Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer:12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease

The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 (NCT00021450) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis-free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance

Mortality and biochemical recurrence after surgery, brachytherapy, or external radiotherapy for localized prostate cancer: a 10-year follow-up cohort study

To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with I-125 brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan-Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making. Study identifier at ClinicalTrials.gov: NCT01492751

Relaciones entre ansiedad, estados de ánimo y lesiones en jugadoras de voleibol

Uno de los aspectos más relevantes de la práctica deportiva es la lesión. Tanto los antecedentes como las consecuencias de la misma han obtenido en los últimos años la atención de los investigadores, y concretamente el estudio de la relación entre la lesión deportiva y los aspectos psicológicos. Sin embargo, esta relación no ha sido estudiada de la misma manera en el deporte femenino que en el masculino. Además, tampoco hay muchos estudios longitudinales a pie de campo. Desde estas premisas se plantea el estudio llevado a cabo: analizar las relaciones entre factores psicológicos y lesiones deportivas en mujeres deportistas, concretamente jugadoras de voleibol, y hacerlo a lo largo de la temporada competitiva. Otro propósito importante fue profundizar en la relación de causalidad entre variables psicológicas y lesiones, especialmente qué tipo de comportamiento en las variables psicológicas a lo largo de la temporada podría asociarse con la incidencia de lesiones, además de explorar el papel de las variables de rendimiento deportivo como posibles protectores o mediadores en la ocurrencia de lesión. Metodología: La muestraestuvo formada por dos equipos femeninos de voleibol con 21 jugadoras en total. Los instrumentos utilizados fueron el Cuestionario de Características Psicológicas relacionadas con el Rendimiento Deportivo (CPRD) de Buceta et al., (1994), la Escala del Perfil de los Estados de Ánimo (POMS abreviado) de McNair et al., (1971). Versión española abreviada de Fuentes et al., (1995) y Competitive Anxiety Inventory-2 (CSAI-2) de Martens et al., (1990), para las variables psicológicas y las Hojas de registro de lesiones deportivas para las variables relativas a las lesiones. El CPRD se administró una vez al inicio de la temporada, mientras que el CSAI 2 y el POMS se aplicaron una hora antes de cada partido. Y se llevó a cabo un registro de las lesiones de cada equipo. Resultados: El análisis de los resultados se organizó en dos fases: En la primera se siguió una estrategia de análisis transversal, teniendoen cuenta el inicio y final de la temporada. En la segunda se llevó a cabo una estrategia de análisis de tipo longitudinal, combinando el análisis estadístico de series temporales interrumpidas con el análisis visual de las líneas temporales. Se registraron un total de 31 lesiones, la rodilla fue la articulación más frecuente de lesión, seguida de la zona lumbar y del tobillo. El primer equipo, que soportó determinadas circunstancias estresantes a lo largo de su temporada, sufrió más lesiones en partidos y de carácter agudo; el segundo equipo, en cambio, se lesionó más en los entrenamientos y fueron más debidas al uso excesivo. Las variables psicológicas de rendimiento no se relacionaron directamente con las lesiones, sólo la ansiedad cognitiva al final de la temporada se relacionó marginalmente con el número de lesiones totales. Los resultados más interesantes se produjeron a partir del análisis visual de las series temporales. Se evidenció tanto la existencia de patrones complejos de respuesta psicológica, como la importancia de la inestabilidad en la respuesta psicológica de algunas variables, especialmente en ansiedad cognitiva y en cólera, sobre las lesiones. Se elaboró unindicador de inestabilidad psicológica general, el cual se asoció fuertemente con la mayor presencia de eventos psicológicos que solían anteceder a las lesiones. Conclusiones: Este estudio encuentra que la inestabilidad en la respuesta psicológica es un concepto clave, que predispone a experimentar malestar psicológico observable, por la presencia de determinadas reacciones psicológicas adversas o que indican un esfuerzo por parte de la jugadora de movilizar sus recursos ante las demandas de la temporada. La ubicación de muchos de estos eventos psicológicos antes de las lesiones lleva a suponer que pudieran desencadenarlas. Ciertas variables psicológicas tienen un papel muy importante en la citada inestabilidad y se ofrecen orientaciones tanto para el trabajo aplicado como para la investigación posteriorOne of the most relevant aspects of sports practice are injuries. Both the reasons and the consequences of injuries have obtained the attention of investigators in recent years, and specially the relation between a sport injury and psychological aspects. However, this relation was not as much studied for women as for men. There are not many long term studies in that field. On this ground this study was carried out: analyzing the relation between psychological factors and sports injuries in female athletes, namely volleyball players, throughout the competitive season. Another important factor was to analyze in details the causal relation between psychological variables and injuries, especially what kind of psychological variables could be associated with the occurrence of injuries throughout the season, additionally exploring the role of psychological variables for the performance and the prevention of injuries. Methodology: The sample consisted of two women's volleyball teams with in total 21 players. The instruments used were the Cuestionario de Características Psicológicas relacionadas con el Rendimiento deportivo (CPRD) by Buceta et al., (1994), the Mood StateProfile Scale (abbreviated POMS) by McNair et al. (1971). Martens et al., (1990), for the psychological variables and sport injury record sheets for related variables. The CPRD was administered once at the beginning of the season, while CSAI-2 and POMS were applied one hour before each game. A registry of injuries of each player was carried out. Results: The analysis of the results was organized in two phases: In the first one, a transversal analysis strategy was followed, taking into account the beginning and end of the season. In the second one, a longitudinal analysis was carried out, combining the statistical analysis of Time Series with the visual analysis. A total of 31 injuries were recorded, the knee was the most concerned area, followed by lower back and ankle injuries. The first team, which endured certain stressful circumstances throughout the season, suffered more acute injuries ingames. The second team was injured more often in training sessions and injuries were more due to overuse. Psychological performance variables were not directly related to injuries, only cognitive anxiety at the end of the season was marginally related to the number of total injuries. The most interesting results were obtained from the visual analysis of the time series. Both the existence of complex patterns of psychological response and the importance of instability in the psychological response of some variables, especially in cognitive anxiety and anger, on injuries were evidenced. An indicator of general psychological instability was developed, which was strongly associated with the greater presence of psychological events that used to precede the lesions. Conclusions: This study finds that instability in psychological response is a key concept and found that the psychological response of the players can produce either discomfort or serves as motivation to mobilize their reserves. The occurrence of many of these psychological events prior to injury leads one to suppose that they could trigger them. Certain psychological variables play a very important role in thisinstability and provide guidance both for applied work and for further research

Relationships between catastrophising in the face of pain and competition anxiety in sportspeople

El catastrofismo ante el dolor se considera un factor importante de pronóstico en el dolor en general, lo que puede ser relevante en el ámbito deportivo. Además se ha relacionado en diferentes estudios con otras variables psicológicas, como la depresión y la ansiedad. El objetivo del presente estudio ha sido conocer la relación entre el catastrofismo y la ansiedad competitiva en una muestra de 61 deportistas, hombres y mujeres, con edades entre los 14 y los 34 años. Los resultados indican que no hay relación estadísticamente significativa entre ansiedad y catastrofismo, aunque aquellos deportistas con niveles mayores de ansiedad, mostraron puntuaciones más elevadas de catastrofismo

Lesões esportivas e psicologia: Uma revisão (2000-2009)

After a research career gradually increasing since the 70's to late twentieth century about the relationship between sports injuries and psychological factors, the first decade of the new century is very interesting insights in this field of knowledge. The aim of this study is to review the literature published between 2000 and 2009, this area of knowledge. We used the EBSCOHost database, and have analyzed 96 research articles. From each of them has analyzed the following variables: a) Title of the journal, b) Year of publication; c) Country of first author; d) Number of authors; e) Research lines f) Design Research; g) Sample under study, h) variables under study; i) recording instruments; j) Intervention programs. The most significant results indicate that the magazine is published more articles Journal of Sport Rehabilitation, the most prolific authors belong to the Anglo-Saxon, the most productive line of research is that related to the rehabilitation process, with samples of athletes performance, that the variables studied are the cognitive strategies, that the instruments used are the self tests and questionnaires, and that the techniques used in psychological intervention programs are visualization and relaxation.Después de una trayectoria de investigación progresivamente en aumento desde los años 70 hasta final del siglo XX acerca de la relación entre lesiones deportivas y factores psicológicos, la primera década del nuevo siglo ofrece unas perspectivas muy interesantes en este campo de conocimiento. El objetivo de este estudio es revisar la bibliografía especializada publicada entre el año 2000 y el 2009, en esta área de conocimiento. Se ha utilizado la base de datos EBSCOHost, y se han analizado 96 artículos de investigación. De cada uno de ellos se han analizado las siguientes variables: a) Título de la revista; b) Año de publicación; c) País del primer autor; d) Número de autores; e) Líneas de investigación; f) Diseño de investigación; g) Muestra objeto de estudio; h) variables objeto de estudio; i) Instrumentos de registro; y j) Programas de intervención. Los resultados más significativos señalan que la revista que más artículos publica es Journal of Sport Rehabilitation, que los autores más prolíficos pertenecen al ámbito anglosajón, que la línea de investigación más productiva es la referida a los procesos de rehabilitación, con muestras de deportistas de rendimiento, que las variables más estudiadas son las estrategias cognitivas, que los instrumentos más utilizados son los tests y cuestionarios de autoinforme y que las técnicas más utilizadas en los programas de intervención psicológica son la visualización y la relajación.Depois de uma trajetória progressiva de investigações sobre a relação entre lesões esportivas e fatores psicológicos, desde os anos 70 até o final do século XX, na primeira década do novo século apresentam umas perspectivas muito interessantes nesta área de conhecimento. O objetivo desse estudo é de revisar a bibliografia especializada publicada nessa área, entre os anos 2000 e 2009. Foi utilizada a base de dados EBSCOHost, sendo analisados 96 artigos científicos e de cada um deles foram analisadas as seguintes variáveis: a) Título da revista; b) Ano de publicação; c) País do primeiro autor; d) Número de autores; e) Linha de investigação; f) Desenho de investigação; g) Amostra objeto de estudo; h) Variável objeto de estudo; i) Instrumentos de registro; j) Programas de intervenção. Os resultados mais significativos apontam que a revista que mais publicou artigos é a Journal of Sport Rehabilitation, que os autores mais prolíficos pertencem ao âmbito anglo saxônico, que a linha de investigação com mais produção científica é a que se refere aos processos de reabilitação com esportistas de alto rendimento, que as variáveis mais estudadas são as estratégias cognitivas, que os instrumentos mais utilizados são os testes e questionários de auto-informe e que as técnicas mais utilizadas nos programa de intervenção psicológica são a visualização e a relaxação

Comparación de costes de tres tratamientos del cáncer de próstata localizado en España: prostatectomía radical, braquiterapia prostática y radioterapia conformacional externa 3D Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy

Objetivo: Comparar los costes de los tratamientos más establecidos para el cáncer de próstata localizado según grupos de riesgo, edad y comorbilidad, desde la perspectiva del proveedor asistencial. Métodos: Comparación de costes en pacientes reclutados consecutivamente entre 2003 y 2005 en una unidad funcional de tratamiento del cáncer de próstata. La utilización de servicios hasta 6 meses después del inicio del tratamiento se obtuvo de las bases de datos hospitalarias, y los costes directos se estimaron mediante cálculo microcoste. La información sobre las características clínicas de los pacientes y los tratamientos recogió prospectivamente. Los costes se compararon mediante tests no paramétricos de comparación de medianas (Kruskall-Wallis) y un modelo semilogarítmico de regresión múltiple. Resultados: La diferencia de costes fue estadísticamente significativa: medianas de 3229.10 &euro;, 5369.00 &euro; y 6265.60 &euro; para los pacientes tratados con radioterapia conformacional externa 3D, braquiterapia, y prostatectomía radical retropública, respectivamente (pObjective: To compare the initial costs of the three most established treatments for clinically localized prostate cancer according to risk, age and comorbidity groups, from the healthcare provider's perspective. Methods: We carried out a cost comparison study in a sample of patients consecutively recruited between 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain). The use of services up to 6 months after the treatment start date was obtained from hospital databases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristics of patients and treatments was collected prospectively. Costs were compared by using nonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regression model. Results: Among the 398 patients included, the cost difference among treatments was statistically significant: medians were &euro;3,229.10, &euro;5,369.00 and &euro;6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001). In the multivariate analysis (adjusted R²=0.8), the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively). Conclusions: Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment

Five-year quality of life in patients with high-risk localized prostate cancer treated with external beam radiotherapy alone versus external beam radiotherapy with high-dose-rate brachytherapy boost: a prospective multicenter study

Introduction: Brachytherapy (BT) and external beam radiation therapy (EBRT) are effective treatments for high-risk prostate cancer (PCa). However, the impact of these treatments on health-related quality of life (HRQL) remains unclear. In this study, we compared EBRT alone with EBRT plus a boost with high-dose rate (HDR)-BT to determine the impact on HRQL in patients with high-risk PCa. Material and methods: Prospective, multicenter study comparing patients with high-risk PCa treated with EBRT alone or EBRT + HDR-BT from 2004 to 2006. HRQL was assessed at baseline (pre-treatment) and periodically over the 5-year follow-up, using the SF-36 (v.2), EPIC, and FACT-G and FACT-P questionnaires. Results: A total of 129 patients were included in the study, of these, 41 received EBRT alone and 88 EBRT + HDR-BT. All patients received hormonotherapy. Baseline clinical characteristics were similar, except for a slightly higher mean number of comorbidities in the EBRT group. During follow-up, the only significant between-group difference was a greater worsening on EPIC hormonal domain in the EBRT alone group (p = 0.028). There were no significant differences in time and interaction of treatment in SF-36, and FACT-G and FACT-P questionnaires or EPIC urinary incontinence, urinary irritative-obstructive, and bowel and sexual domains over the 5-year follow-up. Oncological outcomes were similar in both groups. Conclusions: After five years of follow-up, EBRT alone or combined with HDR-BT boost had a similar impact on HRQL in patients with high-risk localized PCa. However, patients in the EBRT alone group experienced greater worsening of hormonal domain according to EPIC questionnaire