References T
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monotherapy for low-to-intermediate
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Evidence summary Level References M
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for surgery, suggesting that surger
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Microscopic fully resected node pos
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All three trials demonstrated impro
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Evidence summary Level References B
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of an international multicentre ran
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45. Melton LJ, III, Alothman KI, Kh
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76. Little DJ, Kuban DA, Levy LB, Z
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105. Thompson IM, Tangen CM, Parade
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4.2 Androgen deprivation therapy (e
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Evidence summary Level References F
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therapy since such studies would be
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apparent in trials comparing CAB wi
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QLQ instrument published by Cleary
Page 78 and 79: Note: Larger well-powered studies h
Page 80 and 81: Eight trials examined acute toxicit
Page 82 and 83: half of patients experienced pain r
Page 84 and 85: olus) in addition to radiotherapy a
Page 86 and 87: References 1. Seidenfeld J, Samson
Page 88 and 89: Cooperative Group. Scandinavian Jou
Page 90 and 91: Oncology Group, TROG 96.05). Radiot
Page 92 and 93: trial. European Journal of Cancer 1
Page 94 and 95: 6 CASTRATION-RESISTANT PROSTATE CAN
Page 96 and 97: the median overall survival for pat
Page 98 and 99: There are two points regarding bisp
Page 100 and 101: with bone pain at study entry. At n
Page 102 and 103: Recently, there have been reports o
Page 104 and 105: of these studies 56, 58 and in the
Page 106 and 107: Side effects (toxicity) As these ra
Page 108 and 109: hydrocortisone respectively. Tannoc
Page 110 and 111: 5. Manikandan R, Srirangam SJ, Pear
Page 112 and 113: 33. Elomaa I, Kylmala T, Tammela T
Page 114 and 115: 60. Janknegt RA, Abbou CC, Bartolet
Page 116 and 117: physiotherapists, occupational ther
Page 118 and 119: 7.5 Q2: Symptom control There was e
Page 120 and 121: Informal or family caregivers deriv
Page 122 and 123: 8. Hughes SL, Weaver FM, Giobbie-Hu
Page 124 and 125: 8 COMPLEMENTARY AND ALTERNATIVE (UN
Page 126 and 127: corresponding benefit in obstructiv
Page 130 and 131: areas of the state were more likely
Page 132 and 133: 8 Miller DC, Litwin MS, Bergman J,
Page 134 and 135: 10 EMERGING THERAPIES It is impossi
Page 136 and 137: APPENDIX 1 GUIDELINE DEVELOPMENT PR
Page 138 and 139: study type. Studies published befor
Page 140 and 141: Grade of recommendation Description
Page 142 and 143: 2. National Health and Research Cou
Page 144 and 145: Dr Carole Pinnock AM Principal rese
Page 146 and 147: Surgery Professor Villis Marshall A
Page 148 and 149: APPENDIX 3 TNM CLASSIFICATION OF PR
Page 150 and 151: Summary Prostate T1 T2 T3 T4 N1 M1a
Page 152 and 153: APPENDIX 4 ABBREVIATIONS AND GLOSSA
Page 154 and 155: Glossary Actuarial survival A metho
Page 156 and 157: Effectiveness The extent to which a
Page 158 and 159: Lymph nodes Small, generally pea-si
Page 160 and 161: Each stage is divided into subgroup
Page 162 and 163: APPENDIX 6 - ORGANISATIONS WHICH PR
Page 164 and 165: Consultant Urologist, Royal Brisban
Page 166 and 167: No conflict of interest to declare.
Page 168 and 169: Index to Clinical practice guidelin
Page 170 and 171: cardiovascular mortality 19, 54, 55
Page 172 and 173: androgen deprivation therapy (ADT)
Page 174 and 175: and surgery 32-34 survival 18 toxic
Page 176 and 177: and chemotherapy 89-90 see also bon
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spinal cord compression 62-63 see a
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systemic 141 Tasmania Association f
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