1551
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Dutta SW, Alonso CE, Libby B, Showalter TN. Prostate cancer high dose-rate brachytherapy: review of evidence and current perspectives. Expert Rev Med Devices 2017; 15:71-79. [PMID: 29251165 DOI: 10.1080/17434440.2018.1419058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients with intermediate to high risk disease (prostate specific antigen (PSA) ≥ 10, Gleason score ≥ 7, or clinical stage ≥ T2b) suffer from poorer long-term biochemical control (freedom from an increasing prostate specific antigen level) when treated with external beam radiation (EBRT) alone. In order to improve biochemical control while limiting long-term complications, brachytherapy has been incorporated into radiotherapy treatment, either alone or in combination with EBRT. AREAS COVERED Current literature regarding the use of high dose-rate (HDR) brachytherapy for localized prostate cancer, including as a boost and monotherapy. The efficacy and toxicities of various approaches are evaluated including comparisons to low dose-rate (LDR) brachytherapy. EXPERT COMMENTARY Prostate HDR brachytherapy has higher conformality than EBRT, potentially improving the therapeutic ratio by allowing higher doses per fraction to tumor cells. The improved biochemical control shown in trials have resulted in EBRT plus brachytherapy to be included as a standard treatment option supported by the NCCN and ASCO guidance documents for intermediate to high risk prostate cancer.
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Affiliation(s)
- Sunil W Dutta
- a Department of Radiation Oncology , University of Virginia School of Medicine , Charlottesville , VA , USA
| | - Clayton E Alonso
- a Department of Radiation Oncology , University of Virginia School of Medicine , Charlottesville , VA , USA
| | - Bruce Libby
- a Department of Radiation Oncology , University of Virginia School of Medicine , Charlottesville , VA , USA
| | - Timothy N Showalter
- a Department of Radiation Oncology , University of Virginia School of Medicine , Charlottesville , VA , USA
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1552
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Tinay I, Aslan G, Kural A, Özen H, Akdoğan B, Yıldırım A, Ongün Ş, Özkan A, Esen T, Zorlu F, Dillioğlugil Ö, Bekiroglu N, Türkeri L. Pathologic Outcomes of Candidates for Active Surveillance Undergoing Radical Prostatectomy: Results from a Contemporary Turkish Patient Cohort. Urol Int 2017; 100:43-49. [DOI: 10.1159/000481266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022]
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1553
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Intasqui P, Bertolla RP, Sadi MV. Prostate cancer proteomics: clinically useful protein biomarkers and future perspectives. Expert Rev Proteomics 2017; 15:65-79. [PMID: 29251021 DOI: 10.1080/14789450.2018.1417846] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Although prostate cancer constitutes one of the most important, death-related diseases in the male population, there is still a need for identification of sensitive biomarkers that could precociously detect the disease and differentiate aggressive from indolent cancers, in order to decrease overtreatment. Proteomics research has improved understanding on mechanisms underlying tumorigenesis, cancer cells migration and invasion potential, and castration resistance. This review has focused on proteomic studies of prostate cancer published in the recent years, with a special emphasis on determination of biomarkers for cancer progression and diagnosis. Areas covered: Shotgun and targeted-proteomic studies of prostate cancer in different matrices are reviewed, i.e., prostate tissue, prostate cell lines, blood (serum and plasma), urine, seminal plasma, and exosomes. The most important biomarkers for cancer diagnosis and aggressiveness characterization are highlighted. Expert commentary: In general, results demonstrate alteration in cell cycle control, DNA repair, proteasomal degradation, and metabolic activity. However, these studies suffer from low reproducibility due to heterogeneity of the cancer itself, as well as to techniques utilized for protein identification/quantification. Downstream confirmatory studies in separate cohorts are warranted in order to demonstrate accuracy of these results.
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Affiliation(s)
- Paula Intasqui
- a Department of Surgery, Division of Urology, Human Reproduction Section , Universidade Federal de São Paulo (UNIFESP) - Sao Paulo Hospital , Sao Paulo , Brazil
| | - Ricardo P Bertolla
- a Department of Surgery, Division of Urology, Human Reproduction Section , Universidade Federal de São Paulo (UNIFESP) - Sao Paulo Hospital , Sao Paulo , Brazil
| | - Marcus Vinicius Sadi
- a Department of Surgery, Division of Urology, Human Reproduction Section , Universidade Federal de São Paulo (UNIFESP) - Sao Paulo Hospital , Sao Paulo , Brazil
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1554
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Handy CE, Antonarakis ES. Sipuleucel-T for the treatment of prostate cancer: novel insights and future directions. Future Oncol 2017; 14:907-917. [PMID: 29260582 DOI: 10.2217/fon-2017-0531] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Sipuleucel-T, an autologous cellular immunotherapy manufactured from antigen-presenting cells primed to recognize prostatic acid phosphatase, was the first immunotherapy product approved by the US FDA. It was approved for men with asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer after it was shown to provide a survival advantage. Additional studies have examined its use in other clinical settings and in combination with other approved and investigational immunotherapy agents. This review will discuss the pivotal trials leading to approval, will outline some of the biomarkers associated with its efficacy and will review some of the ongoing combination strategies. Maximizing the efficacy of sipuleucel-T through better patient selection or through combination approaches remains the challenge of the future.
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1555
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Thompson JE, Egger S, Böhm M, Siriwardana AR, Haynes AM, Matthews J, Scheltema MJ, Stricker PD. Superior Biochemical Recurrence and Long-term Quality-of-life Outcomes Are Achievable with Robotic Radical Prostatectomy After a Long Learning Curve-Updated Analysis of a Prospective Single-surgeon Cohort of 2206 Consecutive Cases. Eur Urol 2017; 73:664-671. [PMID: 29273404 DOI: 10.1016/j.eururo.2017.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our earlier analysis suggested that robot-assisted radical prostatectomy (RARP) achieved superiority over open radical prostatectomy (ORP) in terms of positive surgical margin (PSM) rates and functional outcomes. OBJECTIVE With larger sample size and longer follow-up, the objective of this study update is to assess whether our previous findings are upheld and whether the improved PSM rates for RARP after an initial learning curve compared with ORP-as observed in our earlier analysis-ultimately resulted in improved biochemical control. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study comparing two surgical techniques; 2271 consecutive men underwent RARP (1520) or ORP (751) at a single centre from 2006 to 2016. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Demographic and clinicopathological data were prospectively collected. The EPIC-QOL questionnaire was administered at baseline and 1.5, 3, 6, 12, and 24 mo. Multivariate linear regression modelled the difference in quality of life (QOL) domains against case number; logistic and Cox regression modelled the differences in PSM and biochemical recurrence (BCR) hazard ratios (HR), respectively. RESULTS AND LIMITATIONS A total of 2206 men were included in BCR/PSM analysis and 1045 consented for QOL analysis. Superior pT2 surgical margins, early and late sexual outcomes, and early urinary outcomes were upheld and became more robust (narrowing of 95% confidence intervals [CIs]). The risk of BCR was initially higher for RARP, improved after 191 RARPs, and was 35% lower (hazard ratio [HR] 0.65, 95% CI 0.47-0.90) at final RARP, plateauing after 226 RARPs. Improved late (12-24 mo) urinary bother scores (adjusted mean difference [AMD]=4.7, 95% CI 1.3-8.0) and irritative-obstructive scores (AMD=3.8, 95% CI 0.9-5.6) at final RARP were demonstrated. Limitations include observational single surgeon data, possible residual confounding, and short follow-up. CONCLUSIONS The results from this updated analysis demonstrate that RARP can be beneficial for patients of high-volume surgeons, although more randomised studies and studies with survival outcomes are needed. PATIENT SUMMARY Robot-assisted radical prostatectomy was able to improve functional and oncological outcomes in this single surgeon's learning curve.
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Affiliation(s)
- James E Thompson
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; The University of New South Wales, Kensington, NSW, Australia.
| | - Sam Egger
- Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Amila R Siriwardana
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Jayne Matthews
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Matthijs J Scheltema
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Academic Medical Center, Amsterdam, The Netherlands
| | - Phillip D Stricker
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; The University of New South Wales, Kensington, NSW, Australia
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1556
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Markovina S, Meeks MW, Badiyan S, Vetter J, Gay HA, Paradis A, Michalski J, Sandhu G. Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis. Adv Radiat Oncol 2017; 3:190-196. [PMID: 29904744 PMCID: PMC6000029 DOI: 10.1016/j.adro.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/18/2017] [Accepted: 12/06/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose For high-risk prostate cancer (HR-PCa) in men with a life expectancy of at least 10 years, the National Comprehensive Cancer Network recommends radiation therapy (RT) plus androgen deprivation therapy (ADT) with category 1 evidence or radical prostatectomy (RP) as an acceptable initial therapy. Randomized evidence regarding which therapy is optimal for disease control is lacking for men with HR-PCa. We performed a propensity-score-matched comparison of outcomes for men with localized HR-PCa treated with primary RT or RP. Methods and materials The medical records of patients with localized HR-PCa who were treated at our institution between 2002 and 2011 were reviewed. Patient and disease characteristics, treatment details, and outcomes were collected. A combination of nearest-neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 comorbidity index, prostate-specific antigen, biopsy Gleason scores, and clinical T-stage as well as exact matching on prostate-specific antigen, biopsy Gleason scores, and clinical T-stage was performed. Outcomes were measured from diagnosis. Multivariate Cox proportional hazards regression was used to compare metastasis-free and overall survival. Results A total of 246 patients were identified with 62 propensity-score-matched pairs. ADT was administered to 6.5% and 80.6% of patients receiving RP and RT, respectively. Five-year rates of metastasis for RP and RT were 33% and 8.9%, respectively (P = .003). Overall survival was not different. Delay of salvage therapy was longer for patients undergoing primary RT (P < .001). Findings were similar when only those patients who did not receive ADT were compared. Conclusions At our institution, treatment with primary RT resulted in superior metastasis-free survival over RP. This was not accompanied by an improvement in OS.
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Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Marshall W Meeks
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joel Vetter
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Alethea Paradis
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Gurdarshan Sandhu
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
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1557
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Albertsen PC. Prostate cancer screening with prostate-specific antigen: Where are we going? Cancer 2017; 124:453-455. [PMID: 29231972 DOI: 10.1002/cncr.31140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/08/2017] [Accepted: 10/20/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Peter C Albertsen
- Department of Surgery (Urology), University of Connecticut Health Center, Farmington, Connecticut
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1558
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Drummond FJ, Gavin AT, Sharp L. Incongruence in treatment decision making is associated with lower health-related quality of life among prostate cancer survivors: results from the PiCTure study. Support Care Cancer 2017; 26:1645-1654. [PMID: 29222597 DOI: 10.1007/s00520-017-3994-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/21/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE We investigated associations between treatment decision making (TDM) and global health-related-quality-of-life (gHRQoL) among prostate cancer (PCa) survivors. METHODS Postal questionnaires were sent to 6559 PCa survivors 2-18 years post-diagnosis, identified through population-based cancer registries in Ireland. The Control Preference Scale was used to investigate respondents' 'actual' and 'preferred' role in TDM. The TDM experience was considered 'congruent' when actual and preferred roles matched and 'incongruent' otherwise. The EORTC QLQ-C30 was used to measure gHRQoL. Multivariate linear regression was employed to investigate associations between (i) actual role in TDM, (ii) congruence in TDM, and gHRQoL. RESULTS The response rate was 54% (n = 3348). The percentages of men whose actual role in TDM was active, shared or passive were 36, 33 and 31%, respectively. Congruence between actual and preferred roles in TDM was 58%. Actual role in TDM was not associated with gHRQoL. In multivariate analysis, after adjusting for socio-demographic and clinical factors, survivors whose TDM experience was incongruent had significantly lower gHRQoL than those who had a congruent experience (- 2.25 95%CI - 4.09, - 0.42; p = 0.008). This effect was most pronounced among survivors who had more involvement in the TDM than they preferred (- 2.69 95%CI - 4.74, - 0.63; p = 0.010). CONCLUSIONS Less than 6 in 10 PCa survivors experienced congruence between their actual and preferred roles in TDM. Having an incongruent TDM experience was associated with lower gHRQoL among survivors. These findings suggest that involving patients in TDM to the degree to which they want to be involved may help improve PCa survivors' gHRQoL.
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Affiliation(s)
- Frances J Drummond
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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1559
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Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active Surveillance. J Urol 2017; 199:1188-1195. [PMID: 29225057 DOI: 10.1016/j.juro.2017.11.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Recent NCCN® (National Comprehensive Cancer Network®) Guidelines® show that patients with biopsy Gleason score 3 + 4/Grade Group 2 but otherwise favorable features are active surveillance candidates. However, little is known about the long-term outcomes compared to that in men in the low risk Gleason score 6/Grade Group 1 group. We sought to clarify the risk of adverse features and oncologic outcomes in surgically treated, favorable Grade Group 2 vs 1 cases. MATERIALS AND METHODS We queried our prospectively maintained radical prostatectomy database for all 8,095 patients with biopsy Grade Group 1 or 2 prostate cancer who otherwise fulfilled the NCCN low risk definition of prostate specific antigen less than 10 ng/ml and cT2a or less, and who underwent radical prostatectomy from 1987 to 2014. Multivariable logistic regression and Kaplan-Meier methods were used to compare pathological and oncologic outcomes. RESULTS Organ confined disease was present in 93.9% and 82.6% of Grade Group 1 and favorable intermediate risk Grade Group 2 cases while seminal vesicle invasion was noted in 1.7% and 4.7%, and nodal disease was noted in 0.3% and 1.8%, respectively (all p <0.0001). On multivariable logistic regression biopsy proven Grade Group 2 disease was associated with a threefold greater risk of nonorgan confined disease (OR 3.1, 95% CI 1.7-5.7, p <0.001). The incidence of late treatment (more than 90 days from surgery) in Grade Group 1 vs 2 was 3.1% vs 8.5% for hormonal therapy and 6.0% vs 12.2% for radiation (p <0.001). In the Grade Group 1 vs 2 cohorts the 10-year biochemical recurrence-free survival rate was 88.9% vs 81.2% and the 10-year systemic progression-free survival rate was 99% vs 96.5% (each p <0.001). CONCLUSIONS Men at favorable risk with Grade Group 2 disease who are considering active surveillance should be informed of the risks of harboring adverse pathological features which impact secondary therapies and an increased risk of cancer progression.
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1560
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Are concurrent systematic cores needed at the time of targeted biopsy in patients with prior negative prostate biopsies? Prog Urol 2017; 28:18-24. [PMID: 29203158 DOI: 10.1016/j.purol.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/13/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES MRI-guided targeted biopsies are advised in patients who have undergone an initial series of negative systematic biopsies, in whom prostate cancer (PCa) suspicion remains elevated. The aim of the study was to evaluate whether, in men with prior negative prostate biopsies, systematic cores are also warranted at the time of an MRI-targeted repeat biopsy. MATERIAL AND METHODS We enrolled patients with prior negative biopsy undergoing real time MRI/TRUS fusion guided prostate biopsy at our institute between 2014 and 2016. Patients with at least one index lesion on multiparametric MRI were included. All eligible patients underwent both systematic random biopsies (12-14 cores) and targeted biopsies (2-4 cores). RESULTS The study included 74 men with a median age of 65 years, PSA level of 9.27ng/mL, and prostatic volume of 45ml. The overall PCa detection rate and the clinically significant cancer detection rate were 56.7% and 39.2%, respectively. Targeted cores demonstrated similar clinically significant PCa detection rate compared to systematic cores (33.8% vs. 28.4%, P=0.38) with significantly less tissue sampling. Indeed, a combination approach was significantly superior to a targeted-only in overall PCa detection (+16.7% overall detection rate, P=0.007). Although differences in clinically significant PCa detection were statistically non-significant (P=0.13), a combination approach did allow detecting 7 extra clinically significant PCas (+13.8%). CONCLUSIONS In patients with elevated PSA and prior negative biopsies, concurrent systematic sampling may be needed at the time of targeted biopsy in order to maximize PCa detection rate. Larger studies are needed to validate our findings. LEVEL OF EVIDENCE 4.
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1561
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Assel MJ, Gerdtsson A, Thorek DLJ, Carlsson SV, Malm J, Scardino PT, Vickers A, Lilja H, Ulmert D. Long-term prediction of prostate cancer diagnosis and death using PSA and obesity related anthropometrics at early middle age: data from the malmö preventive project. Oncotarget 2017; 9:5778-5785. [PMID: 29464033 PMCID: PMC5814173 DOI: 10.18632/oncotarget.22981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/11/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate whether anthropometric parameters add to PSA measurements in middle-aged men for risk assessment of prostate cancer (PCa) diagnosis and death. Results After adjusting for PSA, both BMI and weight were significantly associated with an increased risk of PCa death with the odds of a death corresponding to a 10 kg/m2 or 10 kg increase being 1.58 (95% CI 1.10, 2.28; p = 0.013) and 1.14 (95% CI 1.02, 1.26; p = 0.016) times greater, respectively. AUCs did not meaningfully increase with the addition of weight or BMI to prediction models including PSA. Materials and Methods In 1974 to 1986, 22,444 Swedish men aged 44 to 50 enrolled in Malmö Preventive Project, Sweden, and provided blood samples and anthropometric data. Rates of PSA screening in the cohort were very low. Documentation of PCa diagnosis and disease-specific death up to 2014 was retrieved through national registries. Among men with anthropometric measurements available at baseline, a total of 1692 men diagnosed with PCa were matched to 4190 controls, and 464 men who died of disease were matched to 1390 controls. Multivariable conditional logistic regression was used to determine whether diagnosis or death from PCa were associated with weight and body mass index (BMI) at adulthood after adjusting for PSA. Conclusions Men with higher BMI and weight at early middle age have an increased risk of PCa diagnosis and death after adjusting for PSA. However, in a multi-variable numerical statistical model, BMI and weight do not importantly improve the predictive accuracy of PSA. Risk-stratification of screening should be based on PSA without reference to anthropometrics.
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Affiliation(s)
- Melissa J Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Axel Gerdtsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Daniel L J Thorek
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Science, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sigrid V Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Johan Malm
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - David Ulmert
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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1562
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Is Advocacy for Active Surveillance Over Definitive Intervention in Low-Risk Prostate Cancer Applicable to African American Patients? Int J Radiat Oncol Biol Phys 2017; 99:1076-1077. [DOI: 10.1016/j.ijrobp.2017.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
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1563
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Pompe RS, Tian Z, Preisser F, Tennstedt P, Beyer B, Michl U, Graefen M, Huland H, Karakiewicz PI, Tilki D. Short- and Long-term Functional Outcomes and Quality of Life after Radical Prostatectomy: Patient-reported Outcomes from a Tertiary High-volume Center. Eur Urol Focus 2017; 3:615-620. [DOI: 10.1016/j.euf.2017.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/05/2017] [Indexed: 01/22/2023]
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1564
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Active Surveillance Offers Functional Advantages Without Impacting Survival for Low-risk Prostate Cancer. Eur Urol 2017; 73:868-869. [PMID: 29169932 DOI: 10.1016/j.eururo.2017.10.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022]
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1565
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Zietman AL. Too Big to Fail? The Current Status of Proton Therapy in the USA. Clin Oncol (R Coll Radiol) 2017; 30:271-273. [PMID: 29239732 DOI: 10.1016/j.clon.2017.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- A L Zietman
- Massachusetts General Hospital, Boston, Massachusetts, USA.
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1566
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Aleksic T, Verrill C, Bryant RJ, Han C, Worrall AR, Brureau L, Larré S, Higgins GS, Fazal F, Sabbagh A, Haider S, Buffa FM, Cole D, Macaulay VM. IGF-1R associates with adverse outcomes after radical radiotherapy for prostate cancer. Br J Cancer 2017; 117:1600-1606. [PMID: 28972962 PMCID: PMC5729437 DOI: 10.1038/bjc.2017.337] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/20/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Activated type 1 insulin-like growth factor receptors (IGF-1Rs) undergo internalisation and nuclear translocation, promoting cell survival. We previously reported that IGF-1R inhibition delays DNA damage repair, sensitising prostate cancer cells to ionising radiation. Here we tested the clinical relevance of these findings. METHODS We assessed associations between IGF-1R and clinical outcomes by immunohistochemistry in diagnostic biopsies of 136 men treated with 55-70 Gy external beam radiotherapy for prostate cancer, comparing results with publicly available transcriptional data in surgically treated patients. RESULTS Following radiotherapy, overall recurrence-free survival was shorter in patients whose tumours contained high total, cytoplasmic and internalised (nuclear/cytoplasmic) IGF-1R. High total IGF-1R associated with high primary Gleason grade and risk of metastasis, and cytoplasmic and internalised IGF-1R with biochemical recurrence, which includes patients experiencing local recurrence within the radiation field indicating radioresistance. In multivariate analysis, cytoplasmic, internalised and total IGF-1R were independently associated with risk of overall recurrence, and cytoplasmic IGF-1R was an independent predictor of biochemical recurrence post radiotherapy. Insulin-like growth factor receptors expression did not associate with biochemical recurrence after radical prostatectomy. CONCLUSIONS These data reveal increased risk of post-radiotherapy recurrence in men whose prostate cancers contain high levels of total or cytoplasmic IGF-1R.
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Affiliation(s)
- Tamara Aleksic
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Richard J Bryant
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Cheng Han
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Andrew Ross Worrall
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Laurent Brureau
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Stephane Larré
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Geoff S Higgins
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Fahad Fazal
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Ahmad Sabbagh
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Syed Haider
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Francesca M Buffa
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - David Cole
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Valentine M Macaulay
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LJ, UK
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1567
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Sadi MV. PSA screening for prostate cancer. Rev Assoc Med Bras (1992) 2017; 63:722-725. [PMID: 28977112 DOI: 10.1590/1806-9282.63.08.722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022] Open
Abstract
Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient's quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.
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Affiliation(s)
- Marcus V Sadi
- Adjunct Professor, Habilitation degree (Livre-docência) in Urology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp). Head of the Urologic Oncology Sector at EPM-Unifesp. Graduate degrees from Harvard Medical School and The Johns Hopkins School of Medicine. Member of Academia de Medicina de São Paulo, São Paulo, SP, Brazil
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1568
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Chen C, Chen Z, Wang K, Hu L, Xu R, He X. Comparisons of health-related quality of life among surgery and radiotherapy for localized prostate cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:99057-99065. [PMID: 29228751 PMCID: PMC5716791 DOI: 10.18632/oncotarget.21519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 01/20/2023] Open
Abstract
The objective of this study is to compare health-related quality of life (QOL) outcomes between radical prostatectomy (RP) and external beam radiation therapy (EBRT) for localized prostate cancer. PubMed, EMBASE, the Cochrane Library and Web of Science (to July 2017) were searched. Pooled analysis of each domain-specific score was calculated in relevant studies, and its change with follow-up time was explored by sub-group analysis. A total of six studies containing 4423 patients were included. Men underwent RP was associated with worse urinary and sexual domain score than EBRT (standardized mean difference (SMD) = -0.59, -0.58; 95% confidence interval (CI) = -0.73 to -0.45, -0.72 to -0.44). In contrast, EBRT group had lower bowel domain score than RP group (SMD = 0.42, 95% CI = 0.33 to 0.52). The sub-group analysis revealed the most severe urinary and sexual QOL in RP as well as bowel QOL in EBRT group all happened in the first month post operation. The different performance of two treatments in three QOL domains diminished afterwards. Health-related QOL should be considered comprehensively when planning follow-up for men after RP or EBRT for localized prostate cancer.
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Affiliation(s)
- Cheng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Kun Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Linkun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
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1569
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Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robot-assisted vs open radical prostatectomy for the treatment of localized prostate cancer: a Cochrane systematic review. BJU Int 2017; 121:845-853. [PMID: 29063728 DOI: 10.1111/bju.14062] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the effects of laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP) compared with open radical prostatectomy (ORP) in men with localized prostate cancer. MATERIALS AND METHODS We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings, with no restrictions on the language of publication or publication status, up until 9 June 2017. We included all randomized or pseudo-randomized controlled trials that directly compared LRP and RARP with ORP. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. RESULTS We included two unique studies in a total of 446 randomized participants with clinically localized prostate cancer. All available outcome data were short-term (up to 3 months). We found no study that addressed the outcome of prostate cancer-specific survival. Based on one trial, RARP probably results in little to no difference in urinary quality of life (mean difference [MD] -1.30, 95% confidence interval [CI] -4.65 to 2.05; moderate quality of evidence) and sexual quality of life (MD 3.90, 95% CI: -1.84 to 9.64; moderate quality of evidence). No study addressed the outcomes of biochemical recurrence-free survival or overall survival. Based on one trial, RARP may result in little to no difference in overall surgical complications (risk ratio [RR] 0.41, 95% CI: 0.16-1.04; low quality of evidence) or serious postoperative complications (RR 0.16, 95% CI: 0.02-1.32; low quality of evidence). Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at 1 day (MD -1.05, 95% CI: -1.42 to -0.68; low quality of evidence) and up to 1 week (MD -0.78, 95% CI: -1.40 to -0.17; low quality of evidence). Based on one study, RARP probably results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI: -0.32 to 0.34; moderate quality of evidence). Based on one study, RARP probably reduces the length of hospital stay (MD -1.72, 95% CI: -2.19 to -1.25; moderate quality of evidence). Based on two studies, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI: 0.12-0.46; low quality of evidence). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1,000 men (95% CI: 78-48 fewer). CONCLUSIONS There is no evidence to inform the comparative effectiveness of LRP or RARP compared with ORP for oncological outcomes. Urinary and sexual quality of life appear similar. Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions.
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Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Sue M Evans
- Centre of Research Excellence in Patient Safety, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Christie Ann Allan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.,Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Declan Murphy
- Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Vic., Australia
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1570
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Henkenberens C, Derlin T, Bengel FM, Ross TL, Wester HJ, Hueper K, Kuczyk MA, Christiansen H, von Klot CA. Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy. Strahlenther Onkol 2017; 194:303-310. [DOI: 10.1007/s00066-017-1231-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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1571
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van den Bergh RCN, van Stam MA. In patients with localised prostate cancer, active surveillance is associated with better sexual function, urinary symptoms and bowel symptoms. ACTA ACUST UNITED AC 2017; 22:217-218. [PMID: 29127215 DOI: 10.1136/ebmed-2017-110759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/04/2022]
Affiliation(s)
| | - Marie-Anne van Stam
- Psychosocial Research and Epidemiology, University Medical Centre, Utrecht, The Netherlands
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1572
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The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries. Cancer Causes Control 2017; 28:1187-1193. [PMID: 29119339 DOI: 10.1007/s10552-017-0972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. METHOD We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. RESULTS Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. CONCLUSION This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.
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1573
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Perlis N, Klotz L. Contemporary Active Surveillance: Candidate Selection, Follow-up Tools, and Expected Outcomes. Urol Clin North Am 2017; 44:565-574. [PMID: 29107273 DOI: 10.1016/j.ucl.2017.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article is a summary of the rationale for conservative management, the molecular biology of low-grade cancer, the principles of management, the expected outcome of surveillance, unanswered questions, and research opportunities.
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Affiliation(s)
- Nathan Perlis
- Department of Surgery, University of Toronto, 610 University Avenue, Suite 3-130, Toronto, Ontario M5G 2M9, Canada
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue. # MG 408, Toronto, Ontario M4N3M5, Canada.
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1574
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Mossanen M, Krasnow RE, Nguyen PL, Trinh QD, Preston M, Kibel AS. Approach to the Patient with High-Risk Prostate Cancer. Urol Clin North Am 2017; 44:635-645. [PMID: 29107279 DOI: 10.1016/j.ucl.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Men classified as having high-risk prostate cancer warrant treatment because durable outcomes can be achieved. Judicious use of imaging and considerations of risk factors are essential when caring for men with high-risk disease. Radical prostatectomy, radiation therapy, and androgen deprivation therapy all play pivotal roles in the management of men with high-risk disease, and potentially in men with metastatic disease. The optimal combinations of therapeutic regimens are an evolving area of study and future work looking into therapies for men with high-risk disease will remain critical.
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Affiliation(s)
- Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Ross E Krasnow
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Quoc D Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mark Preston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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1575
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Serrell EC, Pitts D, Hayn M, Beaule L, Hansen MH, Sammon JD. Review of the comparative effectiveness of radical prostatectomy, radiation therapy, or expectant management of localized prostate cancer in registry data. Urol Oncol 2017; 36:183-192. [PMID: 29122446 DOI: 10.1016/j.urolonc.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/26/2022]
Abstract
Evidence regarding the effectiveness of treatment for prostate cancer is primarily based on randomized controlled trials. Long-term outcomes are generally difficult to evaluate within experimental studies and may benefit from large pools of observational data. We conducted a systematic review of administrative and registry studies to evaluate the comparative effectiveness of treatment for clinically localized prostate cancer on overall and prostate-cancer specific mortality. MATERIALS AND METHODS In accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P, 2015), we conducted a systematic search of Ovid Medline and Embase (1946-February 2017) and identified studies that evaluated the relationship between types of treatment for localized prostate cancer and mortality. Additional articles were identified through manual search. Randomized, prospective, and single institution studies were excluded. The risk of bias for each study was evaluated with the Newcastle Ottawa scale. Multivariable adjusted hazard ratios were reported to evaluate overall and cancer-specific mortality. RESULTS We screened 4,721 studies and included for review, 19 that were published between 2001 and 2015. The pooled population included 228,444 patients. Countries of origin included the United States, Canada, China, Switzerland, the Netherlands, and Sweden, and the sources included administrative (n = 6) and cancer registry or prostate databases (n = 11). Overall and cancer-specific mortality were lowest among definitive treatment arms as compared to conservative therapy with no treatment, observation, or active surveillance. Radiotherapy was associated with worse overall and cancer-specific mortality than radical prostatectomy. CONCLUSION Although observational studies using large, population-based cohorts have the potential for bias, we found consistent evidence that high-quality observational studies may be used to evaluate the comparative effectiveness of prostate cancer treatment. Methodologic limitations of observational data should be considered.
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Affiliation(s)
| | - Daniel Pitts
- Division of Urology, Maine Medical Center, Portland, MA
| | - Matthew Hayn
- Tufts University School of Medicine, Boston, MA; Division of Urology, Maine Medical Center, Portland, MA
| | - Lisa Beaule
- Tufts University School of Medicine, Boston, MA; Division of Urology, Maine Medical Center, Portland, MA
| | - Moritz H Hansen
- Tufts University School of Medicine, Boston, MA; Division of Urology, Maine Medical Center, Portland, MA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
| | - Jesse D Sammon
- Tufts University School of Medicine, Boston, MA; Division of Urology, Maine Medical Center, Portland, MA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME.
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1576
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Lamb AD, Brewster SF, Hamdy FC. Reducing Mortality in the Ageing Patient: Treatment of the Primary Tumour Is Not Necessary. Eur Urol Focus 2017; 3:328-329. [PMID: 29097093 DOI: 10.1016/j.euf.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
Robot-assisted radical prostatectomy for older men remains an unproven intervention in terms of both cancer control and functional and voiding outcomes. We highlight some of the evidence against radical surgery for older men while acknowledging that this is the direction of travel.
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Affiliation(s)
- Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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1577
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Smith AB, Mancuso P, Sidhom M, Wong K, Berry M, Rincones O, Forstner D, Bokey L, Girgis A. Prostatectomy versus radiotherapy for early-stage prostate cancer (PREPaRE) study: protocol for a mixed-methods study of treatment decision-making in men with localised prostate cancer. BMJ Open 2017; 7:e018403. [PMID: 29102996 PMCID: PMC5722081 DOI: 10.1136/bmjopen-2017-018403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Men diagnosed with localised prostate cancer (LPC) wanting curative treatment face a highly preference-sensitive choice between prostatectomy and radiotherapy, which offer similar cure rates but different side effects. This study aims to determine the information, decision-making needs and preferences of men with LPC choosing between robotic prostatectomy and standard external beam or stereotactic radiotherapy. METHODS AND ANALYSIS This study will be conducted at a large public teaching hospital in Australia offering the choice between robotic prostatectomy and radiotherapy from early 2017. Men (20-30) diagnosed with LPC who want curative treatment and meet criteria for either treatment will be invited to participate. In this mixed-methods study, patients will complete semistructured interviews before and after attending a combined clinic in which they consult a urologist and a radiation oncologist regarding treatment and four questionnaires (one before treatment decision-making and three after) assessing demographic and clinical characteristics, involvement in decision-making, decisional conflict, satisfaction and regret. Combined clinic consultations will also be audio-recorded and clinicians will report their perceptions regarding patients' suitability for, openness to and preferences for each treatment. Qualitative data will be transcribed verbatim and thematically analysed and descriptive statistical analyses will explore quantitative decision-making outcomes, with comparison according to treatment choice. DISCUSSION Results from this study will inform how to best support men diagnosed with LPC deciding which curative treatment option best suits their needs and may identify the need for and content required in a decision aid to support these men. ETHICS AND DISSEMINATION All participants will provide written informed consent. Data will be rigorously managed in accordance with national legislation. Results will be disseminated via presentations to both scientific and layperson audiences and publications in peer-reviewed scientific journals.
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Affiliation(s)
- Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Pascal Mancuso
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Urological Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Mark Sidhom
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Karen Wong
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Megan Berry
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
| | - Dion Forstner
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Medicine, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Lesley Bokey
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- Division of Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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1578
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The CADMUS trial - Multi-parametric ultrasound targeted biopsies compared to multi-parametric MRI targeted biopsies in the diagnosis of clinically significant prostate cancer. Contemp Clin Trials 2017; 66:86-92. [PMID: 29108869 DOI: 10.1016/j.cct.2017.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the proportion of clinically significant prostate cancers (PCa) found in lesions detected by multiparametric MRI (mpMRI) with that found in lesions detected by multiparametric ultrasound (mpUSS), in men at risk. PATIENTS AND METHODS CADMUS (Cancer Detection by Multiparametric Ultrasound of the prostate) is a prospective, multi-centre paired cohort diagnostic utility study with built-in randomisation of order of biopsies. The trial is registered ISRCTN38541912. All patients will undergo the index test under evaluation (mpUSS±biopsies), as well as the standard test (mpMRI±biopsies). Eligible men will be those at risk of harbouring prostate cancer usually recommended for prostate biopsy, either for the first time or as a repeat, who have not had any prior treatment for prostate cancer. Men in need of repeat biopsy will include those with prior negative results but ongoing suspicion, and those with an existing prostate cancer diagnosis but a need for accurate risk stratification. Both scans will be reported blind to the results of the other and the order in which the targeted biopsies derived from the two different imaging modalities are taken will be randomised. Comparison will be drawn between biopsy results of lesions detected by mpUSS with those lesions detected by mpMRI. Agreement over position between the two imaging modalities will be studied. DISCUSSION CADMUS will provide level one evidence on the performance of mpUSS derived targeted biopsies in the identification of clinically significant prostate cancer in comparison to mpMRI targeted biopsies. Recruitment is underway and expected to complete in 2018.
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1579
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Wroclawski ML. New US Preventive Service Task Force recommendations for prostate cancer screening: a needed update, but not enough. EINSTEIN-SAO PAULO 2017; 15:7-10. [PMID: 29091165 PMCID: PMC5823064 DOI: 10.1590/s1679-45082017ed4151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil
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1580
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Snaterse G, Visser JA, Arlt W, Hofland J. Circulating steroid hormone variations throughout different stages of prostate cancer. Endocr Relat Cancer 2017; 24:R403-R420. [PMID: 28924064 DOI: 10.1530/erc-17-0155] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/18/2017] [Indexed: 01/15/2023]
Abstract
Steroid hormones play a central role in the maintenance and progression of prostate cancer. The androgen receptor is the primary driver of tumor cell proliferation and is activated by the androgens testosterone and 5α-dihydrotestosterone. Inhibition of this pathway through medical or surgical castration improves survival in the majority of advanced prostate cancer patients. However, conversion of adrenal androgen precursors and alternative steroidogenic pathways have been found to contribute to tumor progression and resistance to treatment. The emergence of highly accurate detection methods allows us to study steroidogenic mechanisms in more detail, even after treatment with potent steroidogenic inhibitors such as the CYP17A1 inhibitor abiraterone. A clear overview of steroid hormone levels in patients throughout the local, metastatic and castration-resistant stages of prostate cancer and treatment modalities is key toward a better understanding of their role in tumor progression and treatment resistance. In this review, we summarize the currently available data on steroid hormones that have been implicated in the various stages of prostate cancer. Additionally, this review addresses the implications of these findings, highlights important studies in this field and identifies current gaps in literature.
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Affiliation(s)
- Gido Snaterse
- Section of EndocrinologyDepartment of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jenny A Visser
- Section of EndocrinologyDepartment of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK
| | - Johannes Hofland
- Section of EndocrinologyDepartment of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK
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1581
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Li J, Xu R, Lu X, He J, Jin S. A simple reduction-sensitive micelles co-delivery of paclitaxel and dasatinib to overcome tumor multidrug resistance. Int J Nanomedicine 2017; 12:8043-8056. [PMID: 29138561 PMCID: PMC5677301 DOI: 10.2147/ijn.s148273] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Multidrug resistance (MDR) is one of the major obstacles in successful chemotherapy. The combination of chemotherapy drugs and multidrug-resistant reversing agents for treating MDR tumor is a good strategy to overcome MDR. In this work, we prepared the simple redox-responsive micelles based on mPEG-SS-C18 as a co-delivery system to load the paclitaxel (PTX) and dasatinib (DAS) for treatment of MCF-7/ADR cells. The co-loaded micelles had a good dispersity and a spherical shape with a uniform size distribution, and they could quickly disassemble and rapidly release drugs under the reduction environment. Compared with MCF-7 cells, the DAS and PTX co-loaded redox-sensitive micelle (SS-PDNPs) showed stronger cytotoxicity and a more improving intracellular drug concentration than other drug formulations in MCF-7/ADR cells. In summary, the results suggested that the simple co-delivery micelles of PTX and DAS possessed significant potential to overcome drug resistance in cancer therapy.
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Affiliation(s)
- Jun Li
- Department of Medical Oncology
| | - Ruitong Xu
- Department of General Practice, The First Affiliated Hospital with Nanjing Medical University, Nanjing
| | - Xiao Lu
- Department of Medical Oncology, Changshu No 1 People’s Hospital, Changshu, People’s Republic of China
| | - Jing He
- Department of Medical Oncology
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1582
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Understanding and Improving Recruitment to Randomised Controlled Trials: Qualitative Research Approaches. Eur Urol 2017; 72:789-798. [DOI: 10.1016/j.eururo.2017.04.036] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/28/2017] [Indexed: 11/22/2022]
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1583
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Current Role of Magnetic Resonance Imaging in Prostate Cancer. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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1584
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Danner M, Hung MY, Yung TM, Ayoob M, Lei S, Collins BT, Suy S, Collins SP. Utilization of Patient-Reported Outcomes to Guide Symptom Management during Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer. Front Oncol 2017; 7:227. [PMID: 29085804 PMCID: PMC5650639 DOI: 10.3389/fonc.2017.00227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Utilization of patient-reported outcomes (PROs) to guide symptom management during radiation therapy is increasing. This study focuses on the use of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) as a tool to assess urinary and bowel bother during stereotactic body radiation therapy (SBRT) and its utility in guiding medical management. Methods Between September 2015 and January 2017, 107 patients with clinically localized prostate cancer were treated with 35–36.25 Gy via SBRT in five fractions. PROs were assessed using EPIC-CP 1 h prior to the first fraction and after each subsequent fraction. Symptom management medications were prescribed based on the physician clinical judgment or if patients reported a moderate to big problem. Clinical significance was assessed using a minimally important difference of 1/2 SD from baseline score. Results A median baseline EPIC-CP urinary symptom score of 1.5 significantly increased to 3.7 on the day of the final treatment (p < 0.0001). Prior to treatment, 9.3% of men felt that their overall urinary function was a moderate to big problem that increased to 28% by the end of the fifth treatment. A median baseline EPIC-CP bowel symptom score of 0.3 significantly increased to 1.4 on the day of the final treatment (p < 0.0001). Prior to treatment, 1.9% of men felt that their overall bowel function was a moderate to big problem that increased to 3.7% by the end of the fifth treatment. The percentage of patients requiring an increased dose of alpha-antagonist increased to 47% by the end of treatment, and an additional 28% of patients required a short steroid taper to manage moderate to big urinary problems. Similarly, the percentage of patients requiring antidiarrheals reached 12% by the fifth treatment. Conclusion During the course of SBRT, an increasing percentage of patients experienced clinically significant symptoms many of which required medical management. Monitoring patient symptoms during treatment allowed for prompt detection and management of acute urinary and bowel symptoms. The usage of symptom management medications was high in this study compared to historical controls and may be due to increased physician awareness of moderate to big patient problems.
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Affiliation(s)
- Malika Danner
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ming-Yang Hung
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Thomas M Yung
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
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1585
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Gómez-Veiga F, Alcaraz-Asensio A, Burgos-Revilla J, Cózar-Olmo J. Developments in urologic oncology «OncoForum»: The best of 2016. Actas Urol Esp 2017; 41:543-551. [PMID: 28734596 DOI: 10.1016/j.acuro.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings. ACQUISITION OF EVIDENCE This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. SYNTHESIS OF EVIDENCE In High-Risk Renal-Cell carcinoma after nephrectomy, disease-free survival was significantly greater for sunitinib than placebo group, with adverse events more frequents. In locally advanced and metastatic urotherial carcinoma patients, aletozumab achieved overall response rate in all subgroups of patients, included poor prognostic. In localized prostate cancer, the difference of prostate-cancer-specific mortality among active monitoring, radical prostatectomy and external-beam radiotherapy was not significant (P=0,48). In TERRAIN study, with castration-resistant prostate cancer patients, adverse events was reported in 31% and 23% of patients treated with enzalutamide and bicalutamide, respectively. Moreover, enzalutamide significantly improved median progression-free survival (15.7 months) compared bicalutamide (5.8 months) (P<.0001). In SRTIVE study, Enzalutamide reduced the risk of progression or death by 76% compared with bicalutamide (P<.001). CONCLUSIONS In high-risk renal-cell carcinoma after nephrectomy, sunitinb has been considered as treatment choice. In localized prostate cancer, prostate-cancer-specific mortality was low irrespective of the treatment assigned (active monitoring, radical prostatectomy and external-beam radiotherapy). In metastatic castration-resistant prostate cancer new results of treatment with enzalutamide and abiraterone has been published, wich have been shown beneficial effects in metastatic and no metastatic patients.
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1586
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1587
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Choudhury A. ProtecTing Low-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 99:515-517. [DOI: 10.1016/j.ijrobp.2016.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 01/12/2023]
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1588
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A House Divided: The Irradiation Versus Prostatectomy Debate Continues. Int J Radiat Oncol Biol Phys 2017; 99:512-514. [DOI: 10.1016/j.ijrobp.2017.01.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 01/14/2017] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
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1589
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Elliott PA, Abdelsayed GA, Kilday PS, Kim BJ, Slezak JM, Chien GW. Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy. World J Urol 2017; 36:21-26. [PMID: 29086019 DOI: 10.1007/s00345-017-2112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. MATERIALS AND METHODS From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90 days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. RESULTS A total of 411 men who completed the baseline survey and at 90 days postoperatively were included. On multivariate linear regression, younger age (p < 0.01), higher preoperative sexual function (< 0.01), single marital status (p = 0.04) and more post-surgery email contacts (p = 0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p = 0.01), higher baseline continence (p < 0.01) and more post-surgery physical therapy visits (p < 0.01) were associated with higher declines. CONCLUSIONS Patients with the poorest quality of life outcomes at 90 days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.
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Affiliation(s)
- Peter A Elliott
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - George A Abdelsayed
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Patrick S Kilday
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Brian J Kim
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA
| | - Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
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1590
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van Stam MA, van der Poel HG, van der Voort van Zyp JR, Tillier CN, Horenblas S, Aaronson NK, Ruud Bosch J. The accuracy of patients’ perceptions of the risks associated with localised prostate cancer treatments. BJU Int 2017; 121:405-414. [DOI: 10.1111/bju.14034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-Anne van Stam
- Department of; Urology; University Medical Center Utrecht; Utrecht The Netherlands
- Division of Psychosocial Research and Epidemiology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Henk G. van der Poel
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | | | - Corinne N. Tillier
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Simon Horenblas
- Department of; Urology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Neil K. Aaronson
- Division of Psychosocial Research and Epidemiology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - J.L.H. Ruud Bosch
- Department of; Urology; University Medical Center Utrecht; Utrecht The Netherlands
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1591
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Ynalvez LA, Kosarek CD, Kerr PS, Mahmoud AM, Eyzaguirre EJ, Orihuela E, Sonstein JN, Williams SB. Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm. Int Urol Nephrol 2017; 50:1-6. [PMID: 29064003 DOI: 10.1007/s11255-017-1714-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Guidelines for atypical small acinar proliferation (ASAP) diagnosed on prostate biopsy recommend repeat biopsy within 3-6 months after diagnosis. We sought to discern the rate of detecting clinically significant prostate cancer on repeat biopsy and predictors associated with progression. MATERIALS AND METHODS We performed a retrospective chart review of patients who underwent prostate biopsy at our institution from January 1, 2008, to December 31, 2015. Gleason grade group (GGG) system and D'Amico stratification were used to report pathology and risk stratification, respectively. Logistic and linear regression analyses were performed. RESULTS A total of 593 patients underwent transrectal ultrasound-guided prostate biopsy, of which 27 (4.6%) had the diagnosis of ASAP. Of these, 11 (41%) had a repeat biopsy. Median time from diagnosis to repeat biopsy was 147 days (IQR 83.5-247.0). Distribution across the GGG system on repeat biopsy was as follows: 7 (63.6%) benign, 3 (27.3%) GG1, and 1 (9.1%) GG2. ASAP was not associated with subsequent diagnosis of clinically significant prostate cancer (OR 0.46, 95% CI 0.064-3.247, P = 0.432). There was no association between ASAP and high cancer risk (ASAP: β = - 0.12; P = 0.204). CONCLUSIONS Patients diagnosed with ASAP managed according to guideline recommendations are more likely diagnosed with benign pathology and indolent prostate cancer on repeat biopsy. These findings support prior studies suggesting refinement of guidelines in regard to the appropriateness and timeliness of repeat biopsy among patients diagnosed with ASAP.
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Affiliation(s)
- Leslie A Ynalvez
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Christopher D Kosarek
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Preston S Kerr
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Ali M Mahmoud
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Eduardo J Eyzaguirre
- Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Eduardo Orihuela
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Joseph N Sonstein
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA
| | - Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555, USA.
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1592
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Heijnsdijk EA, Bangma CH, Borràs JM, de Carvalho TM, Castells X, Eklund M, Espinàs JA, Graefen M, Grönberg H, Lansdorp-Vogelaar I, Leeuwen PJV, Nelen V, Recker F, Roobol MJ, Vandenbulcke P, de Koning HJ. Summary statement on screening for prostate cancer in Europe. Int J Cancer 2017; 142:741-746. [DOI: 10.1002/ijc.31102] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Eveline A.M. Heijnsdijk
- Department of Public Health; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Chris H. Bangma
- Department of Urology; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Josep M. Borràs
- Department of Health; Catalan Institute of Oncology, Avinguda de la Granvia de l'Hospitalet 199-203; Barcelona 08908 Spain
| | - Tiago M. de Carvalho
- Department of Public Health; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Xavier Castells
- Department of Epidemiology and Evaluation; IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29; Barcelona 08003 Spain
| | - Martin Eklund
- Department of medical epidemiology and biostatistics; Karolinska Institutet, Karolinska vägen; Solna Stockholm 171 76 Sweden
| | - Josep A. Espinàs
- Department of Health; Catalan Institute of Oncology, Avinguda de la Granvia de l'Hospitalet 199-203; Barcelona 08908 Spain
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52 Building O43; Hamburg 20246 Germany
| | - Henrik Grönberg
- Department of medical epidemiology and biostatistics; Karolinska Institutet, Karolinska vägen; Solna Stockholm 171 76 Sweden
| | - Iris Lansdorp-Vogelaar
- Department of Public Health; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Vera Nelen
- Provinciaal Instituut voor Hygiëne, Kronenburgstraat 45; Antwerp 2000 Belgium
| | - Franz Recker
- Department of Urology; Kantonsspital Aarau, Tellstrasse 25; Aarau 5001 Switzerland
| | - Monique J. Roobol
- Department of Urology; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
| | - Pieter Vandenbulcke
- Agentschap Zorg en gezondheid, Lange Kievitstraat 111-113; Antwerp 2018 Belgium
| | - Harry J. de Koning
- Department of Public Health; Erasmus Medical Center, Wytemaweg 80; CN Rotterdam 3015 The Netherlands
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1593
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Dorth JA, Lee WR, Chino J, Abouassaly R, Ellis RJ, Myers ER. Cost-Effectiveness of Primary Radiation Therapy Versus Radical Prostatectomy for Intermediate- to High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017; 100:383-390. [PMID: 29353655 DOI: 10.1016/j.ijrobp.2017.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare, using a cost-effectiveness analysis, the quality-adjusted life expectancy (QALE) and cost between the 2 treatment options for intermediate- to high-risk prostate cancer: (1) radiation (RT) with androgen deprivation therapy (ADT) or (2) radical prostatectomy (RP) followed by adjuvant RT for patients with risk factors. METHODS AND MATERIALS Our Markov model allowed patients to transition between health states with yearly probabilities of developing cancer recurrence and/or toxicity. Probabilities were assigned according to favorable intermediate, unfavorable intermediate, or high-risk prostate cancer groups. The primary analysis examined outcomes for patients aged 65 years, whereas secondary analyses explored the effects of younger age, elevated baseline cardiovascular risk, and the use of salvage therapy. One-way and probabilistic sensitivity analyses were performed. RESULTS Across all primary and secondary analyses, and using a wide-range of assumptions, RT + ADT was the preferred treatment strategy for men with intermediate- to high-risk prostate cancer. The QALE was higher after RT + ADT by 0.5 to 1.14 quality-adjusted life years, compared with RP. Radiation plus ADT was cost-effective in all situations, falling beneath a threshold of $100,000 per quality-adjusted life year. Among all risk groups, a greater proportion of patients undergoing RP experienced single or multiple treatment toxicities. CONCLUSIONS Radiation plus ADT may result in improved QALE compared with RP for intermediate- to high-risk prostate cancer. Although biochemical failure is similar between treatment groups, there is a higher rate of developing multiple toxicities among patients treated with upfront RP.
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Affiliation(s)
- Jennifer A Dorth
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, Ohio.
| | - W Robert Lee
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Junzo Chino
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Robert Abouassaly
- Department of Urology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, Ohio
| | - Rodney J Ellis
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, Ohio
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
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1594
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Definitive Radiotherapy for Older Patients with Prostate Cancer: Experience of a Medical Center in Taiwan. Sci Rep 2017; 7:13880. [PMID: 29066834 PMCID: PMC5655670 DOI: 10.1038/s41598-017-13119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Whether age predicts treatment outcome of prostate cancer remains controversial. With the aging of the world population, properly understanding the effect of age may facilitate both treatment decision-making and defining the natural history of prostate cancer. Consecutive 581 patients with locally-confined adenocarcinoma of the prostate who received radical definitive radiotherapy(RT) (76-78 Gy) between 2004 and 2015 at a medical center in Taiwan were reviewed retrospectively. Median age was 78 years. The median follow-up was 66 months. The 5-year biochemical failure-free survival(BFFS), distant metastasis-free survival(DMFS), disease-specific survival(DSS), and overall survival(OS) rates were 84.9%, 93.8%, 97.8%, and 86.6%, respectively, for all patients. Comparing those above and below the age of 80, no difference in 5-year BFFS, DMFS, or DSS was found. Multivariate Cox regression analysis showed that tumor stage, Gleason score, initial PSA, and latency before RT were significant risk factors of BFFS. The latency before RT was significantly longer in the older group than in the under 80 group. Delay to start RT might explain the previous finding of inferior disease control in older patients in other studies. With the exception of OS, no other differences in outcomes or toxicities were observed in older patients.
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1595
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Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis. World J Urol 2017; 36:7-13. [DOI: 10.1007/s00345-017-2102-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022] Open
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1596
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Good DW, McNeill AS. Re: Impact of Radical Prostatectomy on Long-term Oncologic Outcomes in a Matched Cohort of Men with Pathological Node Positive Prostate Cancer Managed by Castration. Eur Urol 2017; 73:140. [PMID: 29054500 DOI: 10.1016/j.eururo.2017.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Daniel W Good
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, Scotland, UK; Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, Scotland, UK
| | - Alan S McNeill
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, Scotland, UK; Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, Scotland, UK.
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1597
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Blanchard P, Davis JW, Frank SJ, Kim J, Pettaway CA, Pugh TJ, Pisters LL, Ward JF, Choi S, Chapin BF, Hoffman K, Navai N, Achim M, McGuire SE, Matin SF, Nguyen Q, Mahmood U, Graber WJ, Chen HC, Wang X, Kuban DA. Quality of life after brachytherapy or bilateral nerve-sparing robot-assisted radical prostatectomy for prostate cancer: a prospective cohort. BJU Int 2017; 121:540-548. [DOI: 10.1111/bju.14021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - John W. Davis
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Steven J. Frank
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Jeri Kim
- Department of Genitourinary Medical Oncology; Division of Cancer Medicine; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Curtis A. Pettaway
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Thomas J. Pugh
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Radiation Oncology; University of Colorado School of Medicine; Aurora CO USA
| | - Louis L. Pisters
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - John F. Ward
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Seungtaek Choi
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Brian F. Chapin
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Karen Hoffman
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Neema Navai
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Mary Achim
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Sean E. McGuire
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Surena F. Matin
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Quynh Nguyen
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Usama Mahmood
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Radiation Oncology; Long Beach Memorial Medical Center; Long Beach CA USA
| | - William J. Graber
- Department of Urology; Division of Surgery; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Hsiang-Chun Chen
- Department of Biostatistics; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Xuemei Wang
- Department of Biostatistics; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Deborah A. Kuban
- Department of Radiation Oncology; Division of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston TX USA
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1598
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Whalen MJ, Pak JS, Lascano D, Ahlborn D, Matulay JT, McKiernan JM, Benson MC, Wenske S. Oncologic Outcomes of Definitive Treatments for Low- and Intermediate-Risk Prostate Cancer After a Period of Active Surveillance. Clin Genitourin Cancer 2017; 16:e425-e435. [PMID: 29113772 DOI: 10.1016/j.clgc.2017.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND To compare oncologic outcomes of different definitive treatment (DT) modalities in a cohort of patients with prostate cancer (PCa) after active surveillance (AS). METHODS We identified 237 patients with National Comprehensive Cancer Network (NCCN) low- and intermediate-risk prostate cancer diagnosed from 1990 to 2012 who did not undergo immediate DT within 12 months of diagnosis (ie, AS patients as well as watchful waiting and those refusing DT). Charts were examined for clinical/pathologic data and type of DT: surgery (RP), radiation including brachytherapy (XRT), cryotherapy, and androgen deprivation therapy monotherapy (ADT). The impact of DT on oncologic outcomes of biochemical recurrence (BCR), metastasis, disease-specific (DSS), and overall survival (OS) was examined with the Cox proportional hazards model, along with the Kaplan-Meier method and log-rank test. RESULTS After median time on AS of 63.4 months, 40% of patients underwent DT: 47% XRT, 28% RP, 14% ADT, and 11% cryotherapy. On multivariable analysis, the use of XRT predicted higher BCR (hazard ratio [HR] 6.1, P = .001) and worse overall mortality (HR 2.1, P = .03) compared with other treatments, controlling for age, Charlson Comorbidity Index (CCI), stage, Gleason score, and NCCN risk category. Median follow-up was 71.7 months. On Kaplan-Meier analysis, 10-year OS was superior for RP versus XRT among patients with prostatic specific antigen (PSA) velocity >2.0 ng/mL/y. CONCLUSIONS Low- and intermediate-risk patients with PCa who progress to DT after AS may be inadequately treated with radiation therapy compared with other DT modalities, especially when pretreatment PSA velocity is > 2 ng/mL/y.
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Affiliation(s)
- Michael J Whalen
- Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jamie S Pak
- Department of Urology, Columbia University Medical Center, New York, NY; Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | | | - David Ahlborn
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Justin T Matulay
- Department of Urology, Columbia University Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Mitchell C Benson
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, New York, NY
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1599
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Vanneste BGL, van Wijk Y, Lutgens LC, Van Limbergen EJ, van Lin EN, van de Beek K, Lambin P, Hoffmann AL. Dynamics of rectal balloon implant shrinkage in prostate VMAT : Influence on anorectal dose and late rectal complication risk. Strahlenther Onkol 2017; 194:31-40. [PMID: 29038832 PMCID: PMC5752748 DOI: 10.1007/s00066-017-1222-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/19/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the effect of a shrinking rectal balloon implant (RBI) on the anorectal dose and complication risk during the course of moderately hypofractionated prostate radiotherapy. METHODS In 15 patients with localized prostate cancer, an RBI was implanted. A weekly kilovolt cone-beam computed tomography (CBCT) scan was acquired to measure the dynamics of RBI volume and prostate-rectum separation. The absolute anorectal volume encompassed by the 2 Gy equieffective 75 Gy isodose (V75Gy) was recalculated as well as the mean anorectal dose. The increase in estimated risk of grade 2-3 late rectal bleeding (LRB) between the start and end of treatment was predicted using nomograms. The observed acute and late toxicities were evaluated. RESULTS A significant shrinkage of RBI volumes was observed, with an average volume of 70.4% of baseline at the end of the treatment. Although the prostate-rectum separation significantly decreased over time, it remained at least 1 cm. No significant increase in V75Gy of the anorectum was observed, except in one patient whose RBI had completely deflated in the third week of treatment. No correlation between mean anorectal dose and balloon deflation was found. The increase in predicted LRB risk was not significant, except in the one patient whose RBI completely deflated. The observed toxicities confirmed these findings. CONCLUSIONS Despite significant decrease in RBI volume the high-dose rectal volume and the predicted LRB risk were unaffected due to a persistent spacing between the prostate and the anterior rectal wall.
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Affiliation(s)
- Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands.
| | - Y van Wijk
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands
| | - L C Lutgens
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands
| | - E J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands
| | - E N van Lin
- Radiotherapy Bonn-Rhein-Sieg, Troisdorf, Germany
| | - K van de Beek
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - P Lambin
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands
| | - A L Hoffmann
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 3035, 6202 NA, Maastricht, The Netherlands
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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1600
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Preventing clinical progression and need for treatment in patients on active surveillance for prostate cancer. Curr Opin Urol 2017; 28:46-54. [PMID: 29028765 DOI: 10.1097/mou.0000000000000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. RECENT FINDINGS Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5α-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. SUMMARY Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
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