Prostatic Neoplasms: Eton DT

Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM, Anonymous00324. · American Urological Association Education and Research, Inc. · J Urol. · Pubmed #17509297 No free full text.

This publication has no abstract.

Burnett AL, Aus G, Canby-Hagino ED, Cookson MS, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus S, Liebert M, Moul JW, Tangen C, Thrasher JB, Thompson I, Anonymous00008. · The Johns Hopkins Hospital, 600 North Wolfe St., Marburg 407, Baltimore, Maryland 21287-2411, USA. · J Urol. · Pubmed #17570435 No free full text.

Abstract: PURPOSE: In conjunction with the assignment to update the Guidelines for Management of Clinically Localized Prostate Cancer, the American Urological Association Prostate Cancer Guideline Update Panel performed a side analysis of the reporting of erectile function outcomes in this clinical context as published in the medical literature. MATERIALS AND METHODS: Four National Library of Medicine PubMed(R) Services literature searches targeting articles published from 1991 through early 2004 were done to derive outcome reporting (efficacy or side effects) for the treatment of clinical stage T1 or T2 N0M0 prostate cancer. A database was constructed containing descriptions relating to erectile function as well as numerical frequency rates of complete erectile dysfunction, and partial and intact erectile function for various treatments. A literature review was also done, consisting of a PubMed Services search of current measures and protocols used for assessing erectile function outcomes and a survey of consensus opinion sources on the management of male sexual dysfunctions. RESULTS: Based on inclusion criteria 436 articles were selected. Of these articles database extraction from 100 pertaining to radical prostatectomy garnered various characterizations of erectile function, including qualitative descriptions, generic terminology and rating systems. Database extraction from 31 articles, in which results for at least 50 patients were reported, yielded ranges of rates for complete erectile dysfunction, partial erectile function and intact erectile function that were 26% to 100%, 16% to 48% and 9% to 86% for radical prostatectomy, 8% to 85%, 21% to 47% and 36% to 63% for external beam radiation, and 14% to 61%, 21% and 18% for interstitial radiation, respectively. The literature review showed an evolution in standards for studying and reporting erectile function outcomes. CONCLUSIONS: Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment as well as widely disparate rates of erectile dysfunction and erectile function. Future studies must apply scientifically rigorous methodology and standard outcomes measures to advance this field of study.

Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen C, Thrasher JB, Thompson I. · Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. · J Urol. · Pubmed #17222629 No free full text.

Abstract: PURPOSE: The American Urological Association Prostate Guideline Update Panel was charged with updating the Guidelines for Clinically Localized Prostate Cancer. In assessing outcomes with treatment, it became apparent that a highly variable number of definitions exist with respect to biochemical recurrence. Herein, we review the variability in published definitions of biochemical recurrence and make recommendations directed toward improving this terminology by recommending a standard definition in patients treated with radical prostatectomy. MATERIALS AND METHODS: Four PubMed literature searches were performed between May 2001 and April, 2004 and covered articles published from 1991 through early 2004. The search terms included the MeSH major headings of prostate cancer and prostatic neoplasm. All potentially relevant articles were retrieved and a more detailed screen for relevance was performed. An article was considered relevant if it reported treatment outcomes of patients with clinical T1 or T2N0M0 prostate cancer. Data extractors recorded the definition of biochemical recurrence and definitions were then collapsed into categories representing the same criteria. The results of biochemical failure were subcategorized by initial treatment. RESULTS: Of 13,800 citations, a total of 436 articles were selected. Among these, a total of 145 articles contained 53 different definitions of biochemical recurrence for those treated with radical prostatectomy. Of these, the most common definition (35) was a prostate specific antigen of >0.2 ng/mL or a slight variation thereof. In addition, a total of 208 articles reported 99 different definitions of biochemical failure among those treated with radiation therapy. Of these, the American Society for Therapeutic Radiology and Oncology definition (70) and/or a variation thereof was the most commonly reported. In total, 166 different definitions of biochemical failure were identified. Following radical prostatectomy, the Panel recommends defining biochemical recurrence as an initial serum prostate specific antigen of > or =0.2 ng/mL, with a second confirmatory level of prostate specific antigen of >0.2 ng/mL. The Panel recommends the use of the American Society for Therapeutic Radiology and Oncology criteria for patients treated with radiation therapy and acknowledges that these criteria will soon be updated although not yet published. CONCLUSIONS: A high degree of variability in the definition of biochemical recurrence exists following treatment for localized prostate cancer. Strict definitions for biochemical recurrence are necessary to identify men at risk for disease progression and to allow meaningful comparisons among patients treated similarly. The Panel acknowledges the American Society for Therapeutic Radiology and Oncology criteria and future modifications thereof for those receiving radiation therapy and recommends the newly developed American Urological Association criteria for those treated with radical prostatectomy. The purpose for the establishment of this standard is for data reporting purposes and for comparison of similarly treated patients. It is not intended to represent a threshold value for which to initiate treatment. The Panel acknowledges that the clinical decision to initiate treatment will be dependent on multiple factors including patient and physician interaction rather than a specific prostate specific antigen threshold value.

Eton DT, Lepore SJ. · Evanston Northwestern Healthcare and Northwestern University Evanston, IL, USA. · Psychooncology. · Pubmed #12203744 links to  free full text

Abstract: With the established effectiveness of diverse treatments for prostate cancer, identification of the physical and psychosocial consequences of the disease and various treatments becomes critical. We review the literature on the effects of prostate cancer and its treatment on health-related quality of life (HRQoL). Studies show that prostate cancer and its treatment affect both disease-specific HRQoL (i.e. urinary, sexual, and bowel function) as well as general HRQoL (i.e. energy/vitality, performance in physical and social roles). Yet, these effects appear to differ across stage of disease and type of treatment. We outline evidence from three sources: (1) studies that compare men with the disease with an age-matched sample of men without the disease, (2) studies that assess men with the disease across time, and (3) cross-sectional studies that highlight predictors of HRQoL. Future research directions are discussed.

Lepore SJ, Helgeson VS, Eton DT, Schulz R. · Columbia University, Teachers College, Department of Health & Behavior Studies, New York, NY 10027, USA. · Health Psychol. · Pubmed #14570527 links to  free full text

Abstract: Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors.

Helgeson VS, Lepore SJ, Eton DT. · Psychology Department, Carnegie Mellon University, Pittsburgh, PA 15213, USA. · Health Psychol. · Pubmed #16719606 links to  free full text

Abstract: The authors examined whether 3 individual difference variables--self-esteem, self-efficacy, and depressive symptoms--interacted with psychoeducational group interventions for men with prostate cancer (n = 250) to predict general and prostate-specific quality of life. Men with nonmetastatic prostate cancer were randomly assigned to an education intervention, an education plus group discussion intervention, or usual care and followed for 12 months. Eight groups of 10 to 12 men were convened in each condition. Men who began the study with lower self-esteem, lower prostate-specific self-efficacy, and higher depressive symptoms benefited the most from the interventions. Of these 3 moderator variables, the most consistent results emerged for self-esteem. That is, the benefits of the intervention were strongest for men with low self-esteem.

Eton DT, Lepore SJ, Helgeson VS. · Center on Outcomes, Research, and Education, Evanston Northwestern Healthcare and Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA. · Cancer. · Pubmed #15858824 links to  free full text

Abstract: BACKGROUND: The authors examined levels and predictors of psychological distress in the wives of men treated for early-stage prostate carcinoma (PCa). METHODS: Patients with PCa (N = 165) and spouses were interviewed to assess general and cancer-specific distress. Social and intrapersonal factors of spouses as well as clinical characteristics and quality of life of patients were assessed as potential predictors of spouses' distress. RESULTS: Spouses reported more cancer-specific distress than did patients (P < 0.001), but did not differ from patients in general distress. Several spouse-reported factors predicted higher spouses' distress, including less education (P < 0.005), worse marriage quality and less social support (Ps < 0.005), more negative social interaction with the patient (Ps < 0.001), lower self-esteem (Ps < 0.001), less positive coping (Ps < 0.005), searching for meaning (P < 0.001), not finding meaning (P < 0.005), and greater illness uncertainty (Ps < 0.001). Patients' bowel function and mental health also predicted greater spouses' distress (Ps < 0.005). CONCLUSIONS: The findings indicated that overall distress in spouses of early-stage patients with PCa was modest, and it was more likely to be predicted by psychosocial than medical factors.

Eton DT, Lai JS, Cella D, Reeve BB, Talcott JA, Clark JA, McPherson CP, Litwin MS, Moinpour CM. · Northwestern University School of Medicine, Evanston, IL 60201, USA. · Eval Health Prof. · Pubmed #15851770 No free full text.

Abstract: Assessing bowel function (BF) in prostate cancer can help determine therapeutic trade-offs. We determined the components of BF commonly assessed in prostate cancer studies as an initial step in creating an item bank for clinical and research application. We analyzed six archived data sets representing 4,246 men with prostate cancer. Thirty-one items from validated instruments were available for analysis. Items were classified into domains (diarrhea, rectal urgency, pain, bleeding, bother/distress, and other) then subjected to conventional psychometric and item response theory (IRT) analyses. Items fit the IRT model if the ratio between observed and expected item variance was between 0.60 and 1.40. Four of 31 items had inadequate fit in at least one analysis. Poorly fitting items included bleeding (2), rectal urgency (1), and bother/distress (1). A fifth item assessing hemorrhoids was poorly correlated with other items. Our analyses supported four related components of BF: diarrhea, rectal urgency, pain, and bother/distress.

Eton DT, Lepore SJ, Helgeson VS. · Evanston Northwestern Healthcare and Northwestern University, Evanston, Illinois. · Cancer. · Pubmed #11745222 links to  free full text

Abstract: BACKGROUND: Men with localized prostate carcinoma are faced with important treatment decisions, and quality of life (QoL) information has become a crucial element of decision making. The first objective of this study was to compare the early, health-related QoL (HRQoL) of men with localized prostate carcinoma who were treated with radical prostatectomy, external beam radiotherapy, or brachytherapy. A second objective was to identify demographic and psychosocial variables that predict HRQoL. METHODS: Two-hundred fifty-six men with localized prostate carcinoma were interviewed within 7 weeks of treatment initiation. The interview included measures of prostate-specific HRQoL (the University of California-Los Angeles Prostate Cancer Index), general HRQoL (the SF-36), and psychosocial variables. RESULTS: After adjusting for covariates, treatment group differences were found for both prostate specific HRQoL and general HRQoL. Men who underwent prostatectomy reported more urinary and sexual problems and more general physical dysfunction compared with men who were treated with either form of radiation therapy. Men who were treated with brachytherapy reported the fewest problems in sexual function and the least general physical dysfunction. Few treatment group differences were found in mental functioning. Both demographic factors and psychosocial factors predicted HRQoL. Older men and African-American men reported more physical problems than younger men and Caucasian men, respectively. A supportive social environment, high self-efficacy, and high self-esteem were predictive of better HRQoL. CONCLUSIONS: Shortly after undergoing treatment for localized prostate carcinoma, men who underwent radical prostatectomy, older men, and African-American men are at heightened risk for experiencing prostate-specific and general deficits in HRQoL. Having psychosocial resources from which to draw may enhance HRQoL.