Circulating tumor cells as prognostic biological marker in different stages prostate cancer and the effect of different therapeutic approaches on their expression

BACKGROUND

Circulating tumor cells (CTCs) represent a prerequisite for the formation of metastases. The aim of the study was to identify the role of CTCs as a biological marker of aggressiveness of prostate cancer and verify the expression of molecular markers predictive of response to different therapeutic approaches.

METHODS

Prospective, single-arm, non-randomized trial. Twenty-four patients with prostate cancer were enrolled into two groups: group 1 (N.=11) with localized prostate cancer treated with radical prostatectomy; group 2 (N.=13) with metastatic disease. We performed, dosage of blood PSA and testosterone, detection of EGFR, PSMA, PSA and Androgen Receptor (AR) expression on CTC during pre-treatment and follow-up at 1, 3, 9 and 18 months.

RESULTS

A total of 65 blood samples were evaluated. In group 1, pre-treatment sampling was negative for the expression of markers on CTC in 90% of the patients while group 2 pre-treatment sampling was positive for the expression of at least one biomarker in seven of 13 patients (54%). After treatment, four patients in group 2 experienced a reduced expression of the markers on CTC, however, in one case there was a new increase of PSA and PSMA at 3 months. One patient had a positivity of AR at 3 months.

CONCLUSIONS

The expression of PSA, PSMA, EGFR and AR on CTCs appears to be absent in the pre-treatment samplings in cases of localized prostate cancer. The same markers are hyper-expressed before treatment mostly in metastatic prostate cancer and can relate with early biochemical relapse.

High-intensity focused ultrasound in prostate cancer: today's outcomes and tomorrow's perspectives

High-intensity focused ultrasound (HIFU) is a minimally invasive therapy applied for prostate cancer that capitalizes on the coagulation necrosis that occurs at temperatures greater than 60°C. Owing to a lack of long-term follow-up data the procedure is still considered experimental treatment. As primary therapy, HIFU is indicated in patients aged ≥70 years with clinical organ-confined disease, although it has also been used, with encouraging results, as first line salvage therapy after definitive treatment, and in locally advanced (T3-4) and non-metastatic hormone-resistant prostate cancer. Morbidity associated with this treatment method appears to be low and includes urinary retention (1-9%), urethral stricture (4-14%), incontinence (1-15%), erectile dysfunction (13-53%) and rectourethral fistulae (0-3%). The risk of complications increases with repeated treatments. A few studies have recently been published on HIFU as focal therapy. HIFU technology can be enhanced using means such as ultrasound microbubble contrast agents for assessment of therapy efficacy, magnetic resonance imaging to guide the enhancement of heat rate, and localized drug and gene delivery.

High intensity focused ultrasound as first line salvage therapy in prostate cancer local relapse after radical prostatectomy: 4-year follow-up outcomes

BACKGROUND

Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and the second leading cause of cancer death in developed countries. Despite the primary treatments, 20-30% of patients experience a recurrence. The main objective of this study was to evaluate the clinical efficacy of salvage high intensity focused ultrasound (HIF U) after radical prostatectomy in terms of biochemical free survival rate (BFSR) and PSA nadir.

METHODS

Twenty two patients with local recurrence of Pca after radical prostatectomy underwent HIFU as first-line salvage therapy. Considering that in all HIFU experiences, PSA nadir and PSA failure are different and PSA definition of BFSR is unknown, we defined treatment success as a PSA nadir ≤0.4 ng/mL 3 months after treatment. All early and late medical and surgical complications were recorded.

RESULTS

Ten of the 22 patients (45.5%) were classified as "success" three months after HIFU, showing a nadir PSA≤0.4 ng/mL; 12/22 patients (54.5%) were classified as "failure" during follow-up (median follow-up: 48 months). Seventeen of 22 (77%) patients were continent (no-pad) before HIFU. A new diagnosis of stress urinary incontinence was made in 5 cases (early onset) after treatment. A case of vesicoureteral anastomotic stenosis was treated, endoscopically through cold urethrotomy. We did not observe cases of recto-urinary fistula or persistent lower urinary tract symptoms. Two sevenths of the patients complained about de novo erectile dysfunction after HIFU.

CONCLUSIONS

The positive oncologic outcomes in the short term anyway obtained in selected patients, associated with documented mild side effects, represent the basis to start more organic, prospective, randomized and multicenter study protocols, that with a long term follow-up could confirm these promising preliminary results.

[Focal surgery in testis cancer: current state of the art]

Radical orchiectomy is the standard treatment of testicular neoplasia causing androgen insufficiency, infertility and psychological stress. Focal surgery allows the preservation of fertility, endocrine function and integrity of the genital anatomy, with preservation of the image of the male body. The EAU guidelines suggest focal surgery in case of synchronous bilateral tumors, metachronous contralateral tumours, tumour in solitary testis with normal pre-operative testosterone levels, when the tumor volume less than 30% of the testicular volume. There are two focal surgical techniques: tumorectomy and polar resection, followed by biopsies and frozen section of the resection bed. In case of benign tumours, the treatment is often curative. In case of malignancy, carcinoma in situ is frequently found in the surrounding tissues. Adjuvant treatment with chemotherapy or radiotherapy is performed with a fair success rate. These adjuvant treatments reduce or delete the functional benefits achieved by conservative surgery. The evidence of the literature suggests that focal surgery is a valid option for all patients with testicular tumours that are not palpable and small sized, with the advantage of avoiding unnecessary radical orchiectomy in most cases. Therefore, the selection criteria for focal surgery are the mass size (less than 25 mm) and a safety distance of the tumor from the rete testis, in order to preserve testicular vascularization. A close follow-up with ultrasound, testicular markers and radiological examinations is mandatory in case of germ cell neoplasia treated conservatively in patients with indications for conservative surgery.

The mental and emotional status after radical cystectomy and different urinary diversion orthotopic bladder substitution versus external urinary diversion after radical cystectomy: A propensity score-matched study

OBJECTIVES

The quality of life in patients undergoing radical cystectomy and urinary diversion is gaining importance. Nowadays a broad consensus about the best urinary diversion does not exist. This study presents an all-round analysis of the impact of two types of urinary diversion on life's psycho-social aspects in patients undergoing radical cystectomy.

METHODS

This is an observational, single-centre, prospective study. Eligible participants underwent radical cystectomy and urinary diversion for bladder cancer in our department from January 2020 and February 2024. Of 130 included patients, 90 (45 with Bricker's ureteroileocutaneostomy and 45 received orthotopic bladder replacement) patients were matched and the study groups were well balanced for the baseline-matched variables. Patients completed 4 questionnaires (EORTC QLQ-C30, PGWBI, HADS, PSQI) at three different times: before the surgical procedure, and at 3 and 12 months.

RESULTS

Time shows a statistically significant effect (p < 0.0005) on four of the five functional scales explored (Physical Functioning, Role Functioning, Emotional Functioning, Social Functioning), and for all the nine symptoms/items' scales (p < 0.0005) and the Global Health Status (p = 0.003) in EORTC QLQ-C30. Neobladder's group shows a statistically significant improvement on the scales of Physical Functioning, Role Functioning, and Social Functioning, and for symptoms of nausea (p = 0.0027), pain (p = 0.0005), dyspnea (p = 0.012), insomnia (p = 0.004), constipation (p = 0.003).

CONCLUSION

We do not find a better urinary diversion in absolute terms. Neobladder obtained better results only for specific items and features. The urinary diversion's choice must be made in concert by the patient, the caregiver, and health professionals with adequate counseling.

Local relapse of prostate cancer after primary definitive treatment: the management

INTRODUCTION

Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and the second leading cause of cancer-related death in industrialized countries. Even if the healing chances are very high after definitive treatment of localized disease, 20-30% of patients experience recurrence.

EVIDENCE ACQUISITION

A review of the literature on the management of local recurrent prostate cancer was conducted using the Medline and Embase electronic databases. Search terms included "biochemical relapse", "PSA recurrence", "prostate cancer", "prostate cancer recurrence", "prostate salvage therapy", "radiorecurrent prostate cancer", "Re-HIFU", "post HIFU", "post cryoablation", "postradiation", and "postprostatectomy salvage". The search was restricted to English-language articles. The websites of guidelines organizations (EAU, AUA, NICE) were consulted in order to identify evidence-based practice guidelines. The present role of salvage prostatectomy and radiation therapy was studied and today's outcomes and tomorrow perspectives of salvage focal therapies as cryoablation and HIFU have been analyzed.

EVIDENCE SYNTHESIS

Although the treatment landscape for patients with biochemical recurrence prostate cancer remains challenging, new research is helping to identify patient populations suitable for specific therapies.

CONCLUSIONS

Further evaluation in prospective clinical trials will hopefully confirm the role of therapeutic options in clinical practice and the impact on the long-term survival.