951
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Golbari NM, Katz AE. Salvage Therapy Options for Local Prostate Cancer Recurrence After Primary Radiotherapy: a Literature Review. Curr Urol Rep 2018; 18:63. [PMID: 28688020 DOI: 10.1007/s11934-017-0709-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW While recurrence after primary treatment of prostate cancer (PCa) is not uncommon, there is currently no consensus on the most appropriate management after radiation treatment failure. This article seeks to explore the currently utilized modalities for salvage treatment for radiorecurrent PCa. We focused our review on the oncologic outcomes and reported toxicity rates in the latest studies examining salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage high-intensity focused ultrasound (HIFU) and re-irradiation. RECENT FINDINGS There does not appear to be any significant difference in overall survival for more invasive salvage radical prostatectomy compared to the minimally invasive salvage approaches. Additionally, there seems to be a trend towards lower morbidity rates associated with minimally invasive and focal salvage treatment. We are encouraged by the results presented in this review and find that there is clearly a role for emerging minimally invasive and focal therapies as durable options for salvage treatment in patients with radiorecurrent PCa.
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952
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Prekovic S, Van den Broeck T, Moris L, Smeets E, Claessens F, Joniau S, Helsen C, Attard G. Treatment-induced changes in the androgen receptor axis: Liquid biopsies as diagnostic/prognostic tools for prostate cancer. Mol Cell Endocrinol 2018; 462:56-63. [PMID: 28882555 DOI: 10.1016/j.mce.2017.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023]
Abstract
Prostate cancer progression and treatment relapse is associated with changes in the androgen receptor axis, and analysis of alternations of androgen receptor signaling is valuable for prognostics and treatment optimization. The profile of androgen receptor axis is currently obtained from biopsy specimens, which are not always easy to obtain. Moreover, the information acquired only provides a snapshot of the tumor biology, with strict spatial and temporal limitations. On the other hand, circulation is easily accessible source of both circulating tumor cells and circulating tumor DNA, which can be sampled at numerous time points. This Review will explore the potential use of androgen receptor axis alternations detectable in the blood in therapeutic decision-making and precision medicine for advancing metastatic castration-resistant prostate cancer.
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Affiliation(s)
- S Prekovic
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; Department of Oncogenomics, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - T Van den Broeck
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - L Moris
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - E Smeets
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - F Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - S Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - C Helsen
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - G Attard
- The Institute of Cancer Research, London SM2 5NG, UK; Royal Marsden National Health Service Foundation Trust, London SM2 5PT, UK
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953
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Bernemann C, Steinestel J, Humberg V, Bögemann M, Schrader AJ, Lennerz JK. Performance comparison of two androgen receptor splice variant 7 (AR-V7) detection methods. BJU Int 2018; 122:219-226. [PMID: 29359890 DOI: 10.1111/bju.14146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the performance of two established androgen receptor splice variant 7 (AR-V7) mRNA detection systems, as paradoxical responses to next-generation androgen-deprivation therapy in AR-V7 mRNA-positive circulating tumour cells (CTC) of patients with castration-resistant prostate cancer (CRPC) could be related to false-positive classification using detection systems with different sensitivities. MATERIALS AND METHODS We compared the performance of two established mRNA-based AR-V7 detection technologies using either SYBR Green or TaqMan chemistries. We assessed in vitro performance using eight genitourinary cancer cell lines and serial dilutions in three AR-V7-positive prostate cancer cell lines, as well as in 32 blood samples from patients with CRPC. RESULTS Both assays performed identically in the cell lines and serial dilutions showed identical diagnostic thresholds. Performance comparison in 32 clinical patient samples showed perfect concordance between the assays. In particular, both assays determined AR-V7 mRNA-positive CTCs in three patients with unexpected responses to next-generation anti-androgen therapy. Thus, technical differences between the assays can be excluded as the underlying reason for the unexpected responses to next-generation anti-androgen therapy in a subset of AR-V7 patients. CONCLUSIONS Irrespective of the method used, patients with AR-V7 mRNA-positive CRPC should not be systematically precluded from an otherwise safe treatment option.
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Affiliation(s)
| | - Julie Steinestel
- Urology, University of Muenster Medical Center, Muenster, Germany
| | - Verena Humberg
- Urology, University of Muenster Medical Center, Muenster, Germany
| | - Martin Bögemann
- Urology, University of Muenster Medical Center, Muenster, Germany
| | | | - Jochen K Lennerz
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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954
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Hong JH. Pharmacokinetic/pharmacodynamic drug evaluation of enzalutamide for treating prostate cancer. Expert Opin Drug Metab Toxicol 2018; 14:361-369. [PMID: 29431540 DOI: 10.1080/17425255.2018.1440288] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Enzalutamide is the first approved second-generation androgen receptor (AR) antagonist in the treatment of metastatic castration-resistant prostate cancer (mCRPC) with or without docetaxel-based chemotherapy. Over the past 5 years, a number of attempts were made to determine the efficacy of enzalutamide in the different clinical settings. Areas covered: A literature search was performed at the PubMed, Embase, and Web of Science database to collect the most relevant and impactful studies, including basic science investigations, clinical trials, and reviews. This article focuses on the pharmacology, efficacy, tolerability, and future perspective of enzalutamide. Expert opinion: The treatment paradigm of CRPC has been dramatically challenged of late. Enzalutamide are in wide use because of its favorable efficacy and safety, but primary or acquired resistance to the drug will eventually develop. Further studies are thus necessary to identify appropriate patients who can achieve apparent benefits from enzalutamide alone or in combination with other drugs.
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Affiliation(s)
- Jeong Hee Hong
- a Department of Urology , Dankook University College of Medicine , Cheonan , Republic of Korea
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955
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Bello JO. Natural history of castration-resistant prostate cancer in sub-Saharan African black men: a single-centre study of Nigerian men. Ecancermedicalscience 2018; 12:797. [PMID: 29434663 PMCID: PMC5804715 DOI: 10.3332/ecancer.2018.797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Indexed: 11/06/2022] Open
Abstract
Purpose Native sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa). This study evaluates the natural history and survival of a cohort of SSBM with castration-resistant prostate cancer (CRPC). Methods A retrospective study of patients with CRPC as defined by the Prostate Cancer Working Group 2 managed at a centre in sub-Saharan Africa between January 2011 and December 2015 was conducted. The principal endpoint was overall survival (OS). Potential prognostic variables were evaluated using Cox proportional hazard regression models. Results A total of 48 patients were identified. Median (IQR) age and prostate-specific antigen (PSA) at diagnosis were 70 (64-74.5) years and 42 (8.0-123.6) ng/mL, respectively. Only 15 (31.3%) patients received docetaxel and one patient each received the novel drugs enzalutamide and abiraterone. Twenty-eight patients (58.3%) died during follow-up with a median OS of 11 (95% CI: 8-14) months. Docetaxel chemotherapy and ECOG performance status were found to be prognostic (docetaxel use: hazard ratio 0·25, 95% CI 0·10-0·67, p = 0·006; ECOG 0-2: 0·26, 0·11-0·62, p = 0·003). Conclusion This study of SSBM with CRPC revealed a mainly unmodulated clinical course with poor access to active treatments and poor survival. Improving access to new active therapies would improve survival.
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Affiliation(s)
- Jibril O Bello
- Department of Surgery, Urology Unit, University of Ilorin Teaching Hospital, Ilorin 240001, Nigeria
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956
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Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer. World J Urol 2018; 36:855-861. [DOI: 10.1007/s00345-018-2195-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/19/2018] [Indexed: 12/22/2022] Open
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957
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Huang TB, Zhou GC, Dong CP, Wang LP, Luan Y, Ye JT, Gu X, Yao XD, Zheng JH, Ding XF. Marital status independently predicts prostate cancer survival in men who underwent radical prostatectomy: An analysis of 95,846 individuals. Oncol Lett 2018; 15:4737-4744. [PMID: 29552113 PMCID: PMC5840566 DOI: 10.3892/ol.2018.7964] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/10/2017] [Indexed: 12/15/2022] Open
Abstract
Marital status is an independent prognostic factor for survival in several types of cancer, but has not been fully studied in prostate cancer (PCa). A total of 95,846 men diagnosed with PCa were treated with radical prostatectomy (RP) between 2004 and 2009 within 18 Surveillance, Epidemiology and End Results registries. Survival curves were generated using Kaplan-Meier estimates and differences in survival were assessed using the log-rank test. Cox regression models were used to assess the impact of marital status on survival outcomes. The results demonstrated that the 8-year cancer-cause specific survival (CSS) rate of married men was higher than unmarried individuals. Further analyses revealed that divorced/separated men had a higher proportion of high Gleason scores (GS) PCa at diagnosis [hazard ratio (HR), 1.12; P=0.007] and those patients had the worst survival outcomes independent of age, ethnicity, grade, stage and sequence number [HR, 1.61; 95% confidence interval (CI), 1.34-1.93]. Interestingly, it was observed that CSS among divorced/separated men decreased as the GS increased (GS≤6: HR, 2.5; GS=7: HR, 1.71; GS≥8: HR, 1.50; all P<0.05). Apart from that, no significant differences in CSS were observed in those who had never been married (HR, 1.20) or were widowed (HR, 1.13) relative to the married group. The results of the present study support the hypothesis that marital status is an independent prognostic factor among men with PCa who underwent RP. It was demonstrated that the mortality rates of divorced or separated men with PCa were significantly greater compared with the other groups. A further understanding of the potential associations among marital status, psychosocial factors and survival outcomes may help in developing novel, more effective methods of treating different groups of patients with PCa.
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Affiliation(s)
- Tian-Bao Huang
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Guang-Chen Zhou
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Chuan-Peng Dong
- Department of Biochemistry and Molecular Biology, Institute of Biomedical Science, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Li-Ping Wang
- Department of Biobank, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Yang Luan
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Jing-Ting Ye
- Department of Cardiothoracic Surgery, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiao Gu
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xu-Dong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Jun-Hua Zheng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Xue-Fei Ding
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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958
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Loi M, Di Cataldo V, Simontacchi G, Detti B, Bonomo P, Masi L, Desideri I, Greto D, Francolini G, Carfora V, Pezzulla D, Perna M, Carta G, Livi L. Robotic Stereotactic Retreatment for Biochemical Control in Previously Irradiated Patients Affected by Recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:93-100. [DOI: 10.1016/j.clon.2017.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/28/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022]
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959
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Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges Dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng F, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Higano CS, James N, Kantoff P, Kellokumpu-Lehtinen PL, Khauli RB, Kramer G, Logothetis C, Maluf F, Morgans AK, Morris MJ, Mottet N, Murthy V, Oh W, Ost P, Padhani AR, Parker C, Pritchard CC, Roach M, Rubin MA, Ryan C, Saad F, Sartor O, Scher H, Sella A, Shore N, Smith M, Soule H, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Tannock I, Tombal B, Valdagni R, Wiegel T, Omlin A. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol 2018; 73:178-211. [PMID: 28655541 DOI: 10.1016/j.eururo.2017.06.002] [Citation(s) in RCA: 368] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
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Affiliation(s)
- Silke Gillessen
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
| | - Gerhardt Attard
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, OR, USA
| | - Himisha Beltran
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Rob Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA
| | - Brett Carver
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - Johann de Bono
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Rodolfo Borges Dos Reis
- Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charles G Drake
- Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ros Eeles
- Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Eleni Efstathiou
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, CA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Martin Gleave
- Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Clinical trials and Statistics, Duke University, Durham, NC, USA
| | | | - Celestia S Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA
| | - Nicolas James
- Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Philip Kantoff
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Fernando Maluf
- Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo
| | - Alicia K Morgans
- Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - William Oh
- Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark A Rubin
- Department of Pathology, University of Bern and the Inselspital, Bern (CH)
| | - Charles Ryan
- Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Oliver Sartor
- Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA
| | - Howard Scher
- Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Avishay Sella
- Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Matthew Smith
- Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Japan
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Riccardo Valdagni
- Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Aurelius Omlin
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland
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960
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Klotz L, Shayegan B, Guillemette C, Collins LL, Gotto G, Guérette D, Jammal MP, Pickles T, Richard PO, Saad F. Testosterone suppression in the treatment of recurrent or metastatic prostate cancer - A Canadian consensus statement. Can Urol Assoc J 2018; 12:30-37. [PMID: 29680011 PMCID: PMC5937399 DOI: 10.5489/cuaj.5116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Testosterone suppression, achieved through orchiectomy or medically induced androgen-deprivation therapy (ADT), is a standard treatment for men with recurrent and metastatic prostate cancer. Current assay methods demonstrate the capacity for testosterone suppression to <0.7 nmol/l, and clinical data support improved outcomes from ADT when lower levels are achieved. Practical clinical guidelines are warranted to facilitate adoption of 0.7 nmol/l as the new standard castrate testosterone level.A pan-Canadian group of experts, representing diverse clinical specialties, identified key clinical issues, searched and reviewed relevant literature, and developed consensus statements on testosterone suppression for the treatment of prostate cancer. The expert panel found that current evidence supports the clinical benefit of achieving low testosterone levels during ADT, and encourage adoption of ≤0.7 nmol/l as a new castrate level threshold. The panel recommends regular monitoring of testosterone (e.g., every 3-6 months) and prostate-specific antigen (PSA) levels as clinically appropriate (e.g., every 3-6 months) during ADT, with reassessment of therapeutic strategy if testosterone is not suppressed or if PSA rises regardless of adequate testosterone suppression. The panel also emphasizes the need for greater awareness and education regarding testosterone assay specifications, and strongly promotes the use of mass spectrometry-based assays to ensure accurate measurement of testosterone at castrate levels.
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Affiliation(s)
- Laurence Klotz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON; Canada
| | | | - Chantal Guillemette
- Université Laval and CHU de Québec-Université Laval, Quebec City, QC; Canada
| | | | | | - Dominique Guérette
- Université Laval and CHU de Québec-Université Laval, Quebec City, QC; Canada
| | | | | | - Patrick O. Richard
- Centre Hospitalier Universitaire de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, QC; Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal, Montreal, QC; Canada
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961
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Rathke H, Afshar-Oromieh A, Giesel FL, Kremer C, Flechsig P, Haufe S, Mier W, Holland-Letz T, De Bucourt M, Armor T, Babich JW, Haberkorn U, Kratochwil C. Intraindividual Comparison of 99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand 99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer. J Nucl Med 2018; 59:1373-1379. [PMID: 29371410 DOI: 10.2967/jnumed.117.200220] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/09/2018] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to evaluate the rate of detection of bone metastases obtained with the prostate-specific membrane antigen (PSMA)-targeting tracer 99mTc-MIP-1427, as opposed to conventional bone scanning with 99mTc-methylene diphosphonate (99mTc-MDP), in a collective of patients with known advanced-stage osseous metastasized prostate cancer. Methods: Twenty-one patients with known metastatic disease were staged with both conventional bone scanning and PSMA ligand scintigraphy within a time frame of less than 10 d. Imaging included planar whole-body scanning and SPECT or SPECT/CT with 2 bed positions 3 h after injection of either 500-750 MBq of 99mTc-MIP-1427 or 600-750 MBq of 99mTc-MDP. Lesions were scored as typical tumor, equivocal (benign/malignant), or normal within a standard reporting schema divided into defined anatomic regions. Masked and consensus readings were performed with sequential unmasking: planar scans first, then SPECT/CT, the best evaluable comparator (including MRI), PET/CT, and follow-up examinations. Results: Eleven patients had PSMA-positive visceral metastases that were predictably not diagnosed with conventional bone scanning. However, SPECT/CT was required to distinguish between soft-tissue uptake and overlapping bone. Four patients had extensive 99mTc-MDP-negative bone marrow lesions. Seven patients had superscan characteristics on bone scans; in contrast, the extent of red marrow involvement was more evident on PSMA scans. Only 3 patients had equivalent results on bone scans and PSMA scans. In 16 patients, more suspect lesions were detected with PSMA scanning than with bone scanning. In 2 patients (10%), a PSMA-negative tumor phenotype was present. Conclusion: PSMA scanning provided a clear advantage over bone scanning by reducing the number of equivocal findings in most patients. SPECT/CT was pivotal for differentiating bone metastases from extraosseous tumor lesions.
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Affiliation(s)
- Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christophe Kremer
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Haufe
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Holland-Letz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | | | - Thomas Armor
- Progenics Pharmaceuticals Inc., New York, New York
| | - John W Babich
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, New York, New York; and
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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962
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Zanoni L, Bossert I, Matti A, Schiavina R, Pultrone C, Fanti S, Nanni C. A review discussing fluciclovine ( 18F) PET/CT imaging in the detection of recurrent prostate cancer. Future Oncol 2018; 14:1101-1115. [PMID: 29359581 DOI: 10.2217/fon-2017-0446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A significant number of patients radically treated for prostate cancer (PCa) will develop prostate-specific antigen recurrence (27-53%). Localizing the anatomical site of relapse is critical, in order to achieve the optimal treatment management. To date the diagnostic accuracy of standard imaging is low. Several desirable features have been identified for the amino-acid-based PET agent, fluciclovine (18F) including: long 18F half-life which allows more practical use in centers without a cyclotron onsite; acting as a substrate for amino acid transporters upregulated in PCa or associated with malignant phenotype; lacking of incorporation into protein; and limited urinary excretion. Fluciclovine (18F) is currently approved both in USA and Europe with specific indication in adult men with suspected recurrent PCa based on elevated prostate-specific antigen following prior treatment.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Irene Bossert
- Nuclear Medicine, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Antonella Matti
- Nuclear Medicine, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Cristian Pultrone
- Department of Urology, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy
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963
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68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol 2018; 36:519-527. [DOI: 10.1007/s00345-018-2182-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/06/2018] [Indexed: 11/26/2022] Open
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964
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Bultijnck R, Van de Caveye I, Rammant E, Everaert S, Lumen N, Decaestecker K, Fonteyne V, Deforche B, Ost P. Clinical pathway improves implementation of evidence-based strategies for the management of androgen deprivation therapy-induced side effects in men with prostate cancer. BJU Int 2018; 121:610-618. [DOI: 10.1111/bju.14086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Renée Bultijnck
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | | | - Elke Rammant
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | - Sofie Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Nicolaas Lumen
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | | | - Valérie Fonteyne
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
| | - Benedicte Deforche
- Department of Public Health; Ghent University; Ghent Belgium
- Department of Physical Activity, Nutrition and Health; Vrije Universiteit Brussel; Brussels Belgium
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University; Ghent Belgium
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965
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Poon DMC, Chan CK, Chan TW, Cheung FY, Kwong PWK, Lee EKC, Leung AKC, Leung SYL, Ma WK, So HS, Tam PC, Ho LY. Consensus statements on the management of metastatic prostate cancer from the Hong Kong Urological Association and Hong Kong Society of Uro-Oncology. BJU Int 2018; 121:703-715. [DOI: 10.1111/bju.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Darren Ming-Chun Poon
- Department of Clinical Oncology; State Key Laboratory in Oncology in South China; Sir YK Pao Centre for Cancer; Hong Kong Cancer Institute and Prince of Wales Hospital; Chinese University of Hong Kong; Hong Kong Hong Kong
| | - Chi-Kwok Chan
- Department of Surgery; Prince of Wales Hospital; Hong Kong Hong Kong
| | - Tim-Wai Chan
- Department of Clinical Oncology; Queen Elizabeth Hospital; Hong Kong Hong Kong
| | | | | | - Eric Ka-Chai Lee
- Department of Clinical Oncology; Tuen Mun Hospital; Hong Kong Hong Kong
| | | | | | - Wai-Kit Ma
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
| | - Hing-Shing So
- Division of Urology; Department of Surgery; United Christian Hospital; Hong Kong Hong Kong
| | - Po-Chor Tam
- Department of Surgery; Queen Mary Hospital; Hong Kong Hong Kong
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966
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Treatment effects in prostate cancer. Mod Pathol 2018; 31:S110-121. [PMID: 29297495 DOI: 10.1038/modpathol.2017.158] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023]
Abstract
Nonsurgical treatments for prostate cancer include androgen-deprivation therapy (ADT), radiation therapy (RT), ablative therapies, chemotherapy, and newly emerging immunotherapies. These approaches can be used alone or in combination depending on the clinical scenario. ADT is typically reserved for high-risk locally or systemically advanced disease that is not amenable to curative surgery. Radiation therapy can be used instead of surgery as primary therapy with curative intent for low-intermediate-risk disease as well as for control of locally advanced disease not suitable for surgery. Ablative therapies can be used as primary therapy for low-intermediate-risk disease or as salvage therapy for clinically localized disease where RT has failed. Chemotherapy and immune-based therapies are currently used for androgen-independent disease, although the indications for these approaches may well change as new data from clinical trials accrue. Pathologists should be able to recognize tissue changes associated with these treatments to provide information that will optimize patient management. This is particularly true in situations where clinical history of recent or remote nonsurgical treatment is not provided with the specimen. In the absence of this information, pathologists encountering the features described herein are encouraged to review patient records or communicate directly with clinical colleagues to determine how a given patient was treated and when.
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967
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Schmidkonz C, Hollweg C, Beck M, Reinfelder J, Goetz TI, Sanders JC, Schmidt D, Prante O, Bäuerle T, Cavallaro A, Uder M, Wullich B, Goebell P, Kuwert T, Ritt P. 99m Tc-MIP-1404-SPECT/CT for the detection of PSMA-positive lesions in 225 patients with biochemical recurrence of prostate cancer. Prostate 2018; 78:54-63. [PMID: 29105797 DOI: 10.1002/pros.23444] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND 99m Tc-MIP-1404 (Progenics Pharmaceuticals, Inc., New York, NY) is a novel, SPECT-compatible 99m Tc-labeled PSMA inhibitor for the detection of prostate cancer. We present results of its clinical use in a cohort of 225 men with histologically confirmed prostate cancer referred for workup of biochemical relapse. METHODS From April 2013 to April 2017, 99m Tc-MIP1404-scintigraphy was performed in 225 patients for workup of PSA biochemical relapse of prostate cancer. Whole-body planar and SPECT/CT images of the lower abdomen and thorax were obtained 3-4 h p.i. of 710 ± 64 MBq 99m Tc-MIP-1404. Images were visually analyzed for presence and location of abnormal uptake. In addition, quantitative analysis of the SPECT/CT data was carried out on a subset of 125 patients. Follow-up reports of subsequent therapeutic interventions were available for 59% (139) of all patients. RESULTS Tracer-positive lesions were detected in 77% (174/225) of all patients. Detections occurred at the area of local recurrence in the prostate in 25% of patients (or a total of 56), with metastases in lymph nodes in 47% (105), bone in 27% (60), lung in 5% (12), and other locations in 2% (4) of patients. Detection rates were 90% at PSA levels ≥2 ng/mL and 54% below that threshold. Lesional SUVmax values were, on average, 32.2 ± 29.6 (0.8-142.2), and tumor-to-normal ratios 146.6 ± 160.5 (1.9-1482.4). The PSA level correlated significantly with total uptake of MIP-1404 in tumors (P < 0.001). Furthermore, total tumor uptake was significantly higher in patients with Gleason scores ≥8 compared to those with Gleason scores ≤7 (P < 0.05). In patients with androgen deprivation therapy, the detection rate was significantly higher compared to patients without androgen deprivation therapy (86% vs 71%, P < 0.001). Based on 99m Tc-MIP-1404-imaging and other information, an interdisciplinary tumor board review recommended changes to treatment plans in 74% (104/139) of those patients for whom the necessary documentation was available. CONCLUSION SPECT/CT with 99m Tc-labeled MIP-1404 has a high probability in detecting PSMA-positive lesions in patients with elevated PSA. Statistical analysis disclosed significant relationship between quantitative 99m Tc-MIP-1404 uptake, PSA level, and Gleason score.
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Affiliation(s)
| | - Claudia Hollweg
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Michael Beck
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Julia Reinfelder
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Theresa I Goetz
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
- Pattern Recognition Lab, University Erlangen-Nürnberg, Erlangen, Germany
| | - James C Sanders
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
- Pattern Recognition Lab, University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniela Schmidt
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Olaf Prante
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology, Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Peter Goebell
- Department of Urology, Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Ritt
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
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968
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Ambuehl D, Boxler S, Thalmann G, Spahn M. Management of Nonmetastatic Failure Following Local Prostate Cancer Therapy. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_75-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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969
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Resection of Metastatic Cancer in Castration-Resistant Patients. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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970
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Beauval JB, Loriot Y, Hennequin C, Rozet F, Barthelemy P, Borchiellini D, Schlürmann Constans F, Gross E, Maillet D, Pasticier G, Pignot G, Timsit MO, Vincendeau S, Ploussard G, Sargos P. Loco-regional treatment for castration-resistant prostate cancer: Is there any rationale? A critical review from the AFU-GETUG. Crit Rev Oncol Hematol 2017; 122:144-149. [PMID: 29458782 DOI: 10.1016/j.critrevonc.2017.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/17/2022] Open
Abstract
Emerging evidence from population-based and retrospective series suggests a potential improvement of clinical outcomes in metastatic prostate cancer. Moreover, metastasis-directed treatment has shown encouraging results in this setting. There is an increasing interest in exploring the potential of local therapies in advanced prostate cancer, but this has rarely been specifically addressed in the castration-resistant state, whether non-metastatic or metastatic. A review of relevant articles was performed on the oncologic benefit of local treatment of the primary tumor or metastasis-targeted treatment in castration-resistant prostate cancer patients. The main goal of this strategy is to delay introduction of a new systemic agent to maintain quality of life and potentially to limit resistance. Further investigation is required to provide high-level evidence for the oncologic benefit of this treatment modality.
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Affiliation(s)
| | - Yohann Loriot
- Medical oncology department, Gustave Roussy, Université Paris-Saclay, Paris, France.
| | | | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.
| | - Philippe Barthelemy
- Medical Oncology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | | | | | - Emmanuel Gross
- Ramsay Générale de Santé, Hôpital Privé Clairval, Marseille, France.
| | - Denis Maillet
- Medical Oncology Department, Centre Hospitalier Lyon-Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, F-69310, Pierre-Bénite, France.
| | | | - Géraldine Pignot
- Oncologic surgery department 2, Institut Paoli-Calmettes, Marseille, France.
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Paris-Descartes University, Paris, France.
| | | | - Guillaume Ploussard
- Department of Urology, Clinique St Jean du Languedoc, Toulouse, France; Institut Universitaire du Cancer, Toulouse, France.
| | - Paul Sargos
- Department of Radiation therapy, Institut Bergonié, Bordeaux, France.
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971
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Hegemann M, Maas M, Rausch S, Walz S, Bedke J, Stenzl A, Todenhöfer T. Current concepts and trends in the treatment of bone metastases in patients with advanced prostate cancer. Asian J Androl 2017; 21:221199. [PMID: 29286005 PMCID: PMC6337943 DOI: 10.4103/aja.aja_59_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/31/2017] [Indexed: 12/04/2022] Open
Abstract
Bone metastases have a major impact on quality of life and survival of patients with advanced prostate cancer. In the last decade, the development and approval of substances inhibiting the vicious cycle of bone metastases have enabled the reduction of complications caused by bone metastases in patients with castration-resistant prostate cancer. These drugs have raised awareness of the importance of skeletal-related events which in the meantime represent an important end point also in trials using agents not specifically designed for bone lesions. Second-generation antihormonal drugs such as enzalutamide or abiraterone have been shown to have a positive impact on the incidence of skeletal complications and therefore provide an important tool in the armamentarium used for treating bone metastases. Radiopharmaceuticals such as radium-223 dichloride ([223Ra]) have been demonstrated not only to reduce skeletal-related events and bone-related pain, but also to prolong overall survival, thereby being the first bone-targeting agent showing a survival benefit. As previous studies have not provided an obvious benefit of bone-targeted lesions in castration-sensitive disease, the use of these agents is not recommended. In oligometastatic prostate cancer, the role of local treatment of metastases using stereotactic radiation or radiosurgery is a matter of intense debates and may play an increasing role in the future.
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Affiliation(s)
- Miriam Hegemann
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Moritz Maas
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Simon Walz
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Jens Bedke
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
| | - Tilman Todenhöfer
- Department of Urology, University Hospital Tuebingen, Tuebingen 72076, Germany
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972
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Prognostic and Therapeutic Implications of Circulating Androgen Receptor Gene Copy Number in Prostate Cancer Patients Using Droplet Digital Polymerase Chain Reaction. Clin Genitourin Cancer 2017; 16:197-205.e5. [PMID: 29366632 DOI: 10.1016/j.clgc.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/07/2017] [Accepted: 12/15/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Resistance mechanisms in the androgen receptor (AR) signaling pathway remain key drivers in the progression to castration-resistant prostate cancer (CRPC) and relapse under antihormonal therapy. MATERIALS AND METHODS We evaluated the circulating AR gene copy number (CN) gain using droplet digital polymerase chain reaction in 21 control and 91 prostate cancer serum samples and its prognostic and therapeutic implications in prostate cancer. RESULTS In CRPC, AR CN gain was associated with faster progression to CRPC (P = .026), a greater number of previous treatments (P = .045), and previous chemotherapy (P = .016). Comparing patients with and without CN gain, the median progression-free survival (PFS) in the abiraterone subgroup was 1.7 months versus not reached (P = .004), and the median overall survival (OS) was 7 months versus 20.9 months (P = .020). In the enzalutamide subgroup, PFS was 1.7 versus 10.8 months (P = .006), and OS was 6.1 versus 16.5 months (P = .042). In the taxane subgroup, PFS was 3.2 versus 6.5 months (P = .093), and OS was 3.9 months versus not reached (P = .026). The presence of more AR copies correlated with shorter androgen deprivation (P = .002), abiraterone (P = .022), enzalutamide (P = .008), and taxane (P = .039) therapy. CONCLUSION Circulating AR CN gain predicts for a poor prognosis in CRPC. It is a promising biomarker predetermining rapid CRPC progression and predicting worse abiraterone and enzalutamide outcomes. Furthermore, it is associated with multiple previous treatments and previous chemotherapy.
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973
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Macherey S, Monsef I, Jahn F, Jordan K, Yuen KK, Heidenreich A, Skoetz N. Bisphosphonates for advanced prostate cancer. Cochrane Database Syst Rev 2017; 12:CD006250. [PMID: 29278410 PMCID: PMC6486306 DOI: 10.1002/14651858.cd006250.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence and incidence of pain and skeletal complications of metastatic bone disease such as pathologic fractures, spinal cord compression and hypercalcemia is high and an important contributor to morbidity, poor performance status and decreased quality of life. Moreover, pathologic fractures are associated with increased risk of death in people with disseminated malignancies. Therefore, prevention of pain and fractures are important goals in men with prostate cancer at risk for skeletal complications. OBJECTIVES To assess the effects of bisphosphonates in men with bone metastases from prostate cancer. SEARCH METHODS We identified studies by electronic search of bibliographic databases including the Cochrane Controlled Trials Register and MEDLINE on 13 July 2017 and trial registries. We handsearched the Proceedings of American Society of Clinical Oncology (to July 2017) and reference lists of all eligible trials identified. This is an update of a review last published in 2006. SELECTION CRITERIA We included randomized controlled studies comparing the effectiveness of bisphosphonates in men with bone metastases from prostate cancer. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of trials. We defined the proportion of participants with pain response as the primary end point; secondary outcomes were skeletal-related events, mortality, quality of life, adverse events, analgesic consumption and disease progression. We assessed the quality of the evidence for the main outcomes using the GRADE approach. MAIN RESULTS We included 18 trials reporting on 4843 participants comparing the effect of bisphosphonate administration to control regimens. PRIMARY OUTCOME there was no clear difference in the proportion of participants with pain response (RR 1.15, 95% CI 0.93 to 1.43; P = 0.20; I2 = 0%; 3 trials; 876 participants; low quality evidence). In absolute terms, bisphosphonates resulted in a pain response in 40 more participants per 1000 (19 fewer to 114 more). SECONDARY OUTCOMES bisphosphonates probably reduced the incidence of skeletal-related events in participants with prostate cancer metastatic to bone (RR 0.87, 95% CI 0.81 to 0.94; P = 0.27; I2 = 19%; 9 trials; 3153 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 58 fewer SREs per 1000 (85 fewer to 27 fewer).We found no clinically relevant differences in mortality (RR 0.97, 95% CI 0.91 to 1.04; P = 0.43; I2 = 1%; 9 trials; 2450 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 16 fewer deaths per 1000 (47 fewer to 21 more).Outcome definition of quality of life and the measurement tools varied greatly across trials and we were unable to extract any quantitative data for meta-analysis.Bisphosphonates probably increased the number of participants affected by nausea (RR 1.19, 95% CI 1.00 to 1.41; P = 0.05; I2 = 0%; 9 trials; 3008 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in seven more cases of nausea per 1000 (0 fewer to 14 more). Bisphosphonates probably increased the number of renal adverse events (RR 1.65, 95% CI 1.11 to 2.46; P = 0.01; I2 = 0%; 7 trials; 1794 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 22 more renal adverse events per 1000 (4 more to 50 more). We found no clear difference in the number of participants with osteonecrosis of the jaw between groups (RR 1.92, 95% CI 0.75 to 4.90; P = 0.17; I2 = 0%; 5 trials; 1626 participants; very low quality evidence). In absolute terms, bisphosphonates resulted in seven more cases with osteonecrosis of the jaw per 1000 (2 fewer to 29 more). We observed no clinically relevant difference in the proportion of participants with decreased analgesic consumption (RR 1.19, 95% CI 0.87 to 1.63; P = 0.28; I2 = 37%; 4 trials; 416 participants). Statistical analysis revealed that bisphosphonates probably reduced the number of participants with disease progression (RR 0.94, 95% CI 0.90 to 0.98; P = 0.006; I2 = 0%; 7 trials; 2115 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 36 fewer cases of disease progression per 1000 (71 fewer to 7 fewer).Findings of our predefined subgroup and sensitivity analyses were no different from those of the primary analyses. AUTHORS' CONCLUSIONS Based on low quality evidence, there may be no clinically relevant difference in the proportion of men with pain response between bisphosphonates and control regimens in men with bone metastases from prostate cancer. Bisphosphonates probably decrease the number of skeletal-related events and disease progression. These benefits need to be weighed against the increased risk of renal impairment and nausea in men receiving bisphosphonates. Future studies should explicitly evaluate patient important outcomes such as quality of life and pain by using standardized and comparable assessment tools.
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Affiliation(s)
- Sascha Macherey
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Franziska Jahn
- Martin‐Luther‐University Halle‐WittenbergDepartment of Internal Medicine IV; Hematology/OncologyHalleGermany
| | - Karin Jordan
- University of HeidelbergDepartment of Medicine VHeidelbergGermany
| | - Kwok Keung Yuen
- Queen Mary HospitalDepartment of Clinical Oncology102 Pok Fu Lam Road1/F Professorial BlockHong KongChina
| | - Axel Heidenreich
- University Hospital CologneDepartment of UrologyKerpener Str. 62CologneGermany50937
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
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974
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Iravani A, Hofman MS, Mulcahy T, Williams S, Murphy D, Parameswaran BK, Hicks RJ. 68Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer. Cancer Imaging 2017; 17:31. [PMID: 29268784 PMCID: PMC5740783 DOI: 10.1186/s40644-017-0133-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background 68Ga-labelled prostate specific membrane antigen (PSMA) ligand PET/CT is a promising modality in primary staging (PS) and biochemical relapse (BCR) of prostate cancer (PC). However, pelvic nodes or local recurrences can be difficult to differentiate from radioactive urine. CT urography (CT-U) is an established method, which allows assessment of urological malignancies. The study presents a novel protocol of 68Ga-PSMA-11 PET/CT-U in PS and BCR of PC. Methods A retrospective review of PSMA PET/CT-U preformed on 57 consecutive patients with prostate cancer. Fifty mL of IV contrast was administered 10 min (range 8–15) before the CT component of a combined PET/CT study, acquired approximately 60 min (range 40–85) after administration of 166 MBq (range 91–246) of 68Ga-PSMA-11. PET and PET/CT-U were reviewed by two nuclear medicine physicians and CT-U by a radiologist. First, PET images were reviewed independently followed by PET/CT-U images. Foci of activity which could not unequivocally be assessed as disease or urinary activity were recorded. PET/CT-U was considered of potential benefit in final interpretation when the equivocal focal activity in PET images corresponded to opacified ureter, bladder, prostate bed, seminal vesicles, or urethra. Student’s T test and Pearson’s correlation coefficient was used for assessment of variables including lymph node size and standardized uptake value. Results Overall 50 PSMA PET/CT-U studies were performed for BCR and 7 for PS. Median PSA with BCR and PS were 2.0 ± 11.4 ng/ml (0.06–57.3 ng/ml) and 18 ± 35.3 ng/ml (6.8–100 ng/ml), respectively. The median Gleason-score for both groups was 7 (range 6–10). In BCR group, PSMA PET was reported positive in 36 (72%) patients, CT-U in 11(22%) patients and PET/CT-U in 33 (66%) patients. In PS group, PSMA PET detected the primary site in all seven patients, of which one patient with metastatic nodal disease had negative CT finding. Of 40 equivocal foci (27/57 patients) on PET, 11 foci (10/57 patients, 17.5%) were localized to enhanced urine on PET/CT-U, hence considered of potential benefit in interpretation. Of those, 3 foci (3 patients) were solitary sites of activity on PSMA imaging including two local and one nodal site and 4 foci (3 patients) were in different nodal fields. Conclusions PET/CT-U protocol is a practical approach and may assist in interpretation of 68Ga-PSMA-11 imaging by delineation of the contrast opacified genitourinary system and matching focal PSMA activity with urinary contrast. Electronic supplementary material The online version of this article (10.1186/s40644-017-0133-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amir Iravani
- Centre for Molecular Imaging, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia.
| | - Michael S Hofman
- Centre for Molecular Imaging, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Melbourne, Australia
| | - Tony Mulcahy
- Centre for Molecular Imaging, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia
| | - Scott Williams
- Sir Peter MacCallum Department of Radiation Oncology, University of Melbourne, 305 Grattan Street, Melbourne, Australia
| | - Declan Murphy
- Sir Peter MacCallum Department of Surgical Oncology, University of Melbourne, 305 Grattan Street, Melbourne, Australia
| | - Bimal K Parameswaran
- Centre for Molecular Imaging, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia
| | - Rodney J Hicks
- Centre for Molecular Imaging, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Melbourne, Australia
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975
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Wu YP, Xu N, Wang ST, Chen SH, Lin YZ, Li XD, Zheng QS, Wei Y, Xue XY. The efficacy and feasibility of total reconstruction versus nontotal reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis. World J Surg Oncol 2017; 15:228. [PMID: 29262863 PMCID: PMC5738806 DOI: 10.1186/s12957-017-1296-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022] Open
Abstract
Background Recently, total pelvic floor reconstruction (TR) has been the treatment of choice for improving urinary incontinence (UI) after radical prostatectomy (RP). However, the superiority of TR with respect to urinary continence recovery following RP remains controversial. This study identified the effect of TR versus nonTR of the pelvic floor on short-term and long-term continence rates after RP. Methods A literature search was performed in November 2017 using the PubMed, Embase, and Web of Science databases. Only comparative research or clinical studies reporting urinary continence outcomes was included in the meta-analysis, and the quality of evidence was evaluated using the 2011 Level of Evidence for therapy research. Results We analyzed ten studies reporting urinary continence rates after RP at one or more postoperative time points (1, 2, 4, 12, 24, and 52 weeks). TR was associated with significantly better urinary continence outcomes at 1 week (OR 2.76, 95% CI 1.58–4.84, P < 0.001), 2 weeks (OR 2.57, 95% CI 1.74–3.80, P < 0.001), 4 weeks (OR 2.61, 95% CI 1.56–4.38, P < 0.001), 12 weeks (OR 4.33, 95% CI 2.01–9.33, P < 0.001), 24 weeks (OR 3.83, 95% CI 1.54–9.55, P = 0.004), 52 weeks (OR 4.10, 95% CI 1.80–9.38, P < 0.001) after RP. There was no difference in the rate of complications between the two arms (OR 0.54, 95% CI 0.19–1.54, P = 0.25). Conclusions Compared with nonTR, TR is significantly and positively associated with a return to continence but not with complication rate in men following RP, suggesting that TR may be useful for decreasing the urinary incontinence rate after surgery.
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Affiliation(s)
- Yu-Peng Wu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Shi-Tao Wang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Shao-Hao Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yun-Zhi Lin
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Shui Zheng
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yong Wei
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xue-Yi Xue
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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976
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von Eyben FE, Roviello G, Kiljunen T, Uprimny C, Virgolini I, Kairemo K, Joensuu T. Third-line treatment and 177Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review. Eur J Nucl Med Mol Imaging 2017; 45:496-508. [PMID: 29247284 PMCID: PMC5787223 DOI: 10.1007/s00259-017-3895-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
Aims There is a controversy as to the relative efficacy of 177Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of our systematic review was to elucidate whether 177Lu-PSMA RLT and third-line treatment have similar effects and adverse effects (PROSPERO ID CRD42017067743). Methods The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in Pubmed and Embase selected articles up to September 2017. A search in ClinicalTrials.gov indicated ongoing studies. The meta-analysis used the random-effects model. Results Twelve studies including 669 patients reported 177Lu-PSMA RLT. Overall, 43% of the patients had a maximum decline of PSA of ≥50% following treatment with 177Lu-PSMA RLT. The treatment with 177Lu-PSMA-617 and 177Lu-PSMA for imaging and therapy (I&T) had mainly transient adverse effects. Sixteen studies including 1338 patients reported third-line treatment. Overall, 21% of the patients had a best decline of PSA of ≥50% following third-line treatment. After third-line treatment with enzalutamide and cabazitaxel, adverse effects caused discontinuation of treatment for 10% to 23% of the patients. 177Lu-PSMA RLT gave a best PSA decline ≥50% more often than third-line treatment (mean 44% versus 22%, p = 0.0002, t test). 177Lu-PSMA RLT gave objective remission more often than third-line treatment (overall 31 of 109 patients versus 43 of 275 patients, p = 0.004, χ2 test). Median survival was longer after 177Lu-PSMA RLT than after third-line treatment, but the difference was not statistically significant (mean 14 months versus 12 months, p = 0.32, t test). Adverse effects caused discontinuation of treatment more often for third-line treatment than for 177Lu-PSMA RLT (22 of 66 patients versus 0 of 469 patients, p < 0.001, χ2 test). Conclusions As for patients with mCRPC, treatment with 177Lu-PSMA-617 RTL and 177Lu-PSMA I&T gave better effects and caused fewer adverse effects than third-line treatment.
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Affiliation(s)
| | - Giandomenico Roviello
- Department of Oncology, Medical Oncology Unit, San Donato Hospital, Arezzo, Italy
- Department Medical, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Christian Uprimny
- Department of Nuclear Medicine, University Hospital Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital Innsbruck, Innsbruck, Austria
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977
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Calais J, Fendler WP, Herrmann K, Eiber M, Ceci F. Comparison of 68Ga-PSMA-11 and 18F-Fluciclovine PET/CT in a Case Series of 10 Patients with Prostate Cancer Recurrence. J Nucl Med 2017; 59:789-794. [DOI: 10.2967/jnumed.117.203257] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/26/2017] [Indexed: 11/16/2022] Open
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978
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Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol 2017; 36:446-453. [PMID: 29240541 DOI: 10.1200/jco.2017.75.4853] [Citation(s) in RCA: 853] [Impact Index Per Article: 121.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Retrospective studies suggest that metastasis-directed therapy (MDT) for oligorecurrent prostate cancer (PCa) improves progression-free survival. We aimed to assess the benefit of MDT in a randomized phase II trial. Patients and Methods In this multicenter, randomized, phase II study, patients with asymptomatic PCa were eligible if they had had a biochemical recurrence after primary PCa treatment with curative intent, three or fewer extracranial metastatic lesions on choline positron emission tomography-computed tomography, and serum testosterone levels > 50 ng/mL. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions (surgery or stereotactic body radiotherapy). Surveillance was performed with prostate-specific antigen (PSA) follow-up every 3 months, with repeated imaging at PSA progression or clinical suspicion for progression. Random assignment was balanced dynamically on the basis of two factors: PSA doubling time (≤ 3 v > 3 months) and nodal versus non-nodal metastases. The primary end point was androgen deprivation therapy (ADT)-free survival. ADT was started at symptomatic progression, progression to more than three metastases, or local progression of known metastases. Results Between August 2012 and August 2015, 62 patients were enrolled. At a median follow-up time of 3 years (interquartile range, 2.3-3.75 years), the median ADT-free survival was 13 months (80% CI, 12 to 17 months) for the surveillance group and 21 months (80% CI, 14 to 29 months) for the MDT group (hazard ratio, 0.60 [80% CI, 0.40 to 0.90]; log-rank P = .11). Quality of life was similar between arms at baseline and remained comparable at 3-month and 1-year follow-up. Six patients developed grade 1 toxicity in the MDT arm. No grade 2 to 5 toxicity was observed. Conclusion ADT-free survival was longer with MDT than with surveillance alone for oligorecurrent PCa, suggesting that MDT should be explored further in phase III trials.
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Affiliation(s)
- Piet Ost
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Dries Reynders
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Karel Decaestecker
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Valérie Fonteyne
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Nicolaas Lumen
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Aurélie De Bruycker
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Bieke Lambert
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Louke Delrue
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Renée Bultijnck
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Tom Claeys
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Els Goetghebeur
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Geert Villeirs
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Kathia De Man
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Filip Ameye
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Ignace Billiet
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Steven Joniau
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Friedl Vanhaverbeke
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Gert De Meerleer
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
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979
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Affiliation(s)
- John C. Henegan
- Division of Hematology and Oncology, Department of Medicine, University of Mississippi Cancer Center, Jackson, MS, USA
| | - Guru Sonpavde
- Department of Medical Oncology, GU section, Dana Farber Cancer Institute, Boston, MA, USA
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980
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Horning AM, Wang Y, Lin CK, Louie AD, Jadhav RR, Hung CN, Wang CM, Lin CL, Kirma NB, Liss MA, Kumar AP, Sun L, Liu Z, Chao WT, Wang Q, Jin VX, Chen CL, Huang THM. Single-Cell RNA-seq Reveals a Subpopulation of Prostate Cancer Cells with Enhanced Cell-Cycle-Related Transcription and Attenuated Androgen Response. Cancer Res 2017; 78:853-864. [PMID: 29233929 DOI: 10.1158/0008-5472.can-17-1924] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/27/2017] [Accepted: 12/01/2017] [Indexed: 11/16/2022]
Abstract
Increasing evidence suggests the presence of minor cell subpopulations in prostate cancer that are androgen independent and poised for selection as dominant clones after androgen deprivation therapy. In this study, we investigated this phenomenon by stratifying cell subpopulations based on transcriptome profiling of 144 single LNCaP prostate cancer cells treated or untreated with androgen after cell-cycle synchronization. Model-based clustering of 397 differentially expressed genes identified eight potential subpopulations of LNCaP cells, revealing a previously unappreciable level of cellular heterogeneity to androgen stimulation. One subpopulation displayed stem-like features with a slower cell doubling rate, increased sphere formation capability, and resistance to G2-M arrest induced by a mitosis inhibitor. Advanced growth of this subpopulation was associated with enhanced expression of 10 cell-cycle-related genes (CCNB2, DLGAP5, CENPF, CENPE, MKI67, PTTG1, CDC20, PLK1, HMMR, and CCNB1) and decreased dependence upon androgen receptor signaling. In silico analysis of RNA-seq data from The Cancer Genome Atlas further demonstrated that concordant upregulation of these genes was linked to recurrent prostate cancers. Analysis of receiver operating characteristic curves implicates aberrant expression of these genes and could be useful for early identification of tumors that subsequently develop biochemical recurrence. Moreover, this single-cell approach provides a better understanding of how prostate cancer cells respond heterogeneously to androgen deprivation therapies and reveals characteristics of subpopulations resistant to this treatment.Significance: Illustrating the challenge in treating cancers with targeted drugs, which by selecting for drug resistance can drive metastatic progression, this study characterized the plasticity and heterogeneity of prostate cancer cells with regard to androgen dependence, defining the character or minor subpopulations of androgen-independent cells that are poised for clonal selection after androgen-deprivation therapy. Cancer Res; 78(4); 853-64. ©2017 AACR.
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Affiliation(s)
- Aaron M Horning
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Yao Wang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Che-Kuang Lin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anna D Louie
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rohit R Jadhav
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Chia-Nung Hung
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Chiou-Miin Wang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Chun-Lin Lin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Nameer B Kirma
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center, San Antonio at San Antonio, Texas
| | - Addanki P Kumar
- Department of Urology, University of Texas Health Science Center, San Antonio at San Antonio, Texas
| | - LuZhe Sun
- Department of Cell Systems and Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Zhijie Liu
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Wei-Ting Chao
- Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Qianben Wang
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, Ohio
| | - Victor X Jin
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Chun-Liang Chen
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Tim H-M Huang
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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981
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Li JR, Chiu KY, Wang SS, Yang CK, Chen CS, Ho HC, Hung CF, Cheng CL, Yang CR, Chen CC, Wang SC, Lin CY, Chang CH, Hsu CY, Ou YC. Effectiveness of Deferred Combined Androgen Blockade Therapy Predicts Efficacy in Abiraterone Acetate Treated Metastatic Castration-Resistant Prostate Cancer Patients after Docetaxel. Front Pharmacol 2017; 8:836. [PMID: 29213237 PMCID: PMC5702804 DOI: 10.3389/fphar.2017.00836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: Conventional anti-androgen regimens were widely used as an initiation or combined androgen blockade (CAB) therapy in advanced prostate cancer patients. Currently, new androgen pathway inhibitors such as abiraterone acetate (AA) and enzalutamide had been proven effective in metastatic castration resistant prostate cancer. In this study, we attempt to analyze the role of conventional anti-androgen drugs as deferred CAB therapy in castration-resistant prostate cancer patients. Materials and Methods: From 2012 to 2017, 48 metastatic castration-resistant prostate cancer (CRPC) patients who received sequential treatments with primary androgen blockade, oral anti-androgen regimens, and docetaxel followed by AA treatment were included. We defined effective deferred CAB as any decline of PSA after add-on antiandrogen after CRPC. Patients were separated into effective and ineffective deferred CAB. Comparison between two groups in the first line androgen deprivation therapy duration, CRPC PSA level, pre-AA PSA level, chemotherapy dosages, duration, and patients progression free survival and overall survival after AA treatment were analyzed. Results: Twenty-three patients (47.9%) achieved PSA decline after deferred CAB. Among total 48 patients, 24 patients experienced PSA decline more than 50% after AA treatment. The median PSA progression-free survival and overall survival after AA treatment in the total cohort of 48 patients were 4.4 and 24.3 months, respectively. The effective deferred CAB group showed significantly lower PSA level, lower percentage of PSA progression, higher total follow-up duration, higher percentage of surviving patients, better progression free survival, and overall survival estimate after AA treatment. Of the eight variables analyzed, effectiveness in deferred CAB showed positive association to progression free survival (HR 0.29, 95% CI 0.12–0.67, p = 0.004) and overall survival (HR 0.24, 95% CI 0.07–0.81, p = 0.022). First line androgen deprivation therapy (ADT) duration also showed positive association to overall survival (HR 0.95, 95% CI 0.91–0.99, p = 0.023). Conclusions: Effectiveness of deferred CAB therapy was positively associated with progression free survival and overall survival of AA treatment after docetaxel. It can be used as a pre-treatment predictor.
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Affiliation(s)
- Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Sang Medical University, Taichung, Taiwan.,Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Sang Medical University, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hao-Chung Ho
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Feng Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Sang Medical University, Taichung, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Che Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chi Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Sang Medical University, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan
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982
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De Vergie S, Gaschignard N, Baron M, Branchereau J, Luyckx F, Butel T, Perrouin-Verbe MA, Bouchot O, Rigaud J. [Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]. Prog Urol 2017; 28:25-31. [PMID: 29221663 DOI: 10.1016/j.purol.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. PATIENTS AND METHODS This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. RESULTS Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. CONCLUSION Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S De Vergie
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - N Gaschignard
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - M Baron
- Service d'urologie, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - J Branchereau
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Luyckx
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - T Butel
- Service d'oncologie pédiatrique, institut Gustave-Roussy, 94805 Villejuif, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Bouchot
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Rigaud
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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983
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Ponti E, Lancia A, Ost P, Trippa F, Triggiani L, Detti B, Ingrosso G. Exploring All Avenues for Radiotherapy in Oligorecurrent Prostate Cancer Disease Limited to Lymph Nodes: A Systematic Review of the Role of Stereotactic Body Radiotherapy. Eur Urol Focus 2017; 3:538-544. [DOI: 10.1016/j.euf.2017.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 01/05/2023]
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984
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Ramamurthy C, Doyle J, Uzzo RG, Kutikov A, Smaldone MC, Geynisman DM. Role of collaboration between urologists and medical oncologists in the advanced prostate cancer space. Urol Oncol 2017; 35:665-669. [DOI: 10.1016/j.urolonc.2017.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
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985
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Norum J, Nieder C. Treatments for Metastatic Prostate Cancer (mPC): A Review of Costing Evidence. PHARMACOECONOMICS 2017; 35:1223-1236. [PMID: 28756597 DOI: 10.1007/s40273-017-0555-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC). OBJECTIVES We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers. METHODS A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed® search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In most studies, cabazitaxel was not recommended, because of high cost. Looking at bone-targeting drugs, generic zoledronic acid (ZA) was recommended. External beam radiotherapy (EBRT) was analysed in three studies, and single fraction radiotherapy was concluded to be cost saving. Radium-223 was documented as beneficial, but costly. The quality of the studies was generally good, but sensitivity analyses, discounting and the measurement of health outcomes were present in less than two thirds of the selected studies. CONCLUSIONS The treatment of mCRPC was associated with significant cost. In the post-docetaxel setting, single fraction radiotherapy and enzalutamide were considered cost-effective in most studies. Generic ZA was the recommended bone-targeting therapy.
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Affiliation(s)
- Jan Norum
- Department of Surgery, Finnmark Hospital Trust, 9600, Hammerfest, Norway.
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
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986
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Abstract
Androgen deprivation is still standard therapy for prostate cancer, either as primary androgen deprivation therapy or with the use of secondary hormonal drugs including abiraterone and enzalutamide. However, especially the clinically occult side effects like metabolic changes or cardiovascular complications and effects on the psyche of the patient are often not recognized in daily practice. Active monitoring of such side effects is essential for prevention and early intervention. In addition, the efficacy of androgen deprivation therapies is limited by primary and secondary resistance. The underlying molecular mechanism including splice variants of the androgen receptor in contrast to mutations are usually reversible and should be regarded as a sign of efficacy of the current treatment. Therefore, the clever, timely use of androgen deprivation or even the use of a bipolar androgen therapy should enable reversal of resistance to again render tumor cells sensitive to androgen-deprivation therapy.
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Affiliation(s)
- C H Ohlmann
- Klinik für Urologie und Kinderurologie, Universität des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | - P Thelen
- Klinik für Urologie, Universitätsmedizin Göttingen, 37099 Göttingen, Deutschland
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987
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Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robot-assisted vs open radical prostatectomy for the treatment of localized prostate cancer: a Cochrane systematic review. BJU Int 2017; 121:845-853. [PMID: 29063728 DOI: 10.1111/bju.14062] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the effects of laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP) compared with open radical prostatectomy (ORP) in men with localized prostate cancer. MATERIALS AND METHODS We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings, with no restrictions on the language of publication or publication status, up until 9 June 2017. We included all randomized or pseudo-randomized controlled trials that directly compared LRP and RARP with ORP. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. RESULTS We included two unique studies in a total of 446 randomized participants with clinically localized prostate cancer. All available outcome data were short-term (up to 3 months). We found no study that addressed the outcome of prostate cancer-specific survival. Based on one trial, RARP probably results in little to no difference in urinary quality of life (mean difference [MD] -1.30, 95% confidence interval [CI] -4.65 to 2.05; moderate quality of evidence) and sexual quality of life (MD 3.90, 95% CI: -1.84 to 9.64; moderate quality of evidence). No study addressed the outcomes of biochemical recurrence-free survival or overall survival. Based on one trial, RARP may result in little to no difference in overall surgical complications (risk ratio [RR] 0.41, 95% CI: 0.16-1.04; low quality of evidence) or serious postoperative complications (RR 0.16, 95% CI: 0.02-1.32; low quality of evidence). Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at 1 day (MD -1.05, 95% CI: -1.42 to -0.68; low quality of evidence) and up to 1 week (MD -0.78, 95% CI: -1.40 to -0.17; low quality of evidence). Based on one study, RARP probably results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI: -0.32 to 0.34; moderate quality of evidence). Based on one study, RARP probably reduces the length of hospital stay (MD -1.72, 95% CI: -2.19 to -1.25; moderate quality of evidence). Based on two studies, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI: 0.12-0.46; low quality of evidence). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1,000 men (95% CI: 78-48 fewer). CONCLUSIONS There is no evidence to inform the comparative effectiveness of LRP or RARP compared with ORP for oncological outcomes. Urinary and sexual quality of life appear similar. Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions.
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Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Sue M Evans
- Centre of Research Excellence in Patient Safety, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Christie Ann Allan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.,Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Declan Murphy
- Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Vic., Australia
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988
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Purshouse K, Schuh A, Fairfax BP, Knight S, Antoniou P, Dreau H, Popitsch N, Gatter K, Roberts I, Browning L, Traill Z, Kerr D, Verrill C, Tuthill M, Taylor JC, Protheroe A. Whole-genome sequencing identifies homozygous BRCA2 deletion guiding treatment in dedifferentiated prostate cancer. Cold Spring Harb Mol Case Stud 2017; 3:a001362. [PMID: 28487881 PMCID: PMC5411692 DOI: 10.1101/mcs.a001362] [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] [Indexed: 12/28/2022] Open
Abstract
Whole-genome sequencing (WGS) has transformed the understanding of the genetic drivers of cancer and is increasingly being used in cancer medicine to identify personalized therapies. Here we describe a case in which the application of WGS identified a tumoral BRCA2 deletion in a patient with aggressive dedifferentiated prostate cancer that was repeat-biopsied after disease progression. This would not have been detected by standard BRCA testing, and it led to additional treatment with a maintenance poly ADP ribose polymerase (PARP) inhibitor following platinum-based chemotherapy. This case demonstrates that repeat biopsy upon disease progression and application of WGS to tumor samples has meaningful clinical utility and the potential to transform outcomes in patients with cancer.
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Affiliation(s)
- Karin Purshouse
- Oxford Cancer and Haematology Centre, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Anna Schuh
- Oxford National Institute for Health Research, Biomedical Research Centre/NHS Translational Diagnostics Centre, The Joint Research Office, The Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Benjamin P Fairfax
- Oxford Cancer and Haematology Centre, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Sam Knight
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Pavlos Antoniou
- Oxford National Institute for Health Research, Biomedical Research Centre/NHS Translational Diagnostics Centre, The Joint Research Office, The Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Helene Dreau
- Oxford National Institute for Health Research, Biomedical Research Centre/NHS Translational Diagnostics Centre, The Joint Research Office, The Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Niko Popitsch
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Kevin Gatter
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Ian Roberts
- Molecular Oncology and Haematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford OX3 9DS, United Kingdom
| | - Lisa Browning
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Zoe Traill
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - David Kerr
- Oxford Cancer and Haematology Centre, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Clare Verrill
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Mark Tuthill
- Oxford Cancer and Haematology Centre, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
| | - Jenny C Taylor
- Oxford National Institute for Health Research, Biomedical Research Centre/NHS Translational Diagnostics Centre, The Joint Research Office, The Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Andrew Protheroe
- Oxford Cancer and Haematology Centre, Churchill Hospital, Headington, Oxford OX3 7LE, United Kingdom
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989
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SEOM clinical guidelines for the treatment of metastatic prostate cancer (2017). Clin Transl Oncol 2017; 20:57-68. [PMID: 29134562 PMCID: PMC5785604 DOI: 10.1007/s12094-017-1783-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 02/08/2023]
Abstract
Androgen deprivation treatment was the only treatment available for metastatic prostate cancer until recently, with docetaxel as the only treatment with a proven survival benefit in castration-resistant prostate cancer (CRPC). Several drugs have been approved in the castration-resistant disease (sipuleucel-T, cabazitaxel, abiraterone, enzalutamide, radium-223). More recently, docetaxel and abiraterone have been moved to the hormone-sensitive disease setting, achieving better patient survival. The purpose of this article is to define the state of the art in the treatment of prostate carcinoma.
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990
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Gómez-de la Fuente FJ, Martínez-Rodríguez I, de Arcocha-Torres M, Quirce R, Jiménez-Bonilla J, Martínez-Amador N, Banzo I. Contribution of 11C-Choline PET/CT in prostate carcinoma biochemical relapse with serum PSA level below 1 ng/ml. Rev Esp Med Nucl Imagen Mol 2017; 37:156-162. [PMID: 29137875 DOI: 10.1016/j.remn.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE 11C-choline PET/CT has demonstrated good results in the restaging of prostate cancer (PCa) with high serum prostate specific antigen (PSA), but its use in patients with low serum PSA is controversial. Our aim was to evaluate the contribution of 11C-choline PET/CT in patients with PCa, biochemical relapse and PSA <1 ng/ml. MATERIAL AND METHOD Fifty consecutive patients (mean age: 65.9±5.6 years) with biochemical relapse of PCa and serum PSA <1ng/ml were evaluated retrospectively. PET/CT was performed 20min after intravenous administration of 555-740 MBq of 11C-choline. Minimum follow up time was 30 months. RESULTS Twenty-one out of 50 patients (42%) had an abnormal 11C-choline PET/CT. In 7 out of 21 patients (14%) tumor was confirmed (4 in prostatic bed, 4 in pelvic lymph nodes, 2 in mediastinal lymph nodes and one synchronous sigmoid carcinoma), and in all cases the initial therapeutic planning was modified. In 2 patients (4%) subsequent tests diagnosed a benign disease (one sarcoidosis, one tuberculosis sequelae) and in 3 patients (6%) they ruled out pathology. The other 9 patients (18%) had no further assessment (7 mediastinal and 4 pelvic lymph nodes). Twenty-nine out of 50 patients (58%) had a normal PET/CT. At 30 months, follow up recurrence was confirmed only in 2 of these patients. CONCLUSIONS 11C-choline PET/CT proved its usefulness in demonstrating tumor in 14% of patients with BR of PCa and serum PSA <1ng/ml, with therapeutic implications. In 4% of patients a benign condition was detected. A normal 11C-choline PET/CT was associated with a very low rate of recurrence at 30 months.
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Affiliation(s)
- F J Gómez-de la Fuente
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España.
| | - I Martínez-Rodríguez
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - M de Arcocha-Torres
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - R Quirce
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - J Jiménez-Bonilla
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - N Martínez-Amador
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
| | - I Banzo
- Departamento de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla; Grupo de Imagen Molecular (IDIVAL), Universidad de Cantabria, Santander, España
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991
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Bandini M, Pompe RS, Marchioni M, Zaffuto E, Gandaglia G, Fossati N, Cindolo L, Montorsi F, Briganti A, Saad F, Karakiewicz PI. Improved cancer-specific free survival and overall free survival in contemporary metastatic prostate cancer patients: a population-based study. Int Urol Nephrol 2017; 50:71-78. [PMID: 29129028 DOI: 10.1007/s11255-017-1744-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Over the past decade, several systemic agents as docetaxel, cabazitaxel, sipuleucel-T, abiraterone and enzalutamide have improved overall survival (OS) in metastatic prostate cancer (mPCa) patients. However, to date the OS benefit was not demonstrated in population-based analysis. METHODS Between 2004 and 2014, 19,047 men with de novo mPCa were identified within the Surveillance Epidemiology and End Results database. Median year of diagnosis resulted in two groups: historical (2004-2008) and contemporary (2009-2014). Due to potentially important differences according to year of diagnosis, we relied on propensity score matching. Propensity-score-matched Kaplan-Meier analyses and Cox regression models (CRMs) tested cancer-specific mortality (CSM) free survival and overall mortality (OM) free survival according to treatment period. RESULTS The propensity-score-matched cohort consisted of 8596 patients with mPCa. Of those, 4298 (50.0%) were historical (2004-2008) and 4298 (50.0%) were contemporary (2009-2014). CSM free survival rates and OM free survival rate were 32 versus 36 months (p < 0.0001) and 26 versus 29 months (p < 0.0001) for, respectively, historical and contemporary patients. In multivariable CRMs, patients diagnosed in contemporary years had lower CSM (HR 0.88; CI 0.82-0.93) and OM (HR 0.88; CI 0.84-0.93) risks compared to historical counterpart (all p < 0.0001). CONCLUSION This population-based study provides the first evidence of improved CSM free survival and OM free survival in patients with de novo mPCa since the introduction of several systemic agents for CRPC patients.
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Affiliation(s)
- Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
| | - Raisa S Pompe
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Emanuele Zaffuto
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
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992
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Chaloupka M, Herlemann A, D'Anastasi M, Cyran CC, Ilhan H, Gratzke C, Stief CG. 68Gallium-Prostate-Specific Membrane Antigen PET/Computed Tomography for Primary and Secondary Staging in Prostate Cancer. Urol Clin North Am 2017; 44:557-563. [PMID: 29107272 DOI: 10.1016/j.ucl.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prostate-specific membrane antigen (PSMA) PET has been recently introduced for the diagnosis of patients with metastatic prostate cancer (PCa). Until today, staging of patients with PCa relied mostly on morphologic features, such as size or shape, resulting in low detection rates in disease recurrence. PSMA PET imaging provides molecular information and, in combination with conventional imaging, offers improved sensitivity and specificity. This review discusses the benefits and limitations of PSMA imaging in the setting of primary staging and detection of recurrent disease in comparison with standard-of-care imaging techniques.
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Affiliation(s)
- Michael Chaloupka
- Department of Urology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany.
| | - Annika Herlemann
- Department of Urology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Melvin D'Anastasi
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, Ludwig-Maximilian-University Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany; Comprehensive Cancer Center, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany; Comprehensive Cancer Center, Ludwig-Maximilians-University Munich, Marchioninistraße 15, Munich 81377, Germany
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993
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Zhang Q, Zang S, Zhang C, Fu Y, Lv X, Zhang Q, Deng Y, Zhang C, Luo R, Zhao X, Wang W, Wang F, Guo H. Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med 2017; 15:230. [PMID: 29115970 PMCID: PMC5688809 DOI: 10.1186/s12967-017-1333-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/20/2017] [Indexed: 01/22/2023] Open
Abstract
Background To evaluate the diagnostic value of 68Ga-PSMA-11 PET-CT with multiparametric magnetic resonance imaging (mpMRI) for lymph node (LN) staging in patients with intermediate- to high-risk prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Methods We retrospectively identified 42 consecutive patients with intermediate- to high-risk PCa according to D′Amico and without concomitant cancer. Preoperative 68Ga-PSMA-11 PET-CT, pelvic mpMRI and subsequent robot assisted laparoscopic RP with PLND were performed in all patients. Results Among 42 patients assessed, the preoperative PSA value, Gleason score, pT stage and intraprostatic PCa volume of patients with LN metastases were all significantly higher than those without metastases (P = 0.029, 0.028, 0.004, respectively). The average maximum standardized uptake value (SUV) of 68Ga-PSMA-11 PET-CT positive PCa of patients with or without LN metastases were 13.10 (range 6.12–51.75) and 7.22 (range 5.4–11.2), respectively (P < 0.001). 68Ga-PSMA-11 PET-CT and pelvic mpMRI had the ability of succeed on preoperative definite accurate diagnosis and accurate localization of primary PCa in all 42 patients. Fifteen patients (35.71%) had a pN1 stage. 51 positive LN were found. Both 68Ga-PSMA-11 PET-CT and pelvic mpMRI displayed brillient patient-based and region-based sensitivity, specificity, negative predictive value and positive predictive value. There was no statistical difference for the detection of LNMs according to the diameter of the LNMs between 68Ga-PSMA-11 PET-CT and mpMRI in this study. Conclusions Both 68Ga-PSMA-11 PET-CT and mpMRI performed great value for LN staging in patients with intermediate- to high-risk PCa undergoing RP with PLND. However, despite excellent performance of 68Ga-PSMA-11 PET-CT, it cannot replace mpMRI that remains excellent for lymph node staging.
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Affiliation(s)
- Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Chengwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xiaoyu Lv
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Qinglei Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yongming Deng
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Chuan Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Rui Luo
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wei Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
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994
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Selection and monitoring of patients with metastatic castration-resistant prostate cancer for treatment with radium-223. Clin Transl Oncol 2017; 20:679-686. [PMID: 29098556 DOI: 10.1007/s12094-017-1785-0] [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: 07/31/2017] [Accepted: 10/20/2017] [Indexed: 12/19/2022]
Abstract
Despite the improvement provided by androgenic suppression in the treatment of prostate cancer, most of tumors develop resistance to castration. However, new therapies have demonstrated an increase in patient survival such as radium-223 (Ra-223), an alpha emitter and calcium mimetic with the capability of targeting osteoblastic metastatic lesions. According to results of the ALSYMPCA phase III trial, Ra-223 has demonstrated its activity by improving symptoms and survival of patients with metastatic castration-resistant prostate cancer (mCRPC), symptomatic bone metastases, and no known visceral metastatic disease, without interfering with subsequent treatments. This review examines the key evidence to establish the best patient selection criteria to use Ra-223, how to assess the response to treatment, treatment-related toxicity, and follow-up, but also current research regarding imaging techniques and biomarkers to assess the efficacy of Ra-223. Finally, we briefly describe the clinical trials that are currently ongoing with Ra-223.
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995
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996
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997
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Strömvall K, Sundkvist K, Ljungberg B, Halin Bergström S, Bergh A. Reduced number of CD169 + macrophages in pre-metastatic regional lymph nodes is associated with subsequent metastatic disease in an animal model and with poor outcome in prostate cancer patients. Prostate 2017; 77:1468-1477. [PMID: 28880401 PMCID: PMC5656907 DOI: 10.1002/pros.23407] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tumor-derived antigens are captured by CD169+ (SIGLEC1+ ) sinus macrophages in regional lymph nodes (LNs), and are presented to effector cells inducing an anti-tumor immune response. Reduced CD169 expression in pre-metastatic regional LNs is associated with subsequent metastatic disease and a poor outcome in several tumor types, but if this is the case in prostate cancer has not been explored. METHODS CD169 expression was measured with immunohistochemistry in metastasis-free regional LNs from 109 prostate cancer patients treated with prostatectomy (January 1996 to April 2002). Possible associations of CD169 expression with PSA-relapse, prostate cancer death, Gleason score, and other clinical data were assessed using Kaplan-Meier survival- and Cox regression analysis. In addition, the Dunning rat prostate tumor model was used to examine CD169 expression in pre-metastatic LNs draining either highly metastatic MatLyLu- or poorly metastatic AT1-tumors. RESULTS In patients with low CD169 immunostaining in metastasis-free regional LNs, 8 of the 27 patients died from prostate cancer compared with only three of the 82 patients with high immunostaining (P < 0.001). CD169 expression in regional LNs was not associated with PSA-relapse. Rats with highly metastatic tumors had decreased CD169 immunoreactivity in pre-metastatic regional LNs compared with rats with poorly metastatic tumors. CONCLUSION Low expression of CD169 in metastasis-free regional LNs indicates a reduced anti-tumor immune response. If verified in other studies, CD169 expression in regional LNs could, in combination with other factors, potentially be used as a marker of prostate cancer aggressiveness.
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Affiliation(s)
- Kerstin Strömvall
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Kristoffer Sundkvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | | | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
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998
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999
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New aspects of molecular imaging in prostate cancer. Methods 2017; 130:36-41. [DOI: 10.1016/j.ymeth.2017.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
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1000
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Prostate-Specific Membrane Antigen Positron Emission Tomography–Computed Tomography for Prostate Cancer: Distribution of Disease and Implications for Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:701-709. [DOI: 10.1016/j.ijrobp.2017.06.2448] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/10/2017] [Accepted: 06/19/2017] [Indexed: 02/03/2023]
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