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Unger JM, Nghiem VT, Hershman DL, Vaidya R, LeBlanc M, Blanke CD. Association of National Cancer Institute-Sponsored Clinical Trial Network Group Studies With Guideline Care and New Drug Indications. JAMA Netw Open 2019; 2:e1910593. [PMID: 31483471 PMCID: PMC6727679 DOI: 10.1001/jamanetworkopen.2019.10593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022] Open
Abstract
Importance National Cancer Institute Clinical Trial Network (NCTN) groups serve a vital role in identifying effective new antineoplastic regimens. However, the downstream clinical effect of their trials has not been systematically examined. Objective To examine the association of NCTN trials with guideline care and new drug indications. Design, Setting, and Participants This retrospective cohort study evaluated phase 3 SWOG Cancer Research Network clinical trials from January 1, 1980, through June 30, 2017. Only completed trials with published results were included. To be considered practice influential (PI), a trial must have been associated with guideline care through its inclusion in National Comprehensive Cancer Network (NCCN) clinical guidelines or US Food and Drug Administration (FDA) new drug approvals in favor of a recommended treatment. Data were analyzed from June 15, 2018, through March 29, 2019. Main Outcomes and Measures Estimated overall rate of PI trials, as well as trends over time. The total federal investment supporting the set of trials was also determined. Results In total, 182 trials consisting of 148 028 patients were studied. Eighty-two studies (45.1%; 95% CI, 37.7%-52.6%) were PI, of which 70 (38.5%) influenced NCCN guidelines, 6 (3.3%) influenced FDA new drug approvals, and 6 (3.3%) influenced both. The number of PI trials was 47 of 65 (72.3%) among those with positive findings and 35 of 117 (29.9%) among those with negative findings. Thus, 35 of 82 PI trials (42.7%) were based on studies with negative findings, with nearly half of these studies (17 of 35 [48.6%]) reaffirming standard of care compared with experimental therapy. The total federal investment spent in conducting the trials was $1.36 billion (2017 US dollars), a rate of $7.5 million per study or $16.6 million per PI trial. Conclusions and Relevance Nearly half of all phase 3 trials by one of the NCTN's largest groups were associated with guideline care or new drug indications, including those with positive and negative findings. Compared with the costs of a new drug approval in pharmaceutical companies, typically estimated at more than $1 billion, the amount of federal funds invested to provide this valuable evidence was modest. These results suggest that the NCTN program contributes clinically meaningful, cost-efficient evidence to guide patient care.
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Affiliation(s)
- Joseph M. Unger
- SWOG Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Van T. Nghiem
- SWOG Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dawn L. Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michael LeBlanc
- SWOG Statistics and Data Management Center, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles D. Blanke
- SWOG Group Chair’s Office, Knight Cancer Institute, Oregon Health & Science University, Portland
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Abstract
The field of prostate cancer has been the subject of extensive research that has resulted in important discoveries and shaped our appreciation of this disease and its management. Advances in our understanding of the epidemiology, natural history, anatomy, detection, diagnosis, grading, staging, imaging, and management of prostate cancer have changed clinical practice and influenced guideline recommendations. The development of the Gleason score and subsequent modifications enabled accurate prediction of prognosis. Increased anatomical understanding and improved surgical techniques resulted in the development of nerve-sparing surgery for radical prostatectomy. The advent of active surveillance has changed the management of low-risk disease, and chemotherapy and hormonal therapy have improved the outcomes of patients with distant disease. Ongoing research and clinical trials are expected to yield more practice-changing results in the near future.
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Stabile A, Muttin F, Zamboni S, Moschini M, Gandaglia G, Fossati N, Dell’Oglio P, Capitanio U, Cucchiara V, Mazzone E, Bravi CA, Mirone V, Montorsi F, Briganti A. Therapeutic approaches for lymph node involvement in prostate, bladder and kidney cancer. Expert Rev Anticancer Ther 2019; 19:739-755. [DOI: 10.1080/14737140.2019.1659135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Muttin
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell’Oglio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo A. Bravi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Federico II of Naples, Naples, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ma W, Poon DM, Chan C, Chan T, Cheung F, Ho L, Lee EK, Leung AK, Leung SY, So H, Tam P, Kwong PW. Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology. BJU Int 2019; 124:221-241. [PMID: 30653801 PMCID: PMC6850389 DOI: 10.1111/bju.14681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality. METHODS Through a series of meetings, the panellists discussed their clinical experience and the published evidence regarding various areas of the management of localized PCa, then drafted consensus statements. At the final meeting, each drafted statement was voted on by every panellist based on its practicability of recommendation in the locality. RESULTS A total of 76 consensus statements were ultimately accepted and established by panel voting. CONCLUSION Derived from the recent evidence and major overseas guidelines, along with local clinical experience and practicability, the consensus statements were aimed to serve as a practical reference for physicians in Hong Kong for the management of localized PCa.
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Affiliation(s)
- Wai‐Kit Ma
- Department of SurgeryQueen Mary HospitalUniversity of Hong KongHong KongHong Kong
| | - Darren Ming‐Chun Poon
- State Key Laboratory in Oncology in South ChinaDepartment of Clinical OncologySir YK Pao Centre for CancerHong Kong Cancer Institute and Prince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Chi‐Kwok Chan
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Tim‐Wai Chan
- Department of Clinical OncologyQueen Elizabeth HospitalHong KongHong Kong
| | | | | | - Eric Ka‐Chai Lee
- Department of Clinical OncologyTuen Mun HospitalHong KongHong Kong
| | | | | | - Hing‐Shing So
- Division of UrologyDepartment of SurgeryUnited Christian HospitalHong KongHong Kong
| | - Po‐Chor Tam
- Department of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Philip Wai‐Kay Kwong
- Department of Clinical OncologyQueen Mary HospitalUniversity of Hong KongHong Kong
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Discord Among Radiation Oncologists and Urologists in the Postoperative Management of High-Risk Prostate Cancer. Am J Clin Oncol 2019; 41:739-746. [PMID: 28301348 DOI: 10.1097/coc.0000000000000381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To query specialty-specific differences regarding postoperative radiotherapy (RT) for high-risk prostate cancer. MATERIALS AND METHODS Electronic mail survey of radiation oncologists (ROs) and urologists. We sought to maximize absolute response number to capture contemporary practice ethos. The outcome of interest was association between response and specialty. Training level/expertise, practice setting, percentage of consultation caseload consisting of high-risk prostate cancer, and nationality were set as effect modifiers for multivariate logistic regression. RESULTS In total, 846 ROs and 407 urologists responded. ROs were more likely to prefer adjuvant radiotherapy (ART). ART or early salvage radiotherapy (SRT, with early SRT defined as that delivered at prostate-specific antigen<0.2), whereas urologists were more likely to prefer early or delayed SRT (P<0.0001). ROs were more likely to prefer lower PSA thresholds for initiating SRT (P<0.0001), and more likely to recommend ART in the setting of adverse pathologic features or node-positive disease (P<0.0001). Significantly more ROs would recommend concurrent androgen deprivation therapy or pelvic nodal RT in the setting of node-positive or Gleason score 8 to 10 disease (P<0.0001). CONCLUSIONS Specialty-specific differences were readily elucidated with respect to timing and indications for ART and SRT, as well as for indications for androgen deprivation therapy and nodal RT. These differences are likely to create a sense of dissonance for patients, which may in turn explain the underutilization of postoperative RT in general practice.
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Kunath F, Jensen K, Pinart M, Kahlmeyer A, Schmidt S, Price CL, Lieb V, Dahm P. Early versus deferred standard androgen suppression therapy for advanced hormone-sensitive prostate cancer. Cochrane Database Syst Rev 2019; 6:CD003506. [PMID: 31194882 PMCID: PMC6564091 DOI: 10.1002/14651858.cd003506.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Standard androgen suppression therapy (AST) using surgical or medical castration is considered a mainstay of advanced hormone-sensitive prostate cancer treatment. AST can be initiated early when disease is asymptomatic or deferred when patients suffer symptoms of disseminated prostate cancer. OBJECTIVES To assess the effects of early versus deferred standard AST for advanced hormone-sensitive prostate cancer. SEARCH METHODS For this Cochrane Review update, we performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Web of Science; last searched November 2018) and two clinical trial registers, with no restrictions on the language of publication or publication status. We also searched bibliographies of included studies and conference proceedings (last searched January 2019). SELECTION CRITERIA We included all randomised controlled trials (RCTs) with a direct comparison of early versus deferred standard AST. We excluded all other study designs. Participants included had advanced hormone-sensitive prostate cancer receiving surgical or medical castration. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data. The primary outcomes were time to death of any cause and serious adverse events. Secondary outcomes were time to disease progression, time to death from prostate cancer, adverse events and quality of life. We performed statistical analyses using a random-effects model and assessed the certainty of evidence according to GRADE. We performed subgroup analyses for advanced but non-metastatic disease (T2-4/N+ M0), metastatic disease (M1), and prostate-specific antigen (PSA) relapse. MAIN RESULTS We identified seven new RCTs since publication of the original review in 2002. In total, we included 10 RCTs.Primary outcomesEarly AST probably reduces the risk of death from any cause over time (hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.75 to 0.90; moderate-certainty evidence; 4767 participants). This corresponds to 57 fewer deaths (95% CI 80 fewer to 31 fewer) per 1000 participants at 5 years for the moderate risk group and 23 fewer deaths (95% CI 32 fewer to 13 fewer) per 1000 participants at 5 years in the low risk group. We downgraded for study limitations. Early versus deferred AST may have little or no effect on serious adverse events (risk ratio (RR) 1.05, 95% CI 0.95 to 1.16; low-certainty evidence; 10,575 participants) which corresponds to 6 more serious adverse events (6 fewer to 18 more) per 1000 participants. We downgraded the certainty of evidence for study limitations and selective reporting.Secondary outcomesEarly AST probably reduces the risk of death from prostate cancer over time (HR 0.69, 95% CI 0.57 to 0.84; moderate-certainty evidence). This corresponds to 62 fewer prostate cancer deaths per 1000 (95% CI 87 fewer to 31 fewer) at 5 years for the moderate risk group and 24 fewer death from prostate cancer (95% CI 34 fewer to 12 fewer) per 1000 men at 5 years in the low risk group. We downgraded the certainty of evidence for study limitations.Early AST may decrease the rate of skeletal events (RR 0.37, 95% CI 0.17 to 0.80; low-certainty evidence) corresponding to 23 fewer skeletal events per 1000 (95% CI 31 fewer to 7 fewer). We downgraded for study limitations and imprecision. It may also increase fatigue (RR 1.41, 95% CI 1.23 to 1.62; low-certainty evidence), corresponding to 31 more men with this complaint per 1000 (95% CI 18 more to 48 more). We downgraded for study limitations and imprecision. It may increase the risk of heart failure (RR 1.90, 95% CI 1.09 to 3.33; low-certainty evidence) corresponding to 27 more events per 1000 (95% CI 3 more to 69 more). We downgraded the certainty of evidence for study limitations and imprecision.Global quality of life is probably similar after two years as assessed with the EORTC QLQ-C30 (version 3.0) questionnaire (mean difference -1.56, 95% CI -4.50 to 1.38; moderate-certainty evidence) with higher scores reflecting better quality of life. We downgraded the certainty of evidence for study limitations. AUTHORS' CONCLUSIONS Early AST probably extends time to death of any cause and time to death from prostate cancer. It may slightly decrease the rate of skeletal events. Rates of serious adverse events and quality of life may be similar. It may increase fatigue and may increase the risk of heart failure. Better quality trials would be particularly important to better understand the outcomes related to possible treatment-related harm, for which we only found low-certainty evidence.
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Affiliation(s)
- Frank Kunath
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
| | - Katrin Jensen
- Heidelberg University HospitalInstitute of Medical Biometry and InformaticsMarsilius‐ArkadenIm Neuenheimer Feld 130.3, 12. OGHeidelbergBaden‐WürttembergGermany69120
| | - Mariona Pinart
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
| | - Andreas Kahlmeyer
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
| | | | - Carrie L Price
- Welch Medical Library, Johns Hopkins Medical InstitutionsClinical Informationist Services2024 E. Monument St.BaltimoreMarylandUSA21287
| | - Verena Lieb
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Urology420 Delaware Street SEMMC 394MinneapolisMinnesotaUSA55455
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Min K, Chung JW, Ha YS, Lee JN, Kim BS, Kim HT, Kim TH, Yoo ES, Kwon TG, Chung SK, Tanaka M, Egawa S, Kimura T, Choi SH. Efficacy of Androgen Deprivation Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel-Based Chemotherapy. World J Mens Health 2019; 38:226-235. [PMID: 31190487 PMCID: PMC7076308 DOI: 10.5534/wjmh.190029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the comparative effectiveness of androgen deprivation therapy (ADT) combined with docetaxel (DTX)-based chemotherapy in Korean and Japanese castration-resistant prostate cancer (CRPC) patient cohorts. MATERIALS AND METHODS Metastatic CRPC patients who underwent more than three DTX-based chemotherapy cycles in Korea and Japan between 2002 and 2017 were retrospectively analyzed and divided into the DTX-only (DTX, n=30) and combination (DTX+ADT, n=46) groups. Progression-free survival (PFS) was calculated as the time from the start of chemotherapy to the occurrence of either disease progression (prostate-specific antigen [PSA] progression or radiographic progression) or death. The primary end point was PFS and the secondary end point was overall survival (OS). RESULTS In the DTX and DTX+ADT groups, the median PFS was 6.0 and 11.0 months (log-rank p=0.053). The multivariate Cox regression analysis revealed that the significant predicting factors of PFS were ADT administration (hazard ratio [HR], 0.478; 95% confidence interval [CI], 0.284-0.804; p=0.005) and number of DTX-based chemotherapy cycles (HR, 0.934; 95% CI, 0.899-0.970; p<0.001). In the DTX and DTX+ADT groups, the median OS was 16.0 and 19.5 months (log-rank p=0.825). Through multiple Cox regression analysis, we found that the significant predicting factors of OS were the PSA nadir level (HR, 1.001; 95% CI, 1.000-1.002; p<0.001) and number of DTX-based chemotherapy cycles (HR, 0.932; 95% CI, 0.876-0.991; p=0.024). CONCLUSIONS Concurrent DTX-based chemotherapy and ADT may be beneficial compared with DTX-based chemotherapy alone in chemotherapy-naïve metastatic CRPC patients in terms of the PFS, but not the OS.
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Affiliation(s)
- Kyungchan Min
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jae Wook Chung
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yun Sok Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Hwan Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Kwang Chung
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Masatoshi Tanaka
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
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Li H, Wang Z, Zhang Y, Sun G, Ding B, Yan L, Liu H, Guan W, Hu Z, Wang S, Cheng F, Xu H, Zhang X, Ye Z. The Immune Checkpoint Regulator PDL1 is an Independent Prognostic Biomarker for Biochemical Recurrence in Prostate Cancer Patients Following Adjuvant Hormonal Therapy. J Cancer 2019; 10:3102-3111. [PMID: 31289580 PMCID: PMC6603373 DOI: 10.7150/jca.30384] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/28/2019] [Indexed: 12/31/2022] Open
Abstract
Background: The programmed death 1 (PD1)/programmed death ligand 1 (PDL1) targeted therapies have gained positive outcomes in several tumors, but the evidence of the expression and prognosis value of PD1/PDL1 in high risk prostate cancer was rare. Methods: Immunohistochemical analysis of PDL1/PD1 expression by a validated antibody was performed in a retrospectively collected high risk prostate cancer cohort who received adjuvant hormonal therapy (AHT) after radical prostatectomy (RP). The association between PDL1/PD1 expression and prognosis was determined. Results: In total, 127 patients were enrolled. 49.6% patients were considered PDL1-high expression while the PD1-positive expression proportion was 24.4%. High PDL1 and negative PD1 expression were significantly associated with lower prostate specific antigen (PSA) density (p=0.010 and p=0.033, respectively). Compared with the PDL1-low expression patients, the PDL1-high expression patients had significantly shorter time to PSA nadir (TTN) (P=0.001) and biochemical recurrence (BCR) (P=0.004). In Kaplan-Meier analysis, the PDL1-high expression group (p<0.0001) and the PDL1-high/PD1-negative expression group (p<0.0001) showed markedly lower BCR-free survival in localized disease. Univariate cause-specific Cox proportional hazard regression model concluded total PSA (p=0.047), PDL1-high-expression (p<0.001), PDL1-high/PD1-negative expression (p<0.001) were significant risk factors of shorter progression time to BCR in localized disease. PDL1-high-expression was the independent predictor of time to BCR in multiple Cox regression of all patients (Hazard ratio [HR]: 3.901; 95% Confidence interval [CI]: 1.287-11.824; p=0.016). Conclusions: PDL1 expression is not only highly prevalent in high-risk prostate cancer, but is also an independent biomarker in the prognosis of high-risk prostate cancer received AHT after RP. PDL1/PD1 targeted therapy might be a potentially adjuvant treatment option for high-risk prostate cancer after RP.
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Affiliation(s)
- Heng Li
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhize Wang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yucong Zhang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guoliang Sun
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Beichen Ding
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Libin Yan
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haoran Liu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Guan
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiquan Hu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shaogang Wang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hua Xu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100000, China
| | - Zhangqun Ye
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Beebe‐Dimmer JL, Ruterbusch JJ, Cooney KA, Bolton A, Schwartz K, Schwartz AG, Heath E. Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER-Medicare investigation. Cancer Med 2019; 8:3325-3335. [PMID: 31094098 PMCID: PMC6558501 DOI: 10.1002/cam4.2092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Approximately 5% of men were initially diagnosed with (also referred to as de novo) advanced stage prostate cancer and experience far poorer survival compared to men diagnosed with local or regionally advanced disease. Given the number of new therapies targeting metastatic and castrate-resistant disease, we sought to describe recent treatment patterns by race for de novo AJCC stage IV prostate cancer. METHODS We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to identify men aged 66 and older diagnosed in 2004-2014 with advanced prostate cancer, and examined patterns of treatment among all patients and stratified by race/ethnicity. RESULTS There were 8828 eligible patients identified, and non-Hispanic black (NHB) patients were more likely to go without treatment (P < 0.001) compared to non-Hispanic white (NHW) patients, even after accounting for early mortality and TNM stage. The frequency of nearly all forms of treatment was lower among NHB with the exception of orchiectomy, which was significantly higher (10.1% vs 6.1%, P < 0.001), and the use of the progesterone Megace among Medicare Part D enrollees (24.6% vs 15.0%, P < 0.001). CONCLUSIONS Results from this study of elderly Medicare patients presenting with advanced stage prostate cancer suggest that NHB men are less likely to pursue aggressive treatment options. With the reduction in screening for prostate cancer, presumably tied to USPSTF recommendations, and the increasing incidence of men diagnosed with de novo metastatic disease, understanding drivers of treatment-related decisions are critical in reducing racial disparities in advanced prostate cancer outcomes.
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Affiliation(s)
- Jennifer L. Beebe‐Dimmer
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
- Department of OncologyWayne State University School of MedicineDetroitMichigan
| | - Julie J. Ruterbusch
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
- Department of OncologyWayne State University School of MedicineDetroitMichigan
| | - Kathleen A. Cooney
- Duke University School of Medicine and Duke Cancer InstituteDurhamNorth Carolina
| | - Adam Bolton
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
| | - Kendra Schwartz
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
- Department of OncologyWayne State University School of MedicineDetroitMichigan
| | - Ann G. Schwartz
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
- Department of OncologyWayne State University School of MedicineDetroitMichigan
| | - Elisabeth Heath
- Barbara Ann Karmanos Cancer InstituteDetroitMichigan
- Department of OncologyWayne State University School of MedicineDetroitMichigan
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Kim JK, Jeong CW, Ku JH, Kim HH, Kwak C. Prostate specific antigen (PSA) persistence 6 weeks after radical prostatectomy and pelvic lymph node dissection as predictive factor of radiographic progression in node-positive prostate cancer patients. J Cancer 2019; 10:2237-2242. [PMID: 31258727 PMCID: PMC6584413 DOI: 10.7150/jca.29714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/31/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the prognostic value of early postoperative prostate specific antigen (PSA) levels after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) in prostate cancer patients with lymph node invasion (LNI). Materials and Methods: The retrospective analysis involved 96 patients who had a diagnosis of LNI with available data on the first PSA level at postoperative 6 weeks after RP and PLND between 2002 and 2014 at our institution. PSA persistence was defined as PSA ≥ 0.1 ng/ml at 6 weeks after surgery. Radiographic progression was defined as positive imaging during follow-up after the onset of biochemical recurrence, consisting of a bone scan and/or computed tomography (CT) and/or magnetic resonance imaging and/or 18F-(2-deoxy-2-fluoro-D-glucose positron emission tomography/CT scan. Comparative analysis of patients with and without PSA persistence was done, and Kaplan-Meier curve analysis with log-rank test and Cox proportional hazard regression models assessed radiographic progression free survival (PFS). Results: Fifty two (54.2%) patients displayed PSA persistence. Kaplan-Meier curve analysis showed significantly decreased 5-year radiographic PFS (64.2% vs. 93.2%, log-rank, p=0.009) in the PSA persistence group compared to the no PSA persistence group. In a multivariate analysis, PSA persistence was a statistically significant predictor of radiographic PFS. Conclusions: Early assessment of PSA after surgery is important for predicting radiographic progression in node-positive prostate cancer patients. Risk stratification based on the early PSA value after surgery would be helpful to identify patients who may benefit from early adjuvant therapies.
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Affiliation(s)
- Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Aliberti A, Bada M, Rapisarda S, Natoli C, Schips L, Cindolo L. Adherence to hormonal deprivation therapy in prostate cancer in clinical practice: a retrospective, single-center study. MINERVA UROL NEFROL 2019; 71. [DOI: 10.23736/s0393-2249.18.03109-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Hayman J, Hole KH, Seierstad T, Perin J, DeWeese TL, Tran PT, Lilleby W. Local failure is a dominant mode of recurrence in locally advanced and clinical node positive prostate cancer patients treated with combined pelvic IMRT and androgen deprivation therapy. Urol Oncol 2019; 37:289.e19-289.e26. [DOI: 10.1016/j.urolonc.2018.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
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Chu HH, Shin JH, Kim JW, Noh SY, Yang WJ, Park S. Lymphangiography and Lymphatic Embolization for the Management of Pelvic Lymphocele After Radical Prostatectomy in Prostatic Cancer. Cardiovasc Intervent Radiol 2019; 42:873-879. [PMID: 30919025 DOI: 10.1007/s00270-019-02209-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To retrospectively evaluate the short-term outcomes of lymphangiography and lymphatic embolization in the treatment of pelvic lymphocele after radical prostatectomy in patients with prostate cancer. MATERIALS AND METHODS The data of nine, consecutive patients who underwent lymphangiography and lymphatic embolization for pelvic lymphocele after radical prostatectomy with pelvic lymph node dissection (PLND) between January 2016 and May 2018, were retrospectively reviewed. Lymphangiography was performed through inguinal lymph nodes in order to identify the lymphatic leakage. When a leakage was found, lymphatic embolization was performed using a directly punctured fine needle at the closest upstream lymph node or lymphopseudoaneurysm and with N-butyl cyanoacrylate glue. RESULTS Lymphangiography demonstrated extravasation and/or lymphopseudoaneurysm in all of these patients. A total of 13 sessions of lymphangiography and lymphatic embolization were performed. The median number of lymphangiography and lymphatic embolizations required to achieve clinical success was one (range, 1-3). Three patients underwent repeated embolization with successful results. The technical and clinical success rates were 100%, respectively. The median time to resolution was 7 days (range, 2-19 days). There was no recurrence and no procedure-related complications during the follow-up period (mean, 26 weeks; range, 8-77 weeks) in all patients. CONCLUSIONS Lymphangiography and lymphatic embolization are safe and effective for the management of pelvic lymphoceles after radical prostatectomy with PLND.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Jin Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Application of a Prognostic Stratification System for High-risk Prostate Cancer to Patients Treated With Radiotherapy: Implications for Treatment Optimization. Am J Clin Oncol 2019; 42:382-390. [PMID: 30724780 DOI: 10.1097/coc.0000000000000521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We applied an established prognostic model to high-risk prostate cancer (HRPC) patients treated with radiotherapy (RT) and evaluated the influence of clinical and treatment variables on treatment outcomes. METHODS In total, 1075 HRPC patients undergoing definitive radiotherapy (RT) between 1995 and 2010 were retrospectively reviewed. Median follow-up was 62.3 months. Patients received either dose-escalated external beam radiotherapy (n=628, EBRT) or combined-modality radiotherapy (n=447, pelvic RT and low-dose rate brachytherapy boost, CMRT). 82.9% received androgen-deprivation therapy (ADT). A prognostic model stratified patients into predefined groups (good, intermediate, and poor). Kaplan-Meier methods and Cox proportional hazards regressions assessed biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM) and overall mortality (OM). C-indices analyzed predictive value. RESULTS The model was prognostic; C-indices for BF, DM, PCSM and OM were: 0.62, 0.64, 0.61, and 0.57. On multivariate analysis, CMRT and longer ADT (≥24 mo) were associated with improved BF, DM, and PCSM. Gleason score (GS) 9-10 was the strongest predictor of PCSM. C-indices for BF, DM, PCSM, and OM using a 4-compartment model incorporating GS 9-10 were: 0.62, 0.65, 0.68, and 0.56. In poor-prognosis patients (GS 8-10+additional risk factors), CMRT+LTADT (>12 mo) had 10-year PCSM (3.7%±3.6%), comparing favorably to 25.8%±9.2% with EBRT+LTADT. CONCLUSIONS The model applies to high-risk RT patients; GS 9-10 remains a powerful predictor of PCSM. Comparing similar prognosis patients, CMRT is associated with improved disease-specific outcomes relative to EBRT. In poor-prognosis patients, CMRT+LTADT yields superior 10-year PCSM, potentially improving RT treatment personalization for those with HRPC.
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Rose BS. Postoperative radiation and hormonal therapy for men with node-positive prostate cancer: a new standard? BJU Int 2019; 123:199-200. [PMID: 30656836 DOI: 10.1111/bju.14501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
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Xie W, Stopsack KH, Drouin SJ, Fu H, Pomerantz MM, Mucci LA, Lee GSM, Kantoff PW. Association of genetic variation of the six gene prognostic model for castration-resistant prostate cancer with survival. Prostate 2019; 79:73-80. [PMID: 30141208 PMCID: PMC6476182 DOI: 10.1002/pros.23712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND We previously identified a blood RNA transcript-based model consisting of six immune or inflammatory response genes (ABL2, SEMA4D, ITGAL, C1QA, TIMP1, and CDKN1A) that was prognostic for survival in cohorts of men with castration-resistant prostate cancer (CRPC). We investigated whether inherited variation in these six genes was associated with overall survival (OS) in men with CRPC. METHODS The test cohort comprised 600 patients diagnosed with CRPC between 1996 and 2011 at Dana-Farber Cancer Institute. Genotyping of 66 tagging single nucleotide polymorphisms (SNPs) spanning the six genes was performed on blood derived DNAs. For the top four SNPs (P < 0.05), validation was conducted in an independent cohort of 223 men diagnosed with CRPC between 2000 and 2014. Multivariable Cox regression adjusting for known prognostic factors estimated hazard ratios (HR) and 95% confidence intervals (CI) of the association of genetic variants with OS. RESULTS Two thirds of patients in both cohorts had metastases at CRPC diagnosis. Median OS from CRPC diagnosis was 3.6 (95%CI 3.3-4.0) years in the test cohort and 4.6 (95%CI 3.8-5.2) years in the validation cohort. Fifty-nine SNPs in Hardy-Weinberg equilibrium were analyzed. The major alleles of rs1318056 and rs1490311 in ABL2, and the minor alleles of rs2073917 and rs3764322 in ITGAL were associated with increased risk of death in the test cohort (adjusted-HRs 1.27-1.39; adjusted-p <0.05; false discovery rate <0.35). In the validation cohort, a similar association with OS was observed for rs1318056 in ABL2 (adjusted-HR 1.44; 95%CI 0.89-2.34) and rs2073917 in ITGAL (adjusted-HR 1.41; 95%CI 0.82-2.42). The associations did not reach statistical significance most likely due to the small sample size of the validation cohort (adjusted-p = 0.142 and 0.209, respectively). Additional eQTL analysis indicated that minor alleles of rs1318056 and rs1490311 in ABL2 are associated with a lower ABL2 expression in blood. CONCLUSIONS These findings corroborate our initial work on the RNA expression of genes involved in immunity and inflammation from blood and clinical outcome and suggest that germline polymorphisms in ABL2 and ITGAL may be associated with the risk of death in men with CRPC. Further studies are needed to validate these findings and to explore their functional mechanisms.
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Affiliation(s)
- Wanling Xie
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
| | - Konrad H. Stopsack
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Sarah J Drouin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
| | - Henry Fu
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
| | - Mark M. Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
| | - Lorelei A. Mucci
- Harvard T. H Chan Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02215
| | - Gwo-Shu Mary Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
- Correspondence: Philip W. Kantoff, Phone: 212-639-5851; Fax: 929-321-5023; . Gwo-Shu Mary Lee, Phone: 617-632-5088;
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
- Correspondence: Philip W. Kantoff, Phone: 212-639-5851; Fax: 929-321-5023; . Gwo-Shu Mary Lee, Phone: 617-632-5088;
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Ye D, Zhang W, Ma L, Du C, Xie L, Huang Y, Wei Q, Ye Z, Na Y. Adjuvant hormone therapy after radical prostatectomy in high-risk localized and locally advanced prostate cancer: First multicenter, observational study in China. Chin J Cancer Res 2019; 31:511-520. [PMID: 31354220 PMCID: PMC6613498 DOI: 10.21147/j.issn.1000-9604.2019.03.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective Potential of combined androgen blockade (CAB) has not been explored extensively in Chinese males with prostate cancer (PCa). Therefore, this study evaluated the 2-year prostate-specific antigen (PSA) recurrence rate and quality of life (QoL) in patients with high-risk localized and locally advanced PCa receiving adjuvant hormone therapy (HT) after radical prostatectomy (RP). Methods This prospective, multicenter, observational study conducted in 18 centers across China enrolled patients with high-risk factor (preoperative PSA>20 ng/mL or Gleason score >7) or locally advanced PCa. Different adjuvant HT were administered after RP according to investigator’s decision in routine clinical practice. Relationship of baseline and postoperative characteristics was assessed with recurrence rate. PSA recurrence rate and Functional Assessment of Cancer Therapy-Prostate (FACT-P) QoL scores were recorded at 12 months and 24 months. Kaplan-Meier analysis was used to construct the PSA recurrence rate during follow-up. Results A total of 189 patients (mean age: 66.9±6.5 years) were recruited, among which 112 (59.3%) patients showed serum PSA>20 ng/mL preoperatively. The highest postoperative pathological advancement noticed was from clinical T2 (cT2) to pathological T3 (pT3) (43.9%) stage. The majority of the patients (66.1%) received CAB as adjuvant HT, for a median duration of 20.0 months. The least recurrence (15.2%) was noticed in patients treated with CAB, followed by those treated with luteinizing hormone-releasing hormone agonist (LHRHa) (16.1%), and antiandrogen (19.0%), with non-significant difference noted among the groups. None of the baseline or postoperative characteristics was related with PSA recurrence in our study. The 24-month FACT-P QoL score of 119 patients treated for >12 months showed significant improvement above baseline compared with those treated for ≤12 months. Conclusions Adjuvant CAB therapy after RP showed reduction trend in 2-year PSA recurrence rate in high-risk Chinese patients with localized and locally advanced PCa, compared with adjuvant anti-androgens (AA) or LHRHa therapy. Further long-term therapy (>12 months) significantly improved QoL compared to short-term HT therapy, suggesting the beneficial effect of long-term CAB therapy in improving QoL.
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Affiliation(s)
- Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Wei Zhang
- Department of Urology, Jiangsu Province Hospital, Nanjing 210029, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Chuanjun Du
- Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Liping Xie
- Department of Urology, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yiran Huang
- Department of Urology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yanqun Na
- Department of Urology, Peking University Shougang Hospital, Beijing 100144, China
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Hwang C. Genitourinary Pathology Reporting Parameters Most Relevant to the Medical Oncologist. Surg Pathol Clin 2018; 11:877-891. [PMID: 30447846 DOI: 10.1016/j.path.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pathologic variables play an important role in prognostication in urologic malignancies. Histologic subtype, histologic grade, and anatomic extent of disease (pathologic tumor and nodal staging) influence treatment decisions in both the adjuvant and metastatic settings. This article discusses treatment paradigms for the most common urologic malignancies, followed by the evidence base to support the relationship between pathologic assessment and decision making by the medical oncologist.
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Affiliation(s)
- Clara Hwang
- Department of Internal Medicine, Division of Hematology and Oncology, Henry Ford Cancer Institute, Henry Ford Health System, 2799 West Grand Boulevard, CFP5, Detroit, MI 48202, USA.
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Liu F, Sun D, Zhou X, Ding Y, Ma Y, Hou Y, Kong X, Wang Z. Effect of adjuvant hormone therapy in patients with prostate cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13145. [PMID: 30557966 PMCID: PMC6319968 DOI: 10.1097/md.0000000000013145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To summarize the evidence regarding the treatment effect of adjuvant hormone therapy (AHT) in patients with prostate cancer (PCa). AHT following radiotherapy, chemotherapy, or surgery is widely used in patients with PCa. However, the treatment effect is inconsistent in individual trials. METHODS The electronic databases including PubMed, EmBase, and Cochrane Library were searched to identify randomized controlled trials (RCTs) in September 2016. RCTs that evaluated the effects of AHT in patients with PCa were included. Hazard ratio (HR) and relative risks (RR) were used to measure the treatment effects of AHT using a random effects model. The analyses were further stratified by factors that could affect the treatment efficacy. RESULTS A total of 14,594 potential studies were identified, and 27 RCTs were included. Compared with the control group, patients who received AHT were associated with a significant improvement in overall survival (OS) (HR: 0.78; 95% confidence interval [CI]: 0.71-0.85; P <.001), disease-free survival (DFS) (HR: 0.50; 95% CI: 0.39-0.65; P <.001), total mortality (RR: 0.90; 95% CI: 0.85-0.96; P = .001), recurrence (RR: 0.70; 95% CI: 0.60-0.81; P <.001), and disease-specific mortality (RR: 0.70; 95% CI: 0.56-0.87; P <.001). However, no significant difference was observed between AHT and control for response rate (RR: 1.75; 95% CI: 0.91-3.37; P = .095). CONCLUSIONS The findings of this meta-analysis confirmed that patients who received AHT had a significant improvement in OS, DFS, total mortality, recurrence, and disease-specific mortality. Further, large-scale RCTs are required to evaluate the treatment effect in specific subpopulations.
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Affiliation(s)
| | | | | | - Youpeng Ding
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Yanan Ma
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Yi Hou
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Zhixin Wang
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
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Survival Outcomes in Octogenarian and Nonagenarian Patients Treated with First-line Androgen Deprivation Therapy for Organ-confined Prostate Cancer. Eur Urol Focus 2018; 4:834-841. [DOI: 10.1016/j.euf.2017.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/29/2016] [Accepted: 01/28/2017] [Indexed: 11/19/2022]
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Weng WC, Huang LH, Hsu CY, Tung MC, Yang CK, Jin JS, Ou YC, Yang SF. Impact of prostatic anterior fat pads with lymph node staging in prostate cancer. J Cancer 2018; 9:3361-3365. [PMID: 30271497 PMCID: PMC6160679 DOI: 10.7150/jca.25554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/17/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Several reports have revealed the presence of lymph nodes in the prostatic anterior fat pad (PAFP). To date, no study has described the characteristics of Taiwanese patients harboring PAFP lymph nodes with metastatic prostate cancer involvement. Method: Between December 2006 and May 2015, a total of 849 consecutive patients underwent robot-assisted laparoscopic radical prostatectomy with PAFP dissection. Pathological examination of the dissected PAFP was conducted to assess the presence of lymphoid tissue and prostate cancer involvement. Results: Of the 849 patients, 76 (9.0%) had 1-3 PAFP lymph nodes. Moreover, 11 (1.3%) of the 76 patients had positive lymph node metastases of prostate cancer in the PAFP; 5 (0.6%) of the 11 patients, who had negative pelvic lymph node involvement, were upstaged because of positive metastases in PAFP lymph nodes. Among the 76 patients having PAFP lymph nodes, metastatic lymph nodes were associated with the clinical T stage, preoperative Gleason score, pathological T stage, and pathological N stage (p < 0.001). Patients with pathological seminal vesicle invasion and a higher surgical Gleason score also exhibited PAFP lymph node metastases (p < 0.005). Conclusion: Our data show that 9.0% of patients had PAFP lymph nodes and that 1.3% had prostate cancer metastases. Additionally, 0.6% of patients were upstaged because of positive metastases in PAFP lymph nodes. Because of the pathological analysis of the PAFP, a few patients were upstaged. Thus, routine pathological analysis of the PAFP should only be conducted for those with higher preoperative prostate-specific antigen, higher Gleason score, and advanced T stage observations.
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Affiliation(s)
- Wei-Chun Weng
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Li-Hua Huang
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jong-Shiaw Jin
- Department of Pathology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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Joseph JV, Brasacchio R, Fung C, Reeder J, Bylund K, Sahasrabudhe D, Yeh SY, Ghazi A, Fultz P, Rubens D, Wu G, Singer E, Schwarz E, Mohile S, Mohler J, Theodorescu D, Lee YF, Okunieff P, McConkey D, Rashid H, Chang C, Fradet Y, Guru K, Kukreja J, Sufrin G, Lotan Y, Bailey H, Noyes K, Schwartz S, Rideout K, Bratslavsky G, Campbell SC, Derweesh I, Abrahamsson PA, Soloway M, Gomella L, Golijanin D, Svatek R, Frye T, Lerner S, Palapattu G, Wilding G, Droller M, Trump D. A Festschrift in Honor of Edward M. Messing, MD, FACS. Bladder Cancer 2018; 4:S1-S43. [PMID: 30443561 PMCID: PMC6226303 DOI: 10.3233/blc-189037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Jean V. Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jay Reeder
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Bylund
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Shu Yuan Yeh
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Fultz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah Rubens
- University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Edward Schwarz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Yi Fen Lee
- University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Okunieff
- UF Health Proton Therapy Institute, Gainesville, FL, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Hani Rashid
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Yves Fradet
- CHU de Quebec-Hotel-Dieu de Quebec, Quebec, QC, Canada
| | | | | | - Gerald Sufrin
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Yair Lotan
- UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Howard Bailey
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Kathy Rideout
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Leonard Gomella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Thomas Frye
- University of Rochester Medical Center, Rochester, NY, USA
| | - Seth Lerner
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | | | | | - Donald Trump
- Virginia Commonwealth University, Fairfax, VA, USA
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73
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Sentinel node evaluation in prostate cancer. Clin Exp Metastasis 2018; 35:471-485. [PMID: 30187286 DOI: 10.1007/s10585-018-9936-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Sentinel lymph node (SLN) based pelvic lymph node dissection (PLND) in prostate cancer (PCa) is appealing over the time, cost and morbidity classically attributed to conventional PLND during radical prostatectomy. The initial report of feasibility of the SLN concept in prostate cancer was nearly 20 years ago. However, PLND based on the SLN concept, either SLN biopsy of a single node or targeted SLN dissection of multiple nodes, is still considered investigational in PCa. To better appreciate the challenges, and potential solutions, associated with SLN-based PLND in PCa, this review will discuss the rationale behind PLND in PCa and evaluate current SLN efforts in the most commonly diagnosed malignancy in men in the US.
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74
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Impact of Adjuvant Radiotherapy in Node-positive Prostate Cancer Patients: The Importance of Patient Selection. Eur Urol 2018; 74:253-256. [DOI: 10.1016/j.eururo.2018.04.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
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Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018; 129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
The management of patients with biochemical, local, nodal, or oligometastatic relapsed prostate cancer has become more challenging and controversial. Novel imaging modalities designed to detect recurrence are increasingly used, particularly PSMA-PET scans in Australia, New Zealand and some European countries. Imaging techniques such as MRI and PET scans using other prostate cancer-specific tracers are also being utilised across the world. The optimal timing for commencing salvage treatment, and the role of local and/or systemic therapies remains controversial. Through surveys of the membership, the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) identified wide variation in the management of recurrent prostate cancer. Following a workshop conducted in April 2017, the FROGG management committee reviewed the literature and developed a set of recommendations based on available evidence and expert opinion, for the appropriate investigation and management of recurrent prostate cancer. These recommendations cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, as well as the management of local prostate recurrence after definitive radiotherapy.
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Affiliation(s)
- Hester Lieng
- Central Coast Cancer Centre, Gosford Hospital, Australia.
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Australia
| | - David R H Christie
- Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas N Eade
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Tanya Holt
- University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - George Hruby
- Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
| | - Mark Sidhom
- Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
| | | | | | - John Yaxley
- University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
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76
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Park JW, Jang WS, Koh DH, Ham WS, Rha KH, Hong SJ, Choi YD. Impact of Early Salvage Androgen Deprivation Therapy in Localized Prostate Cancer after Radical Prostatectomy: A Propensity Score Matched Analysis. Yonsei Med J 2018; 59:580-587. [PMID: 29869455 PMCID: PMC5990681 DOI: 10.3349/ymj.2018.59.5.580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/04/2018] [Accepted: 04/17/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) of prostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remains controversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specific antigen (PSA) values met the clinical definition of BCR. MATERIALS AND METHODS We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients were assigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definition of BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed. RESULTS The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analyses showed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but did not have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the non-organ confined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however, did not correlate with CSS (p=0.107). CONCLUSION Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in non-organ confined PCa.
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Affiliation(s)
- Jae Won Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Koh
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Affiliation(s)
- Oliver Sartor
- Oliver Sartor, Tulane Medical School, New Orleans, LA
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78
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Hussain M, Tangen CM, Thompson IM, Swanson GP, Wood DP, Sakr W, Dawson NA, Haas NB, Flaig TW, Dorff TB, Lin DW, Crawford ED, Quinn DI, Vogelzang NJ, Glode LM. Phase III Intergroup Trial of Adjuvant Androgen Deprivation With or Without Mitoxantrone Plus Prednisone in Patients With High-Risk Prostate Cancer After Radical Prostatectomy: SWOG S9921. J Clin Oncol 2018; 36:1498-1504. [PMID: 29624463 PMCID: PMC5959197 DOI: 10.1200/jco.2017.76.4126] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with high-risk prostate cancer after radical prostatectomy are at risk for death. Adjuvant androgen-deprivation therapy (ADT) may reduce this risk. We hypothesized that the addition of mitoxantrone and prednisone (MP) to adjuvant ADT could reduce mortality compared with adjuvant ADT alone. Methods Eligible patients had cT1-3N0 prostate cancer with one or more high-risk factors after radical prostatectomy (Gleason score [GS] ≥ 8; pT3b, pT4, or pN+ disease; GS 7 and positive margins; or preoperative prostate-specific antigen [PSA] > 15 ng/mL, biopsy GS score > 7, or PSA > 10 ng/mL plus biopsy GS > 6. Patients with PSA ≤ 0.2 ng/mL after radical prostatectomy were stratified by pT/N stage, GS, and adjuvant radiation plan and randomly assigned to ADT (bicalutamide and goserelin for 2 years) or ADT plus six cycles of MP. The primary end point was overall survival (OS). Median OS was projected to be 10 years in the ADT arm, requiring 680 patients per arm to detect a hazard ratio of 1.30 with 92% power and one-sided α = .05. Results Nine hundred sixty-one eligible intent-to-treat patients were randomly assigned to ADT or ADT + MP from October 1999 to January 2007, when the Data Safety Monitoring Committee recommended stopping accrual as a result of higher leukemia incidence with ADT + MP. Median follow-up was 11.2 years. The 10-year OS estimates were 87% with ADT (expected 50%) and 86% with ADT + MP (hazard ratio, 1.06; 95% CI, 0.79 to 1.43). The 10-year estimate for disease-free survival was 72% for both arms. Prostate cancer was the cause of death in 18% of patients in the ADT arm and 22% in the ADT + MP arm. More patients in the MP arm died of other cancers (36% v 18% in ADT alone arm). Conclusion MP did not improve OS and increased deaths from other malignancies. The DFS and 10-year OS in these patients treated with 2 years of ADT were encouraging compared with historical estimates, although a definitive conclusion regarding value of ADT may not be made without a nontreatment control arm.
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Affiliation(s)
- Maha Hussain
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Catherine M. Tangen
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Ian M. Thompson
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Gregory P. Swanson
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - David P. Wood
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Wael Sakr
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Nancy A. Dawson
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Naomi B. Haas
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Thomas W. Flaig
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Tanya B. Dorff
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Daniel W. Lin
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - E. David Crawford
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - David I. Quinn
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - Nicholas J. Vogelzang
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | - L. Michael Glode
- Maha Hussain, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Catherine M. Tangen, Fred Hutchinson Cancer Research Center; Daniel W. Lin, University of Washington, Seattle, WA; Ian M. Thompson Jr, University of Texas Health Science Center, San Antonio; Gregory P. Swanson, Baylor Scott and White Health, Temple, TX; David P. Wood, Beaumont Physician Partners and Clinical Faculty, Royal Oak; Wael Sakr, Wayne State University School of Medicine, Detroit, MI; Nancy A. Dawson, Lombardi Comprehensive Cancer Center, Washington, DC; Naomi B. Haas, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Thomas W. Flaig, E. David Crawford, and L. Michael Glode, University of Colorado Cancer Center, Denver, CO; Tanya B. Dorff and David I. Quinn, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; and Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV
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Gupta M, Patel HD, Schwen ZR, Tran PT, Partin AW. Adjuvant radiation with androgen-deprivation therapy for men with lymph node metastases after radical prostatectomy: identifying men who benefit. BJU Int 2018; 123:252-260. [DOI: 10.1111/bju.14241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohit Gupta
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Hiten D. Patel
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Zeyad R. Schwen
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Phuoc T. Tran
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Radiation Oncology and Molecular Radiation Sciences and Oncology; The Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Alan W. Partin
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
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McDonald ML, Howard LE, Aronson WJ, Terris MK, Cooperberg MR, Amling CL, Freedland SJ, Kane CJ. First postoperative PSA is associated with outcomes in patients with node positive prostate cancer: Results from the SEARCH database. Urol Oncol 2018; 36:239.e17-239.e25. [DOI: 10.1016/j.urolonc.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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van Leeuwen PJ, van der Poel HG. Re: Karim A. Touijer, Robert Jeffery Karnes, Niccolo Passoni, et al. Survival Outcomes of Men with Lymph Node-positive Prostate Cancer After Radical Prostatectomy: A Comparative Analysis of Different Postoperative Management Strategies. Eur Urol 2018;73:890-6. Eur Urol 2018; 74:e15-e17. [PMID: 29661485 DOI: 10.1016/j.eururo.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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82
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Sanguineti G, Franzone P, Culp L, Marcenaro M, Barra S, Vitale V. Radiotherapy after Prostatectomy. TUMORI JOURNAL 2018; 88:445-52. [PMID: 12597135 DOI: 10.1177/030089160208800602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. Methods The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. Results As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40–50% of patients are rendered bNED with local salvage radiotherapy, but only 10–50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates ≥70% at 5 years. Conclusions Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (>30%) risk of failure.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX 77555-0711, USA.
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83
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Bianchi L, Schiavina R, Borghesi M, Bianchi FM, Briganti A, Carini M, Terrone C, Mottrie A, Gacci M, Gontero P, Imbimbo C, Marchioro G, Milanese G, Mirone V, Montorsi F, Morgia G, Novara G, Porreca A, Volpe A, Brunocilla E. Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database. Int J Urol 2018; 25:574-581. [DOI: 10.1111/iju.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Marco Borghesi
- Department of Urology; University of Bologna; Bologna Italy
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | - Marco Carini
- Department of Urology; University of Florence; Florence Italy
| | - Carlo Terrone
- Department of Urology; University of Genoa; Genoa Italy
| | - Alex Mottrie
- Department of Urology; OLV Hospital; Aalst Belgium
| | - Mauro Gacci
- Department of Urology; University of Florence; Florence Italy
| | - Paolo Gontero
- Department of Urology; University of Turin; Turin Italy
| | - Ciro Imbimbo
- Department of Urology; University of Naples; Naples Italy
| | | | | | | | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | | | | | - Angelo Porreca
- Department of Urology; Abano Hospital; Abano Terme Italy
| | - Alessandro Volpe
- Department of Urology; University of Eastern Piedmont; Novara Italy
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84
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Hearn JWD, Xie W, Nakabayashi M, Almassi N, Reichard CA, Pomerantz M, Kantoff PW, Sharifi N. Association of HSD3B1 Genotype With Response to Androgen-Deprivation Therapy for Biochemical Recurrence After Radiotherapy for Localized Prostate Cancer. JAMA Oncol 2018; 4:558-562. [PMID: 29049492 PMCID: PMC5933377 DOI: 10.1001/jamaoncol.2017.3164] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/31/2017] [Indexed: 01/25/2023]
Abstract
IMPORTANCE The variant HSD3B1 (1245C) allele enhances dihydrotestosterone synthesis and predicts resistance to androgen-deprivation therapy (ADT) for biochemically recurrent prostate cancer after prostatectomy and for metastatic disease. Whether this is true after radiotherapy is unknown. OBJECTIVE To determine whether the HSD3B1 (1245C) allele predicts worse clinical outcomes from ADT for biochemical recurrence after radiotherapy. DESIGN, SETTING, AND PARTICIPANTS The Prostate Clinical Research Information System at Dana-Farber Cancer Institute was used to identify the study cohort, which included men treated with ADT for biochemical recurrence after primary radiotherapy between 1996 and 2013. We retrospectively determined HSD3B1 genotype. MAIN OUTCOMES AND MEASURES Time to progression, time to metastasis, and overall survival according to genotype. Demographic and treatment characteristics were evaluated for confounders. Multivariable analyses were performed to adjust for known prognostic factors. RESULTS A total of 218 eligible men were identified, of whom 213 (98%) were successfully genotyped. Of these, 97 of 213 (46%), 96 of 213 (45%) and 20 of 213 (9%) carried 0, 1, and 2 variant alleles. Overall variant allele frequency was 136 of 426 alleles (32%). Median patient age (interquartile range) was 69 (63-74), 72 (65-78), and 69 (65-77) years for 0, 1, and 2 variant alleles (P = .03). Demographic and treatment factors were otherwise similar. During a median follow-up of 7.9 years, median time to progression was 2.3 years (95% CI, 1.6-3.1 years) with 0 variant alleles, 2.3 years (95% CI, 1.5-3.3 years) with 1 variant allele, and 1.4 years (95% CI, 0.7-3.3 years) with 2 variant alleles (P = .68). Median time to metastasis diminished with the number of variant alleles inherited: 7.4 (95% CI, 6.7-9.7), 5.8 (95% CI, 4.9-6.5), and 4.4 (95% CI, 3.0-5.7) years, with inheritance of 0, 1, and 2 variant alleles, respectively (P = .03). Median OS was 7.7 (95% CI, 6.7-10.3), 6.9 (95% CI, 5.8-8.4), and 7.2 (95% CI, 3.8-7.9) years with inheritance of 0, 1, and 2 variant alleles, respectively (P = .31). On multivariable analysis with 0 variant alleles as the reference, the adjusted hazard ratio for metastasis was 1.19 (95% CI, 0.74-1.92) (P = .48) for 1 variant allele and 2.01 (95% CI, 1.02-3.97) (P = .045) for 2 variant alleles. Multivariable analysis did not demonstrate significant differences in TTP or OS. CONCLUSIONS AND RELEVANCE In this study, the HSD3B1 (1245C) allele was associated with more rapid development of metastases in men treated with ADT for biochemical recurrence after primary radiation therapy for prostate cancer. Notably, 105 of 213 men (49%) had received prior ADT, and 119 of 213 (56%) received an androgen receptor antagonist during salvage treatment, both of which may attenuate the effect of the variant allele.
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MESH Headings
- Aged
- Alleles
- Androgen Antagonists/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Pharmacological/analysis
- Biomarkers, Pharmacological/metabolism
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Disease Progression
- Genetic Association Studies
- Genotype
- Humans
- Male
- Middle Aged
- Multienzyme Complexes/genetics
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Progesterone Reductase/genetics
- Prostatic Neoplasms/drug therapy
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
- Prostatic Neoplasms/radiotherapy
- Retrospective Studies
- Steroid Isomerases/genetics
- Treatment Outcome
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Affiliation(s)
| | - Wanling Xie
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mari Nakabayashi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nima Almassi
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chad A. Reichard
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mark Pomerantz
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Philip W. Kantoff
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Memorial Sloan Kettering Cancer Center New York, New York
| | - Nima Sharifi
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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85
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Altok M, Babaian K, Achim MF, Achim GC, Troncoso P, Matin SF, Chapin BF, Davis JW. Surgeon-led prostate cancer lymph node staging: pathological outcomes stratified by robot-assisted dissection templates and patient selection. BJU Int 2018; 122:66-75. [DOI: 10.1111/bju.14164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muammer Altok
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Kara Babaian
- Department of Urology; The Louisiana State University (LSU); LSU Health Shreveport; Shreveport LA USA
| | - Mary F. Achim
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Grace C. Achim
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Patricia Troncoso
- Department of Pathology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Surena F. Matin
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Brian F. Chapin
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - John W. Davis
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
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86
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Primary androgen deprivation therapy as monotherapy in unfavourable intermediate- and high-risk localised prostate cancer: a Singaporean single-centre perspective. Int Urol Nephrol 2018; 50:665-673. [PMID: 29492797 DOI: 10.1007/s11255-018-1802-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Primary ADT (pADT) monotherapy is used significantly for patients with clinically localised disease in Asia and is acceptable even by guidelines, especially in intermediate- and high-risk disease. This occurs despite controversy in the West and data suggesting association with adverse effects, notably cardiovascular events. We therefore sought to assess the impact of pADT on all-cause mortality and prostate cancer-specific mortality (PCSM) in Asian men with high-risk and unfavourable intermediate-risk PCa. METHODS With cancer registry data, men from a single centre in Singapore with clinically localised high-risk/unfavourable intermediate-risk PCa diagnosed between 2004 and 2014 and either treated conservatively with no therapy or started on pADT within 1 year of diagnosis were followed up through January 2017. Patients with non-localised PCa (clinical stage T4, regional/distant lymph node involvement, metastases), or receipt of local therapy (radical prostatectomy/radiotherapy) were excluded. The primary outcomes of all-cause mortality and PCSM were analysed with Cox proportional hazards regression models. RESULTS Three hundred and forty Asian men were analysed, and 177 (52.1%) were started on pADT, with mean age of 77 (49-98) years. There were 119 deaths in the cohort, and 68 (38.4%) occurred in patients treated with pADT (median follow-up, 4.4 years). After adjusting for comorbidities and clinical characteristics, pADT did not provide benefit to all-cause mortality, PCSM or cardiovascular mortality. CONCLUSION For clinically localised unfavourable intermediate-risk and high-risk PCa, starting pADT within 12 months of diagnosis is not associated with improved 5-year all-cause mortality or PCSM compared to patients treated conservatively with no therapy and should be discouraged due to lack of mortality benefit.
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87
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Terakawa T, Katsuta E, Yan L, Turaga N, McDonald KA, Fujisawa M, Guru KA, Takabe K. High expression of SLCO2B1 is associated with prostate cancer recurrence after radical prostatectomy. Oncotarget 2018; 9:14207-14218. [PMID: 29581838 PMCID: PMC5865664 DOI: 10.18632/oncotarget.24453] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/01/2018] [Indexed: 01/22/2023] Open
Abstract
Solute carrier organic anion (SLCO) gene families encode organic anion transport proteins, which are transporters that up-take a number of substrates including androgens. Among them, high expression of SLCO2B1 is known to associate with the resistance to androgen deprivation therapy in prostate cancer (PCa). We hypothesized that high expression of SLCO genes enhances PCa progression by promoting the influx of androgen. Here, we demonstrated the impact of the expression levels of SLCO2B1 on prognosis in localized PCa after radical prostatectomy (RP) utilizing 494 PCa cases in The Cancer Genome Atlas (TCGA). SLCO2B1 high expression group showed significantly worse Disease-free survival (DFS) after RP (p = 0.001). The expression level of SLCO2B1 was significantly higher in advanced characteristics including Gleason Score (GS ≤ 6 vs GS = 7; p = 0.047, GS = 7 vs GS ≥ 8; p = 0.002), pathological primary tumor (pT2 vs pT3/4; p < 0.001), and surgical margin status (positive vs negative; p = 0.013), respectively. There was a significant difference in DFS between these two groups only in GS ≥ 8 patients (p = 0.006). Multivariate analysis demonstrated that only SLCO2B1 expression level was an independent predictor for DFS after RP in GS ≥ 8. SLCO2B1 high expressed tumors in GS ≥ 8 not only enriched epithelial mesenchymal transition (EMT) related gene set, (p = 0.027), as well as Hedgehog (p < 0.001), IL-6/JAK/STAT3 (p < 0.001), and K-ras signaling gene sets (p < 0.001), which are known to promote EMT, but also showed higher expression of EMT related genes, including N-cadherin (p = 0.024), SNAIL (p = 0.001), SLUG (p = 0.001), ZEB-1 (p < 0.001) and Vimentin (p < 0.001). In conclusion, PCa with high expression of SLCO2B1 demonstrated worse DFS, which might be due to accelerated EMT.
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Affiliation(s)
- Tomoaki Terakawa
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eriko Katsuta
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Li Yan
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, NY, USA
| | - Nitesh Turaga
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, NY, USA
| | - Kerry-Ann McDonald
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, The State University of New York Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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88
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Bandini M, Fossati N, Gandaglia G, Preisser F, Dell'Oglio P, Zaffuto E, Stabile A, Gallina A, Suardi N, Shariat SF, Montorsi F, Karakiewicz PI, Briganti A. Neoadjuvant and adjuvant treatment in high-risk prostate cancer. Expert Rev Clin Pharmacol 2018; 11:425-438. [PMID: 29355037 DOI: 10.1080/17512433.2018.1429265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High-risk prostate cancer (HRPCa) represents a heterogeneous disease with potential risk for local and distant progression. In these patients, a multi-modal approach consisting of neoadjuvant and/or adjuvant systemic therapies has been proposed. The aim of this review is to summarize the emerging roles of neoadjuvant and adjuvant therapies in HRPCa patients. Areas covered: This review collects the most relevant phase III randomized controlled trials (RCTs) testing the effect of neoadjuvant and adjuvant systemic therapies in combination with radical prostatectomy (RP) or radiotherapy (RT) for HRPCa patients. Specifically, the review examines the benefit provided by androgen deprivation therapy (ADT), chemotherapy (CHT), and novel antiandrogen agents in this setting. A search of bibliographic databases for peer-reviewed literature was conducted. Expert commentary: Three decades of RCTs demonstrated that adjuvant ADT is fundamental in HRPCa treated with RT. Conversely, ADT and CHT did not improve the survival of HRPCa patients managed with RP. The recent introduction of novel antiandrogen agents combined with an appropriated selection of patients at risk of cancer progression, may ultimately extend the indication of neoadjuvant and adjuvant therapy in surgical- and radio-treated patients.
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Affiliation(s)
- Marco Bandini
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy.,c Cancer Prognostics and Health Outcomes Unit , University of Montreal Health Center , Montreal , Quebec , Canada
| | - Nicola Fossati
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Giorgio Gandaglia
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Felix Preisser
- c Cancer Prognostics and Health Outcomes Unit , University of Montreal Health Center , Montreal , Quebec , Canada.,d Department of Urology , Martini Klinik, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Paolo Dell'Oglio
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Emanuele Zaffuto
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Armando Stabile
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Andrea Gallina
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Nazareno Suardi
- b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy.,e Urology Department, IRCCS San Raffaele Scientific Institute , Ville Turro Division , Milan , Italy
| | - Shahrokh F Shariat
- f Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Francesco Montorsi
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
| | - Pierre I Karakiewicz
- c Cancer Prognostics and Health Outcomes Unit , University of Montreal Health Center , Montreal , Quebec , Canada
| | - Alberto Briganti
- a Division of Oncology/Unit of Urology , URI, IRCCS Hospital San Raffaele , Milan , Italy.,b Division of Oncology/Unit of Urology , Vita-Salute San Raffaele University , Milan , Italy
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89
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Pagliarulo V. Androgen Deprivation Therapy for Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:1-30. [PMID: 30324345 DOI: 10.1007/978-3-319-99286-0_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the contemporary scene, less than 5% of men with newly diagnosed prostate cancer (PC) have metastases at first presentation, compared to 20-25%, more than 20 years ago. Nonetheless, the use of androgen deprivation therapy (ADT) has increased over the years, suggesting that patients in Europe and United States may receive ADT in cases of lower disease burden, and not always according to evidence based indications. Nonetheless, PC remains the second most common cause of cancer death after lung cancer in American men. Thus, there is a need for more effective, specific and well tolerated agents which can provide a longer and good quality of life while avoiding the side effects related to disease and treatment morbidity.After mentioning the current knowledge on the endocrinology of androgens and androgen receptor, relevant to PC development, as well as the possible events occurring during PC initiation, we will compare different hormonal compounds available for the treatment of PC, both from a pharmacological standpoint, and in terms of contemporary clinical indications.
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Affiliation(s)
- Vincenzo Pagliarulo
- Department of Urology, University "Aldo Moro", Bari, Italy. .,Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy.
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90
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Bernstein AN, Shoag JE, Golan R, Halpern JA, Schaeffer EM, Hsu WC, Nguyen PL, Sedrakyan A, Chen RC, Eggener SE, Hu JC. Contemporary Incidence and Outcomes of Prostate Cancer Lymph Node Metastases. J Urol 2017; 199:1510-1517. [PMID: 29288121 DOI: 10.1016/j.juro.2017.12.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The incidence of localized prostate cancer has decreased with shifts in prostate cancer screening. While recent population based studies demonstrated a stable incidence of locoregional prostate cancer, they categorized organ confined, extraprostatic and lymph node positive disease together. However, to our knowledge the contemporary incidence of prostate cancer with pelvic lymph node metastases remains unknown. MATERIALS AND METHODS We used SEER (Surveillance, Epidemiology and End Results) data from 2004 to 2014 to identify men diagnosed with prostate cancer. We analyzed trends in the age standardized prostate cancer incidence by stage. The impact of disease extent on mortality was assessed by adjusted Cox proportional hazard analysis. RESULTS During the study period the annual incidence of nonmetastatic prostate cancer decreased from 5,119.1 to 2,931.9 per million men (IR 0.57, 95% CI 0.56-0.58, p <0.01) while the incidence of pelvic lymph node metastases increased from 54.1 to 79.5 per million men (IR 1.47, 95% CI 1.33-1.62, p <0.01). The incidence of distant metastases in men 75 years old or older reached a nadir in 2011 compared to 2004 (IR 0.81, 95% CI 0.74-0.90, p <0.01) and it increased in 2012 compared to 2011 (IR 1.13, 95% CI 1.02-1.24, p <0.05). The risk of cancer specific mortality significantly increased in men diagnosed with pelvic lymph node metastases (HR 4.5, 95% CI 4.2-4.9, p <0.01) and distant metastases (HR 21.9, 95% CI 21.2-22.7, p <0.01) compared to men with nonmetastatic disease. CONCLUSIONS The incidence of pelvic lymph node metastases is increasing coincident with a decline in the detection of localized disease. Whether this portends an increase in the burden of advanced disease or simply reflects decreased lead time remains unclear. However, this should be monitored closely as the increase in N1 disease reflects an increase in incurable prostate cancer at diagnosis.
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Affiliation(s)
- Adrien N Bernstein
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Jonathan E Shoag
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Ron Golan
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Joshua A Halpern
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wei-Chun Hsu
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Scott E Eggener
- Division of Urology, University of Chicago Medicine, Chicago, Illinois
| | - Jim C Hu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
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91
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Kishan AU, Cheng EM, Schmidt E, Saigal C, Reiter RE, Kupelian PA, Steinberg ML, King CR. Use of the Electronic Medical Record to Facilitate Intervention for Patients With Rising Prostate-Specific Antigen Values After Radical Prostatectomy: A Feasibility Study. JCO Clin Cancer Inform 2017; 1:1-6. [PMID: 30657383 DOI: 10.1200/cci.17.00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Salvage radiotherapy (SRT) is the standard of care offered when postprostatectomy prostate-specific antigen (PSA) levels are ≥ 0.2 ng/mL. However, emerging evidence suggests that early SRT (ie, SRT delivered at PSA values < 0.2 ng/mL, but generally ≥ 0.05 ng/mL) improves oncologic outcomes. We evaluated the feasibility of improving referral rates for discussion of early SRT by using a dynamic registry that identifies through the electronic medical record patients with rising postprostatectomy PSA levels. METHODS We developed an iteratively updated registry that identifies patients who fall within two postoperative PSA strata: ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL. We compared referral rates to radiation oncology during a 3-year period before use of this registry with those during a 1-year period after promotion of the registry in multidisciplinary tumor board settings. RESULTS Before promotion of the registry, referral rates for patients with PSA values ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL were 35% and 65%, respectively. After promotion of the registry, referral rates within each stratum increased significantly to 82% and 94%, respectively ( P < .05 for both by Fisher's exact test). The overall rate of referral for patients with PSA values ≥ 0.05 to < 0.2 ng/mL rose from 48% to 90% ( P < .001). CONCLUSION The creation of a registry of patients with rising postprostatectomy PSA values can facilitate increased referral rates for early SRT without burdening providers with a clinical support tool embedded within the EMR itself. This is true even in the case of already high baseline rates of referral for early SRT. The changes reported herein most likely reflect a Hawthorne effect wherein the ability to track referrals rather than a direct function of the registry influenced practice patterns. Nonetheless, the registry provided an integral framework to allow for tracking.
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Affiliation(s)
- Amar U Kishan
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - Eric M Cheng
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - Eric Schmidt
- All authors: University of California, Los Angeles, Los Angeles, CA
| | | | - Robert E Reiter
- All authors: University of California, Los Angeles, Los Angeles, CA
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Touijer KA, Karnes RJ, Passoni N, Sjoberg DD, Assel M, Fossati N, Gandaglia G, Eastham JA, Scardino PT, Vickers A, Cozzarini C, Montorsi F, Briganti A. Survival Outcomes of Men with Lymph Node-positive Prostate Cancer After Radical Prostatectomy: A Comparative Analysis of Different Postoperative Management Strategies. Eur Urol 2017; 73:890-896. [PMID: 29042125 DOI: 10.1016/j.eururo.2017.09.027] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optimal management of patients with lymph node metastasis (LNM) after radical prostatectomy (RP) remains undefined. OBJECTIVE We evaluated the association between three different management strategies and survival in prostate cancer with LNM after RP. DESIGN, SETTING, AND PARTICIPANTS We analyzed data of 1338 patients with LNM after RP from three tertiary care centers. Three hundred and eighty-seven patients (28%) were observed, 676 (49%) received lifelong adjuvant androgen deprivation therapy (ADT), and 325 (23%) received adjuvant external beam radiation therapy (EBRT) and ADT. Three hundred and sixty-eight men were followed for more than 10 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome measure was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and other-cause mortality. Kaplan-Meier methods were used to visualize OS for the three treatment groups. Cox proportional hazards regression was utilized to compare OS and CSS among the three groups. RESULTS AND LIMITATIONS ADT+EBRT was associated with better OS than ADT alone (hazard ratio [HR]: 0.46, 95% confidence interval [CI]: 0.32-0.66, p<0.0001) or observation (HR: 0.41, 95% CI: 0.27-0.64, p<0.0001). Higher-risk patients benefited more from ADT+EBRT than lower-risk patients. Ten-year mortality risk difference between ADT+EBRT, observation, or ADT alone ranged from 5% in low-risk patients to 40% in high-risk patients. Adjuvant ADT+EBRT was also associated with better CSS than observation or ADT alone (p<0.0001), ADT had better CSS compared to observation (HR: 0.64, 95% CI: 0.43-0.95, p=0.027). However, ADT was associated with an increased risk of other-cause mortality (HR: 3.05, 95% CI: 1.45-6.40, p=0.003) compared with observation, resulting in similar OS between ADT and observation (HR: 0.90, 95% CI: 0.65-1.25, p=0.5). While selection bias might remain, its effect would operate in the opposite direction to our findings. CONCLUSIONS In men with LNM after RP, ADT+EBRT improved survival over either observation or adjuvant ADT alone. This survival benefit increases with higher-risk disease. PATIENT SUMMARY Lymph node metastasis following radical prostatectomy is associated with poor survival outcomes. However, we found that adjuvant androgen deprivation therapy with external beam radiation therapy improved survival in these patients.
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Affiliation(s)
- Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Niccolo Passoni
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicola Fossati
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Androgen deprivation in prostate cancer and the long-term risk of fracture. Actas Urol Esp 2017; 41:491-496. [PMID: 28259363 DOI: 10.1016/j.acuro.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the rate of bone mass loss and the risk of fracture induced by androgen deprivation therapy in patients with prostate cancer. MATERIAL AND METHODS Prospective study in 2 phases. In the first phase, demographic variables, FRAX®, bone mineral density and clinical fractures were collected, before starting the therapy and up to 1 year after ending the therapy. In the second phase, we conducted a telephone interview a mean of 8.5 years after the start of the study to assess new fractures. RESULTS We included 150 patients with a mean age of 67 years and a mean therapy duration of 24 months. Before starting the treatment, 62 patients (41%) showed osteoporosis or low bone mass in the densitometry. After the first year of treatment, the bone mineral density decreased a mean of 3.7% and 2.1% in the lumbar spine and femoral neck, respectively. At the end of the second and third year, the loss rate was lower. During the first phase of the study, 4 patients (2.7%) experienced a fracture. In the telephone interviews with 80 patients (53%), only 1 had experienced a fracture. CONCLUSIONS In the patients with prostate cancer and androgen deprivation therapy, greater bone loss occurred during the first year. When the treatment did not exceed 2 years, the absolute risk of fracture was low, and clinical fractures were uncommon in the short and long term.
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Muralidhar V, Mahal BA, Rose BS, Chen YW, Nezolosky MD, Efstathiou JA, Beard CJ, Martin NE, Orio PF, Trinh QD, Choueiri TK, Sweeney CJ, Nguyen PL. Disparities in the Receipt of Local Treatment of Node-positive Prostate Cancer. Clin Genitourin Cancer 2017; 15:563-569.e3. [DOI: 10.1016/j.clgc.2016.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022]
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Chalieopanyarwong V, Attawettayanon W, Kanchanawanichkul W, Pripatnanont C. The Prognostic Factors of Biochemical Recurrence-Free Survival Following Radical Prostatectomy. Asian Pac J Cancer Prev 2017; 18:2555-2559. [PMID: 28952300 PMCID: PMC5720666 DOI: 10.22034/apjcp.2017.18.9.2555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate outcomes, biochemical recurrence-free survival (BCRFS) and to identify parameters
influencing BCRFS of radical prostatectomy (RP) and bilateral pelvic lymph node dissection in a single-institution.
Methods: A retrospective review of prostate cancer (PC) patients received RP was identified from the medical records.
Data was collected from 2007 to 2016. 178 patients received RP were enrolled in a study. These patients were evaluated
on efficacy of RP by using prostate-specific antigen (PSA) to analyze BCRFS and compared with Gleason score,
pathologic staging, margin status and lymph node status with BCRFS. Results: The median follow up was 32.5 months
(n = 178). Sixty-nine patients had extracapsular extension on pathologic results whereas 93 patients were classified as
a high risk group. The median time for biochemical recurrence (BCR) was 22.3 months. The 3-year BCRFS in patients
with a Gleason score 6, 3+4, 4+3, 8 and 9-10 were 85.8%, 84.6%, 78.7%, 53.3% and 35.8% . Multivariate analysis
showed that extracapsular extension was independently associated with BCRFS. Conclusions: New group grading
system indicates impact on BCRFS on univariate analysis but show negative impact on a multivariate Cox regression,
only pathologic staging was independently associated with the cancer control outcome.
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Affiliation(s)
- Virote Chalieopanyarwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University,
Songkhla, Thailand.
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Lymph node-positive prostate cancer after robotic prostatectomy and extended pelvic lymphadenectomy. J Robot Surg 2017; 12:425-431. [DOI: 10.1007/s11701-017-0751-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
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Saad F. Androgen deprivation in prostate cancer: first do no harm. Lancet Oncol 2017; 18:1142-1144. [DOI: 10.1016/s1470-2045(17)30573-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Xie W, Regan MM, Buyse M, Halabi S, Kantoff PW, Sartor O, Soule H, Clarke NW, Collette L, Dignam JJ, Fizazi K, Paruleker WR, Sandler HM, Sydes MR, Tombal B, Williams SG, Sweeney CJ. Metastasis-Free Survival Is a Strong Surrogate of Overall Survival in Localized Prostate Cancer. J Clin Oncol 2017; 35:3097-3104. [PMID: 28796587 DOI: 10.1200/jco.2017.73.9987] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Adjuvant therapy for intermediate-risk and high-risk localized prostate cancer decreases the number of deaths from this disease. Surrogates for overall survival (OS) could expedite the evaluation of new adjuvant therapies. Methods By June 2013, 102 completed or ongoing randomized trials were identified and individual patient data were collected from 28 trials with 28,905 patients. Disease-free survival (DFS) and metastasis-free survival (MFS) were determined for 21,140 patients from 24 trials and 12,712 patients from 19 trials, respectively. We evaluated the surrogacy of DFS and MFS for OS by using a two-stage meta-analytic validation model by determining the correlation of an intermediate clinical end point with OS and the correlation of treatment effects on both the intermediate clinical end point and OS. Results Trials enrolled patients from 1987 to 2011. After a median follow-up of 10 years, 45% of 21,140 men and 45% of 12,712 men experienced a DFS and MFS event, respectively. For DFS and MFS, 61% and 90% of the patients, respectively, were from radiation trials, and 63% and 66%, respectively, had high-risk disease. At the patient level, Kendall's τ correlation with OS was 0.85 and 0.91 for DFS and MFS, respectively. At the trial level, R2 was 0.86 (95% CI, 0.78 to 0.90) and 0.83 (95% CI, 0.71 to 0.88) from weighted linear regression of 8-year OS rates versus 5-year DFS and MFS rates, respectively. Treatment effects-measured by log hazard ratios-for the surrogates and OS were well correlated ( R2, 0.73 [95% CI, 0.53 to 0.82] for DFS and 0.92 [95% CI, 0.81 to 0.95] for MFS). Conclusion MFS is a strong surrogate for OS for localized prostate cancer that is associated with a significant risk of death from prostate cancer.
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Affiliation(s)
- Wanling Xie
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Meredith M Regan
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Marc Buyse
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susan Halabi
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Philip W Kantoff
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Oliver Sartor
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Howard Soule
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Noel W Clarke
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Laurence Collette
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - James J Dignam
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karim Fizazi
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Wendy R Paruleker
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Howard M Sandler
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Matthew R Sydes
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bertrand Tombal
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Scott G Williams
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher J Sweeney
- Wanling Xie, Meredith M. Regan, and Christopher J. Sweeney, Dana-Farber Cancer Institute, Boston, MA; Marc Buyse, International Drug Development Institute; Bertrand Tombal, Université Catholique de Louvain, Louvain-la-Neuve; Laurence Collette, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Susan Halabi, Duke University Medical Center, Durham, NC; Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY; Oliver Sartor, Tulane Medical School, New Orleans, LA; Howard Soule, Prostate Cancer Foundation, Santa Monica; Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles, CA; Noel W. Clarke, The Christie NHS Foundation Trust, Manchester; Matthew R. Sydes, University College London, London, United Kingdom; James J. Dignam, University of Chicago, Chicago, IL; Karim Fizazi, Institut Gustave-Roussy, Villejuif, France; Wendy R. Paruleker, Canadian Cancer Trials Group, Kingston, Ontario, Canada; and Scott G. Williams, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Kaushik D, Boorjian SA, Thompson RH, Eisenberg MS, Carlson RE, Bergstralh EJ, Frank I, Gettman MT, Tollefson MK, Karnes RJ. Oncological outcomes following radical prostatectomy for patients with pT4 prostate cancer. Int Braz J Urol 2017; 42:1091-1098. [PMID: 27649109 PMCID: PMC5117964 DOI: 10.1590/s1677-5538.ibju.2016.0290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022] Open
Abstract
Objectives: Radical prostatectomy (RP) for locally advanced prostate cancer may reduce the risk of metastasis and cancer-specific death. Herein, we evaluated the outcomes for patients with pT4 disease treated with RP. Materials and methods: Among 19,800 men treated with RP at Mayo Clinic from 1987 to 2010, 87 were found to have pT4 tumors. Biochemical recurrence (BCR)-free survival, systemic progression (SP) free survival and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to assess the association of clinic-pathological features with outcome. Results: Median follow-up was 9.8 years (IQR 3.6, 13.4). Of the 87 patients, 50 (57.5%) were diagnosed with BCR, 30 (34.5%) developed SP, and 38 (43.7%) died, with 11 (12.6%) dying of prostate cancer. Adjuvant androgen deprivation therapy was administered to 77 men, while 32 received adjuvant external beam radiation therapy. Ten-year BCR-free survival, SP-free survival, and OS was 37%, 64%, and 70% respectively. On multivariate analysis, the presence of positive lymph nodes was marginally significantly associated with patients' risk of BCR (HR: 1.94; p=0.05), while both positive lymph nodes (HR 2.96; p=0.02) and high pathologic Gleason score (HR 1.95; p=0.03) were associated with SP. Conclusions: Patients with pT4 disease may experience long-term survival following RP, and as such, when technically feasible, surgical resection should be considered in the multimodal treatment approach to these men.
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Affiliation(s)
- Dharam Kaushik
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | | | | | - Rachel E Carlson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Bergstralh
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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