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| Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council trial |
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| Author(s): Adib RS, Anderson JB, Ashken MH, Baumber CD, Bevis CRA, Beynon LL, Blaxland JW, Boag V, Bolger JJ, Boreham J, Bramble FJ, Breakey J, Bullock KN, Burrett J, Carswell GF, Charlton CAC, Chilton CP, Chisholm GD, Clack R, Claridge M, Clark PB, Coulton ER, Cox SR, Cresswell SM, Crowther J, Davies M, DeSousa BA, Deane RF, Devereux MH, Doyle PT, English P, Evans CM, Fellows GJ, Fernie CGM, Fordham M, French ME, Gaches CGC, Gallegos CRR, Gilliland EL, Glaholm J, Glashan RW, Grant JBP, Grayson CEA, Green NA, Griffin S, Hall RR, Hafner B, Hargreave TB, Harrison GSM, Heal MR, Hehir M, Hetherington J, James MJ, Jones PA, Jones RA, Jurczyk LN, Kirk D, Knight S, Lawrence WT, Logie JRC, Lucas M, Luck RJ, McGregor A, McKelvie GB, Moffat LEF, Moore KTH, Morgan RJ, Newling DWK, Orr PGG, Parish S, Perry K, Peto R, Pollard R, Powell CS, Radley A, Rampling R, Rennie CD, Rhind JR, Richards B, Roberts C, Robinson MRG, Rogers ACN, Rose MB, Ross RTA, Royle MG, Sagar S, Sethia KK, Shearer RJ, Shepheard BGF, Smith J, Smith JC, Smith MF, Smith PH, Sole GM, Stephenson TP, Stewart AL, Stower MJ, Styles RA, Thomson RW, Thompson E, Tolley DA, Townell NH, Turner DTL, Urwin GH, Ward JP, Watson GS, Watson GM, Wightman JAK, Williams JL |
| Source: BRITISH JOURNAL OF UROLOGY Volume: 79 Issue: 2 Pages: 235-246 Published: FEB 1997 |
| Times Cited: 19 References: 16 |
| Abstract: Objective To compare the effect on the course of advanced prostate cancer of hormone treatment commenced on diagnosis with that deferred until clinically significant progression occurs. Patients and methods Nine hundred and thirty-eight patients with locally advanced or asymptomatic metastatic prostate cancer were randomized either to immediate treatment (orchidectomy or luteinizing hormone-releasing hormone analogue) or to the same treatment deferred until an indication occurred, Follow-up and management were otherwise according to the participating clinician's normal practice. Information was collected annually on survival, local and distant progression, and major complications (pathological fracture, spinal cord compression, ureteric obstruction and extra-skeletal metastases). Results Follow-up data were returned on 934 patients; 51 deferred patients died from causes other than prostate cancer before treatment was started (but only five of these presented at age <70 years) and 29 died from prostate cancer before treatment could be started, Treatment was commenced for local progression almost as frequently as for metastatic disease, Progression from M0 to M1 disease (P<0.001, two-tailed) and development of metastatic pain occurred more rapidly in deferred patients; 141 deferred patients needed transurethral resection for local progression compared with 65 treated immediately (P<0.001, two-tailed). Pathological fracture, spinal cord compression, ureteric obstruction and development of extra-skeletal metastases were twice as common in deferred patients. Of the patients who died, 67% did so from prostate cancer; 361 patients died in the deferred arm compared with 328 in the immediate arm (P=0.02, two-tailed), where 257 and 203 were deaths from prostate cancer, respectively (P=0.001 two-tailed). This difference was seen largely in M0 patients, with 119 and 81 deaths from prostate cancer, respectively (P<0.001 two-tailed). Conclusions The results consistently favour immediate treatment, although some of the data, especially on M0 patients, are immature. The implications for management of advanced prostate cancer are discussed.
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| Document Type: Article |
| Language: English |
Addresses:
1. GARTNAVEL ROYAL HOSP, DEPT UROL, GLASGOW G12 0YN, LANARK SCOTLAND
2. ROYAL HALLAMSHIRE HOSP, SHEFFIELD S10 2JF, S YORKSHIRE ENGLAND
3. CLAYTON HOSP, WAKEFIELD, W YORKSHIRE ENGLAND
4. NORFOLK & NORWICH HOSP, NORWICH NR1 3SR, NORFOLK ENGLAND
5. BURY GEN HOSP, BURY ST EDMUNDS, SUFFOLK ENGLAND
6. VICTORIA HOSP, BLACKPOOL, LANCS ENGLAND
7. NEW CROSS HOSP, WOLVERHAMPTON, ENGLAND
8. KING EDWARD VII HOSP, WINDSOR, BERKS ENGLAND
9. WESTON PK HOSP, SHEFFIELD, S YORKSHIRE ENGLAND
10. ROYAL BOURNEMOUTH HOSP, BOURNEMOUTH, DORSET ENGLAND
11. ADDENBROOKES HOSP, CAMBRIDGE, ENGLAND
12. MONKLANDS DIST GEN HOSP, AIRDRIE, SCOTLAND
13. ROYAL UNITED HOSP, BATH BA1 3NG, AVON ENGLAND
14. DERBYSHIRE ROYAL INFIRM, DERBY DE1 2QY, ENGLAND
15. WESTERN GEN HOSP, EDINBURGH EH4 2XU, MIDLOTHIAN SCOTLAND
16. KENT & CANTERBURY HOSP, CANTERBURY, KENT ENGLAND
17. LEEDS GEN HOSP, LEEDS, W YORKSHIRE ENGLAND
18. FREEMAN RD HOSP, NEWCASTLE UPON TYNE NE7 7DN, TYNE & WEAR ENGLAND
19. LLANELLI HOSP, LLANELLI, DYFED WALES
20. GLASGOW HOSP, GLASGOW, LANARK SCOTLAND
21. N MIDDLESEX HOSP NHS TRUST, LONDON N18 1QX, ENGLAND
22. DRYBURN HOSP, DURHAM DH1 5TW, ENGLAND
23. GLAN CLYWD HOSP, BODELWYDDAN, WALES
24. CHURCHILL HOSP, OXFORD OX3 7LJ, ENGLAND
25. ROYAL LIVERPOOL HOSP, LIVERPOOL L7 8XP, MERSEYSIDE ENGLAND
26. CITY GEN HOSP, STOKE ON TRENT ST4 6QG, STAFFS ENGLAND
27. ROYAL UNITED HOSP, BATH BA1 3NG, AVON ENGLAND
28. N TEES GEN HOSP, STOCKTON ON TEES, ENGLAND
29. QUEEN ELIZABETH HOSP, BIRMINGHAM B15 2TH, W MIDLANDS ENGLAND
30. ROYAL INFIRM, HUDDERSFIELD, W YORKSHIRE ENGLAND
31. NO GEN HOSP, SHEFFIELD S5 7AU, S YORKSHIRE ENGLAND
32. SHEEN LANE HLTH CTR, LONDON, ENGLAND
33. WESTERN GEN HOSP, EDINBURGH EH4 2XU, MIDLOTHIAN SCOTLAND
34. ROYAL HAMPSHIRE CTY HOSP, WINCHESTER, HANTS ENGLAND
35. HOVE GEN HOSP, HOVE, E SUSSEX ENGLAND
36. LEIGHTON HOSP, CREWE, CHESHIRE ENGLAND
37. STIRLING ROYAL INFIRM, STIRLING, SCOTLAND
38. PRINCESS ROYAL HOSP, KINGSTON UPON HULL, N HUMBERSIDE ENGLAND
39. ROYAL HOSP, CHESTERFIELD, DERBY ENGLAND
40. MAIDSTONE GEN HOSP, MAIDSTONE, KENT ENGLAND
41. LONGFIELD MED CTR, MALDON, ESSEX ENGLAND
42. RAIGMORE HOSP, INVERNESS, SCOTLAND
43. MORRISTON HOSP, SWANSEA, W GLAM WALES
44. ABERDEEN ROYAL INFIRM, ABERDEEN, SCOTLAND
45. ROYAL HALLAMSHIRE HOSP, SHEFFIELD S10 2JF, S YORKSHIRE ENGLAND
46. ROYAL FREE HOSP, LONDON NW3 2QG, ENGLAND
47. PRINCESS ROYAL HOSP, KINGSTON UPON HULL, N HUMBERSIDE ENGLAND
48. INVERCLYDE ROYAL HOSP, GREENOCK, SCOTLAND
49. EASTBOURNE DIST GEN HOSP, EASTBOURNE, E SUSSEX ENGLAND
50. N TYNESIDE GEN HOSP, N SHIELDS, ENGLAND
51. UNIV GLASGOW, WESTERN INFIRM, GLASGOW G11 6NT, LANARK SCOTLAND
52. BROMSGROVE GEN HOSP, BROMSGROVE, ENGLAND
53. GEN HOSP, HARTLEPOOL, CLEVELAND ENGLAND
54. YORK DIST GEN HOSP, YORK, N YORKSHIRE ENGLAND
55. PONTEFRACT DIST GEN HOSP, PONTEFRACT, W YORKSHIRE ENGLAND
56. IRVINE MEM HOSP, PITLOCHRY, SCOTLAND
57. CLATTERBRIDGE HOSP, BEBINGTON, MERSEYSIDE ENGLAND
58. UNIV LONDON ST GEORGES HOSP, LONDON SW17 0RE, ENGLAND
59. OLDHAM ROYAL INFIRM, OLDHAM, ENGLAND
60. MATER MISERICORDIAE HOSP, DUBLIN 7, IRELAND
61. CHURCHILL HOSP, OXFORD OX3 7LJ, ENGLAND
62. LAW HOSP, CARLUKE, SCOTLAND
63. ST JAMES UNIV HOSP, LEEDS LS9 7TF, W YORKSHIRE ENGLAND
64. CTY HOSP, HEREFORD HR1 2ER, ENGLAND
65. CARDIFF ROYAL INFIRM, CARDIFF, S GLAM WALES
66. CHRISTIE HOSP & HOLT RADIUM INST, MANCHESTER M20 9BX, LANCS ENGLAND
67. AYR HOSP, AYR, SCOTLAND
68. STRACATHRO HOSP, BRECHIN, SCOTLAND
69. PILGRIM HOSP, BOSTON, MA USA
70. BALLOCHMYLE HOSP, MAUCHLINE, SCOTLAND |
| Publisher: BLACKWELL SCIENCE LTD, P O BOX 88, OSNEY MEAD, OXFORD, OXON, ENGLAND OX2 0NE |
| Subject Category: Urology & Nephrology |
| IDS Number: WH255 |
| ISSN: 0007-1331 |
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| | | | | | | | | Record from Web of Science® | | | | | | | | | |