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Chys B, Dumont S, Van Calsteren K, Albersen M, Joniau S. Renal Neoplasm During Pregnancy: A Single Center Experience. Clin Genitourin Cancer 2018; 16:e501-e507. [DOI: 10.1016/j.clgc.2018.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 11/29/2022]
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Veys R, Abdollah F, Briganti A, Albersen M, Poppel HV, Joniau S. Oncological and functional efficacy of nephron-sparing surgery versus radical nephrectomy in renal cell carcinoma stages ≥cT1b: a single institution, matched analysis. Cent European J Urol 2018; 71:48-57. [PMID: 29732207 PMCID: PMC5926644 DOI: 10.5173/ceju.2017.1611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction The purpose of this paper is to compare oncological outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) in renal cell carcinoma (RCC) clinical stages ≥T1b, in a retrospective propensity-score matched cohort of a high-volume, tertiary referral center. This paper also aims to compare renal function and complication rates between groups. Material and methods Our single-institution RCC database was queried to select patients with clinical stages defined by tumor size (T), lymph nodes(N), and metastasis (M) scores of T1b-4 N0 M0, that underwent PN or RN between 2000 and 2014. All images of patients that underwent RN were reviewed, and only patients deemed eligible for PN were included. Medical records were reviewed to obtain data on tumor characteristics, comorbidities, renal function, and complications. After propensity score matching, 152 patients (76 per group) were included in the final analysis. Primary outcomes were cancer specific survival (CSS), overall survival (OS), and clinical progression-free survival (CPFS). Secondary outcomes were renal function preservation and post-operative complication rates. Results Groups were propensity-score matched. The only parameters that were significantly different between groups were the median follow-up time (RN: 79 months, range 24.1–100.5 vs. PN: 38.5 months, range 20.5–72.1) and a better performance status in the RN group (p = 0.002). The five-year CPFS, CSS, and OS rates were 77.2%, 90.5%, and 86.4%, respectively, in the RN group, and 83.6%, 91.1%, and 82.0%, respectively, in the PN group (p = 0.33, p = 0.55, and p = 0.33, respectively). In the multivariate Cox model, the surgical method was not an independent predictor of CPFS, CSS, or OS. The RN group showed a significantly greater reduction in estimated glomerular filtration rate (RN: 14.1 vs. PN: 5.4 ml/min per 1.73 m²; p <0.03). There was no significant difference in complication rates between the two groups (p = 0.3). The main limitations of this study were its retrospective design and the medium-term follow-up. Conclusions Our results demonstrated the efficacy and safety of PN in patients with RCC in clinical stages ≥T1b. We observed no significant difference in oncological outcomes between the PN and RN groups at medium-term follow ups. The surgical method did not influence these outcomes. Renal function was preserved significantly more frequently in the PN than in the RN group, but the groups had similar complication rates. These findings suggested that PN could be considered an oncologically safe procedure for treating large RCC tumors; thus, PN should always be considered, when technically feasible, regardless of tumor stage.
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Tosco L, Laenen A, Briganti A, Gontero P, Karnes RJ, Bastian PJ, Chlosta P, Claessens F, Chun FK, Everaerts W, Gratzke C, Albersen M, Graefen M, Kneitz B, Marchioro G, Salas RS, Tombal B, Van den Broeck T, Van Der Poel H, Walz J, De Meerleer G, Bossi A, Haustermans K, Van Poppel H, Spahn M, Joniau S. The EMPaCT Classifier: A Validated Tool to Predict Postoperative Prostate Cancer-related Death Using Competing-risk Analysis. Eur Urol Focus 2018; 4:369-375. [DOI: 10.1016/j.euf.2016.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 11/15/2022]
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Tosco L, Laenen A, Gevaert T, Salmon I, Decaestecker C, Davicioni E, Buerki C, Claessens F, Swinnen J, Goffin K, Oyen R, Everaerts W, Moris L, De Meerleer G, Haustermans K, Joniau S. Neoadjuvant degarelix with or without apalutamide followed by radical prostatectomy for intermediate and high-risk prostate cancer: ARNEO, a randomized, double blind, placebo-controlled trial. BMC Cancer 2018; 18:354. [PMID: 29606109 PMCID: PMC5879743 DOI: 10.1186/s12885-018-4275-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recent retrospective data suggest that neoadjuvant androgen deprivation therapy can improve the prognosis of high-risk prostate cancer (PCa) patients. Novel androgen receptor pathway inhibitors are nowadays available for treatment of metastatic PCa and these compounds are promising for early stage disease. Apalutamide is a pure androgen antagonist with a very high affinity with the androgen receptor. The combination of apalutamide with degarelix, an LHRH antagonist, could increase the efficacy compared to degarelix alone. OBJECTIVE The primary objective is to assess the difference in proportions of minimal residual disease at prostatectomy specimen between apalutamide + degarelix vs placebo + degarelix. Various secondary endpoints are assessed: variations of different biomarkers at the tumour level (tissue microarrays to evaluate DNA-PKs, PARP, AR and splice variants, PSMA, etc.), whole transcriptome sequencing, exome sequencing and clinical (PSA and testosterone kinetics, early biochemical recurrence free survival, quality of life, safety, etc.) and radiological endpoints. METHODS ARNEO is a single centre, phase II, randomized, double blind, placebo-controlled trial. The plan is to include at least 42 patients per each of the two study arms. Patients with intermediate/high-risk PCa and who are amenable for radical prostatectomy with pelvic lymph node dissection can be included. After signing an informed consent, every patient will undergo a pelvic 68Ga -PSMA-11 PSMA PET/MR and receive degarelix at standard dosage and start assuming apalutamide/placebo (60 mg 4 tablets/day) for 12 weeks. Within thirty days from the last study medication intake the same imaging will be repeated. Every patient will undergo PSA and testosterone testing the day of randomization, before the first drug intake, and after the last dose. Formalin fixed paraffin embedded tumour samples will be collected and used for transcriptome analysis, exome sequencing and immunohistochemistry. DISCUSSION ARNEO will allow us to answer, first, whether the combined treatment can result in an increased proportion of patients with minimal residual disease. Secondly, It will enable the study of the molecular consequences at the level of the tumour. Thirdly, what the consequences are of new generation androgen receptor pathway inhibitors on 68Ga -PSMA-11 PET/MR. Finally, various clinical, safety and quality of life data will be collected. TRIAL REGISTRATION EUDRaCT number: 2016-002854-19 (authorization date 3rd August 2017). clinicalTrial.gov: NCT03080116 .
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Tutolo M, Bianchi M, Castagna G, Briganti A, Salonia A, Joniau S, Van Cleynenbreugel B, Bekhuis Y, Montorsi F, Everaerts W, Van der Aa F. PD26-04 IS THE ICIQ-SF QUESTIONNAIRE RELIABLE IN PREDICTING QOL OUTCOMES? RESULTS OF A PROSPECTIVE SINGLE-CENTER STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joniau S, Chys B, Briganti A, Chlosta P, De Meerleer G, Everaerts W, Gontero P, Graefen M, Gratzke C, Karnes RJ, Marchioro G, Sanchez-Salas R, Spahn M, Tombal B, Van der Poel H, Van Poppel H. MP16-18 VALIDATION OF STAMPEDE CRITERIA FOR NON-METASTATIC PROSTATE CANCER - AN EMPACT STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gontero P, Marra G, Alessio P, Oderda M, Palazzetti A, Pisano F, Battaglia A, Munegato S, Frea B, Munoz F, Filippini C, Linares E, Sanchez-Salas R, Goonewardene S, Dasgupta P, Cahill D, Challacombe B, Popert R, Gillatt D, Persad R, Palou J, Joniau S, Smelzo S, Piechaud T, De La Taille A, Roupret M, Albissini S, Van Velthoven R, Morlacco A, Vidit S, Gandaglia G, Mottrie A, Smith J, Joshi S, Fiscus G, Berger A, Aron M, Van Der Poel H, Tilki D, Murphy D, Lawrentschuk N, Davis J, Leung G, Karnes RJ. PD29-04 COMPLICATIONS AND FUNCTIONAL OUTCOMES OF SALVAGE RADICAL PROSTATECTOMY: A COMPARISON BETWEEN OPEN AND ROBOT-ASSISTED APPROACHES IN A MULTICENTRE SERIES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Foerster B, Petros F, Seisen T, Xylinas E, Kimura S, Monteiro LL, Azizi M, Bandini M, Clinton T, Hendricksen K, Ku JH, Grabbert M, Czech AK, Mathieu R, Muilwijk T, Anele U, Matin SF, Krabbe LM, Rouprêt M, Briganti A, Heidenreich A, Pycha A, Autorino R, Egawa S, Chlosta P, Spiess PE, Joniau S, Kassouf W, Shariat SF. MP18-13 VALIDATION OF EAU GUIDELINE’S PRETREATMENT RISK STRATIFICATION PARAMETERS IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fossati N, Suardi N, Gandaglia G, Bravi CA, Soligo M, Karnes JR, Schmautz M, Heidenreich A, Herlemann A, Gratzke C, Stief C, Battaglia A, Everaerts W, Joniau S, Van Poppel H, Kalz A, Osmonov D, Juenemann KP, Rajarubendra N, Gill IS, Shariat SF, Mottrie A, Montorsi F, Briganti A. PD10-03 ASSESSING THE UNDER-ESTIMATION OF NODAL TUMOUR BURDEN BY 68GA-PSMA AND 11C-CHOLINE PET/CT SCAN IN PATIENTS TREATED WITH SALVAGE LYMPH NODE DISSECTION FOR NODAL RECURRENCE OF PROSTATE CANCER: A LARGE MULTI-INSTITUTIONAL ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Foerster B, Matin SF, Gupta M, Schweitzer D, Clinton T, Kimura S, Bandini M, Ku JH, Muilwijk T, Monteiro LL, Abufaraj M, Petros F, Bivalacqua TJ, Hendricksen K, Krabbe LM, Egawa S, Briganti A, Joniau S, Kassouf W, Pierorazio PM, van Rhijn BW, Margulis V, Necchi A, Shariat SF. MP18-02 EFFICACY OF PREOPERATIVE CHEMOTHERAPY ON OUTCOMES OF HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA (UTUC). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Albersen M, Parnham A, Joniau S, Sahdev V, Christodoulidou M, Castiglione F, Nigam R, Malone P, Freeman A, Jameson C, Minhas S, Ralph DJ, Muneer A. Predictive factors for local recurrence after glansectomy and neoglans reconstruction for penile squamous cell carcinoma. Urol Oncol 2018; 36:141-146. [DOI: 10.1016/j.urolonc.2017.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/31/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
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Gandaglia G, Soligo M, Battaglia A, Muilwijk T, Robesti D, Capitanio U, Tutolo M, Gallina A, Fossati N, Zaffuto E, Moschini M, Scattoni V, Joniau S, Karnes JR, Montorsi F, Briganti A. MP34-14 WHICH PATIENTS WITH CLINICALLY NODE POSITIVE PROSTATE CANCER BENEFIT FROM RADICAL PROSTATECTOMY? THE IMPACT OF THE SIZE AND SITE OF NODAL INVOLVEMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gontero P, Marra G, Alessio P, Oderda M, Palazzetti A, Pisano F, Battaglia A, Munegato S, Calleris G, Frea B, Munoz F, Filippini C, Linares E, Sanchez-Salas R, Goonewardene S, Dasgupta P, Cahill D, Challacombe B, Popert R, Gillatt D, Persad R, Palou J, Joniau S, Smelzo S, Piechaud T, De La Taille A, Roupret M, Albissini S, Van Velthoven R, Morlacco A, Vidit S, Gandaglia G, Mottrie A, Smith J, Joshi S, Fiscus G, Berger A, Aron M, Van Der Poel H, Tilki D, Murphy D, Lawrentschuk N, Davis J, Leung G, Karnes RJ. MP11-05 ONCOLOGICAL OUTCOMES OF SALVAGE RADICAL PROSTATECTOMY IN A CONTEMPORARY, MULTICENTRE SERIES OF 395 CASES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Marra G, Gontero P, Alessio P, Oderda M, Palazzetti A, Pisano F, Battaglia A, Munegato S, Calleris G, Frea B, Munoz F, Filippini C, Linares E, Sanchez-Salas R, Goonewardene S, Dasgupta P, Cahill D, Challacombe B, Popert R, Gillatt D, Persad R, Palou J, Joniau S, Smelzo S, Piechaud T, De La Taille A, Roupret M, Albisinni S, Van Velthoven R, Morlacco A, Vidit S, Gandaglia G, Mottrie A, Smith J, Joshi S, Fiscus G, Berger A, Aron M, Van Der Poel H, Tilki D, Murphy D, Lawrentschuk N, Davis J, Gordon L, Karnes R. Is it worth to perform radical prostatectomy in a salvage setting? Results of a contemporary multicentre series of 395 cases. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31234-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oderda M, Joniau S, Palazzetti A, Falcone M, Melloni G, Van Den Bossche H, Deconinck S, Zattoni F, Karnes RJ, Gontero P. Is 11C-choline Positron Emission Tomography/Computed Tomography Accurate to Detect Nodal Relapses of Prostate Cancer After Biochemical Recurrence? A Multicentric Study Based on Pathologic Confirmation from Salvage Lymphadenectomy. Eur Urol Focus 2018; 4:288-293. [DOI: 10.1016/j.euf.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/20/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
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Joniau S, Spyrantis M, Briganti A, Chlosta P, Gontero P, Graefen M, Gratzke C, Karnes J, Marchioro G, Sanchez-Salas R, Spahn M, Tombal B, Van Der Poel H, Van Poppel H. Gleason score 6 prostate cancer is not always harmless. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fossati N, Willemse PP, Van Den Broeck T, Yuan Y, Briers E, Bellmunt J, Bolla M, Cornford P, De Santis M, MacPepple E, Henry A, Matveev S, Van Der Poel H, Van Der Kwast T, Rouvière O, Wiegel T, Lam T, Mottet N, Joniau S. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)32049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gonnissen A, Isebaert S, Perneel C, McKee CM, Van Utterbeeck F, Lerut E, Verrill C, Bryant RJ, Joniau S, Muschel RJ, Haustermans K. Patched 1 Expression Correlates with Biochemical Relapse in High-Risk Prostate Cancer Patients. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:795-804. [PMID: 29339090 PMCID: PMC5840486 DOI: 10.1016/j.ajpath.2017.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 12/26/2022]
Abstract
There is an unmet clinical need for adequate biomarkers to aid risk stratification and management of prostate cancer (PCa) patients. Even within the high-risk PCa category, not all patients will invariably have a poor prognosis, and improved stratification of this heterogeneous group is needed. In this context, components of the hedgehog (Hh) pathway may have promise as biomarkers, because the available evidence suggests increased Hh pathway activity may confer a poorer outcome in advanced and castrate-resistant PCa. In this study, potential associations between Hh pathway protein expression and clinicopathological factors, including time to biochemical recurrence (BCR), were investigated using a tissue microarray constructed from benign and malignant prostate samples from 75 predominantly high-risk PCa patients who underwent radical prostatectomy. Hh signaling activity was found to differ between benign and malignant prostate tissue, with a greater amount of active Hh signaling present in malignant than benign prostate epithelium. High expression of Patched 1 in malignant prostate epithelium was found to be an independent predictor of BCR in high-risk PCa patients. Glioma-associated oncogene 1 may potentially represent a clinically useful biomarker of an aggressive tumor phenotype. Evaluation of Hh signaling activity in PCa patients may be useful for risk stratification, and epithelial Patched 1 expression, in particular, may be a prognostic marker for BCR in high-risk PCa patients.
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Prekovic S, Van den Broeck T, Moris L, Smeets E, Claessens F, Joniau S, Helsen C, Attard G. Treatment-induced changes in the androgen receptor axis: Liquid biopsies as diagnostic/prognostic tools for prostate cancer. Mol Cell Endocrinol 2018; 462:56-63. [PMID: 28882555 DOI: 10.1016/j.mce.2017.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023]
Abstract
Prostate cancer progression and treatment relapse is associated with changes in the androgen receptor axis, and analysis of alternations of androgen receptor signaling is valuable for prognostics and treatment optimization. The profile of androgen receptor axis is currently obtained from biopsy specimens, which are not always easy to obtain. Moreover, the information acquired only provides a snapshot of the tumor biology, with strict spatial and temporal limitations. On the other hand, circulation is easily accessible source of both circulating tumor cells and circulating tumor DNA, which can be sampled at numerous time points. This Review will explore the potential use of androgen receptor axis alternations detectable in the blood in therapeutic decision-making and precision medicine for advancing metastatic castration-resistant prostate cancer.
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Smeets E, Lynch AG, Prekovic S, Van den Broeck T, Moris L, Helsen C, Joniau S, Claessens F, Massie CE. The role of TET-mediated DNA hydroxymethylation in prostate cancer. Mol Cell Endocrinol 2018; 462:41-55. [PMID: 28870782 DOI: 10.1016/j.mce.2017.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/30/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
Ten-eleven translocation (TET) proteins are recently characterized dioxygenases that regulate demethylation by oxidizing 5-methylcytosine to 5-hydroxymethylcytosine and further derivatives. The recent finding that 5hmC is also a stable and independent epigenetic modification indicates that these proteins play an important role in diverse physiological and pathological processes such as neural and tumor development. Both the genomic distribution of (hydroxy)methylation and the expression and activity of TET proteins are dysregulated in a wide range of cancers including prostate cancer. Up to now it is still unknown how changes in TET and 5(h)mC profiles are related to the pathogenesis of prostate cancer. In this review, we explore recent advances in the current understanding of how TET expression and function are regulated in development and cancer. Furthermore, we look at the impact on 5hmC in prostate cancer and the potential underlying mechanisms. Finally, we tried to summarize the latest techniques for detecting and quantifying global and locus-specific 5hmC levels of genomic DNA.
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Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol 2017; 36:446-453. [PMID: 29240541 DOI: 10.1200/jco.2017.75.4853] [Citation(s) in RCA: 842] [Impact Index Per Article: 120.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Retrospective studies suggest that metastasis-directed therapy (MDT) for oligorecurrent prostate cancer (PCa) improves progression-free survival. We aimed to assess the benefit of MDT in a randomized phase II trial. Patients and Methods In this multicenter, randomized, phase II study, patients with asymptomatic PCa were eligible if they had had a biochemical recurrence after primary PCa treatment with curative intent, three or fewer extracranial metastatic lesions on choline positron emission tomography-computed tomography, and serum testosterone levels > 50 ng/mL. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions (surgery or stereotactic body radiotherapy). Surveillance was performed with prostate-specific antigen (PSA) follow-up every 3 months, with repeated imaging at PSA progression or clinical suspicion for progression. Random assignment was balanced dynamically on the basis of two factors: PSA doubling time (≤ 3 v > 3 months) and nodal versus non-nodal metastases. The primary end point was androgen deprivation therapy (ADT)-free survival. ADT was started at symptomatic progression, progression to more than three metastases, or local progression of known metastases. Results Between August 2012 and August 2015, 62 patients were enrolled. At a median follow-up time of 3 years (interquartile range, 2.3-3.75 years), the median ADT-free survival was 13 months (80% CI, 12 to 17 months) for the surveillance group and 21 months (80% CI, 14 to 29 months) for the MDT group (hazard ratio, 0.60 [80% CI, 0.40 to 0.90]; log-rank P = .11). Quality of life was similar between arms at baseline and remained comparable at 3-month and 1-year follow-up. Six patients developed grade 1 toxicity in the MDT arm. No grade 2 to 5 toxicity was observed. Conclusion ADT-free survival was longer with MDT than with surveillance alone for oligorecurrent PCa, suggesting that MDT should be explored further in phase III trials.
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Seikkula H, Janssen P, Tutolo M, Tosco L, Battaglia A, Moris L, Van den Broeck T, Albersen M, De Meerleer G, Van Poppel H, Everaerts W, Joniau S. Comparison of Functional Outcome after Extended versus Super-Extended Pelvic Lymph Node Dissection during Radical Prostatectomy in High-Risk Localized Prostate Cancer. Front Oncol 2017; 7:280. [PMID: 29214148 PMCID: PMC5702642 DOI: 10.3389/fonc.2017.00280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background Urinary continence and erectile function (EF) are best preserved when meticulous dissection of prostate and nerve sparing technique are used during radical prostatectomy (RP). However, extent of lymph node dissection (LND) may also adversely affect functional results. Objective To determine whether performing a super-extended LND (seLND) has a significant effect on recovery of urinary continence and EF after RP. Design, setting, and participants All patients who underwent RP from January 2007 until December 2013 were handed questionnaires assessing continence and EF. All patients in whom at least an extended LND (eLND) was performed were selected. This search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires and were included in our analysis. Outcome measurements and statistical analysis All questionnaires were reviewed. We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full recovery of continence (no loss of urine) and full recovery of EF (successful intercourse possible). Patients who did not reach the endpoint when the last questionnaire was filled out were censored at that time. Median follow-up was 12.43 months for continence, and 18.97 months for EF. Results and limitations Patients undergoing seLND have a lower chance of regaining both urinary continence [hazard ratio (HR) 0.59, 95% CI 0.39–0.90, p = 0.026] and EF (HR 0.28, 95% CI 0.13–0.57, p = 0.009). Age at surgery had a significant influence on both continence and EF in multivariate analysis. Major limitation of the study was that no formal preoperative assessment of continence and potency was done. Conclusion Extending the LND template beyond the eLND template may cause at least a significant delay in recovery of urinary continence and leads to less recovery of EF.
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Marra G, Oderda M, Allasia M, Munegato S, Joniau S, Gontero P. A Review on the Management of Small Renal Masses: Active Surveillance Versus Surgery. Anticancer Agents Med Chem 2017; 18:940-950. [PMID: 29141564 DOI: 10.2174/1871520617666171113123443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/22/2022]
Abstract
Despite the rise of small renal tumour (SRMs) diagnosis and related surgeries, death rate of kidney cancer is increasing, suggesting a non-optimal management of SRMs. Active Surveillance (AS) for kidney cancer was introduced to deal with this paradox. However, incertitude remains on whether and when AS can replace surgery in selected patients. We performed a literature search, reviewed and discussed the evidence in favour of AS or surgery for SRMs. Histopathology and natural history of SRMs, including the percentage of benign tumours amongst SRMs, tumour growth rate, life expectancy of SRMs patients being generally older, and current results of AS series seem to support its use in selected groups. However, kidney cancer is a heterogeneous entity, metastasis and ≥T3a status can be found also for SRMs and no biomarkers or other parameters are available to identify lethal SRMs. Despite the recent improvement in the diagnostic and prognostic work through imaging modalities, renal biopsies and nomograms, the interpretation of a survival plot subjectively is still not possible. The majority of AS studies are retrospective and extensive level 1 evidence cohorts with long term follow up are lacking. No unanimity is present regarding inclusion and exclusion criteria to undergo AS, follow up timings and AS exit criteria. Surgery is the only definitive treatment and remains the current standard. A better understanding of kidney cancer biology and SRMs behaviour is needed to clarify the role of AS and its indications.
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Verbiest A, Couchy G, Job S, Zucman-Rossi J, Caruana L, Lerut E, Oyen R, de Reyniès A, Laguerre B, Rioux-Leclercq N, Wozniak A, Joniau S, Van Poppel H, Van Den Eynde K, Beuselinck B. Molecular Subtypes of Clear Cell Renal Cell Carcinoma Are Associated With Outcome During Pazopanib Therapy in the Metastatic Setting. Clin Genitourin Cancer 2017; 16:e605-e612. [PMID: 29239846 DOI: 10.1016/j.clgc.2017.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously described 4 molecular subtypes of metastatic clear cell renal cell carcinoma (mccRCC), named ccrcc1-4 (Beuselinck et al, 2015). These have both prognostic and predictive value for patients treated with first-line sunitinib, with distinctive objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). The ccrcc2 and ccrcc3 tumors have the best outcomes, followed by ccrcc1 and then ccrcc4. We hypothesized that these molecular subtypes would show similar outcomes with first-line pazopanib treatment. PATIENTS AND METHODS We classified 28 mccRCC tumors treated with pazopanib as first-line therapy, as described previously. The primary endpoints were PFS and OS from the start of pazopanib. A secondary endpoint was ORR. Because there were only 2 ccrcc3 tumors, they were pooled with the ccrcc2 tumors for outcome analysis. RESULTS PFS was 9 months for the ccrcc2 and ccrcc3 tumors, 5 months for ccrcc1 tumors, and 3 months for the ccrcc4 tumors (P = .011). The corresponding OS duration was 69, 19, and 5 months (P = .003). The corresponding ORR was 50%, 33%, and 0%. The corresponding mean tumor size decreased by 34%, 6%, and 2% (P = .032). The ccrcc1-4 classification was a stronger predictor of outcome than the International Metastatic Renal Cell Carcinoma Database Consortium score on univariate analysis (P = .011 vs. P = .094 for PFS and P = .003 vs. .013 for OS). Both remained independent on bivariate analysis. CONCLUSION The molecular subtypes of mccRCC are associated with outcome on pazopanib as first-line therapy. The prognostic and predictive value of the ccrcc1-4 molecular classification requires validation in prospective trials.
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Ouattara A, de Oliveira TR, Holz S, Van den Bossche H, Strybol D, Assenmacher C, Everaerts W, De Meerleer G, Joniau S. Incidental Detection of Occult Thyroid Carcinoma with 11C-Choline PET/CT for High Risk Prostate Cancer. Curr Urol 2017; 10:217-220. [PMID: 29234267 DOI: 10.1159/000447184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022] Open
Abstract
We report a case of a 65-year-old male patient with high-risk prostate cancer, re-staged with 11C-choline positron emission tomography/computed tomography (PET/CT) for prostate specific antigen recurrences 3 years after radical prostatectomy and adjuvant radiation therapy. In addition to 2 suspicious presacral lymph nodes which were resected and proven to be metastatic, PET/CT revealed a very high uptake in a calcified thyroid nodule. Evaluation with fine needle aspiration was suspicious for thyroid carcinoma and the patient underwent total thyroidectomy, confirming a non-metastatic encapsulated follicular variant of papillary thyroid carcinoma. To our knowledge, this is the first report of a thyroid cancer diagnosed with 11C-choline PET/CT for prostate cancer staging.
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