1601
|
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.
Collapse
|
1602
|
|
1603
|
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]
|
1604
|
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]
|
1605
|
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.
Collapse
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.
| |
Collapse
|
1606
|
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
| |
Collapse
|
1607
|
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.
Collapse
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.
| |
Collapse
|
1608
|
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
| |
Collapse
|
1609
|
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.
Collapse
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
| |
Collapse
|
1610
|
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.
Collapse
|
1611
|
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
|
1612
|
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.
| |
Collapse
|
1613
|
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
| |
Collapse
|
1614
|
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.
Collapse
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
| |
Collapse
|
1615
|
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.
Collapse
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
| |
Collapse
|
1616
|
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: 7] [Impact Index Per Article: 1.0] [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.
Collapse
|
1617
|
Rendon RA, Mason RJ, Marzouk K, Finelli A, Saad F, So A, Violette P, Breau RH. Recommandations de l'Association des urologues du Canada sur le dépistage et le diagnostic précoce du cancer de la prostate. Can Urol Assoc J 2017; 11:298-309. [PMID: 29381452 DOI: 10.5489/cuaj.4888] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo A Rendon
- Département d'urologie, Université Dalhousie, Halifax, N.-É., Canada
| | - Ross J Mason
- Département d'urologie, Clinique Mayo, Rochester, Minn., États-Unis
| | - Karim Marzouk
- Division d'urologie, Centre de cancérologie Memorial Sloan Kettering, New York, NY, États-Unis
| | - Antonio Finelli
- Division d'urologie, Université de Toronto, Toronto, Ont., Canada
| | - Fred Saad
- Département de chirurgie (urologie), Université de Montréal, Montréal, Qc, Canada
| | - Alan So
- Département des sciences urologiques, Université de la Colombie-Britannique, Vancouver, C.-B., Canada
| | - Phillipe Violette
- Département de chirurgie, Université Western, London, Ont., Canada.,Départements de chirurgie et de méthodologie de recherche en santé, Données et répercussions, Université McMaster, Hamilton, Ont., Canada
| | - Rodney H Breau
- Division d'urologie, Université d'Ottawa, Ottawa, Ont., Canada
| |
Collapse
|
1618
|
Phillips R, Ost P, Tran PT. What role does stereotactic ablative radiotherapy have in advanced castrate-resistant prostate cancer? Future Oncol 2017; 13:2121-2124. [PMID: 29019420 DOI: 10.2217/fon-2017-0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ryan Phillips
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, MD, USA
| | - Piet Ost
- Department of Radiation Oncology & Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Phuoc T Tran
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, MD, USA.,Departments of Oncology & Urology, Johns Hopkins University, MD, USA
| |
Collapse
|
1619
|
Xie W, Gao Q, Wang D, Wang W, Yuan J, Guo Z, Yan H, Wang X, Sun X, Zhao L. Melatonin potentiates "inside-out" nano-thermotherapy in human breast cancer cells: a potential cancer target multimodality treatment based on melatonin-loaded nanocomposite particles. Int J Nanomedicine 2017; 12:7351-7363. [PMID: 29066887 PMCID: PMC5644531 DOI: 10.2147/ijn.s148520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose With the wide recognition of oncostatic effect of melatonin, the current study proposes a potential breast cancer target multimodality treatment based on melatonin-loaded magnetic nanocomposite particles (Melatonin-MNPs). Methods Melatonin-MNPs were fabricated by the single emulsion solvent extraction/evaporation method. Results Based on the facilitated transport of melatonin by the GLUT overexpressed on the cell membrane, such Melatonin-MNPs can be more favorably uptaken by MCF-7 cells compared with the melatonin-free nanocomposite particles, which indicates the cancer targeting ability of melatonin molecule. Inductive heating can be generated by exposure to the Melatonin-MNPs internalized within cancer cells under alternative magnetic field, so as to achieve the “inside-out” magnetic nano-thermotherapy. In addition to demonstrating the superior cytotoxic effect of such nano-thermotherapy over the conventional exogenous heating by metal bath, more importantly, the sustainable release of melatonin from the Melatonin-MNPs can be greatly promoted upon responsive to the magnetic heating. The multimodality treatment based on Melatonin-MNPs can lead to more significant decrease in cell viability than any single treatment, suggesting the potentiated effect of melatonin on the cytotoxic response to nano-thermotherapy. Conclusion This study is the first to fabricate the precisely engineered melatonin-loaded multifunctional nanocomposite particles and demonstrate the potential in breast cancer target multimodality treatment.
Collapse
Affiliation(s)
- Wensheng Xie
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Qin Gao
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Dan Wang
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Wei Wang
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Jie Yuan
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Zhenhu Guo
- School of Earth Science and Resources, China University of Geosciences, Beijing, China
| | - Hao Yan
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Xiumei Wang
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Xiaodan Sun
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| | - Lingyun Zhao
- State key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University.,Key Laboratory of Advanced Materials, Ministry of Education of China, School of Materials Science & Engineering, Tsinghua University
| |
Collapse
|
1620
|
Audenet F, Vertosick EA, Fine SW, Sjoberg DD, Vickers AJ, Reuter VE, Eastham JA, Scardino PT, Touijer KA. Biopsy Core Features are Poor Predictors of Adverse Pathology in Men with Grade Group 1 Prostate Cancer. J Urol 2017; 199:961-968. [PMID: 29030317 DOI: 10.1016/j.juro.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Active surveillance is often restricted to patients with low risk prostate cancer who have 3 or fewer positive cores. We aimed to identify predictors of adverse pathology results for low risk prostate cancer treated with radical prostatectomy and determine whether a threshold number of positive cores could help the decision process for active surveillance. MATERIALS AND METHODS A total of 3,359 men with low risk prostate cancer underwent radical prostatectomy between January 2000 and August 2016. We analyzed the relationship between biopsy core features and adverse pathology at radical prostatectomy, defined as Grade Group 3 or greater, seminal vesicle invasion or lymph node involvement. RESULTS Of the 171 cases (5.1%) with adverse pathology findings at radical prostatectomy 144 (4.3%) were upgraded to Grade Group 3 or greater, 31 (0.9%) had seminal vesicle invasion and 15 (0.4%) had lymph node involvement. Prostate specific antigen and patient age were the only predictors of adverse pathology results. There was no significant association with the number of positive cores, the total mm of cancer or the maximum percent of cancer in any core. When we expanded the definition of adverse pathology to include Grade Group 2 and extraprostatic extension, the association between core features and outcome was statistically significant but clinically weak, and with no evidence of threshold effects. CONCLUSIONS There is little basis for excluding patients with otherwise low risk prostate cancer on biopsy from active surveillance based on criteria such as the number of positive cores or the maximum cancer involvement of biopsy cores.
Collapse
Affiliation(s)
- François Audenet
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Eastham
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter T Scardino
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim A Touijer
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
1621
|
Syed YA, Patel-Yadav AK, Rivers C, Singh AK. Stereotactic radiotherapy for prostate cancer: A review and future directions. World J Clin Oncol 2017; 8:389-397. [PMID: 29067275 PMCID: PMC5638714 DOI: 10.5306/wjco.v8.i5.389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer affects over 200000 men annually in the United States alone. The role of conventionally fractionated external beam radiation therapy (RT) is well established as a treatment option for eligible prostate cancer patients; however, the use of stereotactic body radiotherapy (SBRT) in this setting is less well defined. Within the past decade, there have been a number of studies investigating the feasibility of SBRT as a potential treatment option for prostate cancer patients. SBRT has been well studied in other disease sites, and the shortened treatment course would allow for greater convenience for patients. There may also be implications for toxicity as well as disease control. In this review we present a number of prospective and retrospective trials of SBRT in the treatment of prostate cancer. We focus on factors such as biochemical progression-free survival, prostate specific antigen (PSA) response, and toxicity in order to compare SBRT to established treatment modalities. We also discuss future steps that the clinical community can take to further explore this new treatment approach. We conclude that initial studies examining the use of SBRT in the treatment of prostate cancer have demonstrated impressive rates of biochemical recurrence-free survival and PSA response, while maintaining a relatively favorable acute toxicity profile, though long-term follow-up is needed.
Collapse
Affiliation(s)
- Yusef A Syed
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30342, United States
| | - Ami K Patel-Yadav
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Charlotte Rivers
- Department of Radiation Oncology, University at Buffalo, Buffalo, NY 14263, United States
| | - Anurag K Singh
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| |
Collapse
|
1622
|
Cheng KC, Chan YS, Chau H, Lam KM, So HS. Comparative study of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy on perioperative, oncological and functional outcomes. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kwun-Chung Cheng
- Department of Surgery; United Christian Hospital, Hong Kong; Hong Kong
| | - Yun-Sang Chan
- Department of Surgery; United Christian Hospital, Hong Kong; Hong Kong
| | - Hin Chau
- Department of Surgery; United Christian Hospital, Hong Kong; Hong Kong
| | - Kin-Man Lam
- Department of Surgery; Tseung Kwan O Hospital; Hong Kong
| | - Hing-Shing So
- Department of Surgery; United Christian Hospital, Hong Kong; Hong Kong
| |
Collapse
|
1623
|
Nouvelles techniques dans le cancer de la prostate localisé : chirurgie et radiothérapie. Cancer Radiother 2017; 21:442-446. [DOI: 10.1016/j.canrad.2017.08.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/18/2022]
|
1624
|
Linch M, Goh G, Hiley C, Shanmugabavan Y, McGranahan N, Rowan A, Wong YNS, King H, Furness A, Freeman A, Linares J, Akarca A, Herrero J, Rosenthal R, Harder N, Schmidt G, Wilson GA, Birkbak NJ, Mitter R, Dentro S, Cathcart P, Arya M, Johnston E, Scott R, Hung M, Emberton M, Attard G, Szallasi Z, Punwani S, Quezada SA, Marafioti T, Gerlinger M, Ahmed HU, Swanton C. Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters. Ann Oncol 2017; 28:2472-2480. [PMID: 28961847 PMCID: PMC5815564 DOI: 10.1093/annonc/mdx355] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies. PATIENTS AND METHODS Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification. RESULTS We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion. CONCLUSIONS The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies. CLINICAL TRIALS.GOV IDENTIFIER NCT02022371.
Collapse
Affiliation(s)
- M Linch
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Goh
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - C Hiley
- Division of Cancer Studies, King's College London, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y Shanmugabavan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N McGranahan
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - A Rowan
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y N S Wong
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - H King
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK
| | - A Furness
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Linares
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Akarca
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - R Rosenthal
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | | | | | - G A Wilson
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - N J Birkbak
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - R Mitter
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - S Dentro
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK;; Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, UK
| | - P Cathcart
- The Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - E Johnston
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - R Scott
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Hung
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - G Attard
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - Z Szallasi
- Centre for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark;; Computational Health Informatics Program (CHIP), Harvard Medical School, Boston, USA;; MTA-SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
| | - S Punwani
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - S A Quezada
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - T Marafioti
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Gerlinger
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK;; Division of Surgery, Department of Surgery and Cancer, Imperial College London, UK;; Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - C Swanton
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK;.
| |
Collapse
|
1625
|
Sebesta EM, Anderson CB. The Surgical Management of Prostate Cancer. Semin Oncol 2017; 44:347-357. [DOI: 10.1053/j.seminoncol.2018.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 11/11/2022]
|
1626
|
Vatne K, Stensvold A, Myklebust TÅ, Møller B, Svindland A, Kvåle R, Fosså SD. Pre- and post-prostatectomy variables associated with pelvic post-operative radiotherapy in prostate cancer patients: a national registry-based study. Acta Oncol 2017; 56:1295-1301. [PMID: 28422584 DOI: 10.1080/0284186x.2017.1314006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In patients with prostate cancer (PCa), the lack of clear guidelines on the use of radiotherapy after radical prostatectomy (RP) invites unwanted variation of this treatment. We describe the hazard ratios and probabilities related to the use of post-RP radiotherapy. MATERIAL AND METHODS Data were collected from the Cancer Registry of Norway and nine radiotherapy units. All patients were diagnosed with a non-metastatic PCa from January 2004 through June 2011. Adjuvant radiotherapy was defined as pelvic radiotherapy initiated <5 months after RP at a PSA <0.2 ng/ml. All other pelvic radiotherapy series were categorized as salvage radiotherapy, and, combined with adjuvant radiotherapy they were termed post-RP radiotherapy. RESULTS Of 6840 prostatectomized patients, 1170 (17%) had undergone post-RP radiotherapy, mainly as salvage radiotherapy. The number of adjuvant radiotherapy series almost tripled from 2009. Based on pre-prostatectomy variables (PSA, Gleason score, and clinical risk group) and findings in the prostatectomy specimens (status of resection margins, pathological tumor category and Gleason's score), the probability of post-RP radiotherapy ranged respectively from 14% to 73%, and from 4% to 83%. CONCLUSIONS In our study, post-RP radiotherapy was applied in approximately one in six patients. Based on the combination of PCa-specific variables routinely available at the time of diagnosis, a patient's probability of post-RP radiotherapy can be determined before decision of primary treatment strategy, followed by probability determination based on histopathological variables emerging from the prostatectomy specimen.
Collapse
Affiliation(s)
- Kari Vatne
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
- Oslo University, Oslo, Norway
| | - Andreas Stensvold
- Division of Clinical Oncology, Østfold Hospital Trust, Kalnes, Norway
| | | | | | - Aud Svindland
- The Norwegian Radium Hospital, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Rune Kvåle
- The Cancer Registry of Norway, Oslo, Norway
- The Norwegian Institute of Public Health, Bergen, Norway
| | - Sophie D. Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
- The Cancer Registry of Norway, Oslo, Norway
| |
Collapse
|
1627
|
Knipper S, Graefen M. Clinical Case Discussion: Primary Treatment for Prostate Cancer in an Elderly Man—Treatment of the Primary Tumor is Necessary. Eur Urol Focus 2017; 3:326-327. [DOI: 10.1016/j.euf.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
|
1628
|
Albertsen PC. Active Surveillance: A Ten-year Journey. Eur Urol 2017; 72:542-543. [DOI: 10.1016/j.eururo.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
|
1629
|
Magin P, Tapley A, Davey A, Morgan S, Henderson K, Holliday E, Ball J, Catzikiris N, Mulquiney K, Spike N, Kerr R, van Driel M. Prevalence and associations of general practitioners' ordering of "non-symptomatic" prostate-specific antigen tests: A cross-sectional analysis. Int J Clin Pract 2017; 71. [PMID: 28869684 DOI: 10.1111/ijcp.12998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS Testing for asymptomatic prostate cancer with prostate specific antigen (PSA) is of uncertain benefit. Most relevant authorities recommend against screening, and for informed patient choice. We aimed to establish the prevalence and associations of "non-symptomatic" PSA-testing of men aged 40 or older by early-career general practitioners (GP registrars). METHODS A cross-sectional analysis from the ReCEnT cohort study of registrars' consultations, 2010-2014 (analysed in 2016). Registrars record 60 consecutive consultations each 6-month training term. The outcome factor was ordering an "asymptomatic" PSA test (a PSA ordered for an indication that was not prostate-related symptoms or prostatic disease monitoring). Independent variables were patient, registrar, practice, consultation and educational factors. RESULTS A total of 856 registrars contributed details of 21,372 individual consultations and 35,696 problems/diagnoses of males 40 or older. Asymptomatic PSAs were ordered for 1.8% (95%CI: 1.7-2.0%) of consultations and for 1.1% (95%CI: 1.0-1.2%) of problems/diagnoses. Multivariable associations of asymptomatic PSA testing (compared with problems/diagnoses for which a PSA was not ordered) included patient age (OR 2.32 [95%CI: 1.53-3.53] for 60-69 years compared with 40-49), patient ethnicity (OR 0.40 [95%CI: 0.19-0.86] for non-English speaking background), the patient being new to both the registrar and practice (ORs 1.46 [95%CI: 1.08-1.99] and 1.79 [95%CI: 1.03-3.10]), the number of problems/diagnoses addressed (OR 1.44 [95%CI: 1.25-1.66] for each extra problem) and more pathology tests being ordered (OR 1.88 [95%CI: 1.79-1.97] for each extra test). CONCLUSION GP registrars frequently order "asymptomatic" PSA tests. Our findings suggest that non-compliance with current guidelines for PSA screening may be relatively common and that targeted education is warranted.
Collapse
Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Simon Morgan
- Elermore Vale General Practice, Elermore Vale, New South Wales, Australia
| | - Kim Henderson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jean Ball
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nigel Catzikiris
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Katie Mulquiney
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria GP Training, Hawthorn, Victoria, Australia
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Rohan Kerr
- General Practice Training Tasmania, Hobart, Tasmania, Australia
| | - Mieke van Driel
- School of Medicine, Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
1630
|
Sathianathen NJ, Philippou YA, Kuntz GM, Konety BR, Lamb AD, Dahm P. Taxane-based chemohormonal therapy for metastatic hormone-sensitive prostate cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Yiannis A Philippou
- University of Oxford; Nuffield Department of Surgical Sciences; John Radcliffe Hospital Headington Oxford UK OX39DU
| | - Gretchen M Kuntz
- University of Florida-Jacksonville; Borland Health Sciences Library; 653-1 West Eight St. 2nd FL LRC Jacksonville Florida USA 32209
| | - Badrinath R Konety
- University of Minnesota; Department of Urology; Minneapolis Minnesota USA
| | - Alastair D Lamb
- University of Oxford; Nuffield Department of Surgical Sciences; John Radcliffe Hospital Headington Oxford UK OX39DU
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
| |
Collapse
|
1631
|
Shah TT, To WKL, Ahmed HU. Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways. Expert Rev Anticancer Ther 2017; 17:1159-1168. [PMID: 28933973 DOI: 10.1080/14737140.2017.1383899] [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: 12/19/2022]
Abstract
INTRODUCTION With level 1 evidence now available on the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI) we must now utilise this data in developing an MRI-stratified diagnostic pathway for the early detection of prostate cancer. Areas covered: A literature review was conducted and identified seven randomised control trials (RCT's) assessing the diagnostic accuracy of such a pathway against the previously accepted systematic/random trans-rectal ultrasound guided (TRUS) biopsy pathway. The studies were heterogeneous in their design. Five studies assessed the addition of MRI-targeted biopsies to a standard care systematic TRUS biopsy pathway. Three of these studies showed either an increase in their diagnostic accuracy or the potential to remove systematic biopsies. Two studies looked specifically at a targeted biopsy only pathway and although the results were again mixed, there was no decrease in the diagnostic rate and overall significantly fewer biopsy cores were taken in the MRI group. Expert commentary: Results from these RCT's together with multiple retrospective and prospective studies point towards either an improved diagnostic rate for clinically significant cancer and/or a reduction in the need for systematic biopsies with a MRI-stratified pathway. The challenge for the urological community will be to implement pre-biopsy MRI into a routine clinical pathway with likely independent monitoring of standards.
Collapse
Affiliation(s)
- Taimur Tariq Shah
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK.,c Division of Surgery and Interventional Sciences , University College London , London , UK.,d Department of Urology , Whittington Hospitals NHS Trust , London , UK
| | - Wilson King Lim To
- c Division of Surgery and Interventional Sciences , University College London , London , UK
| | - Hashim Uddin Ahmed
- a Division of Surgery, Department of Surgery and Cancer , Imperial College London , London , UK.,b Imperial Urology, Charing Cross Hospital , Imperial College Healthcare NHS Trust , London , UK
| |
Collapse
|
1632
|
Thostrup M, Thomsen FB, Iversen P, Brasso K. Active surveillance for localized prostate cancer: update of a prospective single-center cohort. Scand J Urol 2017; 52:14-19. [DOI: 10.1080/21681805.2017.1380697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mathias Thostrup
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik B. Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
1633
|
Affiliation(s)
- Timothy J Wilt
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | | | | |
Collapse
|
1634
|
Chen Y, Fan Y, Yang Y, Jin J, Zhou L, He Z, Zhao Z, He Q, Wang X, Yu W, Wu S. Are prostate biopsies necessary for all patients 75years and older? J Geriatr Oncol 2017; 9:124-129. [PMID: 28939384 DOI: 10.1016/j.jgo.2017.09.001] [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] [Received: 05/12/2017] [Revised: 08/13/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop nomograms predicting prostate cancer (PCa) and high-grade PCa (HGPCa) in the elderly population. METHODS We reviewed the data of patients aged 75years and older who underwent first-time prostate biopsy and multiparametric magnetic resonance imaging (mpMRI). The nomograms were developed based on multivariate analysis and evaluated. We performed the external validation and calibration of the risk calculators from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate Cancer Prevention Trial (PCPT). RESULTS The present study included 302 subjects with a median age of 78years (range: 75-91years). Overall, 225 and 129 subjects were diagnosed with PCa and HGPCa (Gleason score≥4+3), respectively. The ratio of free-to-total PSA, prostate-specific antigen density (PSAD), transrectal ultrasound (TRUS), and Prostate Imaging Reporting and Data System (PI-RADS) were used to develop the PCa-predicting nomogram, and PSAD, TRUS, and PI-RADS were used to develop the HGPCa-predicting nomogram. The area under the curve (AUC) values of PCa-predicting and HGPCa-predicting nomograms were 0.90 and 0.87. The ERSPC calculator had acceptable external calibration and validation outcomes. We recommended a cut-off probability of 42% for PCa-predicting nomogram when used in healthy older men to achieve a sensitivity of 95.6%, and a cut-off probability of 73% for HGPCa-predicting nomogram when used in vulnerable older men to achieve a specificity of 98.3%. CONCLUSIONS The present nomograms could help discriminate patients with PCa from healthy elder adults for standard treatment, and discriminate patients with HGPCa from vulnerable elder adults for modified treatment. External validation is expected.
Collapse
Affiliation(s)
- Yuke Chen
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yang Yang
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Jie Jin
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Zhisong He
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Zheng Zhao
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Qun He
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shiliang Wu
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| |
Collapse
|
1635
|
Parikh RR, Kim S, Stein MN, Haffty BG, Kim IY, Goyal S. Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice? Cancer Med 2017; 6:2410-2418. [PMID: 28925011 PMCID: PMC5633554 DOI: 10.1002/cam4.1132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022] Open
Abstract
As recommended by current NCCN guidelines, patients with very low‐risk prostate cancer may be treated with active surveillance (AS), but this may be underutilized. Using the National Cancer Database (NCDB), we identified men (2010–2013) with biopsy‐proven, very low‐risk prostate cancer that met AS criteria as suggested by Epstein (stage ≤ T1c; Gleason score (GS) ≤ 6; PSA < 10; and ≤2 [or <33%] positive biopsy cores) and aged ≤76, and low comorbidity index (Charlson‐Deyo score = 0). For those patients meeting this criteria, we performed generalized estimation equation (GEE) method with incorporation of correlation in patients clustered within facility to determine the likelihood of undergoing AS. Among the 448 773 patients in the NCDB with low‐risk prostate cancer, 40 839 patients met the inclusion criteria. AS was utilized in 5798 patients (14.2%), while within the very low‐risk patients receiving treatment, up to 52.2% received radical prostatectomy. In univariate analyses, AS utilization was associated with older age, uninsured status (compared to private insurance), farther distance from facility, academic/research institutions and particularly in the New England region (all P < 0.01). After adjustments of other predictors in multivariate analysis, patients preferentially received AS if they were older (all OR's > 1 compared to younger groups), uninsured (vs. any insurance type, OR's > 1); or treated at academic/research center (OR > 1). The overall use of AS increased from 11.6% (2010) to 27.3% (2013). We found a low, but rising rate of AS in a nationally representative group of very low‐risk prostate cancer patients. Disparities in the use of AS may be targeted to improve adherence to national guidelines.
Collapse
Affiliation(s)
- Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sinae Kim
- Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.,Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ, 08903
| | - Mark N Stein
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Isaac Y Kim
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| |
Collapse
|
1636
|
Frendl DM, Olumi AF. Understanding temporal trends in medical costs associated with progression to metastatic prostate cancer. Cancer 2017; 123:3447-3449. [DOI: 10.1002/cncr.30779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel M. Frendl
- Department of Urology, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Aria F. Olumi
- Department of Urology, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
1637
|
Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev 2017; 9:CD009625. [PMID: 28895658 PMCID: PMC6486168 DOI: 10.1002/14651858.cd009625.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prostate cancer is commonly diagnosed in men worldwide. Surgery, in the form of radical prostatectomy, is one of the main forms of treatment for men with localised prostate cancer. Prostatectomy has traditionally been performed as open surgery, typically via a retropubic approach. The advent of laparoscopic approaches, including robotic-assisted, provides a minimally invasive alternative to open radical prostatectomy (ORP). OBJECTIVES To assess the effects of laparoscopic radical prostatectomy or robotic-assisted radical prostatectomy compared to open radical prostatectomy in men with localised prostate cancer. SEARCH 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 also searched bibliographies of included studies and conference proceedings. SELECTION CRITERIA We included all randomised controlled trials (RCTs) with a direct comparison of laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP) to ORP, including pseudo-RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data. 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. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to GRADE. MAIN RESULTS We included two unique studies with 446 randomised participants with clinically localised prostate cancer. The mean age, prostate volume, and prostate-specific antigen (PSA) of the participants were 61.3 years, 49.78 mL, and 7.09 ng/mL, respectively. Primary outcomes We found no study that addressed the outcome of prostate cancer-specific survival. Based on data from one trial, RARP likely results in little to no difference in urinary quality of life (MD -1.30, 95% CI -4.65 to 2.05) and sexual quality of life (MD 3.90, 95% CI -1.84 to 9.64). We rated the quality of evidence as moderate for both quality of life outcomes, downgrading for study limitations. Secondary outcomes We found no study that 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 (RR 0.41, 95% CI 0.16 to 1.04) or serious postoperative complications (RR 0.16, 95% CI 0.02 to 1.32). We rated the quality of evidence as low for both surgical complications, downgrading for study limitations and imprecision.Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at one day (MD -1.05, 95% CI -1.42 to -0.68 ) and up to one week (MD -0.78, 95% CI -1.40 to -0.17). We rated the quality of evidence for both time-points as low, downgrading for study limitations and imprecision. Based on one study, RARP likely results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI -0.32 to 0.34). We rated the quality of evidence as moderate, downgrading for study limitations.Based on one study, RARP likely reduces the length of hospital stay (MD -1.72, 95% CI -2.19 to -1.25). We rated the quality of evidence as moderate, downgrading for study limitations.Based on two study, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI 0.12 to 0.46). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1000 men (95% CI 78 fewer to 48 fewer). We rated the quality of evidence as low, downgrading for study limitations and indirectness.We were unable to perform any of the prespecified secondary analyses based on the available evidence. All available outcome data were short-term and we were unable to account for surgeon volume or experience. AUTHORS' CONCLUSIONS There is no high-quality evidence to inform the comparative effectiveness of LRP or RARP compared to ORP for oncological outcomes. Urinary and sexual quality of life-related outcomes 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. All available outcome data were short-term, and this study was unable to account for surgeon volume or experience.
Collapse
Affiliation(s)
- Dragan Ilic
- Monash UniversityDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineThe Alfred Centre, Level 6, 99 Commercial RdMelbourneVictoriaAustralia3004
| | - Sue M Evans
- School of Public Health & Preventive Medicine, Monash UniversityCentre of Research Excellence in Patient SafetyMelbourneAustralia
| | - Christie Ann Allan
- Monash UniversityDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineThe Alfred Centre, Level 6, 99 Commercial RdMelbourneVictoriaAustralia3004
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- University of MinnesotaDepartment of UrologyMinneapolis, MinnesotaUSA
- Minneapolis VA Health Care SystemUrology SectionMinneapolis, MinnesotaUSA
| | - Declan Murphy
- Peter MacCallum Cancer CentreCancer SurgeryMelbourneAustralia
| | | | | |
Collapse
|
1638
|
[Therapeutic innovations in radiation oncology for localized prostate cancer]. Cancer Radiother 2017; 21:454-461. [PMID: 28890087 DOI: 10.1016/j.canrad.2017.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022]
Abstract
Intensity-modulated radiation therapy, image-guided radiation therapy with fiducial markers and prostate brachytherapy allow the delivery of dose escalation for localized prostate cancer with very low rates of long-term toxicity and sequelae. Nowadays, modern radiotherapy techniques make it possible to shorten treatment time with hypofractionation, to better protect surrounding healthy tissues and to escalate the dose even further. Advances in radiotherapy are closely linked to advances in magnetic resonance imaging (MRI) and/or PET imaging. Functional imaging makes it possible to deliver personalised pelvic nodal radiotherapy, targeting the nodal areas at higher risk of microscopic involvement. In patients with an index lesion at baseline or at failure, MR-based focal therapy or focal dose escalation with brachytherapy or stereotactic body radiation therapy is also currently investigated. MR-based adaptive radiotherapy, which makes it possible to track prostate shifts during radiation delivery, is another step forward in the integration of MR imaging in radiation delivery.
Collapse
|
1639
|
Holmes-Rovner M, Srikanth A, Henry SG, Langford A, Rovner DR, Fagerlin A. Decision aid use during post-biopsy consultations for localized prostate cancer. Health Expect 2017; 21:279-287. [PMID: 28881105 PMCID: PMC5750733 DOI: 10.1111/hex.12613] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Decision Aids (DAs) effectively translate medical evidence for patients but are not routinely used in clinical practice. Little is known about how DAs are used during patient-clinician encounters. OBJECTIVE To characterize the content and communicative function of high-quality DAs during diagnostic clinic visits for prostate cancer. PARTICIPANTS 252 men newly diagnosed with localized prostate cancer who had received a DA, 45 treating physicians at 4 US Veterans Administration urology clinics. METHODS Qualitative analysis of transcribed audio recordings was used to inductively develop categories capturing content and function of all direct references to DAs (booklet talk). The presence or absence of any booklet talk per transcript was also calculated. RESULTS Booklet talk occurred in 55% of transcripts. Content focused on surgical procedures (36%); treatment choice (22%); and clarifying risk classification (17%). The most common function of booklet talk was patient corroboration of physicians' explanations (42%), followed by either physician or patient acknowledgement that the patient had the booklet. Codes reflected the absence of DA use for shared decision-making. In regression analysis, predictors of booklet talk were fewer years of patient education (P = .027) and more time in the encounter (P = .027). Patient race, DA type, time reading the DA, physician informing quality and physician age did not predict booklet talk. CONCLUSIONS Results show that good decision aids, systematically provided to patients, appeared to function not to open up deliberations about how to balance benefits and harms of competing treatments, but rather to allow patients to ask narrow technical questions about recommended treatments.
Collapse
Affiliation(s)
- Margaret Holmes-Rovner
- Centre for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.,Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Akshay Srikanth
- Henry Ford Hospital, Wayne State University, Detroit, MI, USA
| | - Stephen G Henry
- Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CI, USA
| | - Aisha Langford
- Department of Population Health, New York University School of Medicine, New York City, NY, USA
| | - David R Rovner
- Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Angela Fagerlin
- VA Ann Arbor Centre for Clinical Management Research, Department of Internal Medicine and Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
1640
|
Loft MD, Berg KD, Kjaer A, Iversen P, Ferrari M, Zhang CA, Brasso K, Brooks JD, Røder MA. Temporal Trends in Clinical and Pathological Characteristics for Men Undergoing Radical Prostatectomy Between 1995 and 2013 at Rigshospitalet, Copenhagen, Denmark, and Stanford University Hospital, United States. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30269-0. [PMID: 28988695 DOI: 10.1016/j.clgc.2017.08.014] [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] [Received: 06/23/2017] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze how prostate-specific antigen (PSA) screening and practice patterns has affected trends in tumor characteristics in men undergoing radical prostatectomy (RP) in the United States and Denmark. Unlike in the United States, PSA screening has not been recommended in Denmark. PATIENTS AND METHODS We performed an observational register study using pre- and postoperative data on 2168 Danish patients from Rigshospitalet, Copenhagen, Denmark, and 2236 patients from Stanford University Hospital, Stanford, CA, who underwent RP between 1995 and 2013. Patients were stratified according to Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) risk groups and D'Amico risk classification and were clustered into 4 time periods (1995-1999, 2000-2004, 2005-2009, and 2010-2013). Temporal trends in the proportions of patients of a given variable at the 2 institutions were evaluated with Cochran-Armitage test for trends and chi-square testing. RESULTS A total of 4404 patients were included. Temporal changes in preoperative PSA, age, grade, and stage was found in both cohorts. Median preoperative PSA declined in both cohorts, while median age increased, with the Danish cohort showing the greatest changes in both PSA and age. In both cohorts, there was a trend for higher-risk preoperative features before RP over time. In 2010-2013, 27.7% and 21.8% of the patients were in the D'Amico high-risk group at Copenhagen and Stanford, respectively. CONCLUSION Despite recommendation against PSA screening in Denmark, Danish men undergoing RP at Rigshospitalet to a considerable extent now resemble American men undergoing RP at Stanford. At both sites, there is continued trend to reduce the number of men undergoing RP for low-risk prostate cancer.
Collapse
Affiliation(s)
- Mathias Dyrberg Loft
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Urology, Stanford University Medical Center, Stanford, CA; Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
| | - Kasper Drimer Berg
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michelle Ferrari
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Klaus Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - James D Brooks
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Martin Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
1641
|
Clinton TN, Bagrodia A, Lotan Y, Margulis V, Raj GV, Woldu SL. Tissue-based biomarkers in prostate cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017; 2:249-260. [PMID: 29226251 PMCID: PMC5722240 DOI: 10.1080/23808993.2017.1372687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/24/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Prostate cancer is a heterogeneous disease. Existing risk stratification tools based on standard clinlicopathologic variables (prostate specific antigen [PSA], Gleason score, and tumor stage) provide a modest degree of predictive ability. Advances in high-throughput sequencing has led to the development of several novel tissue-based biomarkers that can improve prognostication in prostate cancer management. AREAS COVERED The authors review commercially-available, tissue-based biomarker assays that improve upon existing risk-stratification tools in several areas of prostate cancer management, including the appropriateness of active surveillance and aiding in decision making regarding the use of adjuvant therapy. Additionally, some of the obstacles to the widespread adoption of these biomarkers and discuss several investigational sources of new biomarkers are discussed. EXPERT COMMENTARY Work is ongoing to answer pertinent clinical questions in prostate cancer management including which patients should undergo biopsy, active surveillance, receive adjuvant therapy, and what systemic therapy is best in the first-line. Incorporation into novel biomarkers may allow for the incorporation of a 'personalized' approach to management. Further validation will be required and questions of cost must be considered before wide scale adoption of these biomarkers. Tumor heterogeneity may impose a ceiling on the prognostic ability of biomarkers using currently available techniques.
Collapse
Affiliation(s)
- Timothy N Clinton
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| | - Aditya Bagrodia
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| | - Vitaly Margulis
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| | - Ganesh V Raj
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| | - Solomon L Woldu
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, Texas
| |
Collapse
|
1642
|
Bass EJ, Donaldson IA, Freeman A, Jameson C, Punwani S, Moore C, Arya M, Emberton M, Ahmed HU. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach. Prostate Cancer Prostatic Dis 2017; 20:311-317. [PMID: 28485391 DOI: 10.1038/pcan.2017.13] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/29/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique. METHODS Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05). RESULTS One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0-2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater (irrespective of cancer length). Any cancer was detected in 142/181 (78%). Significant disease was more likely in higher MRI-scoring lesions and in men with PSAs ⩾10 ng ml-1. CONCLUSIONS This approach to prostate biopsy is feasible, tolerable and can be performed in ambulatory settings.
Collapse
Affiliation(s)
- E J Bass
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - I A Donaldson
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - C Jameson
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - S Punwani
- Centre for Medical Imaging, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - C Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| |
Collapse
|
1643
|
Davis JW. Editorial Commentary. UROLOGY PRACTICE 2017. [DOI: 10.1016/j.urpr.2016.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- John W. Davis
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
1644
|
Gaither TW, Awad MA, Osterberg EC, Murphy GP, Allen IE, Chang A, Rosen RC, Breyer BN. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017; 14:1071-1078. [PMID: 28859870 DOI: 10.1016/j.jsxm.2017.07.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/12/2017] [Accepted: 07/25/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education. AIM To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED. METHODS We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis. OUTCOME ED after RT of the prostate. RESULTS In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10-17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29-0.39) at 1 year and 57% (95% CI = 0.53-0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3-22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03-4.7). CLINICAL IMPLICATIONS ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years. STRENGTHS AND LIMITATIONS The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED. CONCLUSION Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071-1078.
Collapse
Affiliation(s)
- Thomas W Gaither
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Mohannad A Awad
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Surgery, King Abdul Aziz University, Rabigh, Saudi Arabia
| | - E Charles Osterberg
- Department of Surgery, University of Texas-Dell Medical School, Austin, TX, USA
| | - Gregory P Murphy
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Albert Chang
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | | | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA.
| |
Collapse
|
1645
|
Ploussard G, Hennequin C, Rozet F. [Active surveillance of prostate cancer]. Cancer Radiother 2017; 21:437-441. [PMID: 28847461 DOI: 10.1016/j.canrad.2017.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Several prospective studies have demonstrated the safety of active surveillance as a first treatment of prostate cancer. It spares many patients of a useless treatment, with its potential sequelae. Patients with a low-risk cancer are all candidates for this approach, as recommended by the American Society of Clinical Oncology (ASCO). Some patients with an intermediate risk could be also concerned by active surveillance, but this is still being discussed. Currently, the presence of grade 4 lesions on biopsy is a contra-indication. Modalities included a repeated prostate specific antigen test and systematic rebiopsy during the first year after diagnosis. MRI is now proposed to better select patients at inclusion and also during surveillance. No life style changes or drugs are significantly associated with a longer duration of surveillance.
Collapse
Affiliation(s)
- G Ploussard
- Clinique Saint-Jean-du-Languedoc, 20, route de Revel, 31400 Toulouse, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France
| | - F Rozet
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| |
Collapse
|
1646
|
Clinical utility of emerging liquid biomarkers in advanced prostate cancer. Cancer Genet 2017; 228-229:151-158. [PMID: 28958406 DOI: 10.1016/j.cancergen.2017.08.003] [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: 07/23/2017] [Accepted: 08/21/2017] [Indexed: 01/04/2023]
Abstract
The therapeutic landscape of advanced prostate cancer (PCa) has rapidly expanded in recent years. Despite significant improvements in patient overall survival, it remains challenging to determine the optimal therapy and sequence of therapies for individual patients. The development of molecular biomarkers will be key for patient stratification, and for monitoring response and resistance to therapy. In this context, minimally-invasive blood-based "liquid" biopsies are attractive as a practical surrogate for solid tumor tissue, providing a window into metastatic disease. Circulating tumor cells and circulating cell-free tumor DNA in particular have demonstrated remarkable potential to inform on PCa patient outcomes through the detection of specific genomic and transcriptomic alterations. This review covers recent advances in the development of clinically-informative liquid biomarkers for advanced PCa.
Collapse
|
1647
|
Zschaeck S, Wust P, Beck M, Wlodarczyk W, Kaul D, Rogasch J, Budach V, Furth C, Ghadjar P. Intermediate-term outcome after PSMA-PET guided high-dose radiotherapy of recurrent high-risk prostate cancer patients. Radiat Oncol 2017; 12:140. [PMID: 28830532 PMCID: PMC5568206 DOI: 10.1186/s13014-017-0877-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By the use of PSMA positron emission tomography (PET) detection of prostate cancer lesions with a high sensitivity and specificity combined with a favorable lesion to background contrast is feasible. Therefore, PSMA-PET is increasingly used for planning of radiotherapy treatment; however, any data on intermediate-term outcome is missing so far. METHODS Patients with high-risk or very high risk prostate cancer, referred for salvage radiotherapy (SRT, n = 22) between 2013 and 2015, underwent PSMA-PET prior to therapy. Irradiation was planned on PET data with boost to macroscopic tumors/metastases. Treatment related toxicity was measured using Common Terminology Criteria for Adverse Events (CTCAE, v4.0). RESULT Findings in PSMA-PET led to treatment modifications in 77% of SRT patients compared to available CT information. One patient did not receive irradiation due to disseminated disease, the other patients received increased boost doses to macroscopic disease and/or inclusion of additional target volumes. Toxicity was low as only 2 patients reported toxicities > grade 1. With a Median follow-up time of 29 in patients that were not lost to follow-up, prolonged PSA responses below baseline were observed in the majority of patients (14 of 20). In hormone-naïve SRT patients (n = 11), radiotherapy led to prolonged PSA decrease in 8/11 patients, however with 3 of these 8 patients receiving repeated PSMA based irradiation of novel lesions during follow-up. CONCLUSION PSMA-PET guided planning of radiotherapy led to change of treatment in the majority of patients. Treatment related toxicity was well tolerated and promising results regarding intermediate-term PSA decrease were observed. TRIAL REGISTRATION No trial registration was performed due to retrospective evaluation.
Collapse
Affiliation(s)
- Sebastian Zschaeck
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peter Wust
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Waldemar Wlodarczyk
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julian Rogasch
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
1648
|
Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions. Eur Urol 2017; 72:899-907. [PMID: 28844371 DOI: 10.1016/j.eururo.2017.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND An increasing proportion of prostate cancer is being managed conservatively. However, there are no randomized trials or consensus regarding the optimal follow-up strategy. OBJECTIVE To compare life expectancy and quality of life between watchful waiting (WW) versus different strategies of active surveillance (AS). DESIGN, SETTING, AND PARTICIPANTS A Markov model was created for US men starting at age 50, diagnosed with localized prostate cancer who chose conservative management by WW or AS using different testing protocols (prostate-specific antigen every 3-6 mo, biopsy every 1-5 yr, or magnetic resonance imaging based). Transition probabilities and utilities were obtained from the literature. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were life years and quality-adjusted life years (QALYs). Secondary outcomes include radical treatment, metastasis, and prostate cancer death. RESULTS AND LIMITATIONS All AS strategies yielded more life years compared with WW. Lifetime risks of prostate cancer death and metastasis were, respectively, 5.42% and 6.40% with AS versus 8.72% and 10.30% with WW. AS yielded more QALYs than WW except in cohorts age >65 yr at diagnosis, or when treatment-related complications were long term. The preferred follow-up strategy was also sensitive to whether people value short-term over long-term benefits (time preference). Depending on the AS protocol, 30-41% underwent radical treatment within 10 yr. Extending the surveillance biopsy interval from 1 to 5 yr reduced life years slightly, with a 0.26 difference in QALYs. CONCLUSIONS AS extends life more than WW, particularly for men with higher-risk features, but this is partly offset by the decrement in quality of life since many men eventually receive treatment. PATIENT SUMMARY More intensive active surveillance protocols extend life more than watchful waiting, but this is partly offset by decrements in quality of life from subsequent treatment.
Collapse
|
1649
|
Hoffman RM, Volk RJ, Wolf AMD. Making the grade: The newest US Preventive Services Task Force prostate cancer screening recommendation. Cancer 2017; 123:3875-3878. [PMID: 28832967 DOI: 10.1002/cncr.30941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.,Cancer Epidemiology and Population Science, University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa
| | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew M D Wolf
- Division of Medicine, Geriatrics, and Palliative Care, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
1650
|
Aas K, Axcrona K, Kvåle R, Møller B, Myklebust TÅ, Axcrona U, Berge V, Fosså SD. Ten-year Mortality in Men With Nonmetastatic Prostate Cancer in Norway. Urology 2017; 110:140-147. [PMID: 28823634 DOI: 10.1016/j.urology.2017.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/01/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide population-based data on 10-year prostate cancer-specific mortality (PCSM), overall mortality (OM), treatment, and prognostic factors in patients with nonmetastatic prostate cancer (PCa). MATERIALS AND METHODS Based on data from the Norwegian Prostate Cancer Registry, we calculated 10-year PCSM and OM in 3449 patients diagnosed with nonmetastatic PCa in 2004-2005 who underwent radical prostatectomy (n = 913), radiotherapy (n = 1334), or no local treatment (n = 1202). Patients were stratified according to risk group, Gleason grade group (GGG), and Eastern Cooperative Oncology Group (ECOG) performance status. Aalen-Johansen and Kaplan-Meier estimates and proportional hazards regressions were used. RESULTS The 10-year PCSM rate was 8.5% (radical prostatectomy: 1.5, radiotherapy: 6.2%, no local treatment: 16.3%) and the OM rate was 25.5%. In the low-risk group, the risk of dying from other causes was 8-fold increased compared with death from PCa, the comparable factor being approximately 2 among high-risk patients. Patients with high-risk factors seemed to benefit the most from local treatment. Within each risk group, the 5 GGGs improved the prediction of PCSM. Having an ECOG performance status of ≥1 doubled the risk of PCSM compared with patients with an ECOG performance status of 0. CONCLUSION For all patients, the 10-year OM was about 3 times higher than PCSM, the greatest and lowest discrepancies emerging among patients with low- and high-risk tumors, respectively. The results support increased use of local treatment in high-risk patients. GGGs should be implemented in clinical practice. The role of ECOG performance status as prognostic factor has to be validated in future studies.
Collapse
Affiliation(s)
- Kirsti Aas
- Department of Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway.
| | - Karol Axcrona
- Department of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Rune Kvåle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; The Cancer Registry of Norway, Norway
| | | | | | - Ulrika Axcrona
- Department of Pathology, The Norwegian Radium Hospital/Oslo University Hospital, Oslo, Norway
| | - Viktor Berge
- Department of Surgery, Oslo University Hospital, Oslo, Norway
| | - Sophie Dorothea Fosså
- The Cancer Registry of Norway, Norway; Department of Oncology, The Norwegian Radium Hospital/Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|