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Janbain A, Farolfi A, Guenegou-Arnoux A, Romengas L, Scharl S, Fanti S, Serani F, Peeken JC, Katsahian S, Strouthos I, Ferentinos K, Koerber SA, Vogel ME, Combs SE, Vrachimis A, Morganti AG, Spohn SK, Grosu AL, Ceci F, Henkenberens C, Kroeze SG, Guckenberger M, Belka C, Bartenstein P, Hruby G, Emmett L, Omerieh AA, Schmidt-Hegemann NS, Mose L, Aebersold DM, Zamboglou C, Wiegel T, Shelan M. A Machine Learning Approach for Predicting Biochemical Outcome After PSMA-PET-Guided Salvage Radiotherapy in Recurrent Prostate Cancer After Radical Prostatectomy: Retrospective Study. JMIR Cancer 2024; 10:e60323. [PMID: 39303279 PMCID: PMC11452751 DOI: 10.2196/60323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/06/2024] [Accepted: 08/07/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Salvage radiation therapy (sRT) is often the sole curative option in patients with biochemical recurrence after radical prostatectomy. After sRT, we developed and validated a nomogram to predict freedom from biochemical failure. OBJECTIVE This study aims to evaluate prostate-specific membrane antigen-positron emission tomography (PSMA-PET)-based sRT efficacy for postprostatectomy prostate-specific antigen (PSA) persistence or recurrence. Objectives include developing a random survival forest (RSF) model for predicting biochemical failure, comparing it with a Cox model, and assessing predictive accuracy over time. Multinational cohort data will validate the model's performance, aiming to improve clinical management of recurrent prostate cancer. METHODS This multicenter retrospective study collected data from 13 medical facilities across 5 countries: Germany, Cyprus, Australia, Italy, and Switzerland. A total of 1029 patients who underwent sRT following PSMA-PET-based assessment for PSA persistence or recurrence were included. Patients were treated between July 2013 and June 2020, with clinical decisions guided by PSMA-PET results and contemporary standards. The primary end point was freedom from biochemical failure, defined as 2 consecutive PSA rises >0.2 ng/mL after treatment. Data were divided into training (708 patients), testing (271 patients), and external validation (50 patients) sets for machine learning algorithm development and validation. RSF models were used, with 1000 trees per model, optimizing predictive performance using the Harrell concordance index and Brier score. Statistical analysis used R Statistical Software (R Foundation for Statistical Computing), and ethical approval was obtained from participating institutions. RESULTS Baseline characteristics of 1029 patients undergoing sRT PSMA-PET-based assessment were analyzed. The median age at sRT was 70 (IQR 64-74) years. PSMA-PET scans revealed local recurrences in 43.9% (430/979) and nodal recurrences in 27.2% (266/979) of patients. Treatment included dose-escalated sRT to pelvic lymphatics in 35.6% (349/979) of cases. The external outlier validation set showed distinct features, including higher rates of positive lymph nodes (47/50, 94% vs 266/979, 27.2% in the learning cohort) and lower delivered sRT doses (<66 Gy in 57/979, 5.8% vs 46/50, 92% of patients; P<.001). The RSF model, validated internally and externally, demonstrated robust predictive performance (Harrell C-index range: 0.54-0.91) across training and validation datasets, outperforming a previously published nomogram. CONCLUSIONS The developed RSF model demonstrates enhanced predictive accuracy, potentially improving patient outcomes and assisting clinicians in making treatment decisions.
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Affiliation(s)
- Ali Janbain
- European Hospital Georges-Pompidou., Clinical research unit, INSERM Clinical Investigation Center., Paris Cité University, Paris, France
| | - Andrea Farolfi
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Armelle Guenegou-Arnoux
- European Hospital Georges-Pompidou., Clinical research unit, INSERM Clinical Investigation Center., Paris Cité University, Paris, France
| | - Louis Romengas
- European Hospital Georges-Pompidou., Clinical research unit, INSERM Clinical Investigation Center., Paris Cité University, Paris, France
| | - Sophia Scharl
- Department of Radiation Oncology, University of Ulm, Ulm, Germany
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Serani
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sandrine Katsahian
- European Hospital Georges-Pompidou., Clinical research unit, INSERM Clinical Investigation Center., Paris Cité University, Paris, France
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco E Vogel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Alexis Vrachimis
- Department of Radiation Oncology, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | | | - Simon Kb Spohn
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - Stephanie Gc Kroeze
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital-University of Sydney, Sydney, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Sydney, Australia
| | - Ali Afshar Omerieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Lucas Mose
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constantinos Zamboglou
- Department of Radiation Oncology, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Thomas Wiegel
- Department of Radiation Oncology, University of Ulm, Ulm, Germany
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Hsu M, Shan X, Zhang R, Berlin E, Goel A, Agarwal M, Wong YN, Christodouleas JP, Vaughn DJ, Narayan V, Takvorian SU, Vapiwala N, Pantel AR, Haas NB. Prostate Cancer Recurrence: Examining the Role of Salvage Radiotherapy Field and Risk Factors for Regional Disease Recurrence Captured on 18F-DCFPyL PET/CT. Clin Genitourin Cancer 2024; 22:102108. [PMID: 38843766 DOI: 10.1016/j.clgc.2024.102108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 06/19/2024]
Abstract
PURPOSE The role of elective pelvic nodal irradiation in salvage radiotherapy (sRT) remains controversial. Utilizing 18F-DCFPyL PET/CT, this study aimed to investigate differences in disease distribution after whole pelvic (WPRT) or prostate bed (PBRT) radiotherapy and to identify risk factors for pelvic lymph node (LN) relapse. METHODS This retrospective study included patients with PSA > 0.1 ng/mL post-radical prostatectomy (RP) or post-RP and sRT who underwent 18F-DCFPyL PET/CT. Disease distribution on 18F-DCFPyL PET/CT after sRT was compared using Chi-square tests. Risk factors were tested for association with pelvic LN relapse after RP and salvage PBRT using logistic regression. RESULTS 979 18F-DCFPyL PET/CTs performed at our institution between 1/1/2022 - 3/24/2023 were analyzed. There were 246 patients meeting criteria, of which 84 received salvage RT after RP (post-salvage RT group) and 162 received only RP (post-RP group). Salvage PBRT patients (n = 58) had frequent pelvic nodal (53.6%) and nodal-only (42.6%) relapse. Salvage WPRT patients (n = 26) had comparatively lower rates of pelvic nodal (16.7%, p = 0.002) and nodal-only (19.2%, p = 0.04) relapse. The proportion of distant metastases did not differ between the two groups. Multiple patient characteristics, including ISUP grade and seminal vesicle invasion, were associated with pelvic LN disease in the post-RP group. CONCLUSION At PSA persistence or progression, salvage WPRT resulted in lower rates of nodal involvement than salvage PBRT, but did not reduce distant metastases. Certain risk factors increase the likelihood of pelvic LN relapse after RP and can help inform salvage RT field selection.
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Affiliation(s)
- Miles Hsu
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Xinhe Shan
- Department of Medicine, Montefiore Einstein, New York, NY
| | - Rebecca Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Eva Berlin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Arun Goel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - Yu-Ning Wong
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - David J Vaughn
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Vivek Narayan
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Samuel U Takvorian
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Naomi B Haas
- Department of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA.
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Fukuda I, Aoki M, Kimura T, Ikeda K. Radiotherapy after radical prostatectomy for prostate cancer: clinical outcomes and factors influencing biochemical recurrence. Ir J Med Sci 2023; 192:2663-2671. [PMID: 37097540 DOI: 10.1007/s11845-023-03356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Radiotherapy (RT) after radical prostatectomy (RP) includes adjuvant radiotherapy (ART) and salvage radiotherapy (SRT), which can prevent or cure biochemical recurrence. AIMS To evaluate long-term outcomes of RT after RP and to examine factors affecting biochemical recurrence-free survival (bRFS). METHODS Sixty-six received ART and 73 received SRT between 2005 and 2012 were included. The clinical outcomes and late toxicities were evaluated. Univariate and multivariate analyses were performed to examine factors affecting bRFS. RESULTS Median follow-up from RP was 111 months. Five-year bRFS and 10-year distant metastasis-free survival from RP were 82.8% and 84.5% in ART, and 74.6% and 92.4% in SRT, respectively. The most frequent late toxicity was hematuria, which was higher in ART (p = .01). No recurrence within RT field was occurred. On univariate analysis, pelvic RT was associated with favorable bRFS in ART (p = .048). In SRT, post-RP prostate-specific antigen (PSA) level (< 0.05 ng/mL), PSA nadir after RT (≤ 0.01 ng/mL), and time to PSA nadir (≥ 10 months) were associated with favorable bRFS (p = .03, p < .001, and p = .002, respectively). On multivariate analysis, post-RP PSA level and time to PSA nadir were independent predictive factors for bRFS in SRT (p = .04 and p = .005). CONCLUSIONS ART and SRT had favorable outcomes with no recurrence within RT field. In SRT, the time to PSA nadir after RT (≥ 10 months) was found to be a new predictor for favorable bRFS and useful in assessing treatment efficacy.
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Affiliation(s)
- Ichiro Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koshi Ikeda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
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4
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Tan YG, Fang AHS, Lim JKS, Khalid F, Chen K, Ho HSS, Yuen JSP, Huang HH, Tay KJ. Incorporating artificial intelligence in urology: Supervised machine learning algorithms demonstrate comparative advantage over nomograms in predicting biochemical recurrence after prostatectomy. Prostate 2022; 82:298-305. [PMID: 34855228 DOI: 10.1002/pros.24272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE After radical prostatectomy (RP), one-third of patients will experience biochemical recurrence (BCR), which is associated with subsequent metastasis and cancer-specific mortality. We employed machine learning (ML) algorithms to predict BCR after RP, and compare them with traditional regression models and nomograms. METHODS Utilizing a prospective Uro-oncology registry, 18 clinicopathological parameters of 1130 consecutive patients who underwent RP (2009-2018) were recorded, yielding over 20,000 data points for analysis. The data set was split into a 70:30 ratio for training and validation. Three ML models: Naïve Bayes (NB), random forest (RF), and support vector machine (SVM) were studied, and compared with traditional regression models and nomograms (Kattan, CAPSURE, John Hopkins [JHH]) to predict BCR at 1, 3, and 5 years. RESULTS Over a median follow-up of 70.0 months, 176 (15.6%) developed BCR, at a median time of 16.0 months (interquartile range [IQR]: 11.0-26.0). Multivariate analyses demonstrated strongest association of BCR with prostate-specific antigen (PSA) (p: 0.015), positive surgical margins (p < 0.001), extraprostatic extension (p: 0.002), seminal vesicle invasion (p: 0.004), and grade group (p < 0.001). The 3 ML models demonstrated good prediction of BCR at 1, 3, and 5 years, with the area under curves (AUC) of NB at 0.894, 0.876, and 0.894, RF at 0.846, 0.875, and 0.888, and SVM at 0.835, 0.850, and 0.855, respectively. All models demonstrated (1) robust accuracy (>0.82), (2) good calibration with minimal overfitting, (3) longitudinal consistency across the three time points, and (4) inter-model validity. The ML models were comparable to traditional regression analyses (AUC: 0.797, 0.848, and 0.862) and outperformed the three nomograms: Kattan (AUC: 0.815, 0.798, and 0.799), JHH (AUC: 0.820, 0.757, and 0.750) and CAPSURE nomograms (AUC: 0.706, 0.720, and 0.749) (p < 0.001). CONCLUSION Supervised ML algorithms can deliver accurate performances and outperform nomograms in predicting BCR after RP. This may facilitate tailored care provisions by identifying high-risk patients who will benefit from multimodal therapy.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | - Jay K S Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Farhan Khalid
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Henry S S Ho
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - John S P Yuen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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5
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Zaharie AT, Moll M, Goldner G. Biochemical control after adjuvant radiation therapy for prostate cancer: a unicentric, retrospective analysis. Strahlenther Onkol 2021; 197:971-975. [PMID: 33502568 PMCID: PMC8545725 DOI: 10.1007/s00066-020-01742-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To retrospectively evaluate the biochemical no evidence of disease (bNED) and late side effects after adjuvant radiotherapy in prostate cancer patients. METHODS Patients (n = 85) treated with external beam radiotherapy between 1997 and 2013 following radical prostatectomy (RPE) with pathological tumour stage pT2c with positive surgical margins or pT3 and pT4 tumours with or without positive margins who presented with a postoperative and a preradiation prostate-specific antigen (PSA) level below 0.1 ng/ml. The mean dose applied was 66 Gy with conventional fractionation (4 field box-technique). No androgen deprivation therapy was administered, and patients with incomplete data (missing Gleason score, pT stage, or PSA values postoperatively and/or prior to radiation at the presentation at our department) have been excluded from the analysis. Biochemical recurrence was defined as reaching a PSA level > 0.2 ng/ml during follow-up and bNED rates were assessed. In addition, patients were divided into two groups according to the Roach formula for predicting the risk of pelvic node involvement at a cut-off value of 15%. Late urogenital and gastrointestinal side effects (EORTC/RTOG) were assessed. RESULTS After a median follow-up of 60 months the bNED rate was 88% at 5 years and 72% at 10 years for all patients. Patients with low risk of lymph node involvement (group < 15%) had a 5 year and 10 year bNED of 97% and 85%, while patients with high risk of positive lymph node involvement (group > 15%) showed corresponding bNED rates of 77% and 52%, respectively. A significant difference according to the Roach stratification was detected (p ≤ 0.002). Late urogenital (UG) and gastrointestinal (GI) grade ≥ 2 side effects were detected in 10% and 15%, respectively. CONCLUSION Postoperative radiotherapy with an average dose of 66 Gy to the prostatic fossa following RPE provides excellent tumour control rates with acceptable side effects. Patients with a higher risk of positive lymph nodes (> 15%) according to the Roach formula show significant worse tumour control rates.
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Affiliation(s)
| | - Matthias Moll
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Gregor Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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6
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Li G, Li Y, Wang J, Gao X, Zhong Q, He L, Li C, Liu M, Liu Y, Ma M, Wang H, Wang X, Zhu H. Guidelines for radiotherapy of prostate cancer (2020 edition). PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Junjie Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xianshu Gao
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Qiuzi Zhong
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Liru He
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou 510060 P. R. China
| | - Chunmei Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yueping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Mingwei Ma
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Hao Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Hui Zhu
- Department of Nuclear Medicine Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
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7
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Valero J, Montero A, Hernando O, Izquierdo M, Sánchez E, García-Aranda M, López M, Ciérvide R, Martí J, Álvarez B, Alonso R, Chen-Zhao X, Fernández-Letón P, Rubio C. Moderate hypofractionated post-prostatectomy radiation therapy is feasible and well tolerated: experience from a single tertiary cancer centre. Clin Transl Oncol 2021; 23:1452-1462. [PMID: 33433839 DOI: 10.1007/s12094-020-02543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Conventional post-prostatectomy radiation therapy comprises 6.5-8 weeks of treatment, therefore, hypofractionated and shortened schemes arouse increasing interest. We describe our experience regarding feasibility and clinical outcome of a post-prostatectomy moderate hypofractionated image-guided radiotherapy schedule MATERIALS AND METHODS: From Oct 2015-Mar 2020, 113 patients, median age of 62 years-old (range 45-76) and prostate adenocarcinoma of low risk (30%), intermediate risk (49%) and high risk (21%) were included for adjuvant (34%) or salvage radiation therapy (66%) after radical prostatectomy (RP). All patients underwent radiotherapy with image-guided IMRT/VMAT to a total dose of 62.5 Gy in 2.5 Gy/fraction in 25 fractions. Sixteen patients (14%) received concomitant androgen deprivation therapy. RESULTS With a median follow-up of 29 months (range 3-60 months) all patients but three are alive. Eleven patients (10%) developed exclusive biochemical relapse while 19 patients (17%) presented macroscopically visible relapse: prostatectomy bed in two patients (2%), pelvic lymph nodes in 13 patients (11.5%) and distant metastases in four patients (4%). The 3 years actuarial rates for OS, bFRS, and DMFS were 99.1, 91.1 and 91.2%, respectively. Acute and late tolerance was satisfactory. Maximal acute genitourinary (AGU) toxicity was G2 in 8% of patients; maximal acute gastrointestinal (AGI) toxicity was G2 in 3.5% of patients; maximal late genitourinary (LGU) toxicity was G3 in 1% of patients and maximal late gastrointestinal (LGI) toxicity was G2 in 2% of patients. There were no cases of severe acute or late toxicity. No relationship was found between acute or late GI/GU adverse effects and dosimetric parameters, age, presence of comorbidities or concomitant treatments. CONCLUSIONS Hypofractionated radiotherapy (62.5 Gy in 25 2.5 Gy fractions) is feasible and well tolerated with low complication rates allowing for a moderate dose-escalation that offers encouraging clinical results for biochemical control and survival in patients with prostate cancer after radical prostatectomy.
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Affiliation(s)
- J Valero
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - A Montero
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain.
| | - O Hernando
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M Izquierdo
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - E Sánchez
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M García-Aranda
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - M López
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - R Ciérvide
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - J Martí
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - B Álvarez
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - R Alonso
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | - X Chen-Zhao
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
| | | | - C Rubio
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, c/Oña 10, 28050, Madrid, Spain
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8
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Kwon YS, Wang W, Srivastava A, Jang TL, Singer EA, Parikh RR, Kim WJ, Kim IY. Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications. Prostate Int 2020; 9:82-89. [PMID: 34386450 PMCID: PMC8322776 DOI: 10.1016/j.prnil.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to illustrate national trends of post-radical prostatectomy (RP) radiotherapy (RT) and compare outcomes and toxicities in patients receiving eRT versus observation with or without late radiotherapy (lRT). Methods Utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥pT3N0 and/or positive surgical margins). Our study cohort consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (lRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both lRT and observation. Trends of post-RP RT were compared using the Cochran–Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan–Meier analyses compared the eRT and the dRT groups. Results Among those with pathologically confirmed high-risk prostate cancer (PCa) after RP, 12.7% (n = 959), 13.2% (n = 1710), and 74.1% (n = 4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p = 0.004). The multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow-up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Conclusions A blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow-up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.
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Affiliation(s)
- Young Suk Kwon
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Wei Wang
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Arnav Srivastava
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USA
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USA
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USA
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Venclovas Z, Jievaltas M, Milonas D. Significance of Time Until PSA Recurrence After Radical Prostatectomy Without Neo- or Adjuvant Treatment to Clinical Progression and Cancer-Related Death in High-Risk Prostate Cancer Patients. Front Oncol 2019; 9:1286. [PMID: 31824859 PMCID: PMC6883747 DOI: 10.3389/fonc.2019.01286] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: The aim of our study was to evaluate the impact of time until biochemical recurrence (BCR) after radical prostatectomy (RP) without neo- or adjuvant treatment on clinical progression (CP) and cancer-related death (CRD) in high-risk prostate cancer (HRPCa) patients. Materials and methods: A total of 433 men with clinically HRPCa treated between 2001 and 2017 were identified. HRPCa was defined as clinical stage ≥T2c and/or biopsy Gleason score (GS) ≥8 and/or preoperative prostate specific antigen (PSA) value ≥20 ng/ml. Exclusion criteria were neo- or adjuvant treatment and incomplete pathological or follow-up data. BCR was defined as two consecutive PSA values ≥0.2 ng/ml after RP. CP was identified as skeletal lesions, local or loco-regional recurrence. CRD was defined as death from PCa. All men were divided into two groups according to BCR. The chi-square and t-tests were used to compare baseline characteristics between groups. Biochemical progression free survival (BPFS), clinical progression free survival (CPFS), and cancer-specific survival (CSS) rates were estimated using Kaplan-Meier analysis. Patients with detected BCR were analyzed for prediction of CP and CRD with respect to time until BCR. The impact of baseline parameters on BCR, CP, and CRD was assessed by Cox regression analysis. Results: BCR, CP, and CRD rates were 47.8% (207/433), 11.3% (49/433), and 5.5% (24/433), respectively. Median (quartiles) time of follow-up after RP was 64 (40-110) months. Ten-year BPFS rate was 34.2%; CPFS, 81%; and CSS, 90.1%. Men with detected BCR were analyzed for prediction of CP and CRD with respect to time until BCR. The most informative cutoff for time from RP until CP and CRD was ≤ 1 year (p < 0.008). According to this cutoff, men were divided into two groups: BCR detected within 1 year and after a 1-year period. Ten-year CPFS was 49.8% in men with early BCR vs. 81.1% in men with late BCR; CSS was 70.9 vs. 92.8% (p = 0.001). Multivariable analysis confirmed that time until BCR within 1 year predicts CP (p = 0.005) and CRD (p = 0.03). Conclusions: Early BCR is associated with poorer oncological outcomes. The presented results may help both to improve follow-up strategy and opt for more aggressive multimodal treatment of HRPCa in men with very early BCR.
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Tao R, Dai J, Bai Y, Yang J, Sun G, Zhang X, Zhao J, Zeng H, Shen P. The prognosis benefits of adjuvant versus salvage radiotherapy for patients after radical prostatectomy with adverse pathological features: a systematic review and meta-analysis. Radiat Oncol 2019; 14:197. [PMID: 31706339 PMCID: PMC6842460 DOI: 10.1186/s13014-019-1384-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
Background The appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). Methods PubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3. Results A total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (p < 0.0001) and DMFS (p < 0.0001), when compared to SRT. The subgroup analysis of the 5-year OS rate demonstrated that the ART group still had survival advantages compared to the SRT group (p = 0.0006). However, ART and SRT were comparable in 10-year OS rate (p = 0.07). ART had advantages over SRT in both 5-year (p = 0.0003) and 10-year BRFS (p = 0.0003). The subgroup analysis with different follow-up starting points from RP or RT was essentially consistent with the above results. The pooled analysis also showed that ART was superior to ESRT on OS (p = 0.008) and DMFS (p = 0.03), and comparable to ESRT on BRFS (p = 0.1). Conclusions According to this meta-analysis, ART could be served as a preferential treatment for patients with APFs after RP to improve prognosis. Certainly, high-quality, multicenter randomized controlled trials (RCTs) are expecting to confirm the outcomes of our meta-analysis in the future.
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Affiliation(s)
- Ronggui Tao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jiyu Yang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
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11
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Santos PMG, Barsky AR, Hwang WT, Deville C, Wang X, Both S, Bekelman JE, Christodouleas JP, Vapiwala N. Comparative toxicity outcomes of proton-beam therapy versus intensity-modulated radiotherapy for prostate cancer in the postoperative setting. Cancer 2019; 125:4278-4293. [PMID: 31503338 DOI: 10.1002/cncr.32457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite increasing utilization of proton-beam therapy (PBT) in the postprostatectomy setting, no data exist regarding toxicity outcomes relative to intensity-modulated radiotherapy (IMRT). The authors compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicity outcomes in patients with prostate cancer (PC) who received treatment with postprostatectomy IMRT versus PBT. METHODS With institutional review board approval, patients with PC who received adjuvant or salvage IMRT or PBT (70.2 gray with an endorectal balloon) after prostatectomy from 2009 through 2017 were reviewed. Factors including combined IMRT and PBT and/or concurrent malignancies prompted exclusion. A case-matched cohort analysis was performed using nearest-neighbor 3-to-1 matching by age and GU/GI disorder history. Logistic and Cox regressions were used to identify univariate and multivariate associations between toxicities and cohort/dosimetric characteristics. Toxicity-free survival (TFS) was assessed using the Kaplan-Meier method. RESULTS Three hundred seven men (mean ± SD age, 59.7 ± 6.3 years; IMRT, n = 237; PBT, n = 70) were identified, generating 70 matched pairs. The median follow-up was 48.6 and 46.1 months for the IMRT and PBT groups, respectively. Although PBT was superior at reducing low-range (volumes receiving 10% to 40% of the dose, respectively) bladder and rectal doses (all P ≤ .01), treatment modality was not associated with differences in clinician-reported acute or late GU/GI toxicities (all P ≥ .05). Five-year grade ≥2 GU and grade ≥1 GI TFS was 61.1% and 73.7% for IMRT, respectively, and 70.7% and 75.3% for PBT, respectively; and 5-year grade ≥3 GU and GI TFS was >95% for both groups (all P ≥ .05). CONCLUSIONS Postprostatectomy PBT minimized low-range bladder and rectal doses relative to IMRT; however, treatment modality was not associated with clinician-reported GU/GI toxicities. Future prospective investigation and ongoing follow-up will determine whether dosimetric differences between IMRT and PBT confer clinically meaningful differences in long-term outcomes.
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Affiliation(s)
- Patricia Mae G Santos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew R Barsky
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xingmei Wang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Both
- Department of Medical Physics, University Medical Center Groningen, Groningen, Netherlands
| | - Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Link C, Honeck P, Makabe A, Giordano FA, Bolenz C, Schaefer J, Bohrer M, Lohr F, Wenz F, Buergy D. Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer - a retrospective analysis of dose-escalated patients. Radiat Oncol 2019; 14:96. [PMID: 31174555 PMCID: PMC6554899 DOI: 10.1186/s13014-019-1301-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background It is uncertain if whole-pelvic irradiation (WPRT) in addition to dose-escalated prostate bed irradiation (PBRT) improves biochemical progression-free survival (bPFS) after prostatectomy for locally advanced tumors. This study was initiated to analyze if WPRT is associated with bPFS in a patient cohort with dose-escalated (> 70 Gy) PBRT. Methods Patients with locally advanced, node-negative prostate carcinoma who had PBRT with or without WPRT after prostatectomy between 2009 and 2017 were retrospectively analyzed. A simultaneous integrated boost with equivalent-doses-in-2-Gy-fractions (EQD-2) of 79.29 Gy or 71.43 Gy to the prostate bed was applied in patients with margin-positive (or detectable) and margin-negative/undetectable tumors, respectively. WPRT (44 Gy) was offered to patients at an increased risk of lymph node metastases. Results Forty-three patients with PBRT/WPRT and 77 with PBRT-only were identified. Baseline imbalances included shorter surgery-radiotherapy intervals (S-RT-Intervals) and fewer resected lymph nodes in the WPRT group. WPRT was significantly associated with better bPFS in univariate (p = 0.032) and multivariate models (HR = 0.484, p = 0.015). Subgroup analysis indicated a benefit of WPRT (p = 0.029) in patients treated with rising PSA values who mostly had negative margins (74.1%); WPRT was not associated with a longer bPFS in the postoperative setting with almost exclusively positive margins (96.8%). Conclusion We observed a longer bPFS after WPRT compared to PBRT in patients with locally advanced prostate carcinoma who underwent dose-escalated radiotherapy. In subset analyses, the association was only observed in patients with rising PSA values but not in patients with non-salvage postoperative radiotherapy for positive margins. Electronic supplementary material The online version of this article (10.1186/s13014-019-1301-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carola Link
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Akiko Makabe
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank Anton Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Joerg Schaefer
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Markus Bohrer
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank Lohr
- Struttura Complessa di Radioterapia, Dipartimento di Oncologia, Azienda Universitario-Ospedaliera, Policlinico, Modena, Italy
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Freiburg Medical Center, Freiburg, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Heinrich-Lanz-Center for Digital Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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13
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Glicksman R, Sanmamed N, Thoms J, Zlotta AR, Finelli A, van der Kwast T, Sweet J, Jewett M, Klotz LH, Rosewall T, Fleshner NE, Bristow RG, Warde P, Berlin A. A Phase 1 Pilot Study of Preoperative Radiation Therapy for Prostate Cancer: Long-Term Toxicity and Oncologic Outcomes. Int J Radiat Oncol Biol Phys 2019; 104:61-66. [PMID: 30625410 DOI: 10.1016/j.ijrobp.2018.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/22/2018] [Accepted: 12/30/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Neoadjuvant radiation therapy (RT) improves disease control in various cancers and has become an established oncologic treatment strategy. During 2001 to 2004, we conducted a phase 1 pilot study assessing the role of short-course preoperative RT (PreORT) for men with unfavorable intermediate- and high-risk localized prostate cancer. Herein, we present long-term follow-up toxicity and oncologic outcomes. METHODS AND MATERIALS Eligible patients had histologically proven prostate cancer, cT1-T2N0M0 disease, prostate-specific antigen >15 to 35 ng/mL regardless of Gleason score, or prostate-specific antigen 10 to 15 ng/mL with Gleason score ≥7. Patients received 25 Gy in 5 consecutive daily fractions (5 Gy per fraction) to the prostate only, followed by radical prostatectomy within 14 days after RT completion. Primary outcomes were intraoperative morbidity and late genitourinary (GU) and gastrointestinal toxicities. RESULTS In total, 15 patients were enrolled; 14 patients completed PreORT followed by radical prostatectomy, which also included bilateral lymph node dissections in 13 cases. Median follow-up was 12.2 years (range, 6.7-16.3). Late GU toxicity was common, with 2 patients (13.3%) experiencing G2 toxicity and 6 patients (40%) G3 toxicity. There were no patients with G4 to G5 late GU toxicity. Late gastrointestinal toxicity was infrequent, with only 1 patient (6.7%) experiencing transient G2 proctitis. At last follow-up, 8 (53.3%) and 6 (40%) patients experienced biochemical and metastatic disease recurrence, respectively. CONCLUSIONS The use of PreORT in men with high-risk prostate cancer is associated with unexpected high rates of late GU toxicity. Future studies examining the role of RT preradical prostatectomy must cautiously select RT technique and dose schedule. Importantly, long-term follow-up data are essential to fully determine the therapeutic index of PreORT in the management of localized disease.
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Affiliation(s)
- Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| | - Noelia Sanmamed
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - John Thoms
- Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Joan Sweet
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Michael Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laurence H Klotz
- Department of Surgery (Urology), Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tara Rosewall
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Robert G Bristow
- Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Techna Institute, University Health Network, Toronto, Canada.
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14
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Omlin A, Spahn M, Beyer J, Eberli D, Gillessen S, Jochum W, Kueng M, Nitzsche E, Rentsch CA, Roggero E, Schmid HP, Stenner F, Templeton AJ, Wild D, Wyler S, Zwahlen D, Cathomas R. [Treatment of Advanced Prostate Carcinoma - an Interdisciplinary Recommendation]. PRAXIS 2018; 107:1043-1051. [PMID: 30227804 DOI: 10.1024/1661-8157/a003054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Aurelius Omlin
- 1 Abteilung für Onkologie und Hämatologie, Kantonsspital St. Gallen
- 2 Universitätsklinik für Medizinische Onkologie, Inselspital, Universität Bern
| | - Martin Spahn
- 3 Zentrum für Urologie Zürich und Prostatakarzinomzentrum Hirslanden Zürich, Klinik Hirslanden Zürich
- 4 Kinderurologie Universität Duisburg/Essen
| | - Jörg Beyer
- 2 Universitätsklinik für Medizinische Onkologie, Inselspital, Universität Bern
| | | | - Silke Gillessen
- 1 Abteilung für Onkologie und Hämatologie, Kantonsspital St. Gallen
- 2 Universitätsklinik für Medizinische Onkologie, Inselspital, Universität Bern
- 6 Division of Cancer Sciences, University of Manchester and The Christie, Manchester, UK
| | | | - Marc Kueng
- 8 Klinik für Onkologie, HFR Kantonsspital Freiburg
| | | | | | - Enrico Roggero
- 11 IOSI, Oncology Institute of Southern Switzerland, Bellinzona
| | | | | | | | - Damian Wild
- 15 Abteilung für Nuklearmedizin, Universitätsspital Basel
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15
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Castellucci P, Ceci F, Fanti S. Imaging of Prostate Cancer Using 11C-Choline PET/Computed Tomography. Urol Clin North Am 2018; 45:481-487. [PMID: 30031467 DOI: 10.1016/j.ucl.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the role of 11C-choline-PET/computed tomography (CT) in patients with prostate cancer for diagnosis, staging, and restaging the disease in case of biochemical recurrence after primary treatment. The main application of this imaging procedure is restaging of the disease in case of biochemical recurrence. 11C-Choline-PET/CT proved its value for metastases-directed salvage therapies and for monitoring therapy response in castration-resistant patients. Prostate-specific antigen and prostate-specific antigen kinetics values confirmed their correlation with 11C-choline PET/CT sensitivity.11C-CholinePET/CT, despite low sensitivity to stage disease or in case of biochemical failure with low PSA levels, has an important impact on the management of patients with prostate cancer.
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Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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16
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Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, Hearn JW, Koontz BF, Lee WR, Michalski JM, Pisansky TM, Liauw SL, Abramowitz MC, Pollack A, Moghanaki D, Anscher MS, Den RB, Zietman AL, Stephenson AJ, Efstathiou JA. Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer With Adverse Pathological Features. JAMA Oncol 2018; 4:e175230. [PMID: 29372236 PMCID: PMC5885162 DOI: 10.1001/jamaoncol.2017.5230] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/16/2017] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer with adverse pathological features (ie, pT3 and/or positive margins) after prostatectomy may be managed with adjuvant radiotherapy (ART) or surveillance followed by early-salvage radiotherapy (ESRT) for biochemical recurrence. The optimal timing of postoperative radiotherapy is unclear. Objective To compare the clinical outcomes of postoperative ART and ESRT administered to patients with prostate cancer with adverse pathological features. Design, Setting, and Participants This multi-institutional, propensity score-matched cohort study involved 1566 consecutive patients who underwent postprostatectomy ART or ESRT at 10 US academic medical centers between January 1, 1987, and December 31, 2013. Propensity score 1-to-1 matching was used to account for covariates potentially associated with treatment selection. Data were collected from January 1 to September 30, 2016. Data analysis was conducted from October 1, 2016, to October 21, 2017. Main Outcomes and Measures Freedom from postirradiation biochemical failure, freedom from distant metastases, and overall survival. All outcomes were measured from date of surgery to address lead-time bias. Results Of 1566 patients, 1195 with prostate-specific antigen levels of 0.1 to 0.5 ng/mL received ESRT and 371 patients with prostate-specific antigen levels lower than 0.1 ng/mL received ART. The median age (interquartile range) was 60 (55-65) years. After propensity score matching, the median (interquartile range) follow-up after surgery was similar between the ESRT and ART groups (73.3 [44.9-106.6] months vs 65.8 [40-107] months; P = .22). Adjuvant RT, compared with ESRT, was associated with higher freedom from biochemical failure (12-year actuarial rates: 69% [95% CI, 60%-76%] vs 43% [95% CI, 35%-51%]; effect size, 26%), freedom from distant metastases (95% [95% CI, 90%-97%] vs 85% [95% CI, 76%-90%]; effect size, 10%), and overall survival (91% [95% CI, 84%-95%] vs 79% [95% CI, 69%-86%]; effect size, 12%). Adjuvant RT, lower Gleason score and T stage, nodal irradiation, and postoperative androgen deprivation therapy were favorable prognostic features on multivariate analysis for biochemical failure. Sensitivity analysis demonstrated that the decreased risk of biochemical failure associated with ART remained significant unless more than 56% of patients in the ART group were cured by surgery alone. This threshold is greater than the estimated 12-year freedom from biochemical failure rate of 33% to 52% after radical prostatectomy alone, as determined by a contemporary dynamic nomogram. Conclusions and Relevance Adjuvant RT, compared with ESRT, was associated with reduced biochemical recurrence, distant metastases, and death for high-risk patients, pending prospective validation. These findings suggest that a greater proportion of patients with prostate cancer who have adverse pathological features may benefit from postprostatectomy ART rather than surveillance followed by ESRT.
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Affiliation(s)
- William L. Hwang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rahul D. Tendulkar
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shree Agrawal
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kevin L. Stephans
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Jason W. Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Bridget F. Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - W. Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | | | - Stanley L. Liauw
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | | | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Drew Moghanaki
- Department of Radiation Oncology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Mitchell S. Anscher
- Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond
| | - Robert B. Den
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J. Stephenson
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Wang YJ, Huang CY, Hou WH, Wang CC, Lan KH, Yu HJ, Lai MK, Liu SP, Pu YS, Cheng JCH. Dual-timing PSA as a biomarker for patients with salvage intensity modulated radiation therapy for biochemical failure after radical prostatectomy. Oncotarget 2018; 7:44224-44235. [PMID: 27317764 PMCID: PMC5190091 DOI: 10.18632/oncotarget.10000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
We investigated the outcomes and the associated clinical-pathological factors in patients with prostate cancer (PCa) undergoing salvage intensity modulated radiation therapy (IMRT) for post-radical-prostatectomy (RP) biochemical failure. We report clinical outcomes of post-RP salvage IMRT, and describe chronic toxicity in these patients.Fifty patients with PCa underwent post-RP salvage IMRT. The median dose of IMRT was 70 Gy to the prostatic and seminal vesicle bed. Clinical-pathological and toxicity information were collected. The prostate cancer-specific survival (PCSS), disease-free survival (DFS), and biochemical-failure-free survival (BFFS) were calculated. Prognostic factors were analyzed for their association with disease control.The median follow-up time was 74 months. The 5-year PCSS, DFS, and BFFS after salvage IMRT were 95%, 88%, and 60%, respectively. Two patients (4%) experienced late gastrointestinal toxicity ≥ grade 3, and 5 patients (10%) had late genitourinary toxicity ≥ grade 3. On multivariate analysis, post-RP prostate-specific antigen (PSA) nadir ≤0.1 ng/ml (P=0.018) and PSA ≤0.5 ng/ml at salvage IMRT (P=0.016) were independent factors predicting better BFFS. Patients with both post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT had a 5-year BFFS of 83% as compared with 43% in other patients (P=0.001).In conclusion, with hormonal therapy in most PCa patients, the addition of salvage IMRT for post-RP biochemical failure can achieve a good outcome with low toxicity. Patients with a post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT could benefit the most from salvage IMRT.
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Affiliation(s)
- Yu-Jen Wang
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wei-Hsien Hou
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chia-Chun Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Keng-Hsueh Lan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hong-Jen Yu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ming-Kuen Lai
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Shihh-Ping Liu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yeong-Shau Pu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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18
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Mohanty SK, Yagiz K, Pradhan D, Luthringer DJ, Amin MB, Alkan S, Cinar B. STAT3 and STAT5A are potential therapeutic targets in castration-resistant prostate cancer. Oncotarget 2017; 8:85997-86010. [PMID: 29156772 PMCID: PMC5689662 DOI: 10.18632/oncotarget.20844] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/03/2017] [Indexed: 11/25/2022] Open
Abstract
Mechanisms of castration-resistant prostate cancer (CRPC) are not well understood, thus hindering rational-based drug design. Activation of STAT3/5A, key components of the JAK/STAT pathway, is implicated in aggressive PC, yet their clinical relevance in CRPC remains elusive. Here, we evaluated the possible role of STAT3/5A in CRPC using immunological, quantitative mRNA expression profiling, and pharmacological methods. We observed a strong nuclear immunoreactivity for STAT3 and STAT5A in 93% (n=14/15) and 80% (n=12/15) of CRPC cases, respectively, compared with benign prostatic hyperplasia (BPH). We demonstrated that PC cells express varying levels of STAT3 and STAT5A transcripts. In addition, we demonstrate that pimozide, a psychotropic drug and an indirect inhibitor of STAT5, attenuated PC cells growth, and induced apoptosis in a dose-dependent manner. Furthermore, our analysis of the PC public data revealed that the STAT3/5A genes were frequently amplified in metastatic CRPC. These findings suggest that STAT3/5A potentially serves as a predictive biomarker to evaluate the therapeutic efficacy of a cancer drug targeting the JAK/STAT pathway. Since the JAK/STAT and AR pathways are suggested to be functionally synergistic, inhibition of the JAK/STAT signaling alone or together with AR may lead to a novel treatment modality for patients with advanced PC.
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Affiliation(s)
- Sambit K. Mohanty
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Kader Yagiz
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dinesh Pradhan
- University of Pittsburgh Medical Center, Pittsburgh, PA 15238, USA
| | - Daniel J. Luthringer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mahul B. Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Serhan Alkan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Bekir Cinar
- Department of Biological Sciences, The Center for Cancer Research and Therapeutic Development, Clark Atlanta University, Atlanta, GA 30314, USA
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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19
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Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions. Eur J Nucl Med Mol Imaging 2017; 44:1622-1635. [DOI: 10.1007/s00259-017-3725-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
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20
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Wallis CJD, Morton G, Jerath A, Satkunasviam R, Szumacher E, Herschorn S, Kodama RT, Kulkarni GS, Naimark D, Nam RK. Adjuvant Versus Salvage Radiotherapy for Patients With Adverse Pathological Findings Following Radical Prostatectomy: A Decision Analysis. MDM Policy Pract 2017; 2:2381468317709476. [PMID: 30288422 PMCID: PMC6124936 DOI: 10.1177/2381468317709476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/05/2017] [Indexed: 01/28/2023] Open
Abstract
Background: Patients undergoing surgery for prostate cancer who have
adverse pathological findings experience high rates of recurrence. While there
are data supporting adjuvant radiotherapy compared to a wait-and-watch strategy
to reduce recurrence rates, there are no randomized controlled trials comparing
adjuvant radiotherapy with the other standard of care, salvage radiotherapy
(radiotherapy administered at the time of recurrence). Methods: We
constructed a health state transition (Markov) model employing two-dimensional
Monte Carlo simulation using a lifetime horizon to compare the quality-adjusted
survival associated with postoperative strategies using adjuvant or salvage
radiotherapy. Prior to analysis, we calibrated and validated our model using the
results of previous randomized controlled trials. We considered clinically
important oncological health states from immediately postoperative to prostate
cancer–specific death, commonly described complications from prostate cancer
treatment, and other causes of mortality. Transition probabilities and utilities
for disease states were derived from a literature search of MEDLINE and expert
consensus. Results: Salvage radiotherapy was associated with an
increased quality-adjusted life expectancy (QALE) (58.3 months) as compared with
adjuvant radiotherapy (53.7 months), a difference of 4.6 months (standard
deviation 8.8). Salvage radiotherapy had higher QALE in 53% of hypothetical
cohorts. There was a minimal difference in overall life expectancy (-0.1
months). Examining recurrence rates, our model showed validity when compared
with available randomized controlled data. Conclusions: A salvage
radiotherapy strategy appears to provide improved QALE for patients with adverse
pathological findings following radical prostatectomy, compared with adjuvant
radiotherapy. As these findings reflect, population averages, specific patient
and tumor factors, and patient preferences remain central for individualized
management.
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Affiliation(s)
- Christopher J D Wallis
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Gerard Morton
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Raj Satkunasviam
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Ronald T Kodama
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre (CJDW, RS, SH, RTK, RKN), University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (CJDW, AJ, DN, RKN), University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology (GM, ES), University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia (AJ), University of Toronto, Toronto, Ontario, Canada.,Division of Urology, University Health Network (GSK), University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre (DN), University of Toronto, Toronto, Ontario, Canada
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21
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Ceci F, Castellucci P, Mapelli P, Incerti E, Picchio M, Fanti S. Evaluation of Prostate Cancer with 11C-Choline PET/CT for Treatment Planning, Response Assessment, and Prognosis. J Nucl Med 2017; 57:49S-54S. [PMID: 27694172 DOI: 10.2967/jnumed.115.170126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/05/2016] [Indexed: 01/29/2023] Open
Abstract
The aim of this review is to report on the value of 11C-choline PET imaging as a diagnostic procedure for metastasis-directed therapies. Furthermore, the role of 11C-choline PET/CT as a diagnostic tool for monitoring castration-resistant prostate cancer patients treated with systematic therapy is assessed. Finally, the role of 11C-choline PET/CT in the prediction of survival in both castration-resistant prostate cancer patients and hormone-naïve patients is investigated.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
| | - Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
| | - Paola Mapelli
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Incerti
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Service of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; and
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22
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Castellucci P, Ceci F, Fanti S. Imaging of Prostate Cancer Using 11C-Choline PET/Computed Tomography. PET Clin 2017; 12:137-143. [PMID: 28267448 DOI: 10.1016/j.cpet.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article reviews the role of 11C-choline-PET/computed tomography (CT) in patients with prostate cancer for diagnosis, staging, and restaging the disease in case of biochemical recurrence after primary treatment. The main application of this imaging procedure is restaging of the disease in case of biochemical recurrence. 11C-Choline-PET/CT proved its value for metastases-directed salvage therapies and for monitoring therapy response in castration-resistant patients. Prostate-specific antigen and prostate-specific antigen kinetics values confirmed their correlation with 11C-choline PET/CT sensitivity.11C-CholinePET/CT, despite low sensitivity to stage disease or in case of biochemical failure with low PSA levels, has an important impact on the management of patients with prostate cancer.
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Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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23
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Wang L, Wang B, Ai Q, Zhang Y, Lv X, Li H, Ma X, Zhang X. Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis. Int Urol Nephrol 2017; 49:995-1005. [DOI: 10.1007/s11255-017-1552-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/21/2017] [Indexed: 01/11/2023]
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24
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Gandaglia G, Briganti A, Clarke N, Karnes RJ, Graefen M, Ost P, Zietman AL, Roach M. Adjuvant and Salvage Radiotherapy after Radical Prostatectomy in Prostate Cancer Patients. Eur Urol 2017; 72:689-709. [PMID: 28189428 DOI: 10.1016/j.eururo.2017.01.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/20/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Prostate cancer (PCa) patients found to have adverse pathologic features following radical prostatectomy (RP) are less likely to be cured with surgery alone. OBJECTIVE To analyze the role of postoperative radiotherapy (RT) in patients with aggressive PCa. EVIDENCE ACQUISITION We performed a systematic literature review of the Medline and EMBASE databases. The search strategy included the terms radical prostatectomy, adjuvant radiotherapy, and salvage radiotherapy, alone or in combination. We limited our search to studies published between January 2009 and August 2016. EVIDENCE SYNTHESIS Three randomized trials demonstrated that immediate RT after RP reduces the risk of recurrence in patients with aggressive PCa. However, immediate postoperative RT is associated with an increased risk of acute and late side effects ranging from 15% to 35% and 2% to 8%, respectively. Retrospective studies support the oncologic efficacy of initial observation followed by salvage RT administered at the first sign of recurrence; however, the impact of this delay on long-term control remains uncertain. Hopefully, ongoing randomized trials will shed light on the role of adjuvant RT versus observation±salvage RT in individuals with adverse features at RP. Accurate patient selection based on clinical characteristics and molecular profile is crucial. Dose escalation, whole-pelvis RT, novel techniques, and the use of hormonal therapy might improve the outcomes of postoperative RT. CONCLUSIONS Immediate RT reduces the risk of recurrence after RP in patients with aggressive disease. However, this approach is associated with an increase in the incidence of short- and long-term side effects. Observation followed by salvage RT administered at the first sign of recurrence might be associated with durable cancer control, but prospective randomized comparison with adjuvant RT is still awaited. Dose escalation, refinements in the technique, and the concomitant use of hormonal therapies might improve outcomes of patients undergoing postoperative RT. PATIENT SUMMARY Postoperative radiotherapy has an impact on oncologic outcomes in patients with aggressive disease characteristics. Salvage radiotherapy administered at the first sign of recurrence might be associated with durable cancer control in selected patients but might compromise cure in others.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Alberto Briganti
- Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Mack Roach
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA
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25
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A Rare Case of Epididymal Metastasis After Radical Prostatectomy Detected by 68Ga-PSMA PET/CT. Clin Genitourin Cancer 2017; 15:e525-e527. [PMID: 28065536 DOI: 10.1016/j.clgc.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 12/31/2022]
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26
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Ceci F, Fiorentino M, Castellucci P, Fanti S. Molecular Imaging and Precision Medicine in Prostate Cancer. PET Clin 2017; 12:83-92. [DOI: 10.1016/j.cpet.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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27
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Bruce HM, Stricker PD, Gupta R, Savdie RR, Haynes AM, Mahon KL, Lin HM, Kench JG, Horvath LG. Loss of AZGP1 as a Superior Predictor of Relapse in Margin-Positive Localized Prostate Cancer. Prostate 2016; 76:1491-1500. [PMID: 27473574 DOI: 10.1002/pros.23233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) in localized prostate cancer (PC) confer a two- to three-fold increased risk of biochemical relapse (BR). Absent/weak AZGP1 expression and Gleason grade ≥4 at the margin are each independent predictors of BR in patients with PSMs. Our study aimed to determine whether the biomarkers AZGP1 expression and Gleason grade at the site of a PSM are significant independent markers of biochemical and clinical relapse (CR) when modeled together and whether one of these biomarkers may be superior in its capacity to predict outcome. METHODS A cohort of 275 consecutive patients with margin-positive localized PC following surgery were assessed for Gleason grade and AZGP1 expression at the PSM. BR-free survival was the primary end-point, while CR-free survival and PC-specific death were secondary endpoints. Kaplan-Meier Analysis and Cox Proportional Hazards Modeling were performed. RESULTS Absent AZGP1 expression was significantly associated with increased risk of BR (P = 0.001) and PC-specific death (P = 0.02). Gleason grade ≥4 at PSM was associated with BR (P = 0.02), CR (P = 0.003), and PC-specific death (P = 0.004). On multivariable analysis, absent AZGP1 expression remained an independent predictor of BR (HR 2.4, 95%CI 1.5-3.9, P < 0.001) when modeled with Gleason grade at margin (HR 1.3, 95%CI 0.9-1.9, P = 0.16), preoperative PSA (P = 0.002), seminal vesicle involvement (P = 0.002), extraprostatic extension (P = 0.001), Gleason score (P = 0.01), adjuvant treatment (P = 0.75), linear length of the involved margin (P = 0.001) and margin number (P = 0.09). CONCLUSION Absent AZGP1 expression is an independent predictor of BR in margin-positive localized PC and is associated with increased PC-specific mortality in a Phase II study. Absent AZGP1 expression was superior to Gleason grade at PSM in predicting relapse and should be incorporated into subsequent clinical trials of post-operative radiotherapy in men with margin-positive PC. Prostate 76:1491-1500, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hannah M Bruce
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Phillip D Stricker
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
- Department of Urology, St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Ruta Gupta
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Richard R Savdie
- Department of Urology, St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Anne-Maree Haynes
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - Kate L Mahon
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Hui-Ming Lin
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - James G Kench
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa G Horvath
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
- University of Sydney, Camperdown, New South Wales, Australia.
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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PET imaging in prostate cancer, state of the art: a review of 18F-choline and 11C-choline PET/CT applications. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tonry CL, Leacy E, Raso C, Finn SP, Armstrong J, Pennington SR. The Role of Proteomics in Biomarker Development for Improved Patient Diagnosis and Clinical Decision Making in Prostate Cancer. Diagnostics (Basel) 2016; 6:E27. [PMID: 27438858 PMCID: PMC5039561 DOI: 10.3390/diagnostics6030027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 02/06/2023] Open
Abstract
Prostate Cancer (PCa) is the second most commonly diagnosed cancer in men worldwide. Although increased expression of prostate-specific antigen (PSA) is an effective indicator for the recurrence of PCa, its intended use as a screening marker for PCa is of considerable controversy. Recent research efforts in the field of PCa biomarkers have focused on the identification of tissue and fluid-based biomarkers that would be better able to stratify those individuals diagnosed with PCa who (i) might best receive no treatment (active surveillance of the disease); (ii) would benefit from existing treatments; or (iii) those who are likely to succumb to disease recurrence and/or have aggressive disease. The growing demand for better prostate cancer biomarkers has coincided with the development of improved discovery and evaluation technologies for multiplexed measurement of proteins in bio-fluids and tissues. This review aims to (i) provide an overview of these technologies as well as describe some of the candidate PCa protein biomarkers that have been discovered using them; (ii) address some of the general limitations in the clinical evaluation and validation of protein biomarkers; and (iii) make recommendations for strategies that could be adopted to improve the successful development of protein biomarkers to deliver improvements in personalized PCa patient decision making.
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Affiliation(s)
- Claire L Tonry
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
| | - Emma Leacy
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
| | - Cinzia Raso
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
| | - Stephen P Finn
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
| | | | - Stephen R Pennington
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
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Risk stratification system and pattern of relapse in patients treated with adjuvant radiotherapy after radical prostatectomy. TUMORI JOURNAL 2016; 2016:323-9. [PMID: 27002951 DOI: 10.5301/tj.5000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To retrospectively evaluate the role of adjuvant radiotherapy (ART) as monotherapy in a cohort of prostate cancer patients with undetectable prostate-specific antigen (PSA) after surgery and to propose a risk stratification system. METHODS Between 2003 and 2010, 174 consecutive patients were treated with ART (median dose 71 Gy) at a single institution. Subsequently, we assigned a score of 1 to the following risk factors (RF): T stage ≥3b, presurgical PSA ≥10 ng/mL, pathologic Gleason score (GS) ≥4 + 3, and positive surgical margin (R1). The scores were then summed to stratify the population into low risk (LR), intermediate risk (IR), and high risk (HR). RESULTS Median follow-up was 61 months (range 4-105). Five-year biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), and overall survival (OS) were respectively 93%, 97.1%, and 98.6%. On univariate analyses, GS was the only variable related to bRFS (p = 0.04) and to cRFS (p = 0.05). Any variable was related to OS. Kaplan-Meier analysis showed that HR patients (3-4 RF) had a worse bRFS (p = 0.02) compared to LR patients (0 RF or R1 as single RF); IR patients (1-2 RF) had a lower bRFS compared to LR patients (p = 0.06). Patients with R1 as single RF have the same bRFS as patients with 0 RF (p = 0.6) and are considered as LR patients. CONCLUSIONS Adjuvant radiotherapy leads to excellent bRFS and cRFS rates at 5 years (93.3% and 97.1%, respectively) in our population. Patients with multiple RF are at higher risk of bRFS. Patients with R1 as single RF have bRFS rates comparable to patients without any RF.
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31
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Moul JW. Population Screening for Prostate Cancer and Early Detection. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ku JY, Lee CH, Ha HK. Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer: Systemic review and meta-analysis of 5-year and 10-year follow-up data. Korean J Urol 2015; 56:735-41. [PMID: 26568790 PMCID: PMC4643168 DOI: 10.4111/kju.2015.56.11.735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/25/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the oncologic outcomes between adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) in patients with locally advanced prostate cancer or with adverse pathologic factors including positive surgical margin and high Gleason score. MATERIALS AND METHODS We searched the literature published from January 2000 until December 2014 at MEDLINE, PubMed, Web of Science, Embase, ProQuest, and Cochrane Library. To be specific, included were studies comparing ART and SRT settings if they followed up oncologic outcomes more than 5 years. RESULTS Overall, 3 retrospective, nonrandomized, observational studies, 1 matched control analysis, and 3 prospective randomized controlled studies met our inclusion criteria including a total of 2,380 patients (1,192 ART vs. 1,188 SRT). Higher favorable results were found in ART than in SRT was seen in the 5-year and 10-year biochemical recurrence (BCR)-free survival (risk ratio [RR], 0.61 and 0.70; 95% confidence interval [CI], 0.54-0.69 and 0.63-0.76). ART had a significantly higher 5-year progression-free survival rate than that in SRT (RR, 0.64; 95% CI, 0.51-0.80), but this was not the same for the 10-year progression-free survival rate (RR, 0.88; 95% CI, 0.72-1.08). There was no significant difference for the 5-year and 10-year overall survival rates between ART and SRT (RR, 0.80 and 0.94; 95% CI, 0.59-1.07 and 0.80-1.11). CONCLUSIONS ART showed favorable results in BCR-free survival during the 5-year follow-up period. However, the 10-year progression-free survival and overall survival did not show any difference between ART and SRT.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chan Ho Lee
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
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Wolff RF, Ryder S, Bossi A, Briganti A, Crook J, Henry A, Karnes J, Potters L, de Reijke T, Stone N, Burckhardt M, Duffy S, Worthy G, Kleijnen J. A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer. Eur J Cancer 2015; 51:2345-67. [DOI: 10.1016/j.ejca.2015.07.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/06/2015] [Accepted: 07/16/2015] [Indexed: 12/30/2022]
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Gandaglia G, Cozzarini C, Mottrie A, Bossi A, Fossati N, Montorsi F, Briganti A. The Role of Radiotherapy After Radical Prostatectomy in Patients with Prostate Cancer. Curr Oncol Rep 2015; 17:53. [DOI: 10.1007/s11912-015-0478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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36
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Ceci F, Castellucci P, Graziani T, Schiavina R, Fanti S. PET/Computed Tomography in the Individualization of Treatment of Prostate Cancer. PET Clin 2015; 10:487-94. [PMID: 26384595 DOI: 10.1016/j.cpet.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Choline PET/computed tomographic (CT) imaging represents the most diffused PET imaging techniques to investigate patients with prostate cancer (PCa). It may show the site of tumor recurrence in a single step examination, earlier than other conventional imaging techniques. In this context, the availability of a diagnostic test capable of differentiating between potentially curable local recurrence and metastatic disease implying palliative approaches may play an important role in those patients in whom targeted therapies could be performed according to choline PET/CT results. This review analyzes the value of choline PET/CT imaging in the evaluation of treatment of patients with PCa.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Paolo Castellucci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Tiziano Graziani
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Gomes CM, Nunes RV, Tse V. Pelvic Irradiation and Its Effects on the Lower Urinary Tract: a Literature Review. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0316-5] [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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38
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Muller BG, Kaushal A, Sankineni S, Lita E, Hoang AN, George AK, Rais-Bahrami S, Kruecker J, Yan P, Xu S, de la Rosette JJ, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Multiparametric magnetic resonance imaging-transrectal ultrasound fusion-assisted biopsy for the diagnosis of local recurrence after radical prostatectomy. Urol Oncol 2015; 33:425.e1-425.e6. [PMID: 26259666 DOI: 10.1016/j.urolonc.2015.05.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Approximately 15% of patients who undergo radical prostatectomy (RP) for prostate cancer develop local recurrence, which is heralded by a rise in serum prostate-specific antigen (PSA) levels. Early detection and treatment of recurrence improves the outcome of salvage treatment. We investigated the ability of multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion-guided biopsy (FGB) combined with "cognitive biopsy" to confirm local recurrence of prostate cancer after RP. MATERIALS AND METHODS In this retrospective study conducted between January 2010 and December 2014, patients with rising PSA levels after RP who had no known evidence of distant metastases underwent mpMRI including T2-weighted (T2W) imaging, diffusion-weighted imaging, dynamic contrast-enhanced (DCE) MRI at 3 Tesla, and subsequent MRI-ultrasound fusion biopsy with cognitive assistance. The detection rate of locally recurrent disease was determined. RESULTS A total of 10 patients (mean age = 67y, mean PSA level = 3.44ng/ml) met the inclusion criteria. Of the 10 patients, all had positive findings suspicious for local recurrence on mpMRI per entrance criterion. The most important features on mpMRI were early enhancement on DCE MR images and hypointensity on T2W images. The average lesion diameter on mpMRI was 1.12cm (range: 0.40-2.20cm). All suspicious lesions (16/16, 100%) were positive on T2W MR images, 14 (89%) showed positive features on apparent diffusion coefficient maps of diffusion-weighted images, and 16 (100%) were positive on DCE MR images. MRI-TRUS FGBs were positive in 10/16 lesions (62.5%) and 8/10 (80%) patients. CONCLUSION MRI-TRUS FGB with cognitive assistance is able to detect and diagnose locally recurrent lesions after RP, even at low PSA levels. This may facilitate early detection of recurrent disease and improve salvage treatment outcomes.
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Affiliation(s)
- Berrend G Muller
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands
| | - Aradhana Kaushal
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Sankineni
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elena Lita
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anthony N Hoang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Pingkun Yan
- Philips Research North America, Briarcliff Manor, NY
| | - Sheng Xu
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Gu C, Li Q, Zhu Y, Qu Y, Zhang G, Wang M, Yang Y, Wang J, Jin L, Wei Q, Ye D. Genetic variants in the TEP1 gene are associated with prostate cancer risk and recurrence. Prostate Cancer Prostatic Dis 2015; 18:310-6. [DOI: 10.1038/pcan.2015.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 02/06/2023]
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40
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Devos J, Van Praet C, Decaestecker K, Claeys T, Fonteyne V, Decalf V, De Meerleer G, Ost P, Lumen N. Cognitive factors influencing treatment decision-making in patients with localised prostate cancer: development of a standardised questionnaire. Acta Clin Belg 2015; 70:272-9. [PMID: 25816107 DOI: 10.1179/2295333715y.0000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Men diagnosed with localised prostate cancer have to make a well-informed treatment choice between (robot-assisted) radical prostatectomy, external beam radiotherapy and, in selected cases, brachytherapy and active surveillance. We developed and validated a questionnaire to determine the cognitive reasons motivating this choice. MATERIALS AND METHODS The Prostate Cancer Decision-Making Questionnaire (PC-DMQ) was designed in-house and validated through the Delphi method. Finally, we tested the questionnaire in a cohort of 24 men, recently diagnosed with localised PC, before undergoing RARP (n = 16), EBRT (n = 6), brachytherapy (n = 1) or active surveillance (n = 1). RESULTS The experts reached consensus after three rounds. In the patient cohort, 75% of men undergoing RARP chose this treatment because 'it provides the best chance of cure'. Reasons to choose EBRT were not as explicit: 33.3% chose this treatment because 'it provides the best chance of cure' and 33.3% because 'the maintenance of potency is important to them'. CONCLUSIONS The PC-DMQ is a comprehensive and standardised tool that allows further research into cognitive factors that influence treatment decision-making in patients with localised PC.
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41
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Bayne CE, Williams SB, Cooperberg MR, Gleave ME, Graefen M, Montorsi F, Novara G, Smaldone MC, Sooriakumaran P, Wiklund PN, Chapin BF. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol 2015; 69:775-87. [PMID: 26003223 DOI: 10.1016/j.eururo.2015.04.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Multimodal treatment for men with locally advanced prostate cancer (PCa) using neoadjuvant/adjuvant systemic therapy, surgery, and radiation therapy is being increasingly explored. There is also interest in the oncologic benefit of treating the primary tumor in the setting of metastatic PCa (mPCa). OBJECTIVE To perform a review of the literature regarding the treatment of the primary tumor in the setting of mPCa. EVIDENCE ACQUISITION Medline, PubMed, and Scopus electronic databases were queried for English language articles from January 1990 to September 2014. Prospective and retrospective studies were included. EVIDENCE SYNTHESIS There is no published randomized controlled trial (RCT) comparing local therapy and systemic therapy to systemic therapy alone in the treatment of mPCa. Prospective studies of men with locally advanced PCa and retrospective studies of occult node-positive PCa have consistently shown the addition of local therapy to a multimodal treatment regimen improves outcomes. Molecular and genomic evidence further suggests the primary tumor may have an active role in mPCa. CONCLUSIONS Treatment of the primary tumor in mPCa is being increasingly explored. While preclinical, translational, and retrospective evidence supports local therapy in advanced disease, further prospective studies are under way to evaluate this multimodal approach and identify the patients most likely to benefit from the inclusion of local therapy in the setting of metastatic disease. PATIENT SUMMARY In this review we explored preclinical and clinical evidence for treatment of the primary tumor in metastatic prostate cancer (mPCa). We found evidence to support clinical trials investigating mPCa therapy that includes local treatment of the primary tumor. Currently, treating the primary tumor in mPCa is controversial and lacks high-level evidence sufficient for routine recommendation.
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Affiliation(s)
- Christopher E Bayne
- Department of Urology, The George Washington University, Washington, DC, USA
| | - Stephen B Williams
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew R Cooperberg
- Departments of Urology and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Martin E Gleave
- The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Italy
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Prasanna Sooriakumaran
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Peter N Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Kozal S, Peyronnet B, Cattarino S, Seisen T, Comperat E, Vaessen C, Mozer P, Renard-Penna R, Cussenot O, Rouprêt M, Drouin SJ. Influence of pathological factors on oncological outcomes after robot-assisted radical prostatectomy for localized prostate cancer: Results of a prospective study. Urol Oncol 2015; 33:330.e1-7. [PMID: 25998747 DOI: 10.1016/j.urolonc.2015.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the prognostic significance of lymphovascular invasion (LVI), maximum tumor diameter (MTD), high-grade prostatic intraepithelial neoplasia, perineural invasion, and length of positive surgical margins after robot-assisted radical prostatectomy (RARP). METHODS A single-institution prospective analysis of all patients who underwent RARP for localized prostate cancer was performed between January 2005 and June 2013. The primary end point was biochemical recurrence-free survival (BRFS). BRFS was estimated using the Kaplan-Meier method and compared to that from the log-rank test. Cox׳s proportional hazards regression univariate and multivariate analyses were performed to define the prognostic factors. RESULTS Overall, 742 men were included. After a median follow-up of 31.4 months, biochemical recurrence occurred in 80 patients (10.8%). BRFS was 93%, 87%, and 80.7% at 1, 3, and 5 years, respectively. Progression to local recurrence occurred in 49 patients (6.6%). During the follow-up period, 3 patients experienced progression to metastatic disease and were treated with hormonotherapy. No patient died of disease during the study period. In multivariate analyses, Gleason score was the strongest predictor of BRFS (hazard ratio [HR] = 3.4; P<0.001). There were 3 other predictive factors of BRFS were LVI (HR = 7.64; P = 0.005), MTD (HR = 4.04; P =0.009), and margin length ≥ 3 mm (HR = 1.25; P = 0.04). CONCLUSION In the era of serum prostate-specific antigen testing maturity in conjunction with a single approach to extirpation of the prostate gland by RARP, LVI, MTD, and positive surgical margins ≥ 3 mm are prognostic factors associated with BRFS after RARP. Consideration could be given to incorporate them in the pathology report of the radical prostatectomy specimens and they could assist physicians in clinical decision making.
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Affiliation(s)
- Sébastien Kozal
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | - Benoit Peyronnet
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; Service d'Urologie, CHU Rennes, Rennes, France
| | | | - Thomas Seisen
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | - Eva Comperat
- Service d'Anatomopathologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | | | - Pierre Mozer
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | | | - Olivier Cussenot
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France
| | - Morgan Rouprêt
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France.
| | - Sarah J Drouin
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
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Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, Bektic J, Horninger W, Lukas P, Decristoforo C, Castellucci P, Fanti S, Virgolini IJ. (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging 2015; 42:1284-94. [PMID: 25975367 DOI: 10.1007/s00259-015-3078-6] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the association between PSA levels, PSA kinetics and other factors and a pathological (68)Ga-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy. METHODS Seventy consecutive rPCA patients referred for (68)Ga-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean ± SD PSA level was 3.5 ± 5.3 ng/mL (median 1.7, range 0.2 - 32.2 ng/mL), the mean ± SD PSA doubling time (PSAdt) was 6.5 ± 5.5 months (median 5.5, range 1.3 - 31.6 months), and the mean ± SD PSA velocity was 7.9 ± 20.5 (median 2.1, range 0.2 - 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on (68)Ga-PSMA PET/CT. RESULTS (68)Ga-PSMA PET/CT was positive in 52 of 70 patients (74.2%). In 30 patients (42.8%) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4%). Local plus systemic lesions were detected in 14 patients (20%). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with (68)Ga-PSMA PET/CT positivity. (68)Ga-PSMA PET/CT was positive in 17 of 20 patients (85%) with PSA <2 ng/mL and PSAdt <6.5 months, and in 3 of 16 patients (18.7%) with PSA <2 ng/mL and PSAdt ≥6.5 months. CONCLUSION The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.
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Affiliation(s)
- Francesco Ceci
- Department of Nuclear Medicine, Medizinische Universität Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria,
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Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: What should we care about? World J Urol 2015; 33:1973-8. [PMID: 25939539 DOI: 10.1007/s00345-015-1580-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). METHODS Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). RESULTS The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038]. CONCLUSION Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.
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Affiliation(s)
- Caroline Pettenati
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
| | - Yann Neuzillet
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Camelia Radulescu
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Jean-Marie Hervé
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Vincent Molinié
- Department of Pathology, Fort de France University Hospital, Fort de France, France
| | - Thierry Lebret
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
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Den RB, Yousefi K, Trabulsi EJ, Abdollah F, Choeurng V, Feng FY, Dicker AP, Lallas CD, Gomella LG, Davicioni E, Karnes RJ. Genomic classifier identifies men with adverse pathology after radical prostatectomy who benefit from adjuvant radiation therapy. J Clin Oncol 2015; 33:944-51. [PMID: 25667284 PMCID: PMC4884273 DOI: 10.1200/jco.2014.59.0026] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The optimal timing of postoperative radiotherapy (RT) after radical prostatectomy (RP) is unclear. We hypothesized that a genomic classifier (GC) would provide prognostic and predictive insight into the development of clinical metastases in men receiving post-RP RT and inform decision making. PATIENTS AND METHODS GC scores were calculated from 188 patients with pT3 or margin-positive prostate cancer, who received post-RP RT at Thomas Jefferson University and Mayo Clinic between 1990 and 2009. The primary end point was clinical metastasis. Prognostic accuracy of the models was tested using the concordance index for censored data and decision curve analysis. Cox regression analysis tested the relationship between GC and metastasis. RESULTS The cumulative incidence of metastasis at 5 years after RT was 0%, 9%, and 29% for low, average, and high GC scores, respectively (P = .002). In multivariable analysis, GC and pre-RP prostate-specific antigen were independent predictors of metastasis (both P < .01). Within the low GC score (< 0.4), there were no differences in the cumulative incidence of metastasis comparing patients who received adjuvant or salvage RT (P = .79). However, for patients with higher GC scores (≥ 0.4), cumulative incidence of metastasis at 5 years was 6% for patients treated with adjuvant RT compared with 23% for patients treated with salvage RT (P < .01). CONCLUSION In patients treated with post-RP RT, GC is prognostic for the development of clinical metastasis beyond routine clinical and pathologic features. Although preliminary, patients with low GC scores are best treated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy. These findings provide the first rational selection of timing for post-RP RT.
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Affiliation(s)
- Robert B Den
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada.
| | - Kasra Yousefi
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Edouard J Trabulsi
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Firas Abdollah
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Voleak Choeurng
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Felix Y Feng
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Adam P Dicker
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Costas D Lallas
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Leonard G Gomella
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Elai Davicioni
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - R Jeffrey Karnes
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
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Jia X, Sun Y, Wang B. Gray level entropy matrix is a superior predictor than multiplex ELISA in the detection of reactive stroma and metastatic potential of high-grade prostatic adenocarcinoma. IUBMB Life 2015; 66:847-53. [PMID: 25631296 DOI: 10.1002/iub.1337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Xiaopeng Jia
- Department of Urology; The Third Hospital of Hebei Medical University; Shijiazhuang Hebei China
| | - Yanan Sun
- Department of Obstetrics and Gynecology; Bethune International Peace Hospital of PLA; Shijiazhuang Hebei China
| | - Baozhi Wang
- Department of Human Anatomy; School of Basic Medical Sciences, Hebei Medical University; Shijiazhuang Hebei China
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de Boo L, Pintilie M, Yip P, Baniel J, Fleshner N, Margel D. Time from first detectable PSA following radical prostatectomy to biochemical recurrence: A competing risk analysis. Can Urol Assoc J 2015; 9:E14-21. [PMID: 25624961 PMCID: PMC4301963 DOI: 10.5489/cuaj.2147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we estimated the time from first detectable prostate-specific antigen (PSA) following radical prostatectomy (RP) to commonly used definitions of biochemical recurrence (BCR). We also identified the predictors of time to BCR. METHODS We identified subjects who underwent a RP and had an undetectable PSA after surgery followed by at least 1 detectable PSA between 2000 and 2011. The primary outcome was time to BCR (PSA ≥0.2 and successive PSA ≥0.2) and prediction of the rate of PSA rise. Outcomes were calculated using a competing risk analysis, with univariable and multivariable Fine and Grey models. We employed a mixed effect model to test clinical predictors that are associated with the rate of PSA rise. RESULTS The cohort included 376 patients. The median follow-up from surgery was 60.5 months (interquartile range [IQR] 40.8-91.5) and from detectable PSA was 18 months (IQR 11-32). Only 45.74% (n = 172) had PSA values ≥0.2 ng/mL, while 15.16% (n = 57) reached the PSA level of ≥0.4 ng/mL and rising. On multivariable analysis, the values of the first detectable PSA and pathologic Gleason grade 8 or higher were consistently independent predictors of time to BCR. In the mixed effect model rate, the PSA rise was associated with time from surgery to first detectable PSA, Gleason score, and prostate volume. The main limitation of this study is the large proportion of patients that received treatment without reaching BCR. It is plausible that shorter estimated median times would occur at a centre that does not use salvage therapy at such an early state. CONCLUSION The time from first detectable PSA to BCR may be lengthy. Our analyses of the predictors of the rate of PSA rise can help determine a personalized approach for patients with a detectable PSA after surgery.
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Affiliation(s)
- Leonora de Boo
- Division of Urology, Department of Surgical Oncology,University Health Network, Toronto, ON and Erasmus MC-beurs, Erasmus University Rotterdam, Netherlands
| | - Melania Pintilie
- Clinical Study Coordination and Biostatistics, University Health Network, Toronto, ON
| | - Paul Yip
- Laboratory Medicine Program, University Health Network, Toronto, ON
| | - Jack Baniel
- Division of Urology, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON
| | - David Margel
- Division of Urology and Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Israel
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Buyyounouski MK. Radiobiological Modeling and the Study of Hypofractionated Radiotherapy for Prostate Cancer. Eur Urol 2014; 66:1031-2. [DOI: 10.1016/j.eururo.2014.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
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Su MZ, Kneebone AB, Woo HH. Adjuvant versus salvage radiotherapy following radical prostatectomy: do the AUA/ASTRO guidelines have all the answers? Expert Rev Anticancer Ther 2014; 14:1265-1270. [DOI: 10.1586/14737140.2014.972381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Blanchard P, Bakkour M, De Crevoisier R, Levy A, Baumert H, Patard JJ, Wibault P, Fizazi K, Bossi A. Early PSA level decline is an independent predictor of biochemical and clinical control for salvage postprostatectomy radiotherapy. Urol Oncol 2014; 33:108.e15-20. [PMID: 25176583 DOI: 10.1016/j.urolonc.2014.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND To improve the early detection of responders to salvage external beam radiotherapy (RT) after radical prostatectomy (RP). METHODS Between 2002 and 2007, in a single institution, 136 consecutive patients received salvage RT to a dose of 66 Gy without androgen-deprivation therapy after RP for a rising prostate-specific antigen (PSA) level. PSA measurements were systematically performed before RT (PSART), at the fifth week of RT (PSA5), and in the follow-up at least twice a year (every 6 mo). The PSA level decline during RT was expressed as PSA ratio (PSA5/PSART). Two different definitions of biochemical failure after salvage RT were considered: PSA level>0.4 ng/ml and PSA>PSA nadir post-RT +0.4 ng/ml. Statistical analyses included univariate and multivariate Cox regression models. RESULTS The median follow-up was 60 months. The 5-year freedom from biochemical and clinical failure rates were 57% (95% CI: 48%-66%) and 92% (95% CI: 87%-97%), respectively. The mean PSA5 was 0.61 ng/ml (range: 0-7) and the mean PSA ratio was 0.67 (0-1.7). A PSA ratio<1 was a significant prognostic factor in multivariate analysis for both definitions of biochemical failure (P = 0.01 for both) and for clinical failure (P = 0.005). CONCLUSIONS For patients undergoing salvage RT after RP for a rising PSA level, the absence of PSA level decline during RT is predictive of biochemical and clinical failure and may be used to rapidly identify poor responders.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France; University Paris Sud, France.
| | - Moudar Bakkour
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | | | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Hervé Baumert
- Department of Urology, Hôpital Saint Joseph, Paris, France
| | | | - Pierre Wibault
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Karim Fizazi
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France; University Paris Sud, France
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
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