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Surcel CI, Sooriakumaran P, Briganti A, De Visschere PJ, Fütterer JJ, Ghadjar P, Isbarn H, Ost P, Ploussard G, van den Bergh RC, van Oort IM, Yossepowitch O, Sedelaar JM, Giannarini G. Preferences in the management of high-risk prostate cancer among urologists in Europe: results of a web-based survey. BJU Int 2014; 115:571-9. [DOI: 10.1111/bju.12796] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cristian I. Surcel
- Centre of Uronephrology and Renal Transplantation; Fundeni Clinical Institute; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
| | - Prasanna Sooriakumaran
- Surgical Intervention Trials Unit; Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
- Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Alberto Briganti
- Department of Urology; Urological Research Institute; Vita-Salute University San Raffaele; Milan
| | | | - Jurgen J. Fütterer
- Department of Radiology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Hendrik Isbarn
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University Hospital; Ghent Belgium
| | - Guillaume Ploussard
- Department of Urology; CHU Saint-Louis; Assistance Publique - Hôpitaux de Paris; Université Paris Est Creteil; Paris France
| | | | - Inge M. van Oort
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Ofer Yossepowitch
- Department of Urology; Rabin Medical Center - Beilinson; Petach-Tikva Israel
- Sackler Faculty of Medicine; University of Tel Aviv; Tel Aviv Israel
| | | | - Gianluca Giannarini
- Department of Experimental and Clinical Medical Sciences; Urology Unit, University of Udine; Udine Italy
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Mir MC, Li J, Klink JC, Kattan MW, Klein EA, Stephenson AJ. Optimal Definition of Biochemical Recurrence After Radical Prostatectomy Depends on Pathologic Risk Factors: Identifying Candidates for Early Salvage Therapy. Eur Urol 2014; 66:204-10. [DOI: 10.1016/j.eururo.2013.08.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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Castellucci P, Ceci F, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, Pettinato C, Celli M, Lodi F, Fanti S. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-Choline PET/CT scan before salvage radiation therapy? J Nucl Med 2014; 55:1424-9. [PMID: 24935990 DOI: 10.2967/jnumed.114.138313] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED The aim of the study was to assess which factors may influence (11)C-choline PET/CT detection rate in a population of recurrent prostate cancer (PCa) patients listed for salvage radiation therapy (S-RT) in an early phase of biochemical relapse, to select which patients could obtain the most benefit by performing restaging (11)C-choline PET/CT before S-RT. METHODS The study comprised 605 patients, treated with radical prostatectomy (RP) with curative intent for PCa who showed rising PSA levels after primary therapy and listed for S-RT. Prostate-specific antigen (PSA) values were >0.2 ng/mL and <2 ng/mL (mean, 1.05 ng/mL; median, 1.07 ng/mL; range, 0.2-2 ng/m; SD, ±0.59). All patients were classified as N0 after RP. Seventeen of 605 patients received adjuvant RT together with RP, whereas 148 of 605 patients received androgen-deprivation therapy (ADT) at the time of PET/CT. PSA, PSA kinetics, Gleason score, age, time to biochemical relapse, ADT, and initial tumor stage were statistically analyzed to assess which factor could influence PET/CT positivity and the detection of local versus distant relapse. RESULTS (11)C-choline PET/CT was positive in 28.4% of patients (172/605). Eighty-three of 605 patients were positive in the pelvis (group A), distant metastasis (group B) were detected in 72 of 605 patients, and local and distant sites of relapse were detected in 17 of 605 patients (group C). At multivariate analysis, PSA, PSA doubling time (PSAdt), and ongoing ADT were significant predictors for positive scan results, whereas PSA and PSAdt were significantly related to distant relapse detection (P < 0.05). At the receiver-operating-characteristic analysis, a PSA value of 1.05 ng/mL and PSAdt of 5.95 mo were determined to be the optimal cutoff values in the prediction of a positive (11)C-choline PET/CT scan, with an area under the curve (AUC) of 0.625 for PSA and 0.677 for PSAdt. CONCLUSION (11)C-choline PET/CT may be suggested before S-RT during the early phase of biochemical relapse, to select patients who may benefit from this aggressive treatment. Particularly, patients showing fast PSA kinetics or PSA increasing levels despite ongoing ADT should be studied with (11)C-choline PET/CT before S-RT, considering the higher probability to detect positive findings outside the pelvis.
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Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Tiziano Graziani
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy; and
| | - Eugenio Brunocilla
- Department of Urology, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy; and
| | - Renzo Mazzarotto
- Service of Radiotherapy, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Cinzia Pettinato
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Monica Celli
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Filippo Lodi
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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Trock BJ. Adjuvant radiation following radical prostatectomy: what are the known unknowns? Eur Urol 2014; 66:251-2. [PMID: 24830627 DOI: 10.1016/j.eururo.2014.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 04/26/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Bruce J Trock
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Aoki M, Mizowaki T, Akimoto T, Nakamura K, Ejima Y, Jingu K, Tamai Y, Nakajima N, Takemoto S, Kokubo M, Katoh H. Adjuvant radiotherapy after prostatectomy for prostate cancer in Japan: a multi-institutional survey study of the JROSG. JOURNAL OF RADIATION RESEARCH 2014; 55:533-40. [PMID: 24385470 PMCID: PMC4014160 DOI: 10.1093/jrr/rrt137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/27/2013] [Accepted: 10/28/2013] [Indexed: 06/03/2023]
Abstract
In Japan, the use of adjuvant radiotherapy after prostatectomy for prostate cancer has not increased compared with the use of salvage radiotherapy. We retrospectively evaluated the outcome of adjuvant radiotherapy together with prognostic factors of outcome in Japan. Between 2005 and 2007, a total of 87 patients were referred for adjuvant radiotherapy in 23 institutions [median age: 64 years (54-77 years), median initial prostate-specific antigen: 11.0 ng/ml (2.9-284 ng/ml), Gleason score (GS): 6, 7, 8, 9, 10 = 13.8, 35.6, 23.0, 27.6, 0%, respectively]. Rates of positive marginal status, seminal vesicle invasion (SVI) and extra-prostatic extension (EPE) were 74%, 26% and 64%, respectively. Median post-operative PSA nadir: 0.167 ng/ml (0-2.51 ng/ml). Median time from surgery to radiotherapy was 3 months (1-6 months). A total dose of ≥ 60 Gy and <65 Gy was administered to 69% of patients. The median follow-up time was 62 months. The 3- and 5-year biochemical relapse-free survival (bRFS) rates for all patients were 66.5% and 57.1%, respectively. The GS and marginal status (P = 0.019), GS and SVI (P = 0.001), marginal status and EPE (P = 0.017), type of hormonal therapy and total dose (P = 0.026) were significantly related. The 5-year bRFS rate was significantly higher in SVI-negative patients than SVI-positive patients (P = 0.001), and significantly higher in patients with post-operative PSA nadir ≤ 0.2 than in patients with post-operative PSA nadir >0.2 (P = 0.02), and tended to be more favorable after radiotherapy ≤ 3 months from surgery than >3 months from surgery (P = 0.069). Multivariate analysis identified SVI and post-operative PSA nadir as independent prognostic factors for bRFS (P = 0.001 and 0.018, respectively).
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Affiliation(s)
- Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, 54 Shogoin-kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuo Ejima
- Department of Radiology, Dokkyo Medical University, 880 Kita-kobayashi, Mibu-cho, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai Miyagi 980-8575, Japan
| | - Yoshifumi Tamai
- Department of Radiation Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Nobuaki Nakajima
- Department of Radiology, Shizuoka General Hospital, 4-27-1 Kita-ando, Aoi-ku Shizuoka 420-8527, Japan
| | - Shinya Takemoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, Aichi 467-8601, Japan
| | - Masaki Kokubo
- Division of Radiation Oncology, Institute of Biomedical Research and Innovation Hospital, 2-2 Minatojima Minami-machi, Chuo-ku Kobe, Hyogo 650-0047, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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The accuracy of magnetic resonance imaging in prostate cancer staging: a single-institution experience. Ir J Med Sci 2014; 184:313-7. [DOI: 10.1007/s11845-014-1109-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
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Maximum tumor diameter and the risk of prostate-specific antigen recurrence after radical prostatectomy. Clin Genitourin Cancer 2014; 12:e173-9. [PMID: 24787967 DOI: 10.1016/j.clgc.2014.03.008] [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] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION/BACKGROUND The aim of this study was to investigate whether the MTD could identify men at low risk of PSA recurrence after RP who might not benefit from ART despite other adverse features. PATIENTS AND METHODS The study cohort consisted of 354 men with T1c to T2 prostate cancer diagnosed between September 2001 and December 2008 who underwent RP without adjuvant therapy. Multivariable Cox regression was used to assess the effect of MTD on the risk of PSA recurrence (> 0.1 ng/mL and verified), adjusting for known predictors. RESULTS After a median follow-up of 4.0 years, 34 men (9.6%) experienced PSA failure. In multivariable analysis, increasing MTD was significantly associated with an increased PSA recurrence risk (hazard ratio, 2.74; 95% confidence interval, 1.23-6.10; P = .01) within the interaction model. Estimates of PSA recurrence-free survival stratified around the median MTD value (1.2 cm) were significantly different in men with a pre-RP PSA > 4 ng/mL (P < .001; 5-year estimate: 74.5% vs. 99.0%) but not in men with PSA ≤ 4 ng/mL (P = .59; 5-year estimate: 89.6% vs. 92.6%), consistent with the significant interaction (P = .004) between PSA and MTD. Moreover, in men with a pre-RP PSA > 4 ng/mL these estimates were significantly different if at least 1 adverse feature (pT3, R1, or Gleason score ≥ 8) was present at RP (P = .01; 5-year estimate: 46.6% vs. 100%) versus none (P = .09; 5-year estimate: 93.4% vs. 98.9%). CONCLUSION Men with a low MTD (≤ 1.2 cm) appear to be at low risk of PSA recurrence despite adverse features at RP and might not benefit from ART.
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Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, Golz R, Störkel S, Willich N, Semjonow A, Stöckle M, Rübe C, Rebmann U, Kälble T, Feldmann HJ, Wirth M, Hofmann R, Engenhart-Cabillic R, Hinke A, Hinkelbein W, Miller K. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol 2014; 66:243-50. [PMID: 24680359 DOI: 10.1016/j.eururo.2014.03.011] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Local failure after radical prostatectomy (RP) is common in patients with cancer extending beyond the capsule. Three prospectively randomized trials demonstrated an advantage for adjuvant radiotherapy (ART) compared with a wait-and-see (WS) policy. OBJECTIVE To determine the efficiency of ART after a 10-yr follow-up in the ARO 96-02 study. DESIGN, SETTING, AND PARTICIPANTS After RP, 388 patients with pT3 pN0 prostate cancer (PCa) were randomized to WS or three-dimensional conformal ART with 60 Gy. The present analysis focuses on intent-to-treat patients who achieved an undetectable prostate-specific antigen after RP (ITT2 population)--that is, 159 WS plus 148 ART men. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point of the study was progression-free survival (PFS) (events: biochemical recurrence, clinical recurrence, or death). Outcomes were compared by log-rank test. Cox regression analysis served to identify variables influencing the course of disease. RESULTS AND LIMITATIONS The median follow-up was 111 mo for ART and 113 mo for WS. At 10 yr, PFS was 56% for ART and 35% for WS (p<0.0001). In pT3b and R1 patients, the rates for WS even dropped to 28% and 27%, respectively. Of all 307 ITT2 patients, 15 died from PCa, and 28 died for other or unknown reasons. Neither metastasis-free survival nor overall survival was significantly improved by ART. However, the study was underpowered for these end points. The worst late sequelae in the ART cohort were one grade 3 and three grade 2 cases of bladder toxicity and two grade 2 cases of rectum toxicity. No grade 4 events occurred. CONCLUSIONS Compared with WS, ART reduced the risk of (biochemical) progression with a hazard ratio of 0.51 in pT3 PCa. With only one grade 3 case of late toxicity, ART was safe. PATIENT SUMMARY Precautionary radiotherapy counteracts relapse after surgery for prostate cancer with specific risk factors.
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Affiliation(s)
- Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
| | - Detlef Bartkowiak
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Dirk Bottke
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Claudia Bronner
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Ursula Steiner
- Department of Urology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Alessandra Siegmann
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Reinhard Golz
- Department of Pathology, Helios-Clinic Wuppertal, Wuppertal, Germany
| | - Stephan Störkel
- Department of Pathology, Helios-Clinic Wuppertal, Wuppertal, Germany
| | - Normann Willich
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Axel Semjonow
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Michael Stöckle
- Department of Urology, University Hospital Homburg/Saar, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, University Hospital Homburg/Saar, Homburg, Germany
| | - Udo Rebmann
- Department of Urology, Diakonissen-Krankenhaus Dessau, Dessau-Rosslau, Germany
| | - Tilman Kälble
- Department of Urology, General Hospital Fulda, Fulda, Germany
| | | | - Manfred Wirth
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Rainer Hofmann
- Departments of Urology, University Hospital Giessen-Marburg, Marburg, Germany
| | | | | | - Wolfgang Hinkelbein
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
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Suardi N, Gallina A, Lista G, Gandaglia G, Abdollah F, Capitanio U, Dell’Oglio P, Nini A, Salonia A, Montorsi F, Briganti A. Impact of Adjuvant Radiation Therapy on Urinary Continence Recovery After Radical Prostatectomy. Eur Urol 2014; 65:546-51. [DOI: 10.1016/j.eururo.2013.01.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/24/2013] [Indexed: 11/26/2022]
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Aizer AA, Paly JJ, Efstathiou JA. Multidisciplinary care and management selection in prostate cancer. Semin Radiat Oncol 2014; 23:157-64. [PMID: 23763881 DOI: 10.1016/j.semradonc.2013.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The management of prostate cancer is complicated by the multitude of treatment options, the lack of proven superiority of one modality of management, and the presence of physician bias. Care at a multidisciplinary prostate cancer clinic offers patients the relative convenience of consultation with physicians of multiple specialties within the confines of a single visit and appears to serve as a venue in which patients can be counseled regarding the risks and benefits of available therapies in an open and interactive environment. Physician bias may be minimized in such an environment, and patient satisfaction rates are high. Available data suggest that low-risk patients who are seen at a multidisciplinary prostate cancer clinic appear to select active surveillance in greater proportion. However, relatively few studies have investigated the other added value that multidisciplinary clinics provide to the patient or health care system, and therefore, additional studies assessing the impact of multidisciplinary care in the management of patients with prostate cancer are needed.
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Affiliation(s)
- Ayal A Aizer
- Harvard Radiation Oncology Program, Boston, MA, USA
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Extended salvage pelvic lymph node dissection in patients with recurrent prostate cancer. Adv Urol 2014; 2014:321619. [PMID: 24688536 PMCID: PMC3945023 DOI: 10.1155/2014/321619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Treatment of patients with a biochemical recurrence (BCR) of prostate cancer (PCa) is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients. Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of 40.3 ± 20.8 months. Group 1 (n = 10): salvage radical prostatectomy (sRP) with SePLND (salvage extended pelvic lymph nodes dissection) (initial treatment: combined brachytherapy). Group 2 (n = 22): SePLND (initial treatment: radical prostatectomy (RP)). Group 3 (n = 9): SePLND (initial treatment: RP and adjuvant radiation therapy (RT)). We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response). Results. Group 1: 60% with BCR-freedom (mean 27.2 months). Group 2: 63.6% with BCR-freedom (mean 17.5 months). Group 3: 33.3% with BCR-freedom (mean 17.6 months). In total, BCR-freedom was observed in 23 of 41 patients (56.1%) after salvage surgery. 75.6% of all patients showed a BR. 765 LNs were removed and 14.8% of these were LN+. Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output.
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Population-Based Referrals for Adjuvant Radiotherapy After Radical Prostatectomy in Men With Prostate Cancer: Impact of Randomized Trials. Clin Genitourin Cancer 2014; 12:e1-5. [DOI: 10.1016/j.clgc.2013.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bjerklund Johansen TE, Witzsch U, Greene D. Salvage treatment in prostate cancer: a clinical approach. Expert Rev Anticancer Ther 2014; 13:613-23. [DOI: 10.1586/era.13.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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64
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Luz MA, Dal Pra A, Tu HYV, Duclos M, Cury FLB, Bachir BG, Aprikian AG, Tanguay S, Kassouf W. Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation? Can Urol Assoc J 2014; 7:444-8. [PMID: 24381666 DOI: 10.5489/cuaj.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Transperitoneal minimally invasive radical prostatectomy (MIRP) has become first choice for several urologists and patients dealing with localized prostate cancer. We evaluate the effect of postoperative radiation on the small bowel in patients who underwent extraperitoneal open versus transperitoneal MIRP. METHODS We reviewed all patients who received postoperative radiation from 2006 to 2010. Planning target volume (PTV) and surrounding organs, including the small bowel, were delineated. The presence of the small bowel in PTV and its volume in receiving each dose level were analyzed. RESULTS A total of 122 patients were included: 26 underwent MIRP and 96 underwent open prostatectomy. The median age of patients was 66 years, with median body mass index 27 kg/m(2). The total PTV dose was 66 Gy, with the minimum and maximum doses received by the small bowel 0.4 and 66.4 Gy, respectively. The maximum volume of small bowel that received the safe limit of 40 Gy was 569 cm(3). Of the 26 patients who underwent MIRP, 12 (46%) had small bowel identified inside the PTV compared to 57 (59%) among patients who underwent open prostatectomy (p = 0.228). The mean volume of the small bowel receiving 40 Gy was 26 and 67 cm(3) in open and MIRP groups, respectively (p = 0.006); the incidence of acute complications was the same in both groups. CONCLUSIONS Higher volumes of the small bowel are subjected to significant radiation after MIRP procedures compared to open procedures; however, we could not demonstrate any impact on acute complications. Whether there is a difference in late complications remains to be evaluated.
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Affiliation(s)
- Murilo A Luz
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Alan Dal Pra
- Department of Surgery, Division of Urology, McGill University, Montreal, QC; ; Department of Radiation Oncology, McGill University, Montreal, QC
| | - Hin-Yu Vincent Tu
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Marie Duclos
- Department of Surgery, Division of Urology, McGill University, Montreal, QC; ; Department of Radiation Oncology, McGill University, Montreal, QC
| | - Fabio L B Cury
- Department of Surgery, Division of Urology, McGill University, Montreal, QC; ; Department of Radiation Oncology, McGill University, Montreal, QC
| | - Bassel G Bachir
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Armen G Aprikian
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
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Williams S, Chiong E, Lojanapiwat B, Umbas R, Akaza H. Management of prostate cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013; 14:e524-34. [PMID: 24176571 DOI: 10.1016/s1470-2045(13)70451-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many local and systemic options for prostate cancer have emerged in recent years, but existing management guidelines do not account for diversity in health resources between different countries. We present recommendations for the management of prostate cancer, stratified according to the extent of resource availability-based on a four-tier system of basic, limited, enhanced, and maximum resources-to enable applicability to Asian countries with differing levels of health-care resources. This statement of recommendations was formulated by a multidisciplinary panel from Asia-Pacific countries, at a consensus session on prostate cancer that was held as part of the 2013 Asian Oncology Summit in Bangkok, Thailand.
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Affiliation(s)
- Scott Williams
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
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Punnen S, Cooperberg MR, Freedland SJ. Reply from Authors re: Ronald C. Chen. Making Individualized Decisions in the Midst of Uncertainties: The Case of Prostate Cancer and Biochemical Recurrence. Eur Urol 2013;64:916–8. Eur Urol 2013. [DOI: 10.1016/j.eururo.2013.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lavallée LT, Fergusson D, Mallick R, Grenon R, Morgan SC, Momoli F, Witiuk K, Morash C, Cagiannos I, Breau RH. Radiotherapy after radical prostatectomy: treatment recommendations differ between urologists and radiation oncologists. PLoS One 2013; 8:e79773. [PMID: 24224003 PMCID: PMC3817258 DOI: 10.1371/journal.pone.0079773] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/04/2013] [Indexed: 12/03/2022] Open
Abstract
Purpose There is no consensus on optimal use of radiotherapy following radical prostatectomy. The purpose of this study was to describe opinions of urologists and radiation oncologists regarding adjuvant and salvage radiotherapy following radical prostatectomy. Methods Urologists and genitourinary radiation oncologists were solicited to participate in an online survey. Respondent characteristics included demographics, training, practice setting, patient volume/experience, and access to radiotherapy. Participant practice patterns and attitudes towards use of adjuvant and salvage radiotherapy in standardized clinical scenarios were assessed. Results One hundred and forty-six staff physicians participated in the survey (104 urologists and 42 genitourinary radiation oncologists). Overall, high Gleason score (Gleason 7 vs. 6, RR 1.37 95% CI 1.19-1.56, p<0.0001 and Gleason 8-10 vs. 6, RR 1.56 95% CI 1.37-1.78, p<0.0001), positive surgical margin (RR 1.43 95% CI 1.26-1.62, p<0.0001), and extraprostatic tumour extension (RR 1.16 95% CI 1.05-1.28, p<0.002) conferred an increased probability of recommending adjuvant radiotherapy. Radiation oncologists were more likely to recommend adjuvant radiotherapy across all clinical scenarios (RR 1.48, 95% CI 1.39, 1.60, p <0.001). Major differences were found for patients with Gleason 6 and isolated positive surgical margin (radiotherapy selected by 21% of urologists vs. 70% of radiation oncologists), and patients with extraprostatic extension and negative surgical margins (radiotherapy selected by 18% of urologist vs. 57% of radiation oncologists). Conclusions Urologists and radiation oncologists frequently disagree about recommendation for post-prostatectomy adjuvant radiotherapy. Since clinical equipoise exists between adjuvant versus early salvage post-operative radiotherapy, support of clinical trials comparing these approaches is strongly encouraged.
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Affiliation(s)
- Luke T. Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Renée Grenon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Scott C. Morgan
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kelsey Witiuk
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodney H. Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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68
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Eisenberg MS, Karnes RJ, Kaushik D, Rangel L, Bergstralh EJ, Boorjian SA. Risk Stratification of Patients with Extraprostatic Extension and Negative Lymph Nodes at Radical Prostatectomy: Identifying Optimal Candidates for Adjuvant Therapy. J Urol 2013; 190:1735-41. [DOI: 10.1016/j.juro.2013.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Manuel S. Eisenberg
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - R. Jeffrey Karnes
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Dharam Kaushik
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Laureano Rangel
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Eric J. Bergstralh
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
| | - Stephen A. Boorjian
- Departments of Urology and Health Sciences Research (LR, EJB), Mayo Clinic, Rochester, Minnesota
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Bartkowiak D, Bottke D, Wiegel T. Radiotherapy in the management of prostate cancer after radical prostatectomy. Future Oncol 2013; 9:669-79. [PMID: 23647296 DOI: 10.2217/fon.13.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The choice of treatment options for prostate cancer patients who have undergone radical prostatectomy depends on their risk profile, which is determined by the tumor node metastasis (TNM) status, histopathologic findings, and the pre- and post-radical prostatectomy PSA characteristics. The results of large clinical studies with a 10-year follow-up or more are the backbone of predictive models for risk estimates that incorporate these criteria and also for guideline recommendations. For low-to-intermediate-risk prostate cancer patients and older patients, observation with--in case of biochemical recurrence--early salvage radiotherapy can be advised after R0 resection, thus, avoiding overtreatment. After R1 resection, adjuvant radiotherapy should be considered. Patients with two or more positive lymph nodes and/or with distant metastasis may benefit from adjuvant hormone deprivation therapy. Beyond this rough outline, detailed analysis of subgroups is still required (and ongoing) to enable individually optimized treatment.
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Affiliation(s)
- Detlef Bartkowiak
- Radiation Oncology Department, University Hospital Ulm, Ulm, Germany.
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70
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Fairey AS, Daneshmand S, Skinner EC, Schuckman A, Cai J, Lieskovsky G. Long-term cancer control after radical prostatectomy and bilateral pelvic lymph node dissection for pT3bN0M0 prostate cancer in the prostate-specific antigen era. Urol Oncol 2013; 32:85-91. [PMID: 24183191 DOI: 10.1016/j.urolonc.2013.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluated long-term cancer control outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for pT3bN0M0 prostate cancer in the era of prostate-specific antigen (PSA) screening. MATERIALS AND METHODS A retrospective analysis of prospectively collected data from the University of Southern California Prostate Cancer Database was performed. Between 1987 and 2008, 229 men underwent open RP for pT3bN0M0 prostate cancer. The cohort was divided into early (1987-1997) and contemporary (1998-2008) PSA eras. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR). RESULTS The median follow-up duration was 14.5 years (range, 0.2-21.1y). The predicted 10-year freedom from CR and BCR rates for men treated in the early and contemporary PSA eras were 73% and 95% (Log-rank P = 0.001) and 65% and 73% (Log-rank P = 0.055), respectively. Multivariable analysis showed that pathologic Gleason grade 8-10 (CR: hazard ratio [HR] = 5.11; 95% confidence interval [CI] = 1.72-15.20; P = 0.003; BCR: HR = 3.47; 95% CI = 1.60-7.48; P = 0.002) and contemporary PSA era (CR: HR = 0.15; 95% CI = 0.06-0.41; P<0.001; BCR: HR = 0.49; 95% CI = 0.28-0.86; P = 0.013) were independently associated with cancer control. Adjuvant radiation therapy and positive surgical margins were not independently associated with outcomes. CONCLUSIONS RP conferred long-term cancer control in men with pT3bN0M0 prostate cancer treated in the PSA era. Pathologic Gleason grade 8-10 and treatment in the early PSA era were independently associated with poorer cancer control outcomes.
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Affiliation(s)
- Adrian S Fairey
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Eila C Skinner
- Department of Urology, Stanford University, Stanford, CA
| | - Anne Schuckman
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Jie Cai
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Gary Lieskovsky
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
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71
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Strom TJ, Wilder RB, Fernandez DC, Mellon EA, Saini AS, Hunt DC, Biagioli MC. High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated, gross local recurrence of prostate cancer post-prostatectomy. Brachytherapy 2013; 13:123-7. [PMID: 24269146 DOI: 10.1016/j.brachy.2013.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the use of high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) as salvage therapy for patients with an isolated, gross local recurrence of prostate cancer after radical prostatectomy. METHODS AND MATERIALS Between October 2009 and May 2013, the authors treated six patients with salvage iridium-192 HDR brachytherapy ± IMRT for biopsy-proven, recurrent prostate cancer post-prostatectomy. In each patient, a pelvic MRI scan or CT scan demonstrated a nodule (range 1.6, 4.7 cm) in the prostate bed. Although prostate-specific antigen values were 0.2-9.5 ng/mL at the time of salvage brachytherapy, there was no pelvic adenopathy on CT or MRI scan, and a bone scan was negative in all cases. Five patients were treated with IMRT to 4500-5040 cGy in 25-28 fractions to the prostate bed followed by two 950 cGy HDR brachytherapy fractions separated by 1-2 weeks. A sixth patient underwent HDR brachytherapy monotherapy consisting of 3800 cGy in four fractions over 3 days. Toxicities were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Median followup was 9 months (range 3, 40 months). All six patients have been free of androgen deprivation therapy and have an undetectable prostate-specific antigen. One patient developed late Grade 2 urinary incontinence. There was no late grade ≥2 gastrointestinal toxicity. CONCLUSIONS HDR brachytherapy ± IMRT is a safe and effective salvage therapy option for an isolated, gross local recurrence of prostate cancer after radical prostatectomy and merits further study.
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Affiliation(s)
- Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Richard B Wilder
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Daniel C Fernandez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Eric A Mellon
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Amarjit S Saini
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Dylan C Hunt
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Matthew C Biagioli
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL. matthew.biagioli.@mofitt.org
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Stephenson AJ, Eggener SE, Hernandez AV, Klein EA, Kattan MW, Wood DP, Rabah DM, Eastham JA, Scardino PT. Do margins matter? The influence of positive surgical margins on prostate cancer-specific mortality. Eur Urol 2013; 65:675-80. [PMID: 24035631 DOI: 10.1016/j.eururo.2013.08.036] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) in radical prostatectomy (RP) specimens are a frequent indication for adjuvant radiotherapy and are used as a measure of surgical quality. However, the association between PSMs and prostate cancer-specific mortality (CSM) is poorly defined. OBJECTIVE Analyze the association of PSMs with CSM, adjusting for fixed and time-dependent parameters. DESIGN, SETTING, AND PARTICIPANTS Fine and Gray competing risk regression analysis was used to model the clinical data and follow-up information of 11,521 patients treated by RP between 1987 and 2005. Two extended models were used that adjusted for the use of postoperative radiotherapy, which was handled as a time-dependent covariate. Postoperative radiotherapy was modeled as a single parameter and also as early and late therapy, based on the prostate-specific antigen level at the start of treatment (≤0.5 vs >0.5 ng/ml). INTERVENTION RP for clinically localized prostate cancer and selective use of secondary local and/or systemic therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome measure was prostate cancer-specific mortality. RESULTS AND LIMITATIONS The 15-yr CSM rates for patients with PSMs and negative surgical margins were 10% and 6%, respectively (p<0.001). No significant association between PSM and CSM was observed in the conventional model with fixed covariates (hazard ratio [HR]: 1.04; 95% confidence interval [CI], 0.7-1.5; p=0.8) or in the two extended models that adjusted for postoperative radiotherapy (HR: 0.96; 95% CI, 0.7-1.4; p=0.9), or early and late postoperative radiotherapy (HR: 1.01; 95% CI, 0.7-1.4; p=0.9). CONCLUSIONS PSMs alone are not associated with a significantly increased risk of CSM within 15 yr of RP. However, urologists should continue to strive to avoid PSMs, as they increase a man's risk of biochemical recurrence and need for secondary therapy and may be a source of considerable patient anxiety.
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Affiliation(s)
- Andrew J Stephenson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Scott E Eggener
- Section of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Adrian V Hernandez
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Klein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - David P Wood
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Danny M Rabah
- Division of Urology, Department of Surgery, Princess Johara Alibrahim Center for Cancer Research, King Saud University, Riyadh, Saudi Arabia
| | - James A Eastham
- Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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73
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van der Poel HG, Tillier C, de Blok W, Acar C, van Muilekom EHAM. Salvage radiotherapy after robot-assisted laparoscopic radical prostatectomy. Urology 2013; 82:834-8. [PMID: 23972339 DOI: 10.1016/j.urology.2013.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/27/2013] [Accepted: 04/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the incidence and efficacy of salvage radiotherapy (SRT) after robot-assisted radical prostatectomy (RARP). RARP has been linked to an increased use of adjuvant treatments. If RARP would result in an increased local recurrence rate, response rates to SRT could be expected to be better after RARP than after more conventional methods of prostatectomy. The incidence and efficacy of SRT in a RARP population were compared with nomogram prediction. METHODS Patient data were prospectively registered. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) ≥0.1 ng/mL. SRT was offered to men with BCR after RARP. The Stephenson nomogram predictions were compared with outcome after SRT. RESULTS Of 1087 men, 157 (14.4%) received SRT for BCR or persistent PSA levels during a median follow-up of 1078 days after RARP. Median PSA level before SRT was 0.2 ng/mL. Three-year BCR-free rate was 64% for men after SRT. pN (pNx, pN0, pN1) and PSA level before SRT were independent predictors of the BCR interval after SRT. Men with more extensive fascia preservation were more likely to respond favorably to SRT. The Stephenson nomogram prediction showed a concordance rate of 0.66 in this RARP population. Limitations of the study are the retrospective design and limited follow-up duration. CONCLUSION In our RARP series, the use and efficacy of SRT were comparable with open prostatectomy series. The Stephenson nomogram reliably predicted outcome in patients with RARP with SRT, suggesting that similar characteristics predict response to SRT after RARP compared with open prostatectomy.
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Affiliation(s)
- Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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74
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Pfister D, Bolla M, Briganti A, Carroll P, Cozzarini C, Joniau S, van Poppel H, Roach M, Stephenson A, Wiegel T, Zelefsky MJ. Early salvage radiotherapy following radical prostatectomy. Eur Urol 2013; 65:1034-43. [PMID: 23972524 DOI: 10.1016/j.eururo.2013.08.013] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/06/2013] [Indexed: 12/17/2022]
Abstract
CONTEXT Depending on the pathologic tumour stage, up to 60% of prostate cancer patients who undergo radical prostatectomy will develop biochemical relapse and require further local treatment. OBJECTIVES We reviewed the results of early salvage radiation therapy (RT), defined as prostate-specific antigen (PSA) values prior to RT ≤ 0.5 ng/ml in the setting of lymph node-negative disease. EVIDENCE ACQUISITION Ten retrospective studies, including one multicentre analysis, were used for this analysis. Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT. EVIDENCE SYNTHESIS Patients treated with early salvage RT have a significantly improved biochemical recurrence-free survival (BRFS) rate compared with those receiving salvage RT initiated after PSA values are >0.5 ng/ml. Similarly, within the cohort of patients with pre-RT PSA values <0.5 ng/ml, improved BRFS rates were noted among those with lower rather higher pre-RT PSA levels. It is possible that higher RT dose levels and the use of adjunctive androgen-deprivation therapy improve biochemical control outcomes in the salvage setting. CONCLUSIONS Based on a literature review, improved 5-yr BRFS rates are observed for patients who receive early salvage RT compared with patients treated with salvage RT with a pre-RT PSA value >0.5 ng/ml. Whether the routine application of early salvage RT in patients with initially undetectable PSA levels will be associated with demonstrable clinical benefit awaits the results of ongoing prospective trials.
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Affiliation(s)
- David Pfister
- Department of Urology, RWTH Aachen University, Aachen, Germany.
| | - Michel Bolla
- Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France
| | - Alberto Briganti
- Department of Urology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Peter Carroll
- Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Cesare Cozzarini
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hein van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mack Roach
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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75
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Chen RC. Making individualized decisions in the midst of uncertainties: the case of prostate cancer and biochemical recurrence. Eur Urol 2013; 64:916-8; discussion 918-9. [PMID: 23871403 DOI: 10.1016/j.eururo.2013.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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76
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Adjuvant radiotherapy or early salvage radiotherapy in pT3R0 or pT3R1 prostate cancer. Curr Opin Urol 2013; 23:360-5. [DOI: 10.1097/mou.0b013e328361d3ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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77
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Touijer KA, Mazzola CR, Sjoberg DD, Scardino PT, Eastham JA. Long-term outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy. Eur Urol 2013; 65:20-5. [PMID: 23619390 DOI: 10.1016/j.eururo.2013.03.053] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of lymph node metastasis (LNM) at radical prostatectomy (RP) is associated with poor outcome, and optimal treatment remains undefined. An understanding of the natural history of node-positive prostate cancer (PCa) and identifying prognostic factors is needed. OBJECTIVE To assess outcomes for patients with LNM treated with RP and lymph node dissection (LND) alone. DESIGN, SETTING, AND PARTICIPANTS We analyzed data from a consecutive cohort of 369 men with LNM treated at a single institution from 1988 to 2010. INTERVENTION RP and extended LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Our primary aim was to model overall survival, PCa-specific survival, metastasis-free progression, and freedom from biochemical recurrence (BCR). We used univariate Cox proportional hazard regression models for survival outcomes. Multivariable Cox proportional hazard regression models were used for freedom from metastasis and freedom from BCR, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesical invasion, surgical margin status, and number of positive nodes as predictors. RESULTS AND LIMITATIONS Sixty-four patients with LNM died, 37 from disease. Seventy patients developed metastasis, and 201 experienced BCR. The predicted 10-yr overall survival and cancer-specific survival were 60% (95% confidence interval [CI], 49-69) and 72% (95% CI, 61-80), respectively. The 10-yr probability of freedom from distant metastasis and freedom from BCR were 65% (95% CI, 56-73) and 28% (95% CI, 21-36), respectively. Higher pathologic Gleason score (>7 compared with ≤ 7; hazard ratio [HR]: 2.23; 95% CI, 1.64-3.04; p < 0.0001) and three or more positive lymph nodes (HR: 2.61; 95% CI, 1.81-3.76; p < 0.0001) were significantly associated with increased risk of BCR on multivariable analysis. The retrospective nature and single-center source of data are study limitations. CONCLUSIONS A considerable subset of men with LNM remained free of disease 10 yr after RP and extended LND alone. Patients with pathologic Gleason score <8 and low nodal metastatic burden represent a favorable group. Our data confirm prior findings and support a plea for risk subclassification for patients with LNM.
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Affiliation(s)
- Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
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78
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Garzotto M, Hung AY. Advances in the Multimodality Management of High-risk Prostate Cancer. Surg Oncol Clin N Am 2013; 22:375-94. [DOI: 10.1016/j.soc.2012.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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79
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Bolla M, Collette L. Postoperative radiotherapy for high-risk prostate cancer - Authors' reply. Lancet 2013; 381:1093. [PMID: 23540845 DOI: 10.1016/s0140-6736(13)60752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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80
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Schiavina R, Borghesi M, Fiorentino M, Brunocilla E, Manferrari F, Vagnoni V, Martorana G. Identification of prostate cancer risk categories according to surgical margins status, pathological stage and Gleason score. Int J Urol 2013; 20:1097-103. [DOI: 10.1111/iju.12124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Marco Borghesi
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Michelangelo Fiorentino
- Department of Pathology and Molecular Oncology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Harvard University; Dana-Farber Cancer Institute; Boston Massachusetts USA
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Fabio Manferrari
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Valerio Vagnoni
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Giuseppe Martorana
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
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81
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Kinoshita H, Shimizu Y, Mizowaki T, Takayama K, Norihisa Y, Kamoto T, Kamba T, Hayashino Y, Hiraoka M, Ogawa O. Risk factors predicting the outcome of salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy. Int J Urol 2013; 20:806-11. [PMID: 23293977 DOI: 10.1111/iju.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 11/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Salvage radiotherapy is the only curative treatment for patients with prostate cancer showing biochemical progression after radical prostatectomy. In this study, we evaluated the clinicopathological parameters that influence the outcome of salvage radiotherapy. METHODS Medical records of 49 patients who underwent salvage radiotherapy after radical prostatectomy from 1997 to 2008 at the Graduate School of Medicine, Kyoto University, were retrospectively reviewed. Radiotherapy was carried out with 66 Gy on the prostatic bed. RESULTS Biochemical progression-free survival after salvage radiotherapy at 2, 5 and 7 years was 51.0%, 42.2% and 42.2%, respectively. Significant parameters predicting biochemical progression after salvage radiotherapy by Cox regression analysis were prostatectomy Gleason score sum ≥ 8 (hazard ratio 0.08; 95% confidence interval 0.03-0.22; P=0.001), prostate-specific antigen nadir after radical prostatectomy ≥ 0.04 ng/mL (hazard ratio 0.30; 95% confidence interval 0.13-0.69; P=0.005) and negative surgical margin (hazard ratio 0.28; 95% confidence interval 0.12-0.70; P=0.006). When the patients were subgrouped by these risk factors, the 5-year progression-free survival rates after salvage radiotherapy were 77.8%, 50.0% and 6.7% in patients with 0, 1 and ≥ 2 predictors, respectively. CONCLUSION In order to discriminate favorable candidates for salvage radiotherapy, Gleason score of prostatectomy, prostate-specific antigen nadir after prostatectomy and positive surgical margin represent independent predictors. Thus, progression-free survival might be more precisely predicted according to the presence/absence of these risk factors. The significance of this risk classification should be confirmed by large prospective studies.
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Affiliation(s)
- Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan.
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Bolla M. Adjuvant or immediate external irradiation after radical prostatectomy with pelvic lymph node dissection for high-risk prostate cancer: a multidisciplinary decision. Eur Urol 2012; 63:1009-10; discussion 1011-2. [PMID: 23265386 DOI: 10.1016/j.eururo.2012.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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83
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Treatment of locally advanced prostate cancer: a case report and narrative review. Case Rep Urol 2012; 2012:402513. [PMID: 23346453 PMCID: PMC3533609 DOI: 10.1155/2012/402513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction. Treatment of locally advanced prostate cancer is under discussion. Differences between clinical and pathological staging and risk factors such as positive surgical margins and seminal vesicle involvement challenge the individual treatment decisions. Case Presentation. Clinical tumor stage before treatment was assessed to be T2. After radical prostatectomy, pathological examination revealed the stage pT3b N0 M0 including positive surgical margin and seminal vesicle involvement. Early adjuvant androgen deprivation therapy and late adjuvant radiation therapy were added in response to the pathological risk factors. No evidence of disease was observed for 15 years after the treatment. The unexpected pathological findings were not explained by the physicians in charge. Discussion. A narrative review of the recent literature showed that multiple treatment modalities including adjuvant radiotherapy following radical prostatectomy are consistent with current recommendations. The multimodal approach has possibly cured a high-risk patient and may also work successfully in other patients. An alternative treatment option with better preservation of health-related quality of life might have also achieved a similar good overall survival.
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Affiliation(s)
- Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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Böhmer D. Strahlentherapie des fortgeschrittenen und rezidivierenden Prostatakarzinoms. Urologe A 2012; 51:1759-69; quiz 1770-1. [DOI: 10.1007/s00120-012-3030-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sydes MR, Vale C, Kneebone A, Pearse M, Richaud P, Tierney JF, Parker CC. Re: Andrew J. Stephenson, Michel Bolla, Alberto Briganti, et al. Postoperative Radiation Therapy for Pathologically Advanced Prostate Cancer After Radical Prostatectomy. Eur Urol 2012;61:443–51. Eur Urol 2012; 62:e99. [DOI: 10.1016/j.eururo.2012.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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87
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The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol 2012; 64:19-25. [PMID: 22901983 DOI: 10.1016/j.eururo.2012.08.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) increase the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), but their impact on hard clinical end points is a topic of ongoing discussion. OBJECTIVE To evaluate the influence of solitary PSMs (sPSMs) and multiple PSMs (mPSMs) on important clinical end points. DESIGN, SETTING, AND PARTICIPANTS Data from 1712 patients from the Centre Hospitalier Universitaire de Québec with pT2-4 N0 prostate cancer (PCa) and undetectable prostate-specific antigen after RP were analyzed. INTERVENTION RP without neoadjuvant or adjuvant treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier analysis estimated survival functions, and Cox proportional hazards models addressed predictors of clinical end points. RESULTS AND LIMITATIONS Median follow-up was 74.9 mo. A total of 1121 patients (65.5%) were margin-negative, 281 patients (16.4%) had sPSMs, and 310 patients (18.1%) had mPSMs. A total of 280 patients (16.4%) experienced BCR, and 197 patients (11.5%) were treated with salvage radiotherapy (SRT). Sixty-eight patients (4.0%) received definitive androgen deprivation therapy, 19 patients (1.1%) developed metastatic disease, and 15 patients (0.9%) had castration-resistant PCa (CRPC). Thirteen patients (0.8%) died from PCa, and 194 patients (11.3%) died from other causes. Ten-year Kaplan-Meier estimates for BCR-free survival were 82% for margin-negative patients, 72% for patients with sPSMs, and 59% for patients with mPSMs (p<0.0001). Time to metastatic disease, CRPC, PCa-specific mortality (PCSM), or all-cause mortality did not differ significantly among the three groups (p=0.991, p=0.988, p=0.889, and p=0.218, respectively). On multivariable analysis, sPSMs and mPSMs were associated with BCR (hazard ratio [HR]: 1.711; p=0.001 and HR: 2.075; p<0.0001), but sPSMs and mPSMs could not predict metastatic disease (p=0.705 and p=0.242), CRPC (p=0.705 and p=0.224), PCSM (p=0.972 and p=0.260), or all-cause death (p=0.102 and p=0.067). The major limitation was the retrospective design. CONCLUSIONS In a cohort of patients who received early SRT in 70% of cases upon BCR, sPSMs and mPSMs predicted BCR but not long-term clinical end points. Adjuvant radiotherapy for margin-positive patients might not be justified, as only a minority of patients progressed to end points other than BCR. PCSM was exceeded 15-fold by competing risk mortality.
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Bolla M. The moving landscape of locally advanced prostate cancer: combination of external irradiation and endocrine treatment and/or multimodal approach. Eur Urol 2012; 62:220-1; author reply 222-3. [PMID: 22552217 DOI: 10.1016/j.eururo.2012.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/16/2022]
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Ghadjar P, Aebersold DM. Re: Andrew J. Stephenson, Michel Bolla, Alberto Briganti, et al. Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy. Eur Urol 2012;61:443-51. Eur Urol 2011; 61:e39. [PMID: 22169076 DOI: 10.1016/j.eururo.2011.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/29/2011] [Indexed: 11/15/2022]
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Kibel AS. Treat now or later: the dilemma of postoperative radiotherapy. Eur Urol 2011; 61:452-4. [PMID: 22176781 DOI: 10.1016/j.eururo.2011.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022]
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