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Borkowetz A, Blana A, Böhmer D, Cash H, Ehrmann U, Franiel T, Henkel TO, Höcht S, Kristiansen G, Machtens S, Niehoff P, Penzkofer T, Pinkawa M, Radtke JP, Roth W, Witzsch U, Ganzer R, Schlemmer HP, Grimm MO, Hakenberg OW, Schostak M. German S3 Evidence-Based Guidelines on Focal Therapy in Localized Prostate Cancer: The First Evidence-Based Guidelines on Focal Therapy. Urol Int 2022; 106:431-439. [PMID: 35144260 DOI: 10.1159/000521882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/21/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Focal therapy (FT) is an option to treat localized prostate cancer (PCa) and preserve healthy prostate tissue in order to reduce known side effects from primary whole-gland treatment. The available FT modalities are manifold. Until now, national and international PCa guidelines have been cautious to propose recommendations regarding FT treatment since data from prospective controlled trials are lacking for most FT modalities. Moreover, none of the international guidelines provides a separate section on FT. In this purpose, we provide a synopsis of the consensus-based German S3 guidelines for a possible international use. SUMMARY The recently published update of the German S3 guidelines, an evidence- and consensus-based guideline, provides a section on FT with recommendations for diagnostic work-up, indications, modalities, and follow-up. This section consists of 12 statements and recommendations for FT in the treatment of localized PCa. Key Message: The German S3 guidelines on PCa are the first to incorporate recommendations for FT based on evidence and expert consensus including indication criteria for FT, pretreatment, and follow-up diagnostic pathways as well as an extended overview of FT techniques and the current supportive evidence.
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Affiliation(s)
- Angelika Borkowetz
- German Society of Urology (DGU), Berlin, Germany.,Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Blana
- German Society of Urology (DGU), Berlin, Germany.,Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - Dirk Böhmer
- Working Group Radiooncology German Cancer Society (ARO), Berlin, Germany.,Department of Radiooncology, University Hospital, Charite Berlin, Berlin, Germany
| | - Hannes Cash
- Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,ProUro, Berlin, Germany.,Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - Udo Ehrmann
- Bundesverband Prostatakrebshilfe (BPS), Würzburg, Germany
| | - Tobias Franiel
- Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,German Röntgen Society, Berlin, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Thomas-Oliver Henkel
- German Society of Urology (DGU), Berlin, Germany.,Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Urologie Praxis, Berlin, Germany
| | - Stefan Höcht
- Working Group Radiooncology German Cancer Society (ARO), Berlin, Germany.,Xcare Praxis für Strahlentherapie, Saarlouis, Germany
| | - Glen Kristiansen
- German Society of Pathology, Berlin, Germany.,Bundesverband Deutscher Urologen, Berlin, Germany.,Department of Pathology, Universitätsklinikum Bonn, Bonn, Germany
| | - Stefan Machtens
- German Society of Urology (DGU), Berlin, Germany.,Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, GFO Hospitals Rhein-Berg, Marien-Hospital, Bergisch-Gladbach, Germany
| | - Peter Niehoff
- Berufsverband Deutscher Strahlentherapeuten, Berlin, Germany.,Department of Radiooncology, Sana Hospital Offenbach, Offenbach, Germany
| | - Tobias Penzkofer
- Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Radiology, University Hospital Charite Berlin, Berlin, Germany
| | - Michael Pinkawa
- Berufsverband Deutscher Strahlentherapeuten, Berlin, Germany.,Department of Radiooncology, MediClin Robert Janker Hospital, Bonn, Germany
| | - Jan Philipp Radtke
- Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, University Hospital Essen, Essen, Germany
| | - Wilfried Roth
- German Society of Pathology, Berlin, Germany.,Bundesverband Deutscher Urologen, Berlin, Germany.,Department of Pathology, University Hospital Mainz, Mainz, Germany
| | - Ullrich Witzsch
- Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Roman Ganzer
- German Society of Urology (DGU), Berlin, Germany.,Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Heinz Peter Schlemmer
- German Röntgen Society, Berlin, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc-Oliver Grimm
- German Society of Urology (DGU), Berlin, Germany.,Department of Urology, University Hospital Jena, Jena, Germany
| | - Oliver W Hakenberg
- German Society of Urology (DGU), Berlin, Germany.,Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Martin Schostak
- German Society of Urology (DGU), Berlin, Germany.,Working Group of Focal and Microtherapy of the German Society of Urology (DGU), Berlin, Germany.,Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
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2
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Hamdy FC, Elliott D, le Conte S, Davies LC, Burns RM, Thomson C, Gray R, Wolstenholme J, Donovan JL, Fitzpatrick R, Verrill C, Gleeson F, Singh S, Rosario D, Catto JW, Brewster S, Dudderidge T, Hindley R, Emara A, Sooriakumaran P, Ahmed HU, Leslie TA. Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT. Health Technol Assess 2019; 22:1-96. [PMID: 30264692 DOI: 10.3310/hta22520] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk, clinically localised disease are offered radical treatments such as surgery or radiotherapy, which can result in severe side effects. A number of alternative partial ablation (PA) technologies that may reduce treatment burden are available; however the comparative effectiveness of these techniques has never been evaluated in a randomised controlled trial (RCT). OBJECTIVES To assess the feasibility of a RCT of PA using high-intensity focused ultrasound (HIFU) versus radical prostatectomy (RP) for intermediate-risk PCa and to test and optimise methods of data capture. DESIGN We carried out a prospective, multicentre, open-label feasibility study to inform the design and conduct of a future RCT, involving a QuinteT Recruitment Intervention (QRI) to understand barriers to participation. SETTING Five NHS hospitals in England. PARTICIPANTS Men with unilateral, intermediate-risk, clinically localised PCa. INTERVENTIONS Radical prostatectomy compared with HIFU. PRIMARY OUTCOME MEASURE The randomisation of 80 men. SECONDARY OUTCOME MEASURES Findings of the QRI and assessment of data capture methods. RESULTS Eighty-seven patients consented to participate by 31 March 2017 and 82 men were randomised by 4 May 2017 (41 men to the RP arm and 41 to the HIFU arm). The QRI was conducted in two iterative phases: phase I identified a number of barriers to recruitment, including organisational challenges, lack of recruiter equipoise and difficulties communicating with patients about the study, and phase II comprised the development and delivery of tailored strategies to optimise recruitment, including group training, individual feedback and 'tips' documents. At the time of data extraction, on 10 October 2017, treatment data were available for 71 patients. Patient characteristics were similar at baseline and the rate of return of all clinical case report forms (CRFs) was 95%; the return rate of the patient-reported outcome measures (PROMs) questionnaire pack was 90.5%. Centres with specific long-standing expertise in offering HIFU as a routine NHS treatment option had lower recruitment rates (Basingstoke and Southampton) - with University College Hospital failing to enrol any participants - than centres offering HIFU in the trial context only. CONCLUSIONS Randomisation of men to a RCT comparing PA with radical treatments of the prostate is feasible. The QRI provided insights into the complexities of recruiting to this surgical trial and has highlighted a number of key lessons that are likely to be important if the study progresses to a main trial. A full RCT comparing clinical effectiveness, cost-effectiveness and quality-of-life outcomes between radical treatments and PA is now warranted. FUTURE WORK Men recruited to the feasibility study will be followed up for 36 months in accordance with the protocol. We will design a full RCT, taking into account the lessons learnt from this study. CRFs will be streamlined, and the length and frequency of PROMs and resource use diaries will be reviewed to reduce the burden on patients and research nurses and to optimise data completeness. TRIAL REGISTRATION Current Controlled Trials ISRCTN99760303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Daisy Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steffi le Conte
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy C Davies
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richéal M Burns
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Thomson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jenny L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Fergus Gleeson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Surjeet Singh
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - James Wf Catto
- Department of Oncology, University of Oxford, Oxford, UK
| | - Simon Brewster
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Amr Emara
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tom A Leslie
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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3
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Möglichkeiten der Kryotherapie beim Prostatakarzinom. Urologe A 2018; 57:1490-1493. [DOI: 10.1007/s00120-018-0805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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4
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Jung JH, Risk MC, Goldfarb R, Reddy B, Coles B, Dahm P. Primary cryotherapy for localised or locally advanced prostate cancer. Cochrane Database Syst Rev 2018; 5:CD005010. [PMID: 29845595 PMCID: PMC6494517 DOI: 10.1002/14651858.cd005010.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Traditionally, radical prostatectomy and radiotherapy with or without androgen deprivation therapy have been the main treatment options to attempt to cure men with localised or locally advanced prostate cancer. Cryotherapy is an alternative option for treatment of prostate cancer that involves freezing of the whole prostate (whole gland therapy) or only the cancer (focal therapy), but it is unclear how effective this is in comparison to other treatments. OBJECTIVES To assess the effects of cryotherapy (whole gland or focal) compared with other interventions for primary treatment of clinically localised (cT1-T2) or locally-advanced (cT3) non-metastatic prostate cancer. SEARCH METHODS We updated a previously published Cochrane Review by performing a comprehensive search of multiple databases (CENTRAL, MEDLINE, EMBASE), clinical trial registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) up to 6 March 2018. We also searched the reference lists of other relevant publications and conference proceedings. We applied no language restrictions. SELECTION CRITERIA We included randomised or quasi-randomised trials comparing cryotherapy to other interventions for the primary treatment of prostate cancer. DATA COLLECTION AND ANALYSIS Two independent reviewers screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of evidence (QoE) according to the GRADE approach. MAIN RESULTS We included only one comparison of whole gland cryotherapy versus external beam radiotherapy, which was informed by two trials with a total of 307 randomised participants. The median age of the included studies was around 70 years. The median follow-up of included studies ranged from 100 to 105 months.Primary outcomes: we are uncertain about the effect of whole gland cryotherapy compared to radiation therapy on time to death from prostate cancer; hazard ratio (HR) of 1.00 (95% confidence interval (CI) 0.11 to 9.45; 2 trials, 293 participants; very low QoE); this would correspond to zero fewer death from prostate cancer per 1000 men (95% CI 85 fewer to 520 more). We are equally uncertain about the effect of quality of life-related urinary function and bowel function (QoL) at 36 months using the UCLA-Prostate Cancer Index score for which higher values (range: 0 to 100) reflect better quality of life using minimal clinically important differences (MCID) of 8 and 7 points, respectively; mean difference (MD) of 4.4 (95% CI -6.5 to 15.3) and 4.0 (95% CI -73.96 to 81.96), respectively (1 trial, 195 participants; very low QoE). We are also uncertain about sexual function-related QoL using a MCID of 8 points; MD of -20.7 (95% CI -36.29 to -5.11; 1 trial, 195 participants; very low QoE). Lastly, we are uncertain of the risk for major adverse events; risk ratio (RR): 0.91 (95% CI 0.47 to 1.78; 2 trials, 293 participants; very low QoE); this corresponds to 10 fewer major adverse events per 1000 men (95% CI 58 fewer to 86 more). SECONDARY OUTCOMES we are very uncertain about the effects of cryotherapy on time to death from any cause (HR 0.99, 95% CI 0.05 to 18.79; 2 trials, 293 participants; very low QoE), and time to biochemical failure (HR 2.15, 95% CI 0.07 to 62.12; 2 trials, 293 participants; very low QoE). Rates of secondary interventions for treatment failure and minor adverse events were either not reported in the trials, or the data could not be used for analyses.We found no trials that compared whole gland cryotherapy or focal cryotherapy to other treatment forms such as radical surgery, active surveillance, watchful waiting or other forms of radiotherapy. AUTHORS' CONCLUSIONS Based on very low quality evidence, primary whole gland cryotherapy has uncertain effects on oncologic outcomes, QoL, and major adverse events compared to external beam radiotherapy. Reasons for downgrading the QoE included serious study limitations, indirectness due to the use of lower doses of radiation in the comparison group than currently recommended, and serious or very serious imprecision.
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Affiliation(s)
- Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Michael C Risk
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55408
| | - Robert Goldfarb
- University of MinnesotaDepartment of UrologyMayo Memorial Building, 420 Delaware St. SE MMC 394Clinic Fourth Floor Suite B435MinneapolisMinnesotaUSA55455
| | - Balaji Reddy
- Massachusetts General HospitalDepartment of Urology55 Fruit StreetBostonUSAMA 02114
| | - Bernadette Coles
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreWhitchurchCardiffUKCF14 2TL
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55408
- University of MinnesotaDepartment of UrologyMayo Memorial Building, 420 Delaware St. SE MMC 394Clinic Fourth Floor Suite B435MinneapolisMinnesotaUSA55455
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5
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Coakley FV, Foster BR, Farsad K, Hung AY, Wilder KJ, Amling CL, Caughey AB. Pelvic applications of MR-guided high intensity focused ultrasound. ACTA ACUST UNITED AC 2014; 38:1120-9. [PMID: 23589077 DOI: 10.1007/s00261-013-9999-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
MR-guided high intensity focused ultrasound (MRg HIFU) is a novel method of tissue ablation that incorporates high energy focused ultrasound for tissue heating and necrosis within an MR scanner that provides simultaneous stereotactic tissue targeting and thermometry. To date, MRg HIFU has been used primarily to treat uterine fibroids, but many additional applications in the pelvis are in development. This article reviews the basic technology of MRg HIFU, and the use of MRg HIFU to treat uterine fibroids, adenomyosis, and prostate cancer.
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Affiliation(s)
- Fergus V Coakley
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR, 97239, USA,
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6
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Xiong T, Turner RM, Wei Y, Neal DE, Lyratzopoulos G, Higgins JPT. Comparative efficacy and safety of treatments for localised prostate cancer: an application of network meta-analysis. BMJ Open 2014; 4:e004285. [PMID: 24833678 PMCID: PMC4024605 DOI: 10.1136/bmjopen-2013-004285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CONTEXT There is ongoing uncertainty about the optimal management of patients with localised prostate cancer. OBJECTIVE To evaluate the comparative efficacy and safety of different treatments for patients with localised prostate cancer. DESIGN Systematic review with Bayesian network meta-analysis to estimate comparative ORs, and a score (0-100%) that, for a given outcome, reflects average rank order of superiority of each treatment compared against all others, using the Surface Under the Cumulative RAnking curve (SUCRA) statistic. DATA SOURCES Electronic searches of MEDLINE without language restriction. STUDY SELECTION Randomised trials comparing the efficacy and safety of different primary treatments (48 papers from 21 randomised trials included 7350 men). DATA EXTRACTION 2 reviewers independently extracted data and assessed risk of bias. RESULTS Comparative efficacy and safety evidence was available for prostatectomy, external beam radiotherapy (different types and regimens), observational management and cryotherapy, but not high-intensity focused ultrasound. There was no evidence of superiority for any of the compared treatments in respect of all-cause mortality after 5 years. Cryotherapy was associated with less gastrointestinal and genitourinary toxicity than radiotherapy (SUCRA: 99% and 77% for gastrointestinal and genitourinary toxicity, respectively). CONCLUSIONS The limited available evidence suggests that different treatments may be optimal for different efficacy and safety outcomes. These findings highlight the importance of informed patient choice and shared decision-making about treatment modality and acceptable trade-offs between different outcomes. More trial evidence is required to reduce uncertainty. Network meta-analysis may be useful to optimise the power of evidence synthesis studies once data from new randomised controlled studies in this field are published in the future.
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Affiliation(s)
- Tengbin Xiong
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca M Turner
- MRC Biostatistics Unit, Institute of Public Health, Forvie Site, Cambridge, UK
| | - Yinghui Wei
- MRC Clinical Trials Unit, London Hub for Trials Methodology Research, London, UK
- School of Computing and Mathematics, Plymouth University, Plymouth, UK
| | - David E Neal
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Georgios Lyratzopoulos
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Julian P T Higgins
- MRC Biostatistics Unit, Institute of Public Health, Forvie Site, Cambridge, UK
- Centre for Reviews and Dissemination, University of York, York, UK
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7
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Rodríguez SA, Arias Fúnez F, Bueno Bravo C, Rodríguez-Patrón Rodríguez R, Sanz Mayayo E, Palacios VH, Burgos Revilla FJ. Cryotherapy for primary treatment of prostate cancer: intermediate term results of a prospective study from a single institution. Prostate Cancer 2014; 2014:571576. [PMID: 24693437 PMCID: PMC3945790 DOI: 10.1155/2014/571576] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/12/2013] [Accepted: 12/26/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution. Material and Methods. Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported. Results. The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%. Conclusions. Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.
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Affiliation(s)
- S. Alvarez Rodríguez
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - F. Arias Fúnez
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - C. Bueno Bravo
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | | | - E. Sanz Mayayo
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - V. Hevia Palacios
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
| | - F. J. Burgos Revilla
- Urology Department, Ramón y Cajal Hospital, University of Alcalá de Henares, Colmenar km 9,100, 28034 Madrid, Spain
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8
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Wallace T, Torre T, Grob M, Yu J, Avital I, Brücher BLDM, Stojadinovic A, Man Y. Current approaches, challenges and future directions for monitoring treatment response in prostate cancer. J Cancer 2014; 5:3-24. [PMID: 24396494 PMCID: PMC3881217 DOI: 10.7150/jca.7709] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/01/2013] [Indexed: 01/23/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed non-cutaneous neoplasm in men in the United States and the second leading cause of cancer mortality. One in 7 men will be diagnosed with prostate cancer during their lifetime. As a result, monitoring treatment response is of vital importance. The cornerstone of current approaches in monitoring treatment response remains the prostate-specific antigen (PSA). However, with the limitations of PSA come challenges in our ability to monitor treatment success. Defining PSA response is different depending on the individual treatment rendered potentially making it difficult for those not trained in urologic oncology to understand. Furthermore, standard treatment response criteria do not apply to prostate cancer further complicating the issue of treatment response. Historically, prostate cancer has been difficult to image and no single modality has been consistently relied upon to measure treatment response. However, with newer imaging modalities and advances in our understanding and utilization of specific biomarkers, the future for monitoring treatment response in prostate cancer looks bright.
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Affiliation(s)
- T.J. Wallace
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - T. Torre
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - M. Grob
- 4. Department of Urology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - J. Yu
- 5. Department of Radiology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - I. Avital
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
| | - BLDM Brücher
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - A. Stojadinovic
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - Y.G. Man
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 8. South Hospital of Nanjing, Nanjing, China
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Salomon L, Bastide C, Beuzeboc P, Cormier L, Fromont G, Hennequin C, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Rozet F, Azria D, Coloby P, Molinié V, Ravery V, Rebillard X, Richaud P, Villers A, Soulié M. Recommandations en onco-urologie 2013 du CCAFU : Cancer de la prostate. Prog Urol 2013; 23 Suppl 2:S69-101. [DOI: 10.1016/s1166-7087(13)70048-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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10
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Salomon L, Azria D, Bastide C, Beuzeboc P, Cormier L, Cornud F, Eiss D, Eschwège P, Gaschignard N, Hennequin C, Molinié V, Mongiat Artus P, Moreau JL, Péneau M, Peyromaure M, Ravery V, Rebillard X, Richaud P, Rischmann P, Rozet F, Staerman F, Villers A, Soulié M. Recommandations en Onco-Urologie 2010 : Cancer de la prostate. Prog Urol 2010; 20 Suppl 4:S217-51. [PMID: 21129644 DOI: 10.1016/s1166-7087(10)70042-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2009:CD004767. [PMID: 19821333 DOI: 10.1002/14651858.cd004767.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Molluscum contagiosum is a common skin infection, caused by a pox virus. The infection will usually resolve within months in people with a normal immune system. Many treatments have been used for molluscum contagiosum but a clear evidence base supporting them is lacking.This is an updated version of the original Cochrane Review published in Issue 2, 2006. OBJECTIVES To assess the effects of management strategies (including waiting for natural resolution) for cutaneous, non-genital molluscum contagiosum in otherwise healthy people. SEARCH STRATEGY In June 2009 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2009), MEDLINE, EMBASE, and LILACS. We also searched ongoing trials registers, reference lists, and contacted pharmaceutical companies and experts in the field. SELECTION CRITERIA We investigated randomised controlled trials (RCTs) for the treatment of molluscum contagiosum. We excluded trials on sexually transmitted molluscum contagiosum and in people with lowered immunity (including those with HIV infection). DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed methodological quality, and extracted data from selected studies. MAIN RESULTS Eleven studies, with a total number of 495 participants, examined the effects of topical (9 studies), systemic, and homoeopathic interventions (1 study each). Limited evidence was found for the efficacy of sodium nitrite co-applied with salicylic acid compared to salicylic acid alone (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.23 to 9.92); for Australian lemon myrtle oil compared to its vehicle, olive oil (RR 17.88, 95% CI 1.13 to 282.72); and for benzoyl peroxide cream compared to tretinoin (RR 2.20, 95% CI 1.01 to 4.79). No statistically significant differences were found for 10 other comparisons, most of which addressed 2 topical treatments.Study limitations included no blinding (four studies), many dropouts (three studies), and no intention-to-treat analysis; small study sizes may have led to important differences being missed. None of the evaluated treatment options were associated with serious adverse effects. AUTHORS' CONCLUSIONS No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change.
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Affiliation(s)
- Johannes C van der Wouden
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 1738, Rotterdam, Zuid-Holland, Netherlands, 3000 DR
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Abstract
The European Association of Urology guidelines on prostate cancer state that cryotherapy is a true therapeutic alternative for patients with clinically localized prostate cancer. The aim of this paper is to establish a uniform practice for performing prostate cryoablation. A collaboration has been set up among five European centres with experience in almost 1000 prostate cancer patients on the use of cryotherapy. The present recommendations were developed through sharing of experience and thorough discussions within the group. This first paper from the group establishes the technical recommendations for use of prostate cryotherapy.
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Parsons BA, Evans S, Wright MP. Prostate cancer and urinary incontinence. Maturitas 2009; 63:323-8. [DOI: 10.1016/j.maturitas.2009.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 06/05/2009] [Accepted: 06/09/2009] [Indexed: 02/05/2023]
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Baker J, Ajani J, Scotté F, Winther D, Martin M, Aapro MS, von Minckwitz G. Docetaxel-related side effects and their management. Eur J Oncol Nurs 2009; 13:49-59. [PMID: 19201649 DOI: 10.1016/j.ejon.2008.10.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Docetaxel is an effective treatment approved in five key cancers, but its effectiveness in clinical practice can be compromised by sub-optimal side-effect management. The aim of this review was to investigate the extent of the published work on specific docetaxel-related side effects and to provide, where possible, evidence-based recommendations for their prevention and management. PubMed and the American Society of Clinical Oncology (ASCO) databases were systematically searched for articles published in English over the past 5 years and 2 years, respectively, and pertaining to six side effects identified as being common to the majority of docetaxel regimens and indications and of particular relevance to the oncology nurse. The Cochrane library was also searched. A total of 103 citations were identified, 14 of which discussed strategies for the prevention or management of febrile neutropenia (n=6), hypersensitivity reactions (3), fluid retention (1) and nail changes (4). No articles were identified that related to asthenia or neuropathy. Based on the literature review, evidence/guidelines-based advice for the use of G-CSF in febrile neutropenia is provided. The evidence base with respect to the other side effects does not permit the formulation of recommendations. It is the experience of the authors, however, that the severity of symptoms experienced by patients is generally mild and the side effects are for the most part easily managed with prophylactic and supportive care measures. It is, therefore, important to share and build on experiences, through research and discussion, to maximise the healthcare professional's ability to offer the best standard of care to patients.
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Affiliation(s)
- Jackie Baker
- University of Texas MD Anderson Cancer Center, Gastrointestinal Medical Oncology, Faculty Center, Houston, TX 77030, USA.
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Cryosurgery for Prostate Cancer: an Update on Clinical Results of Modern Cryotechnology. Eur Urol 2009; 55:76-86. [DOI: 10.1016/j.eururo.2008.08.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/26/2008] [Indexed: 12/29/2022]
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Macura KJ, Stoianovici D. Advancements in magnetic resonance-guided robotic interventions in the prostate. Top Magn Reson Imaging 2008; 19:297-304. [PMID: 19512852 PMCID: PMC3099454 DOI: 10.1097/rmr.0b013e3181aa68b8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI) provides more detailed anatomical images of the prostate compared with the transrectal ultrasound imaging. Therefore, for the purpose of intervention in the prostate gland, diagnostic or therapeutic, MRI guidance offers a possibility of more precise targeting that may be crucial to the success of prostate interventions. However, access within the scanner is limited for manual instrument handling and the MR environment is most demanding among all imaging equipment with respect to the instrumentation used. A solution to this problem is the use of MR-compatible robots purposely designed to operate in the space and environmental restrictions inside the MR scanner allowing real-time interventions. Building an MRI-compatible robot is a very challenging engineering task because, in addition to the material restrictions that MRI instruments have, the robot requires actuators and sensors that limit the type of energies that can be used. Several important design problems have to be overcome before a successful MR-compatible robot application can be built. A number of MR-compatible robots, ranging from a simple manipulator to a fully automated system, have been developed, proposing ingenious solutions to the design challenge. Several systems have been already tested clinically for prostate biopsy and brachytherapy. As technology matures, precise image guidance for prostate interventions performed or assisted by specialized MR-compatible robotic devices may provide a uniquely accurate solution for guiding the intervention directly based on MR findings and feedback. Such an instrument would become a valuable clinical tool for biopsies directly targeting imaged tumor foci and delivering tumor-centered focal therapy.
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Affiliation(s)
- Katarzyna J Macura
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Brady Urological Institute, School of Medicine, Johns Hopkins University, Baltimore, MD 21287-0750, USA.
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Factors Predicting for Formation of Bladder Outlet Obstruction After High-Intensity Focused Ultrasound in Treatment of Localized Prostate Cancer. Urology 2008; 71:863-7. [DOI: 10.1016/j.urology.2007.12.076] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 12/14/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
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