451
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The German S3 Guideline Prostate Cancer. Strahlenther Onkol 2010; 186:531-4. [DOI: 10.1007/s00066-010-2193-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
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452
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Schmitz MD, Padula GDA, Chun PY, Davis AT. Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer. Radiat Oncol 2010; 5:80. [PMID: 20846422 PMCID: PMC2949678 DOI: 10.1186/1748-717x-5-80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/16/2010] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to determine the expected time to prostate specific antigen (PSA) normalization with or without neoadjuvant androgen deprivation (NAAD) therapy after treatment with intensity modulated radiotherapy (IMRT) for patients with clinically localized prostate cancer. Methods A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging) treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p < 0.05. Results Fifty-six of the 133 patients received NAAD (42.1%). Thirty-one patients (23.8%) received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%). The times to serum PSA normalization < 2 ng/mL when treated with or without NAAD were 298 ± 24 and 302 ± 33 days (mean ± SEM), respectively (p > 0.05), and 303 ± 24 and 405 ± 46 days, respectively, for PSA < 1 ng/mL (p < 0.05). Stage T1 and T2 tumors had significantly increased time to PSA normalization < 1 ng/mL in comparison to Stage T3 tumors. Also, higher Gleason scores were significantly correlated with a faster time to PSA normalization < 1 ng/mL. Conclusions Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA < 1 ng/mL in patients with clinically localized prostate cancer.
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Affiliation(s)
- Matthew D Schmitz
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
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453
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Kyrdalen AE, Dahl AA, Hernes E, Hem E, Fosså SD. Fatigue in prostate cancer survivors treated with definitive radiotherapy and LHRH analogs. Prostate 2010; 70:1480-9. [PMID: 20687221 DOI: 10.1002/pros.21183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few studies have dealt with chronic fatigue (CF) in definitive radiotherapy (RAD) patients during and after (neo-)adjuvant androgen deprivation therapy (ADT) for prostate cancer. METHODS CF was the primary outcome in this population-based cross-sectional study as evaluated by the Fatigue Questionnaire. We compared the post-RAD levels of fatigue in two groups of > or = 1 year prostate cancer survivors; those with ongoing medical castration (HTcont) and those who had used a luteinizing hormone-releasing hormone analog (LHRHa), but had discontinued the therapy at the time of the survey (HTdis). The prevalence of CF and the levels of total fatigue were compared to comparable parameters in men with prostatic RAD who never had had ADT (Control group) and to men > 60 years old from the general population. RESULTS After an observation time of median 18 months since start of radiotherapy about 40% of our > or = 1 year prostate cancer survivors from the HTcont group reported CF, as compared to approximately a quarter of men from the HTdis group and, the prevalence of CF in the latter group being similar to that of hormone-naïve RAD controls and males from the general population. After discontinuation of ADT, age 65 years or below was associated with increased risk of CF. CONCLUSIONS Pre-counseling of prostate cancer patients starting (neo-)adjuvant LHRHa therapy must include fatigue, mainly physical fatigue, in particular in men aged 65 years or younger. Future studies of testosterone recovery after ADT discontinuation should also include measures of CF.
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Affiliation(s)
- Anne E Kyrdalen
- National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital, Norway
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454
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Armstrong JG, Gillham CM, Dunne MT, Fitzpatrick DA, Finn MA, Cannon ME, Taylor JC, O'Shea CM, Buckney SJ, Thirion PG. A randomized trial (Irish clinical oncology research group 97-01) comparing short versus protracted neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2010; 81:35-45. [PMID: 20797824 DOI: 10.1016/j.ijrobp.2010.04.065] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/10/2010] [Accepted: 04/23/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the long-term outcomes of a randomized trial comparing short (4 months; Arm 1) and long (8 months; Arm 2) neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer. METHODS AND MATERIALS Between 1997 and 2001, 276 patients were enrolled and the data from 261 were analyzed. The stratification risk factors were prostate-specific antigen level >20 ng/mL, Gleason score≥7, and Stage T3 or more. The intermediate-risk stratum had one factor and the high-risk stratum had two or more. Staging was done from the bone scan and computed tomography findings. The primary endpoint was biochemical failure-free survival. RESULTS The median follow-up was 102 months. The overall survival, biochemical failure-free survival. and prostate cancer-specific survival did not differ significantly between the two treatment arms, overall or at 5 years. The cumulative probability of overall survival at 5 years was 90% (range, 87-92%) in Arm 1 and 83% (range, 80-86%) in Arm 2. The biochemical failure-free survival rate at 5 years was 66% (range, 62-71%) in Arm 1 and 63% (range, 58-67%) in Arm 2. CONCLUSION No statistically significant difference was found in biochemical failure-free survival between 4 months and 8 months of neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer.
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Affiliation(s)
- John G Armstrong
- Department of Radiation Oncology, St. Luke's Hospital, Dublin, Ireland
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455
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Rodrigues G, Bae K, Roach M, Lawton C, Donnelly B, Grignon D, Hanks G, Porter A, Lepor H, Sandler H. Impact of ultrahigh baseline PSA levels on biochemical and clinical outcomes in two Radiation Therapy Oncology Group prostate clinical trials. Int J Radiat Oncol Biol Phys 2010; 80:445-52. [PMID: 20615632 DOI: 10.1016/j.ijrobp.2010.02.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/27/2010] [Accepted: 02/05/2010] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess ultrahigh (UH; prostate-specific antigen [PSA] levels ≥50 ng/ml) patient outcomes by comparison to other high-risk patient outcomes and to identify outcome predictors. METHODS AND MATERIALS Prostate cancer patients (PCP) from two Phase III Radiation Therapy Oncology Group clinical trials (studies 9202 and 9413) were divided into two groups: high-risk patients with and without UH baseline PSA levels. Predictive variables included age, Gleason score, clinical T stage, Karnofsky performance score, and treatment arm. Outcomes included overall survival (OS), distant metastasis (DM), and biochemical failure (BF). Unadjusted and adjusted hazard ratios (HRs) were calculated using either the Cox or Fine and Gray's regression model with associated 95% confidence intervals (CI) and p values. RESULTS There were 401 patients in the UH PSA group and 1,792 patients in the non-UH PSA PCP group of a total of 2,193 high-risk PCP. PCP with UH PSA were found to have inferior OS (HR, 1.19; 95% CI, 1.02-1.39, p = 0.02), DM (HR, 1.51; 95% CI, 1.19-1.92; p = 0.0006), and BF (HR, 1.50; 95% CI, 1.29-1.73; p < 0.0001) compared to other high-risk PCP. In the UH cohort, PSA level was found to be a significant factor for the risk of DM (HR, 1.01; 95% CI, 1.001-1.02) but not OS and BF. Gleason grades of 8 to 10 were found to consistently predict for poor OS, DM, and BF outcomes (with HR estimates ranging from 1.41-2.36) in both the high-risk cohort and the UH cohort multivariable analyses. CONCLUSIONS UH PSA levels at diagnosis are related to detrimental changes in OS, DM, and BF. All three outcomes can be modeled by various combinations of all predictive variables tested.
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Affiliation(s)
- George Rodrigues
- Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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456
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[Combination of external irradiation and androgen suppression for prostate cancer: facts and questions]. Cancer Radiother 2010; 14:510-4. [PMID: 20728391 DOI: 10.1016/j.canrad.2010.07.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
The combination of radiotherapy and androgen suppression with luteinizing hormone releasing hormone agonist is mainly devoted to locally advanced prostate cancer and intermediate or poor risk localized prostate cancer. They are based on phase III randomized trials which have shown that for locally advanced prostate cancer, a four-month complete androgen blockade initiated two months prior radiotherapy and stopped at the completion of radiotherapy increased overall survival in patients with Gleason scores 2-6, meanwhile, an adjuvant long-term androgen suppression (2.5 to three years) improved significantly the overall survival. Complete androgen blockade with a four to six months duration, combined with external irradiation, enhanced the overall survival in patients with intermediate or poor risk localized prostate cancer.
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457
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Rosenthal SA, Sandler HM. Treatment strategies for high-risk locally advanced prostate cancer. Nat Rev Urol 2010; 7:31-8. [PMID: 20062072 DOI: 10.1038/nrurol.2009.237] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
High-risk prostate cancer can be defined by the assessment of pretreatment prognostic factors such as clinical stage, Gleason score, and PSA level. High-risk features include PSA >20 ng/ml, Gleason score 8-10, and stage T3 tumors. Patients with adverse prognostic factors have historically fared poorly with monotherapeutic approaches. Multimodal treatment utilizing combined androgen suppression and radiotherapy has improved survival rates for patients with high-risk prostate cancer. In addition, multiple randomized trials in patients treated with primary radical prostatectomy have demonstrated improved outcomes with the addition of adjuvant radiotherapy. Improved radiotherapy techniques that allow for dose escalation, and new systemic therapy approaches such as adjuvant chemotherapy, present promising future therapeutic alternatives for patients with high-risk prostate cancer.
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Affiliation(s)
- Seth A Rosenthal
- Radiation Oncology Centers, Radiological Associates of Sacramento, 1500 Expo Parkway, Sacramento, CA 95815, USA.
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458
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Gomella LG, Singh J, Lallas C, Trabulsi EJ. Hormone therapy in the management of prostate cancer: evidence-based approaches. Ther Adv Urol 2010; 2:171-81. [PMID: 21789093 PMCID: PMC3126080 DOI: 10.1177/1756287210375270] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hormonal therapy has been the standard for advanced prostate cancer for over 60 years. Recently, the utility of androgen ablation through various means has been demonstrated for earlier stages of disease. In particular, the strongest evidence to date involves the use of hormonal therapy in combination with radiation therapy. In this article we review the basic concepts in hormonal ablation for prostate cancer and review the evidence-based studies that support the use of hormonal therapy in early stage prostate cancer.
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Affiliation(s)
- Leonard G Gomella
- Chairman, Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1112, Philadelphia, PA 19107, USA
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459
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Long-term outcomes of three-dimensional conformal radiation therapy combined with neoadjuvant hormonal therapy in Japanese patients with locally advanced prostate cancer. Int J Clin Oncol 2010; 15:571-7. [PMID: 20652347 DOI: 10.1007/s10147-010-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The outcomes of three-dimensional conformal radiation therapy (3D-CRT) combined with neoadjuvant hormonal therapy (NAHT) in Japanese patients with locally advanced prostate cancer who initiated salvage hormonal therapy (SHT) at a relatively early phase were evaluated. METHODS Between April 1998 and April 2003, 70 Japanese patients with T3N0M0 prostate cancer who received radical 3D-CRT treatment were evaluated. The median age, initial prostate-specific antigen (PSA) level, and duration of NAHT were 73 years old, 26.3 ng/ml, and 4 months, respectively. Seventy grays were given in 35 fractions that were confined to the prostate and seminal vesicles. Adjuvant hormonal therapy was not administered after 3D-CRT in any of the cases. RESULTS The median follow-up period was 64.9 months. The median PSA value at the time of initiation of SHT was 5.0 ng/ml (range 0.1-21.6 ng/ml). Overall, disease-specific, PSA failure-free (based on the Phoenix definition) and SHT-free survival rates at 5 years were 90.3% (95% CI 86.5-94.0), 96.5% (94.0-98.9), 60.5% (48.2-72.7), and 63.5% (57.2-69.8), respectively. Therefore, two-thirds of the patients were still hormone-free at 5 years. CONCLUSIONS PSA control rates in our series of Japanese patients with stage T3N0M0 prostate cancer treated with the standard dose of 3D-CRT combined with NAHT seemed higher than expected. This approach involving 3D-CRT combined with NAHT with the initiation of SHT at PSA values of around 5 ng/ml may be one option for Japanese patients with locally advanced prostate cancer, although further prospective study is required to confirm the validity.
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460
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Nanda A, D’Amico AV. Hormonal therapy and radiation for prostate cancer: is it safe? Expert Rev Anticancer Ther 2010; 10:979-81. [DOI: 10.1586/era.10.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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461
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Verhagen PCMS, Schröder FH, Collette L, Bangma CH. Does local treatment of the prostate in advanced and/or lymph node metastatic disease improve efficacy of androgen-deprivation therapy? A systematic review. Eur Urol 2010; 58:261-9. [PMID: 20627403 DOI: 10.1016/j.eururo.2010.05.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/13/2010] [Indexed: 12/01/2022]
Abstract
CONTEXT Androgen-deprivation therapy (ADT) plays a pivotal role in the management of locally advanced and metastatic prostate cancer (PCa). When and for how long to apply ADT have remained controversial issues. OBJECTIVE To review randomised studies of ADT (orchiectomy or luteinising hormone-releasing hormone analogues) in PCa-both immediate and deferred/adjuvant studies-to elucidate a possible interaction between local treatment and ADT. EVIDENCE ACQUISITION Published randomised studies on ADT in various stages of PCa were included in this review. EVIDENCE SYNTHESIS Studies of immediate versus deferred ADT without local treatment consistently showed only limited benefit for overall survival (OS; hazard ratio [HR]: 0.90; 95% confidence interval [CI], 0.83-0.97) and cancer-specific survival (CSS; HR: 0.79; 95% CI, 0.71-0.89). In contrast, ADT as an adjuvant to radiation therapy in patients with high-risk localised disease or locally advanced disease was associated with substantial OS and CSS benefits. A similar benefit was seen in patients with proven systemic disease (node-positive patients after radical prostatectomy). Overall, the data suggest a clinically important survival benefit (HR for OS: 0.69; 95% CI, 0.61-0.79) when a local treatment has been applied to the primary tumour. Possible mechanisms of this therapeutic effect are discussed. CONCLUSIONS We conclude that an interaction between local treatment and ADT is suggested by this systematic review. In patients with advanced and aggressive disease who are at a high risk to die from PCa and who are treated for their primary tumour with curative intent, immediate and sustained ADT improves OS and CSS significantly. The local therapy in T3 and/or lymph node-positive disease is an essential part of the optimal treatment. However, this intensive treatment is unnecessary in a substantial number of patients with T3 and/or N1 disease with a slow natural history or high competing death risk.
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Affiliation(s)
- Paul C M S Verhagen
- Department of Urology, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands.
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462
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Al-Mamgani A, Lebesque JV, Heemsbergen WD, Tans L, Kirkels WJ, Levendag PC, Incrocci L. Controversies in the treatment of high-risk prostate cancer--what is the optimal combination of hormonal therapy and radiotherapy: a review of literature. Prostate 2010; 70:701-9. [PMID: 20017166 DOI: 10.1002/pros.21102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In high-risk prostate carcinoma, there is controversy whether these patients should be treated with escalated-dose (> or =74 Gy) or conventional-dose radiotherapy (<74 Gy) combined with hormonal therapy. Furthermore, the issue of the optimal duration and timing of hormonal therapy are not well crystallized. PATIENTS AND METHODS A search for evidence from randomized- and large non-randomized studies in order to address these issues, was therefore initiated. For this purpose, MedLine, EMbase, and PubMed and the data base of the Dutch randomized dose-escalation trial, were consulted. RESULTS AND CONCLUSIONS From this search it was concluded that the benefit of hormonal therapy in combination with conventional-dose radiotherapy (<74 Gy) in high-risk prostate cancer is evident (Level 2 evidence); Levels 2 and 3 evidence were provided by several studies supporting the use of escalated-dose radiotherapy in high-risk prostate cancer. For the combination of hormonal therapy with escalated-dose radiotherapy in these patients, there is Level 2 evidence for moderately escalated dose (74 Gy) and high escalated dose (> or =78 Gy). The optimal duration and timing of hormonal therapy are not well defined. More randomized-controlled trials and meta-analyses are therefore needed to clearly determine the independent role of dose-escalation in high-risk patients treated with hormonal therapy and the optimal duration and timing of hormonal therapy.
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Affiliation(s)
- Abrahim Al-Mamgani
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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463
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Corn PG, Thompson TC. Identification of a novel prostate cancer biomarker, caveolin-1: Implications and potential clinical benefit. Cancer Manag Res 2010. [PMID: 21188102 DOI: 10.2147/cmr.s9835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
While prostate cancer is a common disease in men, it is uncommonly life-threatening. To better understand this phenomenon, tumor biologists have sought to elucidate the mechanisms that contribute to the development of virulent prostate cancer. The recent discovery that caveolin-1 (Cav-1) functions as an important oncogene involved in prostate cancer progression reflects the success of this effort. Cav-1 is a major structural coat protein of caveolae, specialized plasma membrane invaginations involved in multiple cellular functions, including molecular transport, cell adhesion, and signal transduction. Cav-1 is aberrantly overexpressed in human prostate cancer, with higher levels evident in metastatic versus primary sites. Intracellular Cav-1 promotes cell survival through activation of Akt and enhancement of additional growth factor pro-survival pathways. Cav-1 is also secreted as a biologically active molecule that promotes cell survival and angiogenesis within the tumor microenvironment. Secreted Cav-1 can be reproducibly detected in peripheral blood using a sensitive and specific immunoassay. Cav-1 levels distinguish men with prostate cancer from normal controls, and preoperative Cav-1 levels predict which patients are at highest risk for relapse following radical prostatectomy for localized disease. Thus, secreted Cav-1 is a promising biomarker in identifying clinically significant prostate cancer.
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Affiliation(s)
- Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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464
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Corn PG, Thompson TC. Identification of a novel prostate cancer biomarker, caveolin-1: Implications and potential clinical benefit. Cancer Manag Res 2010; 2:111-22. [PMID: 21188102 PMCID: PMC3004586 DOI: 10.2147/cmar.s9835] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 12/21/2022] Open
Abstract
While prostate cancer is a common disease in men, it is uncommonly life-threatening. To better understand this phenomenon, tumor biologists have sought to elucidate the mechanisms that contribute to the development of virulent prostate cancer. The recent discovery that caveolin-1 (Cav-1) functions as an important oncogene involved in prostate cancer progression reflects the success of this effort. Cav-1 is a major structural coat protein of caveolae, specialized plasma membrane invaginations involved in multiple cellular functions, including molecular transport, cell adhesion, and signal transduction. Cav-1 is aberrantly overexpressed in human prostate cancer, with higher levels evident in metastatic versus primary sites. Intracellular Cav-1 promotes cell survival through activation of Akt and enhancement of additional growth factor pro-survival pathways. Cav-1 is also secreted as a biologically active molecule that promotes cell survival and angiogenesis within the tumor microenvironment. Secreted Cav-1 can be reproducibly detected in peripheral blood using a sensitive and specific immunoassay. Cav-1 levels distinguish men with prostate cancer from normal controls, and preoperative Cav-1 levels predict which patients are at highest risk for relapse following radical prostatectomy for localized disease. Thus, secreted Cav-1 is a promising biomarker in identifying clinically significant prostate cancer.
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Affiliation(s)
- Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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465
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Denham JW, Bender R, Paradice WEJ. It's time to depolarise the unhelpful PSA-testing debate and put into practice lessons from the two major international screening trials. Med J Aust 2010; 192:393-6. [PMID: 20367587 DOI: 10.5694/j.1326-5377.2010.tb03562.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 11/10/2009] [Indexed: 11/17/2022]
Abstract
Two recently reported large-scale trials conducted in the United States and western Europe have provided evidence that coordinated screening programs will not reduce mortality in countries or regions where prostate-specific antigen (PSA) testing is already highly prevalent, but will reduce mortality in places where PSA testing prevalence is low. The trials also produce evidence that coordinated screening will cause over-diagnosis and over-treatment. The instigation of a national screening program should be delayed until a more specific marker for aggressive disease than PSA level becomes available. In the meantime, results of the two trials can be used to inform the development of regional testing policies in Australia. These policies should encourage regular PSA testing in regions with low testing prevalence, but must also embrace methods of dealing with over-diagnosis and over-treatment. "Active surveillance" programs (whereby men with early-stage cancers are monitored regularly by PSA testing and digital rectal examinations) and development of counselling services should be encouraged.
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Affiliation(s)
- James W Denham
- Prostate Cancer Trials Group, University of Newcastle, Newcastle, NSW, Australia.
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466
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Wilke DR, Krahn M, Tomlinson G, Bezjak A, Rutledge R, Warde P. Sex or survival: short-term versus long-term androgen deprivation in patients with locally advanced prostate cancer treated with radiotherapy. Cancer 2010; 116:1909-17. [PMID: 20162716 DOI: 10.1002/cncr.24905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Combined long-term androgen deprivation (LTAD) and radiation conveys a prostate cancer-specific survival advantage over combined short-term androgen deprivation (STAD) and radiation. The seminal question is whether or not the gains are worth the adverse effects of LTAD with respect to patient preferences. METHODS Preferences for LTAD compared with STAD were elicited by direct patient interview using the probability trade-off method. "Time trade-off utilities" (TTOu) for erectile dysfunction and osteoporosis were elicited using the time trade-off method. Participants' current prostate cancer-specific health state was assessed using the Patient-Oriented Prostate Utility Scale-Psychometric. Participants' current sexual function was assessed using the International Index of Erectile Function (IIEF). RESULTS All participants were willing to trade survival rather than undergo LTAD compared with STAD. The mean minimally required increment in prostate cancer-specific survival (MRIS) was 8.2%. The mean TTOu for impotence was 0.78, and the mean TTOu for osteoporosis was 0.71. The MRIS was correlated with the Sexual Desire domain score of the IIEF (Spearman rank-correlation coefficient, r = 0.50; P<.0001). CONCLUSIONS Patients desired more prostate cancer-specific survival than what was afforded by LTAD and radiotherapy compared with STAD and radiotherapy.
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Affiliation(s)
- Derek R Wilke
- Department of Radiation Oncology, Nova Scotia Cancer Center, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada.
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467
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Winkfield KM, Albert MA. Unanswered Questions Regarding the Effect of Androgen Deprivation Therapy for Prostate Cancer on Cardiovascular Disease Risk in Black Men. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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468
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Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, Milani RV, Sagalowsky AI, Smith MR, Zakai N. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. CA Cancer J Clin 2010; 60:194-201. [PMID: 20124400 PMCID: PMC3049943 DOI: 10.3322/caac.20061] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Glenn N Levine
- Michael E. DeBakey Veteran's Affairs Medical Center, Houston, TX, USA.
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469
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Résultats carcinologiques de la prostatectomie totale chez 81 patients à haut risque. Prog Urol 2010; 20:356-63. [DOI: 10.1016/j.purol.2010.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 01/05/2010] [Accepted: 01/10/2010] [Indexed: 11/22/2022]
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470
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Nanda A, Chen MH, Moran BJ, Braccioforte MH, Dosoretz D, Salenius S, Katin M, Ross R, D'Amico AV. Total Androgen Blockade Versus a Luteinizing Hormone–Releasing Hormone Agonist Alone in Men With High-Risk Prostate Cancer Treated With Radiotherapy. Int J Radiat Oncol Biol Phys 2010; 76:1439-44. [DOI: 10.1016/j.ijrobp.2009.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/12/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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471
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Intensity-modulated Radiotherapy Allows Escalation of the Radiation Dose to the Pelvic Lymph Nodes in Patients with Locally Advanced Prostate Cancer: Preliminary Results of a Phase I Dose Escalation Study. Clin Oncol (R Coll Radiol) 2010; 22:236-44. [DOI: 10.1016/j.clon.2010.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/14/2009] [Accepted: 01/05/2010] [Indexed: 11/17/2022]
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472
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Schutz FAB, Oh WK. Neoadjuvant and adjuvant therapies in prostate cancer. Urol Clin North Am 2010; 37:97-104, Table of Contents. [PMID: 20152523 DOI: 10.1016/j.ucl.2009.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prostate cancer is the most common cancer in men in the United States and the second leading cause of cancer death. Advances in surgical therapies have paralleled advances in radiation therapy and chemotherapy for metastatic disease. There is a great interest in neoadjuvant and adjuvant therapies for patients at intermediate and high risk of recurrence and prostate cancer-specific death. Because high-risk prostate cancer patients can be readily identified by clinical criteria, many studies have attempted to use local and systemic adjuvant therapy to reduce the risk of recurrence. This review discusses neoadjuvant and adjuvant therapies in prostate cancer, including hormonal therapy, chemotherapy, and postoperative radiotherapy.
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Affiliation(s)
- Fabio A B Schutz
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02215, USA
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473
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Quéro L, Giocanti N, Hennequin C, Favaudon V. Antagonistic interaction between bicalutamide (Casodex) and radiation in androgen-positive prostate cancer LNCaP cells. Prostate 2010; 70:401-11. [PMID: 19902473 DOI: 10.1002/pros.21074] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bicalutamide (Casodex) reportedly improves high-risk prostate cancer survival as an adjuvant treatment following radiotherapy. However, biological data for the interaction between bicalutamide and ionizing radiation in concomitant association are lacking. METHODS To explore this issue, androgen-dependent (LNCaP) and -independent (DU145) human prostate cancer cells were exposed for 48 hr to 20, 40, or 80 microM bicalutamide introduced before (neoadjuvant), during (concomitant), or following (adjuvant) radiation. Growth inhibition and cytotoxicity, cell cycle distribution and expression of the prostate serum antigen (PSA) and androgen receptor (AR), were measured as endpoints. RESULTS Bicalutamide-induced cytotoxic and cytostatic effects were found to be correlated with a marked G1 phase arrest and S phase depression. The drug down-regulated PSA and AR proteins and psa mRNA in LNCaP cells. However, transient up-regulation of the expression of ar mRNA was observed in the presence of 40 microM drug. DU145 cells did not express PSA and proved to be comparatively resistant to the drug from both cytostatic and cytotoxic effects. Bicalutamide dose-dependently induced a significant decrease of radiation susceptibility among drug survivors in LNCaP cells, whilst the interaction appeared to be additive in DU145 cells. CONCLUSIONS The antagonistic radiation-drug interaction observed in LNCaP cells is of significance in relation to combined radiotherapy-bicalutamide treatments directed against tumors expressing the AR. The results suggest that bicalutamide is amenable to combined schedule with radiotherapy provided the drug and radiation are not given in close temporal proximity.
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Affiliation(s)
- Laurent Quéro
- Institut Curie, Bât. 110-112, Centre Universitaire, Orsay, France
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474
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Cancer de la prostate localement avancé et hormonothérapie. Prog Urol 2010; 20 Suppl 1:S68-71. [DOI: 10.1016/s1166-7087(10)70031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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475
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Böhmer D, Wenz F, Martin T, Sedlmayr F, Hinkelbein W, Wiegel T. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie. Urologe A 2010; 49:211-5. [DOI: 10.1007/s00120-010-2241-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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476
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Deville C, Both S, Hwang WT, Tochner Z, Vapiwala N. Clinical toxicities and dosimetric parameters after whole-pelvis versus prostate-only intensity-modulated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010; 78:763-72. [PMID: 20171807 DOI: 10.1016/j.ijrobp.2009.08.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 08/19/2009] [Accepted: 08/21/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess whether whole-pelvis (WP) intensity-modulated radiation therapy (IMRT) is associated with increased toxicity compared with prostate-only (PO) IMRT. METHODS AND MATERIALS We retrospectively analyzed all patients with prostate cancer undergoing definitive IMRT to 79.2 Gy with concurrent androgen deprivation at our institution from November 2005 to May 2007 with a minimum follow-up of 12 months. Thirty patients received initial WP IMRT to 45 Gy in 1.8-Gy fractions, and thirty patients received PO IMRT. Study patients underwent computed tomography simulation and treatment planning by use of predefined dose constraints. Bladder and rectal dose-volume histograms, maximum genitourinary (GU) and gastrointestinal (GI) Radiation Therapy Oncology Group toxicity grade, and late Grade 2 or greater toxicity-free survival curves were compared between the two groups by use of the Student t test, Fisher exact test, and Kaplan-Meier curve, respectively. RESULTS Bladder minimum dose, mean dose, median dose, volume receiving 5 Gy, volume receiving 20 Gy, volume receiving 40 Gy, and volume receiving 45 Gy and rectal minimum dose, median dose, and volume receiving 20 Gy were significantly increased in the WP group (all p values < 0.01). Maximum acute GI toxicity was limited to Grade 2 and was significantly increased in the WP group at 50% vs. 13% the PO group (p = 0.006). With a median follow-up of 24 months (range, 12-35 months), there was no difference in late GI toxicity (p = 0.884) or in acute or late GU toxicity. CONCLUSIONS Despite dosimetric differences in the volume of bowel, bladder, and rectum irradiated in the low-dose and median-dose regions, WP IMRT results only in a clinically significant increase in acute GI toxicity, in comparison to PO IMRT, with no difference in GU or late GI toxicity.
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Affiliation(s)
- Curtiland Deville
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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477
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Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, Vickers A, Scardino PT. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol 2010; 28:1508-13. [PMID: 20159826 DOI: 10.1200/jco.2009.22.2265] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We assessed the effect of radical prostatectomy (RP) and external beam radiotherapy (EBRT) on distant metastases (DM) rates in patients with localized prostate cancer treated with RP or EBRT at a single specialized cancer center. PATIENTS AND METHODS Patients with clinical stages T1c-T3b prostate cancer were treated with intensity-modulated EBRT (> or = 81 Gy) or RP. Both cohorts included patients treated with salvage radiotherapy or androgen-deprivation therapy for biochemical failure. Salvage therapy for patients with RP was delivered a median of 13 months after biochemical failure compared with 69 months for EBRT patients. DM was compared controlling for patient age, clinical stage, serum prostate-specific antigen level, biopsy Gleason score, and year of treatment. RESULTS The 8-year probability of freedom from metastatic progression was 97% for RP patients and 93% for EBRT patients. After adjustment for case mix, surgery was associated with a reduced risk of metastasis (hazard ratio, 0.35; 95% CI, 0.19 to 0.65; P < .001). Results were similar for prostate cancer-specific mortality (hazard ratio, 0.32; 95% CI, 0.13 to 0.80; P = .015). Rates of metastatic progression were similar for favorable-risk disease (1.9% difference in 8-year metastasis-free survival), somewhat reduced for intermediate-risk disease (3.3%), and more substantially reduced in unfavorable-risk disease (7.8% in 8-year metastatic progression). CONCLUSION Metastatic progression is infrequent in men with low-risk prostate cancer treated with either RP or EBRT. RP patients with higher-risk disease treated had a lower risk of metastatic progression and prostate cancer-specific death than EBRT patients. These results may be confounded by differences in the use and timing of salvage therapy.
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Affiliation(s)
- Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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478
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Lin K, Lee SP, Steinberg ML. Selection bias clouds apparent benefit of longer hormone duration. J Clin Oncol 2010; 28:e79; author reply e80. [PMID: 19841313 DOI: 10.1200/jco.2009.25.0969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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479
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Valero J, Cambeiro M, Galán C, Teijeira M, Romero P, Zudaire J, Moreno M, Ciérvide R, Aristu JJ, Martínez-Monge R. Phase II Trial of Radiation Dose Escalation With Conformal External Beam Radiotherapy and High-Dose-Rate Brachytherapy Combined With Long-Term Androgen Suppression in Unfavorable Prostate Cancer: Feasibility Report. Int J Radiat Oncol Biol Phys 2010; 76:386-92. [DOI: 10.1016/j.ijrobp.2009.01.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/26/2009] [Accepted: 01/29/2009] [Indexed: 11/30/2022]
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480
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Stock RG, Stone NN. Current Topics in the Treatment of Prostate Cancer with Low-Dose-Rate Brachytherapy. Urol Clin North Am 2010; 37:83-96, Table of Contents. [DOI: 10.1016/j.ucl.2009.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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481
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Stock RG, Yamalachi S, Hall SJ, Stone NN. Impact of Hormonal Therapy on Intermediate Risk Prostate Cancer Treated With Combination Brachytherapy and External Beam Irradiation. J Urol 2010; 183:546-50. [DOI: 10.1016/j.juro.2009.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Richard G. Stock
- Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, New York
| | - Swati Yamalachi
- Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, New York
| | - Simon J. Hall
- Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, New York
| | - Nelson N. Stone
- Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, New York
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482
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Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, Milani RV, Sagalowsky AI, Smith MR, Zakai N. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation 2010; 121:833-40. [PMID: 20124128 DOI: 10.1161/circulationaha.109.192695] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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483
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Haseen F, Murray LJ, Cardwell CR, O'Sullivan JM, Cantwell MM. The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv 2010; 4:128-39. [PMID: 20091248 DOI: 10.1007/s11764-009-0114-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/22/2009] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The use of androgen deprivation therapy (ADT) in the treatment of prostate cancer is associated with changes in body composition including increased fat and decreased lean mass. Limited information exists regarding the rate and extent of these changes. This systematic review was conducted to determine the effects of ADT on body composition in prostate cancer patients. METHODS Literature searches were conducted on MEDLINE, EMBASE and Web of Science for studies until January 2009. Only longitudinal studies that examined ADT and body composition in prostate cancer patients were included. Data were extracted on body weight, BMI, percentage of fat mass and lean body mass. RESULTS Sixteen studies (14 cohorts and 2 RCTs) met the inclusion criteria. Pooled data, calculated according to a random effects model, showed that ADT increased % body fat by on average 7.7% (95% CI 4.3, 11.2, from seven studies, P < 0.0001) and decreased % lean body mass by on average -2.8% (95% CI -3.6, -2.0, from six studies, P < 0.0001) but for both there was marked heterogeneity between studies (I2 = 99% I2 = 73%, respectively). Similarly, body weight (2.1%, P < 0.0001 from nine studies) and BMI (2.2%, P < 0.0001, from eight studies) increased significantly. More extensive changes were seen with longer duration of treatment. CONCLUSIONS Substantial increases in fat and declines in lean mass were observed in prostate cancer patients treated with ADT. Lifestyle changes or suitable interventions to minimize the effect of ADT on body composition need to be investigated. IMPLICATIONS FOR CANCER SURVIVORS Prostate cancer survivors should be made aware of the side effect of treatment on body composition and further work is required to determine what interventions can minimize the impact of ADT on body composition and therefore what evidence based advice they should be provided with. In general, though recommendation of a healthy diet and moderate exercise is reasonable.
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Affiliation(s)
- Farhana Haseen
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
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484
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Horwitz EM. Prostate cancer: Optimizing the duration of androgen deprivation therapy. Nat Rev Urol 2009; 6:527-9. [PMID: 19806170 DOI: 10.1038/nrurol.2009.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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485
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486
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Boccon-Gibod L, Richaud P, Coloby P, Coulange C, Culine S, Davin JL, Soulié M, Zerbib M. [First line indications for hormonal therapy in prostate cancer]. Prog Urol 2009; 20:109-15. [PMID: 20142051 DOI: 10.1016/j.purol.2009.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/10/2009] [Indexed: 11/30/2022]
Abstract
The utilization of androgen deprivation therapy in prostate cancer has evolved over time. Unquestionably considered first line treatment in metastatic cancers or in case of lymph node involvement, it is increasingly used in locally advanced and high-risk cancers, combined with radiation therapy. However, the practical modalities of treatment are still controversial (neoadjuvant, concomitant/adjuvant) and should be discussed on a case-by-case basis, taking into account tumor stage and risk level, which depends mainly on Gleason score and PSA levels and kinetics. Hormone therapy is also indicated in case of systemic relapse, especially if PSA doubling time is less than 12 months. LHRH agonists have become the standard care; antiandrogens can be added at the beginning of the LHRH agonist therapy to obtain a complete androgen blockade. Intermittent androgen deprivation therapy has recently proved efficacious and might be more widely used in the future, provided that strict prescription and follow-up recommendations are clearly established.
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Affiliation(s)
- L Boccon-Gibod
- Clinique d'urologie, université Paris VII - Denis-Diderot, hôpital Bichat Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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487
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Adjuvant hormone therapy for localised and locally advanced prostate carcinoma: A systematic review and meta-analysis of randomised trials. Cancer Treat Rev 2009; 35:540-6. [DOI: 10.1016/j.ctrv.2009.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 11/22/2022]
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488
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Aizer AA, Yu JB, Colberg JW, McKeon AM, Decker RH, Peschel RE. Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma. Radiother Oncol 2009; 93:185-91. [DOI: 10.1016/j.radonc.2009.09.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/25/2009] [Accepted: 09/01/2009] [Indexed: 11/30/2022]
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489
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D'Amico AV, Braccioforte MH, Moran BJ, Chen MH. Causes of death in men with prevalent diabetes and newly diagnosed high- versus favorable-risk prostate cancer. Int J Radiat Oncol Biol Phys 2009; 77:1329-37. [PMID: 19879061 DOI: 10.1016/j.ijrobp.2009.06.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/25/2009] [Accepted: 06/26/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether prevalent diabetes mellitus (pDM) affects the presentation, extent of radiotherapy, or prostate cancer (PCa)-specific mortality (PCSM) and whether PCa aggressiveness affects the risk of non-PCSM, DM-related mortality, and all-cause mortality in men with pDM. METHODS Between October 1997 and July 2907, 5,279 men treated at the Chicago Prostate Cancer Center with radiotherapy for PCa were included in the study. Logistic and competing risk regression analyses were performed to assess whether pDM was associated with high-grade PCa, less aggressive radiotherapy, and an increased risk of PCSM. Competing risks and Cox regression analyses were performed to assess whether PCa aggressiveness described by risk group in men with pDM was associated with the risk of non-PCSM, DM-related mortality, and all-cause mortality. Analyses were adjusted for predictors of high-grade PCa and factors that could affect treatment extent and mortality. RESULTS Men with pDM were more likely (adjusted hazard ratio [AHR], 1.9; 95% confidence interval [CI], 1.3-2.7; p = .002) to present with high-grade PCa but were not treated less aggressively (p = .33) and did not have an increased risk of PCSM (p = .58) compared to men without pDM. Among the men with pDM, high-risk PCa was associated with a greater risk of non-PCSM (AHR, 2.2; 95% CI, 1.1-4.5; p = .035), DM-related mortality (AHR, 5.2; 95% CI, 2.0-14.0; p = .001), and all-cause mortality (AHR, 2.4; 95% CI, 1.2-4.7; p = .01) compared to favorable-risk PCa. CONCLUSION Aggressive management of pDM is warranted in men with high-risk PCa.
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Affiliation(s)
- Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA 02215, USA.
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490
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Benefit of whole pelvic radiotherapy combined with neoadjuvant androgen deprivation for the high-risk prostate cancer. J Biomed Biotechnol 2009; 2009:625394. [PMID: 19859572 PMCID: PMC2765690 DOI: 10.1155/2009/625394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 07/27/2009] [Indexed: 11/18/2022] Open
Abstract
AIM To study whether use of neoadjuvant androgen deprivation therapy (N-ADT) combined with whole pelvic radiotherapy (WPRT) for high-risk prostate cancer patients was associated with survival benefit over prostate radiotherapy (PORT) only. MATERIAL AND METHODS Between 1999 and 2004, 162 high-risk prostate cancer patients were treated with radiotherapy combined with long-term androgen deprivation therapy (L-ADT). Patients were prospectively assigned into two groups: A (N-ADT + WPRT + L-ADT) n = 70 pts, B (PORT + L-ADT) n = 92 pts. RESULTS The 5-year actuarial overall survival (OS) rates were 89% for A and 78% for B (P = .13). The 5-year actuarial cause specific survival (CSS) rates were A = 90% and B = 79% (P = .01). Biochemical progression-free survival (bPFS) rates were 52% versus 40% (P = .07), for groups A and B, respectively. CONCLUSIONS The WPRT combined with N-ADT compared to PORT for high-risk patients resulted in improvement in CSS and bPFS; however no OS benefit was observed.
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491
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Villari D, Nesi G, Della Melina A, Palli D, Ceroti M, Castigli M, Filocamo MT, Li Marzi V, Nicita G. Radical retropubic prostatectomy for prostate cancer with microscopic bladder neck involvement: survival and prognostic implications. BJU Int 2009; 105:946-50. [PMID: 19804424 DOI: 10.1111/j.1464-410x.2009.08914.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the oncological outcome of 106 patients who had locally advanced prostate cancer with microscopic bladder neck invasion, identified in a series of 1129 patients surgically treated with retropubic radical prostatectomy over a 12-year period. PATIENTS AND METHODS All specimens were reviewed. Microscopic bladder neck invasion was defined as the presence of neoplastic cells within the smooth muscle bundles of the bladder neck, with no accompanying prostatic glandular tissue on the corresponding slide. Survival was analysed for different subgroups in relation to several variables. RESULTS The follow-up (median 7.2 years, mean 6.68, range 0.3-14) was available for 106 patients with microscopic bladder neck invasion. Seminal vesicle invasion was present in 69.8% of the cases, lymph node involvement in 29.2%, apex infiltration in 31.8%, and positive surgical margins in 23.6%. Biochemical progression occurred in 61 (57.5%) patients, and 25 of them died from cancer. The mean (sd) biochemical progression-free survival was 0.68 (0.05), 0.59 (0.05), 0.40 (0.05) and 0.38 (0.05) at 1, 2, 5 and 10 years, respectively. Age, Gleason score and lymph node invasion were independent prognostic factors on multivariate analysis. Overall and cancer-specific survival rates were 0.75 (0.04) and 0.80 (0.04) at 5 years and 0.57 (0.04) and 0.75 (0.04) at 10 years, respectively. Univariate analysis showed that seminal vesicle invasion, lymph node involvement and surgical Gleason score > or =8 significantly increased the risk of death. On multivariate analysis only the surgical Gleason score had an independent prognostic role with regard to overall survival (P = 0.01; odds ratio 2.82, 95% confidence interval 1.2-6.4) and cancer-specific survival (P < 0.001; 8.6, 2.5-28.8). CONCLUSIONS In this series, overall and cancer-specific survival rates were comparable to those reported for surgically treated cT3 prostate cancers. The lack of need for external urinary diversion during the entire follow-up significantly contributed to the patients' quality of life.
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492
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McCammon R, Rusthoven KE, Kavanagh B, Newell S, Newman F, Raben D. Toxicity Assessment of Pelvic Intensity-Modulated Radiotherapy With Hypofractionated Simultaneous Integrated Boost to Prostate for Intermediate- and High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2009; 75:413-20. [DOI: 10.1016/j.ijrobp.2008.10.050] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/15/2008] [Accepted: 10/31/2008] [Indexed: 02/07/2023]
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493
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Kariya S, Sawada K, Kobayashi T, Karashima T, Shuin T, Nishioka A, Ogawa Y. Combination Treatment of Hydrogen Peroxide and X-Rays Induces Apoptosis in Human Prostate Cancer PC-3 Cells. Int J Radiat Oncol Biol Phys 2009; 75:449-54. [DOI: 10.1016/j.ijrobp.2009.04.092] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 04/16/2009] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
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494
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Excellent results from high dose rate brachytherapy and external beam for prostate cancer are not improved by androgen deprivation. Am J Clin Oncol 2009; 32:342-7. [PMID: 19398902 DOI: 10.1097/coc.0b013e31818cd277] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prostate cancer patients treated with high dose rate brachytherapy and external beam radiation therapy were stratified by risk group for analysis to determine whether androgen deprivation therapy (ADT) affected outcome. METHODS From 1991 through 1998, 411 patients were treated with 4 fractions of 5.5 to 6.0 Gy high dose rate brachytherapy and a total of 36.0 to 39.6 Gy external beam radiation therapy (dose escalation over time). The dataset was prospective. Administration of ADT was not randomized, but it was the primary study variable. During this period, ADT was administered across all risk groups for various indications. It did not necessarily reflect advanced disease or large prostate size. There were 200 patients in the "ADT Group" (20% low, 48% intermediate, and 32% high risk) and 211 in the "No ADT Group" (33% low, 44% intermediate, 23% high risk). The median follow-up was 6.4 years. Cases were grouped according to low, intermediate, and high risk groups to reduce the effects of unrecognized selection bias for or against the ADT group. The prostate specific antigen (PSA) nadir plus 2.0 ng/ml (nadir + 2) was used as the biochemical control end point. Local control, PSA progression-free survival, distant metastasis free survival, and cause-specific survival were compared. RESULTS The 10 year PSA-PFS (nadir + 2) for all 411 patients was 81%. The results stratified by risk group were: low 92%, intermediate 87%, and high 63%. The low and intermediate risk groups were not statistically different from one another but they were both significantly better than the high risk group. ADT versus No ADT 10-year survival showed no significant differences for any outcome variable: PSA-PFS (83% vs. 81% ns), local control (97% vs. 99%), distant metastasis free survival (94% vs. 97%), and cause-specific survival (97% vs. 97%). A subset analysis of PSA-PFS (nadir + 2) stratified by risk group revealed no difference between the ADT and No ADT groups. CONCLUSIONS high dose rate brachytherapy and external beam radiation therapy resulted in high rates of local control, PSA progression-free survival, distant metastasis free survival, and cause-specific survival in all risk groups. Improved outcome from the use of androgen deprivation was not observed.
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495
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D'Amico AV, Moran BJ, Braccioforte MH, Dosoretz D, Salenius S, Katin M, Ross R, Chen MH. Risk of Death From Prostate Cancer After Brachytherapy Alone or With Radiation, Androgen Suppression Therapy, or Both in Men With High-Risk Disease. J Clin Oncol 2009; 27:3923-8. [DOI: 10.1200/jco.2008.20.3992] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeWe estimated the risk of prostate cancer (PC) –specific mortality (PCSM) after brachytherapy alone or in conjunction with androgen suppression therapy (AST), external-beam radiation therapy (EBRT), or both in men with high-risk PC.Patients and MethodsThe study cohort comprised 1,342 men with a prostate-specific antigen level more than 20 ng/mL and clinical T3 or 4 and/or Gleason score 8 to 10 disease. Competing risks multivariable regression was performed to estimate the risk of PCSM in men treated with brachytherapy alone or with supplemental AST, EBRT, or both, adjusting for age, year of treatment, and known PC prognostic factors.ResultsDespite higher baseline probabilities of PCSM after a median follow-up of 5.1 years, there was a significant reduction in the risk of PCSM (adjusted hazard ratio [AHR], 0.32; 95% CI, 0.14 to 0.73; P = .006) in men treated with brachytherapy and both AST and EBRT as compared with neither. When compared with brachytherapy alone, a significant decrease in the risk of PCSM was not observed in men treated with either supplemental AST (AHR, 0.63; 95% CI, 0.27 to 1.47; P = .28) or EBRT (AHR, 0.57; 95% CI, 0.21 to 1.52; P = .26). There was a near-significant reduction (AHR, 0.53; 95% CI, 0.27 to 1.07; P = .079) in the risk of PCSM in men treated with tri- as compared with bimodality therapy.ConclusionSupplemental AST and EBRT but not either supplement compared with brachytherapy alone was associated with a decreased risk of PCSM in men with high-risk PC.
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Affiliation(s)
- Anthony V. D'Amico
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Brian J. Moran
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Michelle H. Braccioforte
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Daniel Dosoretz
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Sharon Salenius
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Michael Katin
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Rudi Ross
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
| | - Ming-Hui Chen
- From the Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL; 21st Century Oncology, Fort Myers, FL; and Department of Statistics, University of Connecticut, Storrs, CT
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496
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Wilson S. Update on the management of prostate cancer with goserelin acetate: patient perspectives. Cancer Manag Res 2009; 1:99-105. [PMID: 21188128 PMCID: PMC3004656 DOI: 10.2147/cmr.s5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Indexed: 11/23/2022] Open
Abstract
The guidelines for the use of androgen deprivation therapy (ADT) have changed significantly over the last 5 years. This paper reviews the current recommendations and documents the reasons for these changes, in a review of the world's literature on ADT over the last 5 years. Special emphasis on randomized controlled trials and high-impact journals was included in the Medline search and review. One hundred articles on this topic written in the last 5 years were reviewed. Fifty-nine contained nonindustry-biased findings in major-impact journals and were available in English. The benefits of ADT are evident in several areas, including neoadjuvantly and adjuvantly in patients treated with external beam radiation therapy for intermediate- and high-risk disease; in patients who have undergone prostatectomy and who are found to have lymph node involvement on surgical resection; in high-risk patients after definitive therapy; and in patients who have developed symptomatic local progression or metastasis. This paper reviews the risks and benefits in each of these scenarios and the risks of androgen deprivation in general, and delineates the areas where ADT was previously recommended, but has been found to no longer be of benefit.
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Affiliation(s)
- Shandra Wilson
- Division of Urology, University of Colorado, Aurora, CO, USA
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497
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Bria E, Cuppone F, Giannarelli D, Milella M, Ruggeri EM, Sperduti I, Pinnarò P, Terzoli E, Cognetti F, Carlini P. Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer? Cancer 2009; 115:3446-56. [DOI: 10.1002/cncr.24392] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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498
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D'Amico AV, Chen MH. Pretreatment Prostate-Specific Antigen Velocity and the Risk of Death From Prostate Cancer in the Individual With Low-Risk Prostate Cancer. J Clin Oncol 2009; 27:3575-6. [DOI: 10.1200/jco.2009.22.6068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony V. D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
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499
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Tanaka N, Fujimoto K, Hirao Y, Shimizu K, Tsujimoto S, Samma S. Endocrine Response to a Single Injection of Goserelin 3.6 mg or Leuprolide 3.75 mg in Men with Prostate Cancer. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/01485010701601222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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500
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Radiothérapie chez les patients à haut risque après prostatectomie radicale : postopératoire ou de rattrapage ? Prog Urol 2009; 19:447-56. [DOI: 10.1016/j.purol.2009.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 03/01/2009] [Accepted: 03/09/2009] [Indexed: 11/19/2022]
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