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Reeves F, Costello AJ. Is there a place for cytoreduction in metastatic prostate cancer? BJU Int 2015; 118:14-5. [PMID: 26384467 DOI: 10.1111/bju.13323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fairleigh Reeves
- Department of Urology and Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Anthony J Costello
- Department of Urology and Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Vic., Australia
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Arcangeli S, Zilli T, De Bari B, Alongi F. "Hit the primary": A paradigm shift in the treatment of metastatic prostate cancer? Crit Rev Oncol Hematol 2015; 97:231-7. [PMID: 26375435 DOI: 10.1016/j.critrevonc.2015.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 01/17/2023] Open
Abstract
Patients with metastatic prostate cancer (PC) represent a heterogeneous group with survival rates varying between 13 and 75 months. The current standard treatment in this setting is hormonal therapy, with or without docetaxel-based chemotherapy. In the era of individualized medicine, however, maximizing treatment options, especially in long-term surviving patients with limited disease burden, is of capital importance. Emerging data, mainly from retrospective surgical series, show survival benefits in men diagnosed with metastatic PC following definitive therapy for the prostate. Whether the irradiation of primary tumor in a metastatic disease might improve the therapeutic ratio in association with systemic treatments remains investigational. In this scenario, modern radiation therapy (RT) can play a significant role owing to its intrinsic capability to act as a more general immune response modifier, as well as to the potentially better toxicity profile compared to surgery. Preclinical data, clinical experience, and challenges in local treatment in de novo metastatic PC are reviewed and discussed.
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Affiliation(s)
- Stefano Arcangeli
- Radiation Oncology, San Camillo and Forlanini Hospital - Rome, Italy.
| | - Thomas Zilli
- Radiation Oncology Department, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) - Lausanne, Switzerland
| | - Filippo Alongi
- Radiation Oncology Department, Sacro Cuore - Don Calabria Hospital - Negrar, (Verona), Italy
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103
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Tosev G, Kuru TH, Huber J, Freier G, Bergmann F, Hassel JC, Pahernik SA, Hohenfellner M, Hadaschik BA. Primary melanoma of the prostate: case report and review of the literature. BMC Urol 2015; 15:68. [PMID: 26169921 PMCID: PMC4501120 DOI: 10.1186/s12894-015-0052-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/10/2015] [Indexed: 12/05/2022] Open
Abstract
Background Primary melanoma of the prostate has an extremely rare incidence. Only five cases have been reported in the literature and prognosis is poor. The most likely origin of prostatic melanoma is the transitional epithelium of the prostatic urethra. Surgical care for primary melanoma of mucosal sites is less well established than for primary cutaneous melanoma, but excision of the primary is recommended if the patient has no systemic disease. Case presentation Here, we describe a case of primary malignant melanoma of the prostate. A 37-year-old male patient with history of both chemo- and radiation therapy for Hodgkin’s disease was admitted to the University Hospital Heidelberg on suspicion of pleomorphic sarcoma of the bladder. In-house diagnostic work-up revealed a malignant melanoma of the prostate. We then performed radical prostatectomy with extended lymphadenectomy. Despite presumably curative surgery, the patient suffered from early relapse of disease with pulmonary metastasis. Systemic chemotherapy and subsequent immuno-oncologic treatment was thereafter initiated. Conclusion Since prostatic melanoma is a rare disease and a melanoma metastasis of unknown primary is the differential diagnosis, a multidisciplinary approach including early imaging to rule out possible metastases and to search for another potentially existing primary is advisable. To prevent complications related to local tumor progression and to receive tissue for mutational analysis, we recommend complete surgical resection to reduce the tumor mass. Novel immune and targeted oncologic therapies can lead to an improved survival in some cases and support of clinical trials is needed.
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Affiliation(s)
- Georgi Tosev
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Timur H Kuru
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Johannes Huber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Gerald Freier
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Frank Bergmann
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
| | - Jessica C Hassel
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | - Sascha A Pahernik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - Boris A Hadaschik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
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104
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Faria EF, Chapin BF, Muller RL, Machado RD, Reis RB, Matin SF. Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status. Urology 2015; 86:10-5. [DOI: 10.1016/j.urology.2015.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
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105
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Bossi A. Re: The Impact of Definitive Local Therapy for Lymph Node-positive Prostate Cancer: A Population-based Study. Eur Urol 2015; 68:161. [PMID: 26088730 DOI: 10.1016/j.eururo.2015.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France.
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106
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Zurita AJ, Pisters LL, Wang X, Troncoso P, Dieringer P, Ward JF, Davis JW, Pettaway CA, Logothetis CJ, Pagliaro LC. Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer. Prostate Cancer Prostatic Dis 2015; 18:276-80. [PMID: 26171883 DOI: 10.1038/pcan.2015.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/12/2015] [Accepted: 04/08/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival. METHODS Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml(-1) were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy. RESULTS Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5). CONCLUSIONS Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.
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Affiliation(s)
- A J Zurita
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - L L Pisters
- Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - X Wang
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - P Troncoso
- Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - P Dieringer
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - J F Ward
- Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - J W Davis
- Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - C A Pettaway
- Department of Urology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - C J Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - L C Pagliaro
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
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Bayne CE, Williams SB, Cooperberg MR, Gleave ME, Graefen M, Montorsi F, Novara G, Smaldone MC, Sooriakumaran P, Wiklund PN, Chapin BF. Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives. Eur Urol 2015; 69:775-87. [PMID: 26003223 DOI: 10.1016/j.eururo.2015.04.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Multimodal treatment for men with locally advanced prostate cancer (PCa) using neoadjuvant/adjuvant systemic therapy, surgery, and radiation therapy is being increasingly explored. There is also interest in the oncologic benefit of treating the primary tumor in the setting of metastatic PCa (mPCa). OBJECTIVE To perform a review of the literature regarding the treatment of the primary tumor in the setting of mPCa. EVIDENCE ACQUISITION Medline, PubMed, and Scopus electronic databases were queried for English language articles from January 1990 to September 2014. Prospective and retrospective studies were included. EVIDENCE SYNTHESIS There is no published randomized controlled trial (RCT) comparing local therapy and systemic therapy to systemic therapy alone in the treatment of mPCa. Prospective studies of men with locally advanced PCa and retrospective studies of occult node-positive PCa have consistently shown the addition of local therapy to a multimodal treatment regimen improves outcomes. Molecular and genomic evidence further suggests the primary tumor may have an active role in mPCa. CONCLUSIONS Treatment of the primary tumor in mPCa is being increasingly explored. While preclinical, translational, and retrospective evidence supports local therapy in advanced disease, further prospective studies are under way to evaluate this multimodal approach and identify the patients most likely to benefit from the inclusion of local therapy in the setting of metastatic disease. PATIENT SUMMARY In this review we explored preclinical and clinical evidence for treatment of the primary tumor in metastatic prostate cancer (mPCa). We found evidence to support clinical trials investigating mPCa therapy that includes local treatment of the primary tumor. Currently, treating the primary tumor in mPCa is controversial and lacks high-level evidence sufficient for routine recommendation.
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Affiliation(s)
- Christopher E Bayne
- Department of Urology, The George Washington University, Washington, DC, USA
| | - Stephen B Williams
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew R Cooperberg
- Departments of Urology and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Martin E Gleave
- The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Italy
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Prasanna Sooriakumaran
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Peter N Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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108
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Qin X, Han C, Zhang H, Dai B, Zhu Y, Shen Y, Zhu Y, Shi G, Ye D. Outcomes of patients with lymph node metastasis treated with radical prostatectomy and adjuvant androgen deprivation therapy in a Chinese population: results from a cohort study. World J Surg Oncol 2015; 13:172. [PMID: 25943443 PMCID: PMC4426650 DOI: 10.1186/s12957-015-0597-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/24/2015] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND The aim of this study is to assess the prognosis of prostate cancer (PCa) with lymph node metastases (LNM) detected in pelvic lymph node dissection (PLND) after radical prostatectomy (RP) and adjuvant androgen deprivation therapy (ADT) in a Chinese population. METHODS From June 2005 to September 2012, the medical histories of 67 Chinese PCa patients with LNM detected after RP and extended PLND were collected, and all these patients received continuous adjuvant ADT. Postoperative survival was estimated using the Kaplan-Meier method. The impact of various clinicopathological factors on outcome was analyzed using Cox proportional hazard regression models. All tests were two-sided with P < 0.05 considered significant. RESULTS Median follow-up was 46.7 months, and two patients were lost to follow-up. Five-year event-free survival for patients with positive lymph nodes was 93.0%, 83.0%, and 96.0% for local recurrence, systemic progression, and cancer death, respectively. One-year, 2-year, and 3-year biochemical recurrence (BCR)-free survival was 52%, 40%, and 22%, respectively. Postoperative BCR-free survival was 25.7 months. BCR-free survival for patients with a single LNM was longer than those with two or more LNM (median 39.1 months vs. median 17.2 months, P = 0.002). In a multivariate Cox model, only two or more LNM was a significant predictor of BCR (hazard ratio 2.6, P = 0.005). CONCLUSIONS Despite low BCR-free survival, Chinese patients with LNM can benefit from RP and adjuvant ADT. Patients with low nodal metastatic burden had a favorable prognosis.
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Affiliation(s)
- Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Chengtao Han
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
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Patrikidou A, Brureau L, Casenave J, Albiges L, Di Palma M, Patard JJ, Baumert H, Blanchard P, Bossi A, Kitikidou K, Massard C, Fizazi K, Blanchet P, Loriot Y. Locoregional symptoms in patients with de novo metastatic prostate cancer: Morbidity, management, and disease outcome. Urol Oncol 2015; 33:202.e9-17. [DOI: 10.1016/j.urolonc.2015.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/24/2015] [Accepted: 01/26/2015] [Indexed: 01/03/2023]
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110
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Stewart SB, Boorjian SA. Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol 2015; 33:235-44. [DOI: 10.1016/j.urolonc.2014.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/30/2014] [Accepted: 10/05/2014] [Indexed: 11/28/2022]
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111
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Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget 2015; 6:8491-524. [PMID: 25940699 PMCID: PMC4496163 DOI: 10.18632/oncotarget.3455] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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Affiliation(s)
- Diane K. Reyes
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Kenneth J. Pienta
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
- Departments of Pharmacology and Molecular Sciences, and Chemical and Biomolecular Engineering, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
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Words of wisdom. Re: Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumour? A SEER-based study. Eur Urol 2015; 67:972. [PMID: 25845957 DOI: 10.1016/j.eururo.2014.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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113
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114
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Harbin AC, Eun DD. The role of extended pelvic lymphadenectomy with radical prostatectomy for high-risk prostate cancer. Urol Oncol 2014; 33:208-16. [PMID: 25547974 DOI: 10.1016/j.urolonc.2014.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/22/2014] [Accepted: 11/20/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The role of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) for prostate cancer (PCa) is controversial. Despite extensive research in both patterns of lymphatic drainage and the clinical effect of lymph node involvement, the exact role of PLND in PCa is yet to be defined. METHODS A systematic search of the MEDLINE database was performed, and all relevant articles were reviewed in depth. RESULTS We included 84 relevant articles in our review and subdivided the information into the following categories: preoperative patient evaluation, procedure/extent of dissection, complications, and robotic surgery era. Most authors agree that the greatest benefit is seen in patients with high-risk PCa undergoing RP. Multiple imaging modalities have been evaluated for assistance in patient selection, but the use of preoperative nomograms appears to be the most helpful selection tool. The role of limited PLND vs. extended PLND (e-PLND) is yet to be defined, though many authors agree that e-PLND is preferred in the setting of high-risk PCa. Although PLND is associated with a higher incidence of complications, especially lymphocele formation, it is unclear whether e-PLND leads to more complications than limited PLND. The introduction of minimally invasive surgery may have had a negative effect on implementation of PLND in the appropriate patients undergoing RP. CONCLUSION Despite a lack of prospective, randomized trials evaluating PLND in RP, there does appear to be a consistent benefit in patients with high-risk disease.
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Affiliation(s)
- Andrew C Harbin
- Department of Urology, Temple University Hospital, Philadelphia, PA.
| | - Daniel D Eun
- Department of Urology, Temple University Hospital, Philadelphia, PA
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115
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Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients. Prostate Cancer Prostatic Dis 2014; 18:31-7. [PMID: 25535100 DOI: 10.1038/pcan.2014.41] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The value of radical prostatectomy (RP) as an approach for very high-risk prostate cancer (PCa) patients is controversial. To examine the risk of 10-year cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathological characteristics of very high-risk cT3b/4 PCa patients treated with RP as the primary treatment option. METHODS In a multi-institutional cohort, 266 patients with very high-risk cT3b/4 PCa treated with RP were identified. All patients underwent RP and pelvic lymph-node dissection. Competing-risk analyses assessed 10-year CSM and OCM before and after stratification for age and Charlson comorbidity index (CCI). RESULTS Overall, 34 (13%) patients died from PCa and 73 (28%) from OCM. Ten-year CSM and OCM rates ranged from 5.6% to 12.9% and from 10% to 38%, respectively. OCM was the leading cause of death in all subgroups. Age and comorbidities were the main determinants of OCM. In healthy men, CSM rate did not differ among age groups (10-year CSM rate for ⩽64, 65-69 and ⩾70 years: 16.2%, 11.5% and 17.1%, respectively). Men with a CCI ⩾1 showed a very low risk of CSM irrespective of age (10-year CSM: 5.6-6.1%), whereas the 10-year OCM rates increased with age up to 38% in men ⩾70 years. CONCLUSION Very high-risk cT3b/4 PCa represents a heterogeneous group. We revealed overall low CSM rates despite the highly unfavorable clinical disease. For healthy men, CSM was independent of age, supporting RP even for older men. Conversely, less healthy patients had the highest risk of dying from OCM while sharing very low risk of CSM, indicating that this group might not benefit from an aggressive surgical treatment. Outcome after RP as the primary treatment option in cT3b/4 PCa patients is related to age and comorbidity status.
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116
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Aoun F, Peltier A, van Velthoven R. A comprehensive review of contemporary role of local treatment of the primary tumor and/or the metastases in metastatic prostate cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:501213. [PMID: 25485280 PMCID: PMC4251412 DOI: 10.1155/2014/501213] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/09/2014] [Indexed: 01/09/2023]
Abstract
To provide an overview of the currently available literature regarding local control of primary tumor and oligometastases in metastatic prostate cancer and salvage lymph node dissection of clinical lymph node relapse after curative treatment of prostate cancer. Evidence Acquisition. A systematic literature search was conducted in 2014 to identify abstracts, original articles, review articles, research articles, and editorials relevant to the local control in metastatic prostate cancer. Evidence Synthesis. Local control of primary tumor in metastatic prostate cancer remains experimental with low level of evidence. The concept is supported by a growing body of genetic and molecular research as well as analogy with other cancers. There is only one retrospective observational population based study showing prolonged survival. To eradicate oligometastases, several options exist with excellent local control rates. Stereotactic body radiotherapy is safe, well tolerated, and efficacious treatment for lymph node and bone lesions. Both biochemical and clinical progression are slowed down with a median time to initiate ADT of 2 years. Salvage lymph node dissection is feasible in patients with clinical lymph node relapse after local curable treatment. Conclusion. Despite encouraging oncologic midterm results, a complete cure remains elusive in metastatic prostate cancer patients. Further advances in imaging are crucial in order to rapidly evolve beyond the proof of concept.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Roland van Velthoven
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
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117
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Gautam G. Is it truly outrageous to consider radical prostatectomy for men with metastatic prostate cancer? Indian J Urol 2014; 30:366-7. [PMID: 25378813 PMCID: PMC4220371 DOI: 10.4103/0970-1591.139593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Radical prostatectomy is a leading form of treatment for non metastatic prostate cancer. It has been shown to improve survival in the long term as well as delay or prevent the onset of metastatic disease. However, as the treatment of metastatic prostate cancer has evolved in the last few years with the introduction of newer agents, the possible role of ‘cytoreductive’ radical prostatectomy is now being explored. Preliminary evidence suggests that radical prostatectomy may have a future role in this clinical scenario with a potential to improve quality and quantity of life in selected patients with metastatic disease.
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Affiliation(s)
- Gagan Gautam
- Department of Urology, Medanta - The Medicity, Gurgaon, Haryana, India
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Kang HW, Lee JY, Kwon JK, Jeh SU, Jung HD, Choi YD. Current status of radical prostatectomy for high-risk prostate cancer. Korean J Urol 2014; 55:629-35. [PMID: 25324944 PMCID: PMC4198760 DOI: 10.4111/kju.2014.55.10.629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/16/2014] [Indexed: 01/17/2023] Open
Abstract
Despite the wide application of prostate-specific antigen-based screening leading to a profound stage migration in prostate cancer (PC), a significant percentage of men are still being diagnosed with clinically high-risk disease that requires aggressive treatment. Optimal management in these patients remains challenging, and strong advocates for radical prostatectomy (RP), radiotherapy, androgen deprivation therapy, and, increasingly, a multimodal approach abound. Currently, surgery for high-risk PC is frequently applied. RP offers an attractive opportunity for tumor excision either as a definitive management or as a first step in multimodal therapy. Nevertheless, this approach is still controversial. In this review, we discuss the current evidence for the role of RP in this clinical setting, including surgical considerations and outcomes. The role of robot-assisted RP, which is increasingly utilized in Korea in this clinical scenario, is discussed.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Uk Jeh
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Do Jung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. ; Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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119
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120
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Faiena I, Singer EA, Pumill C, Kim IY. Cytoreductive prostatectomy: evidence in support of a new surgical paradigm (Review). Int J Oncol 2014; 45:2193-8. [PMID: 25340386 PMCID: PMC4215584 DOI: 10.3892/ijo.2014.2656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/13/2014] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) remains the second ranked cause of cancer deaths in the United States. The current standard of care for metastatic prostate cancer (mPCa) includes systemic therapies with no option for surgery. In contrast, in other malignancies such as breast and kidney cancer, cyto-reduction plays an integral role in the treatment of metastatic disease. In this framework, there are emerging data that suggest a potential oncologic benefit to cytoreduction in mPCa. The majority of the data are retrospective in nature suggesting that patients with mPCa who had prior radical prostatectomy (RP) had a better survival, as well as improved response to systemic therapy. Similarly, patients who presented with metastatic disease and received definitive local therapy (RP or radiation) had greater survival than patients who received no treatment. In order to confer maximum potential benefit, operating in the setting of mPCa must be technically feasible with acceptable morbidity. It has been demonstrated in many studies that operating on locally advanced disease (T3a/b) does have similar morbidity as lower stage cancer. This may be applicable in the metastatic setting, because although PCa may have metastasized, it may remain locally advanced. On the molecular level there are a number of explanations concerning the potential benefit of cytoreduction. However, these ideas remain speculative with no concrete evidence to date.
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Affiliation(s)
- Izak Faiena
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Chris Pumill
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
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121
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Muck A, Langesberg C, Mugler M, Rahnenführer J, Wullich B, Schafhauser W. Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection. Urol Int 2014; 94:296-306. [DOI: 10.1159/000365011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022]
Abstract
Objective: This study sought to evaluate the clinical outcome after extended sentinel lymph node dissection (eSLND) and radical retropubic prostatectomy (RRP) in patients with clinically localized prostate cancer (PCa). Subjects and Methods: From August 2002 until February 2011, a total of 819 patients with clinically localized PCa, confirmed by biopsy, were treated with RRP plus eSLND. Biochemical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were assessed with Kaplan-Meier curves. Various histopathological parameters were analyzed by univariate and multivariate analysis. Results: The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup ‘micrometastases only'. Conclusion: Despite the presence of LN metastases, patients with a low nodal tumor burden demonstrate a remarkable clinical outcome after undergoing eSLND and RRP, thus suggesting a potential curative therapeutic approach.
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Stief C. Mere extension of the field of resection cannot be the answer to surgery for metastatic spread: we need individualized approaches based on modern imaging techniques. Eur Urol 2014; 67:220-1; discussion 221-2. [PMID: 25129853 DOI: 10.1016/j.eururo.2014.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Christian Stief
- Department of Urology, Ludwig-Maximilians-Universität München, München, Germany.
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123
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Allan CA, Collins VR, Frydenberg M, McLachlan RI, Matthiesson KL. Androgen deprivation therapy complications. Endocr Relat Cancer 2014; 21:T119-29. [PMID: 24872511 DOI: 10.1530/erc-13-0467] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Androgen deprivation therapy (ADT) is increasingly used to treat advanced prostate cancer and is also utilised as adjuvant or neo-adjuvant treatment for high-risk disease. The resulting suppression of endogenous testosterone production has deleterious effects on quality of life, including hot flushes, reduced mood and cognition and diminished sexual function. Cross-sectional and longitudinal studies show that ADT has adverse bone and cardio-metabolic effects. The rate of bone loss is accelerated, increasing the risk of osteoporosis and subsequent fracture. Fat mass is increased and lean mass reduced, and adverse effects on lipid levels and insulin resistance are observed, the latter increasing the risk of developing type 2 diabetes. ADT also appears to increase the risk of incident cardiovascular events, although whether it increases cardiovascular mortality is not certain from the observational evidence published to date. Until high-quality evidence is available to guide management, it is reasonable to consider men undergoing ADT to be at a higher risk of psychosexual dysfunction, osteoporotic fracture, diabetes and cardiovascular disease, especially when treated for extended periods of time and therefore subjected to profound and prolonged hypoandrogenism. Health professionals caring for men undergoing treatment for prostate cancer should be aware of the potential risks of ADT and ensure appropriate monitoring and clinical management.
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Affiliation(s)
- Carolyn A Allan
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Veronica R Collins
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Robert I McLachlan
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
| | - Kati L Matthiesson
- MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia
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Castelli T, Russo GI, Favilla V, Urzi D, Spitaleri F, Reale G, Giardina R, Saita A, Madonia M, Cimino S, Morgia G. Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study. Int Braz J Urol 2014; 40:322-9. [PMID: 25010298 DOI: 10.1590/s1677-5538.ibju.2014.03.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/05/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT). MATHERIALS AND METHODS 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse. RESULTS After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p < 0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference. CONCLUSIONS Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up.
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Affiliation(s)
| | | | | | - Daniele Urzi
- Department of Urology, University of Catania, Catania, Italy
| | - Fabio Spitaleri
- Department of Urology, University of Catania, Catania, Italy
| | - Giulio Reale
- Department of Urology, University of Catania, Catania, Italy
| | | | - Alberto Saita
- Department of Urology, University of Catania, Catania, Italy
| | - Massimo Madonia
- Department of Urology, University of Sassari, Sassari, Italy
| | | | - Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
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125
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Ghadjar P, Briganti A, De Visschere PJL, Fütterer JJ, Giannarini G, Isbarn H, Ost P, Sooriakumaran P, Surcel CI, van den Bergh RCN, van Oort IM, Yossepowitch O, Ploussard G. The oncologic role of local treatment in primary metastatic prostate cancer. World J Urol 2014; 33:755-61. [DOI: 10.1007/s00345-014-1347-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022] Open
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Abstract
Surgery remains a mainstay in the management of localized prostate cancer. This article addresses surgical aspects germane to the management of men with prostate cancer, including patient selection for surgery, nerve-sparing approaches, minimization of positive surgical margins, and indications for pelvic lymph node dissection. Outcomes for men with high-risk prostate cancer following surgery are reviewed, and the present role of neoadjuvant therapy before radical prostatectomy is discussed. In addition, there is a review of the published literature on surgical ablative therapies for prostate cancer.
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127
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Huber J, Groeben C, Wirth MP. [Removal of the primary tumor in hematogenous metastatic tumor disease: reasons against]. Urologe A 2014; 53:840-6. [PMID: 24841423 DOI: 10.1007/s00120-014-3548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.
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Affiliation(s)
- J Huber
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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128
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Chang AJ, Autio KA, Roach M, Scher HI. High-risk prostate cancer-classification and therapy. Nat Rev Clin Oncol 2014; 11:308-23. [PMID: 24840073 DOI: 10.1038/nrclinonc.2014.68] [Citation(s) in RCA: 296] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Approximately 15% of patients with prostate cancer are diagnosed with high-risk disease. However, the current definitions of high-risk prostate cancer include a heterogeneous group of patients with a range of prognoses. Some have the potential to progress to a lethal phenotype that can be fatal, while others can be cured with treatment of the primary tumour alone. The optimal management of this patient subgroup is evolving. A refined classification scheme is needed to enable the early and accurate identification of high-risk disease so that more-effective treatment paradigms can be developed. We discuss several principles established from clinical trials, and highlight other questions that remain unanswered. This Review critically evaluates the existing literature focused on defining the high-risk population, the management of patients with high-risk prostate cancer, and future directions to optimize care.
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Affiliation(s)
- Albert J Chang
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, CA 94115, USA
| | - Karen A Autio
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, CA 94115, USA
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA
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129
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Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D, Persad R, Koupparis A. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11:342-51. [DOI: 10.1038/nrurol.2014.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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130
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Rusthoven CG, Carlson JA, Waxweiler TV, Raben D, Dewitt PE, Crawford ED, Maroni PD, Kavanagh BD. The Impact of Definitive Local Therapy for Lymph Node-Positive Prostate Cancer: A Population-Based Study. Int J Radiat Oncol Biol Phys 2014; 88:1064-73. [DOI: 10.1016/j.ijrobp.2014.01.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/05/2014] [Accepted: 01/08/2014] [Indexed: 11/16/2022]
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131
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Richard V, Paillard MJ, Mouillet G, Lescut N, Maurina T, Guichard G, Montcuquet P, Martin L, Kleinclauss F, Thiery-Vuillemin A. [Neoadjuvant before surgery treatments: state of the art in prostate cancer]. Prog Urol 2014; 24:595-607. [PMID: 24975795 DOI: 10.1016/j.purol.2014.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 11/28/2013] [Accepted: 02/18/2014] [Indexed: 11/25/2022]
Abstract
GOAL To study the impact of systemic treatment in neoadjuvant strategy before surgery in prostate cancer. MATERIALS Literature reviews with data analysis from PubMed search using the keywords "neoadjuvant", "chemotherapy", "hormonal therapy", "prostate surgery", "radical prostatectomy", but also reports from ASCO and ESMO conferences. The articles on neoadjuvant treatment before radiotherapy were excluded. RESULTS First studies with former therapy are more than 15-years-old and with questionable methodology: lack of power to have a clear idea of the impact on survival criteria such as overall survival or relapse-free survival. However, the impact of neoadjuvant hormone therapy on the classic risk factors for relapse (positive margins, intraprostatic disease, positive lymph nodes) was demonstrated by these studies and a Cochrane meta-analysis. The association with hormone therapy seems mandatory in comparison to treatment based solely on chemotherapy and/or targeted therapy. Promising data on the use of new drugs and their combinations arise: abiraterone acetate combined with LHRH analogue showed a fast PSA decrease and higher rates of pathologic complete response. Other results are promising with hormonal blockages at various key points. CONCLUSION Studies with 2nd generation anti-androgene agents or enzyme inhibitors seem to show very promising results. To provide answers about the effectiveness of current neoadjuvant strategy in terms of survival, other studies are needed: randomized phase III or phase II exploring predictive biomarkers. The design of such trials requires a multidisciplinary approach with urologists, oncologists, radiologists and methodologists.
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Affiliation(s)
- V Richard
- Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France
| | - M-J Paillard
- Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France
| | - G Mouillet
- Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France
| | - N Lescut
- Service de radiothérapie, CHU de Besançon, 25030 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France
| | - T Maurina
- Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France
| | - G Guichard
- Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France
| | - P Montcuquet
- Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France
| | - L Martin
- Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France
| | - F Kleinclauss
- Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France
| | - A Thiery-Vuillemin
- Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France.
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132
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Tosco L, Van Poppel H. Prostate cancer: The role of local therapy for metastatic prostate cancer. Nat Rev Urol 2014; 11:134-5. [PMID: 24567085 DOI: 10.1038/nrurol.2014.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lorenzo Tosco
- University Hospitals Leuven, Urology, Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
| | - Hendrik Van Poppel
- University Hospitals Leuven, Urology, Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
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133
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Extended salvage pelvic lymph node dissection in patients with recurrent prostate cancer. Adv Urol 2014; 2014:321619. [PMID: 24688536 PMCID: PMC3945023 DOI: 10.1155/2014/321619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Treatment of patients with a biochemical recurrence (BCR) of prostate cancer (PCa) is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients. Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of 40.3 ± 20.8 months. Group 1 (n = 10): salvage radical prostatectomy (sRP) with SePLND (salvage extended pelvic lymph nodes dissection) (initial treatment: combined brachytherapy). Group 2 (n = 22): SePLND (initial treatment: radical prostatectomy (RP)). Group 3 (n = 9): SePLND (initial treatment: RP and adjuvant radiation therapy (RT)). We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response). Results. Group 1: 60% with BCR-freedom (mean 27.2 months). Group 2: 63.6% with BCR-freedom (mean 17.5 months). Group 3: 33.3% with BCR-freedom (mean 17.6 months). In total, BCR-freedom was observed in 23 of 41 patients (56.1%) after salvage surgery. 75.6% of all patients showed a BR. 765 LNs were removed and 14.8% of these were LN+. Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output.
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134
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Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation. Case Rep Urol 2014; 2014:218628. [PMID: 24600526 PMCID: PMC3926244 DOI: 10.1155/2014/218628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Mucinous adenocarcinoma of the prostate is a rare variant of prostate cancer. Its malignant potential and the clinical course of the affected patients remain, by and large, controversial. No data exist about the course of metastatic mucinous adenocarcinoma of the prostate. Case Presentation. This case report describes the excellent clinical course of a 68-year-old patient with metastatic mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, irradiation, and androgen deprivation. Conclusion. In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer. Its malignant potential is dependent on its Gleason score.
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Abstract
PURPOSE OF REVIEW Surgery for high-risk prostate cancer (PCa) is applied frequently nowadays. Nevertheless, this approach is still surrounded by many controversies. The present review discusses the most recent literature regarding surgery for high-risk PCa. RECENT FINDINGS As there is no standard definition of high-risk PCa, outcome comparison between series and treatment approaches is hampered. Nevertheless, recent radical prostatectomy series have shown excellent cancer-specific survival in patients with high-risk PCa. Even for very-high-risk PCa (cT3b-T4 or any cT, N1), surgery may be applied to highly selected patients as a first step of a multimodality approach. Recent experience with robot-assisted surgery opens new possibilities for a minimally invasive approach in this field.Patient selection for surgery was also addressed in recent studies. Excellent cancer-specific survival is seen when specimen-confined PCa is found at final histopathology; a recently published nomogram enables the prediction of specimen-confined disease. Another issue in high-risk PCa is the impact of age and comorbidities on cancer-specific and overall mortality. In a recent study, it was shown that patients with low comorbidity scores, even when at least 70 years old, had a significant risk of dying from their cancer and may benefit most from a surgical approach. A modified extended pelvic lymphadenectomy template was presented, providing optimal removal of positive lymph nodes. SUMMARY Radical prostatectomy with extended pelvic lymphadenectomy delivers very good cancer-related outcomes in high-risk and very-high-risk PCa, often within a multimodal approach. Minimally invasive surgery and improved patient selection will be key to further improve oncological and functional outcomes.
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Culp SH, Schellhammer PF, Williams MB. Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. Eur Urol 2013; 65:1058-66. [PMID: 24290503 DOI: 10.1016/j.eururo.2013.11.012] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/08/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few data exist regarding the impact on survival of definitive treatment of the prostate in men diagnosed with metastatic prostate cancer (mPCa). OBJECTIVE To evaluate the survival of men diagnosed with mPCa based on definitive treatment of the prostate. DESIGN, SETTING, AND PARTICIPANTS Men with documented stage IV (M1a-c) PCa at diagnosis identified using Surveillance Epidemiology and End Results (SEER) (2004-2010) and divided based on definitive treatment of the prostate (radical prostatectomy [RP] or brachytherapy [BT]) or no surgery or radiation therapy (NSR). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier methods were used to calculate overall survival (OS). Multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and identify factors associated with cause-specific mortality (CSM). RESULTS AND LIMITATIONS A total of 8185 patients were identified: NSR (n=7811), RP (n=245), and BT (n=129). The 5-yr OS and predicted DSS were each significantly higher in patients undergoing RP (67.4% and 75.8%, respectively) or BT (52.6 and 61.3%, respectively) compared with NSR patients (22.5% and 48.7%, respectively) (p<0.001). Undergoing RP or BT was each independently associated with decreased CSM (p<0.01). Similar results were noted regardless of the American Joint Committee on Cancer (AJCC) M stage. Factors associated with increased CSM in patients undergoing local therapy included AJCC T4 stage, high-grade disease, prostate-specific antigen ≥20 ng/ml, age ≥70 yr, and pelvic lymphadenopathy (p<0.05). The major limitation of this study was the lack of variables from SEER known to influence survival of patients with mPCa, including treatment with systemic therapy. CONCLUSIONS Definitive treatment of the prostate in men diagnosed with mPCa suggests a survival benefit in this large population-based study. These results should serve as a foundation for future prospective trials. PATIENT SUMMARY We used a large population-based cancer database to examine survival in men diagnosed with metastatic prostate cancer (mPCa) undergoing definitive therapy for the prostate. Local therapy (LT) appeared to confer a survival benefit. Therefore, we conclude that prospective trials are needed to further evaluate the role of LT in mPCa.
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Affiliation(s)
- Stephen H Culp
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | | | - Michael B Williams
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
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Rasmusson E, Gunnlaugsson A, Blom R, Björk-Eriksson T, Nilsson P, Ahlgen G, Jönsson C, Johansson K, Kjellén E. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer. Radiat Oncol 2013; 8:271. [PMID: 24252686 PMCID: PMC3842657 DOI: 10.1186/1748-717x-8-271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 11/13/2013] [Indexed: 12/25/2022] Open
Abstract
Background The aim of the present study was to evaluate the prevalence and severity of lower limb lymphedema after pelvic lymphadenectomy and radiotherapy to the pelvic lymph nodes in patients with prostate cancer. Methods Twenty-six patients underwent combined treatment for high-risk node-positive prostate cancer at Skåne University Hospital between April 2008 and March 2011. The treatment consisted of extended pelvic lymphadenectomy followed by androgen deprivation therapy and radiotherapy. The pelvic lymphnodes, prostate and seminal vesicles were treated with external beam radiotherapy (EBRT) to an absorbed dose of 50 Gy followed by a brachytherapy (BT) boost of 2x10 Gy to the prostate only. Twenty-two patients accepted an invitation to a clinical examination with focus on lower limb swelling. The median time between the end of radiotherapy and examination was 2.2 years (range 1.2–4.1). Results Six patients (27%) experienced grade 1 lymphedema and two patients (9%) grade 2 while none had grade 3 or 4 according to the CTC Common Toxicity Criteria scale 4.0. Three patients required treatment with compression stockings. Conclusion Brachytherapy and pelvic EBRT have a low incidence of lymphedema (at median 2.2 y after treatment) in patients with high-risk node-positive prostate cancer that have undergone pelvic lymph node dissection.
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138
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Van Praet C, Ost P, Lumen N, De Meerleer G, Vandecasteele K, Villeirs G, Decaestecker K, Fonteyne V. Postoperative high-dose pelvic radiotherapy for N+ prostate cancer: Toxicity and matched case comparison with postoperative prostate bed-only radiotherapy. Radiother Oncol 2013; 109:222-8. [DOI: 10.1016/j.radonc.2013.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022]
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Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2013; 65:124-37. [PMID: 24207135 DOI: 10.1016/j.eururo.2013.09.046] [Citation(s) in RCA: 1385] [Impact Index Per Article: 125.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 09/26/2013] [Indexed: 12/18/2022]
Abstract
CONTEXT The most recent summary of the European Association of Urology (EAU) guidelines on prostate cancer (PCa) was published in 2011. OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined PCa. EVIDENCE ACQUISITION A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group. The guidelines have been updated, and levels of evidence and grades of recommendation have been added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. EVIDENCE SYNTHESIS A full version of the guidelines is available at the EAU office or online (www.uroweb.org). Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa. Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method. Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy. A biopsy progression indicates the need for active intervention, whereas the role of PSA doubling time is controversial. In men with locally advanced PCa for whom local therapy is not mandatory, watchful waiting (WW) is a treatment alternative to androgen-deprivation therapy (ADT), with equivalent oncologic efficacy. Active treatment is recommended mostly for patients with localized disease and a long life expectancy, with radical prostatectomy (RP) shown to be superior to WW in prospective randomized trials. Nerve-sparing RP is the approach of choice in organ-confined disease, while neoadjuvant ADT provides no improvement in outcome variables. Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa. For locally advanced disease, adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice. Follow-up after local therapy is largely based on PSA and a disease-specific history, with imaging indicated only when symptoms occur. CONCLUSIONS Knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice. PATIENT SUMMARY A summary is presented of the 2013 EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined prostate cancer (PCa). Screening continues to be done on an individual basis, in consultation with a physician. Diagnosis is by prostate biopsy. Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to androgen-deprivation therapy in locally advanced PCa not requiring immediate local treatment. Radical prostatectomy is the only surgical option. Radiation therapy can be external or delivered by way of prostate implants. Treatment follow-up is based on the PSA level.
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140
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Park J, Yoo DS, Song C, Park S, Park S, Kim SC, Cho Y, Ahn H. Comparison of oncological outcomes between retropubic radical prostatectomy and robot-assisted radical prostatectomy: an analysis stratified by surgical experience. World J Urol 2013; 32:193-9. [PMID: 24062092 DOI: 10.1007/s00345-013-1168-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare oncological outcomes of a consecutive retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) series performed by a single surgeon who had performed >750 prior RRPs and was starting to perform RARPs. MATERIALS AND METHODS Prospectively collected longitudinal data of 277 RRP and 730 RARP cases over a 5-year period were retrospectively analyzed. The RARP series were divided into 3 subgroups (1st, <250 cases; 2nd, 250-500; and 3rd, >500) according to the surgical period. The positive surgical margin (PSM) and biochemical recurrence-free survival (BCRFS) rates were compared at each pathological stage. RESULTS The pT2 PSM rates showed no significant difference between the RRP (7.8%) and RARP series (1st, 9.5%; 2nd, 14.1%; and 3rd, 9.8%) throughout the study period (P = 0.689, 0.079, and 0.688, respectively). Although the pT3 PSM rates of the 1st (50.6%) and 2nd RARP series (50.0%) were higher than that of the RRP series (36.0%; P = 0.044 and P = 0.069, respectively), the 3rd RARP series had a comparable pT3 PSM rate (32.4%, P = 0.641). The 3-year BCRFS rates of the RRP and RARP series were similar at each pathological stage (pT2, 92.1 vs. 96.8%, P = 0.517; pT3, 60.0 vs. 67.3%, P = 0.265, respectively). CONCLUSIONS The pT2 PSM and short-term BCRFS rates were similar between RRP and RARP, and RARP showed comparable pT3 PSM rate with RRP after >500 cases of surgical experience. Our data suggest that an experienced robotic surgeon at a high-volume center may achieve comparable oncological outcomes with open prostatectomy even in locally advanced disease.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University, Daejeon, Korea
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Sridharan S, Dal Pra A, Catton C, Bristow R, Warde P. Locally Advanced Prostate Cancer: Current Controversies and Optimisation Opportunities. Clin Oncol (R Coll Radiol) 2013; 25:499-505. [DOI: 10.1016/j.clon.2013.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 01/08/2023]
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[Outcome after radical prostatectomy with extended pelvic lymphadenectomy for untreated high-risk clinically localized prostate cancer]. Nihon Hinyokika Gakkai Zasshi 2013; 104:496-504. [PMID: 23819361 DOI: 10.5980/jpnjurol.104.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE We assessed the outcome after radical prostatectomy and extended pelvic lymphadenectomy in patients with untreated high-risk clinically localized prostate cancer, retrospectively. MATERIALS AND METHODS Between 2001 and 2010, 89 patients for untreated high-risk clinically localized prostate cancer on the risk classification as defined by D'Amico, underwent retropubic radical prostatectomy and extended pelvic lymphadenectomy. Boundaries of the pelvic lymph node dissection field divided into external iliac vessels, obturator fossa, and internal iliac vessels. We investigated mainly the postoperative outcome of 84 patients without any adjuvant therapies. PSA recurrence-free survival among the pretreatment variables was estimated using Kaplan-Meier plots, and the statistical significance was determined by log rank test. RESULTS In 89 high-risk patients, 32.7% had pT3-pT4 tumors, 16.9% positive surgical margin, 6.7% positive lymph node metastases and 30.3% Gleason score 8-10 at the pathological examination. A median of 13 nodes (mean 14.0, range 9-25 nodes) were removed per patient. In 96.6% cases, postoperative PSA values decreased less than 0.2 ng/ml. The median observation period after operation was 1,819 days. Median PSA recurrence-free survival rates, overall survival and cancer cause-specific survival rates at 5 year, in 84 high-risk patients without any adjuvant therapies, were 73.8%, 100% and 100%, respectively. Median PSA recurrence-free survival rates according to pathological T stage and surgical margin status were statistically significant, but that according to preoperative 3 factors (clinical T stage, Gleason score at biopsy, preoperative PSA values) were statistically insignificant. Moreover, that according to both the number of positive preoperative 3 factors (1 vs. 2 positive factors) and the number of removed lymph nodes (< or =13 vs. > or = 14), were statistically insignificant. The median PSA recurrence-free survival rates at 5 year for positive margin cases were 0%. CONCLUSION Radical prostatectomy and extended pelvic lymphadenectomy is feasible in patients with high-risk clinically localized prostate cancer. We suggest that both wide resection and extended pelvic lymphadenectomy may improve the postoperative outcome for high-risk clinically localized prostate cancer.
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143
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Gakis G, Boorjian SA, Briganti A, Joniau S, Karazanashvili G, Karnes RJ, Mattei A, Shariat SF, Stenzl A, Wirth M, Stief CG. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol 2013; 66:191-9. [PMID: 23735200 DOI: 10.1016/j.eururo.2013.05.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
CONTEXT Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. OBJECTIVE To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach using local radiotherapy and/or androgen-deprivation therapy (ADT), in LN-positive PCa. EVIDENCE ACQUISITION A systematic Medline search for studies reporting on treatment regimens and outcomes in patients with LN-positive PCa undergoing RP between 1993 and 2012 was performed. EVIDENCE SYNTHESIS RP can improve progression-free and overall survival in LN-positive PCa, although there is a lack of high-level evidence. Therefore, the former practice of aborting surgery in the presence of positive nodes might no longer be supported by current evidence, especially in those patients with a limited LN tumor burden. Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum, in which the internal and the common iliac nodes represent critical landmarks in the metastatic distribution. Sophisticated imaging technologies are still under investigation to improve the prediction of LN-positive PCa. Nonetheless, extended PLND including the common iliac arteries should be offered to intermediate- and high-risk patients to improve nodal staging with a possible benefit in prostate-specific antigen progression-free survival by removing significant metastatic load. Adjuvant ADT has the potential to improve overall survival after RP; the therapeutic role of a trimodal approach with adjuvant local radiotherapy awaits further elucidation. Age is a critical parameter for survival because cancer-specific mortality exceeds overall mortality in younger patients (<60 yr) with high-risk PCa and should be an impetus to treat as thoroughly as possible. CONCLUSIONS Increasing evidence suggests that RP and extended PLND improve survival in LN-positive PCa. Our understanding of surgery of the primary tumor in LN-positive PCa needs a conceptual change from a palliative option to the first step in a multimodal approach with a significant improvement of long-term survival and cure in selected patients.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany.
| | | | - Alberto Briganti
- Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium
| | | | | | - Agostino Mattei
- Department of Urology, Kantonsspital Lucerne, Lucerne, Switzerland
| | | | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich-Grosshadern, Germany
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Results of hormone therapy as first-line treatment for high-risk prostate cancer. Curr Opin Urol 2013; 23:355-9. [PMID: 23665742 DOI: 10.1097/mou.0b013e328361f503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To assess the current place for androgen deprivation therapy as single modality in locally advanced nonmetastatic situations. RECENT FINDINGS One standard of care for node negative locally advanced disease is a combination of external beam with androgen deprivation treatment. Several recent randomized trials have confirmed the key role of a local treatment combined to a systemic one in terms of specific and overall survival. The specific morbidity of this combined modality appears to be minimal. Retrospective data also suggest that a local treatment should be considered in case of positive nodes. Finally, the real place of immediate single hormonal treatment has also been clarified. The limited survival benefit has to be balanced with the side-effects. Therefore, this single modality should be limited to the most aggressive situations when no local treatment is planned. SUMMARY Single hormonal treatment for nonmetastatic advanced prostate cancer appears to be limited to the few patients unfit or unwilling for a local treatment and having a high prostate-specific antigen and a short prostate-specific antigen doubling time. In all other situations, it might represent a clear undertreatment.
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Horwich A, Hugosson J, de Reijke T, Wiegel T, Fizazi K, Kataja V, Parker C, Bellmunt J, Berthold D, Bill-Axelson A, Carlsson S, Daugaard G, De Meerleer G, de Reijke T, Dearnaley D, Fizazi K, Fonteyne V, Gillessen S, Heinrich D, Horwich A, Hugosson J, Kataja V, Kwiatkowski M, Nilsson S, Padhani A, Papandreou C, Parker C, Roobol M, Sella A, Valdagni R, Van der Kwast T, Verhagen P, Wiegel T. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013; 24:1141-62. [DOI: 10.1093/annonc/mds624] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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146
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Ischia J, Gleave M. Radical prostatectomy in high-risk prostate cancer. Int J Urol 2013; 20:290-300. [DOI: 10.1111/iju.12069] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph Ischia
- Vancouver Prostate Centre; Vancouver General Hospital; Vancouver; British Columbia; Canada
| | - Martin Gleave
- Vancouver Prostate Centre; Vancouver General Hospital; Vancouver; British Columbia; Canada
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147
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Png KS, Koch MO. Technique of pelvic lymphadenectomy after robot-assisted laparoscopic prostatectomy for prostate cancer. J Endourol 2012; 26:1600-4. [PMID: 23075403 DOI: 10.1089/end.2012.0375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pelvic lymphadenectomy for prostate cancer is an important tool in the prognostication of the disease in selected patients who are at risk of occult lymph node metastases. This procedure, usually performed in conjunction with radical prostatectomy, had progressed successfully from an open approach to the current robot-assisted approach. The following article and accompanying video describe the surgical technique of robot-assisted pelvic lymphadenectomy for prostate cancer. We also discuss the indications, patient selection, preparation, complications, and tips to avoid the major pitfalls in the procedure.
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Affiliation(s)
- Keng-Siang Png
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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148
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Kreydin EI, Ko DSC. Immediate renal transplantation after radical prostatectomy for low-risk prostate cancer. Clin Transplant 2012; 27:162-7. [DOI: 10.1111/ctr.12023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 11/28/2022]
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149
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Bertz S, Schmitz-Dräger BJ, Protzel C, Hartmann A. [Intraoperative frozen section diagnosis of the genitourinary tract]. DER PATHOLOGE 2012; 33:441-9. [PMID: 22892659 DOI: 10.1007/s00292-012-1600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Up to now intraoperative frozen section, diagnosis has been of limited utility in urologic oncology. In the future, it may become more important due to a significant increase in the number of nerve-sparing operations performed for prostate cancer. Accuracy and benefit of intraoperative frozen sections depend both on a good communication between surgeons and pathologists as well as on a strict assessment of the need for surgery in the individual patient. In order to optimize cost-efficiency and to reduce the associated risks the indications for intraoperative frozen sections must be rigorously appraised. This report outlines clinically relevant indications for intraoperative frozen section diagnosis in tumors of the urinary tract, kidneys, prostate, testis and penis according to the most recent guidelines. The diagnostic scope and problems of this method are also discussed.
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Affiliation(s)
- S Bertz
- Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland
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Addition of Radiotherapy to Long-Term Androgen Deprivation in Locally Advanced Prostate Cancer: An Open Randomised Phase 3 Trial. Eur Urol 2012; 62:213-9. [DOI: 10.1016/j.eururo.2012.03.053] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/23/2012] [Indexed: 11/20/2022]
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