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Gogineni E, Chen H, Cruickshank IK, Koempel A, Gogineni A, Li H, Deville C. In Silico Comparison of Three Different Beam Arrangements for Intensity-Modulated Proton Therapy for Postoperative Whole Pelvic Irradiation of Prostate Cancer. Cancers (Basel) 2024; 16:2702. [PMID: 39123430 PMCID: PMC11311848 DOI: 10.3390/cancers16152702] [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: 04/15/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background and purpose: Proton therapy has been shown to provide dosimetric benefits in comparison with IMRT when treating prostate cancer with whole pelvis radiation; however, the optimal proton beam arrangement has yet to be established. The aim of this study was to evaluate three different intensity-modulated proton therapy (IMPT) beam arrangements when treating the prostate bed and pelvis in the postoperative setting. Materials and Methods: Twenty-three post-prostatectomy patients were planned using three different beam arrangements: two-field (IMPT2B) (opposed laterals), three-field (IMPT3B) (opposed laterals inferiorly matched to a posterior-anterior beam superiorly), and four-field (IMPT4B) (opposed laterals inferiorly matched to two posterior oblique beams superiorly) arrangements. The prescription was 50 Gy radiobiological equivalent (GyE) to the pelvis and 70 GyE to the prostate bed. Comparisons were made using paired two-sided Wilcoxon signed-rank tests. Results: CTV coverages were met for all IMPT plans, with 99% of CTVs receiving ≥ 100% of prescription doses. All organ at risk (OAR) objectives were met with IMPT3B and IMPT4B plans, while several rectum objectives were exceeded by IMPT2B plans. IMPT4B provided the lowest doses to OARs for the majority of analyzed outcomes, with significantly lower doses than IMPT2B +/- IMPT3B for bladder V30-V50 and mean dose; bowel V15-V45 and mean dose; sigmoid maximum dose; rectum V40-V72.1, maximum dose, and mean dose; femoral head V37-40 and maximum dose; bone V40 and mean dose; penile bulb mean dose; and skin maximum dose. Conclusion: This study is the first to compare proton beam arrangements when treating the prostate bed and pelvis. four-field plans provided better sparing of the bladder, bowel, and rectum than 2- and three-field plans. The data presented herein may help inform the future delivery of whole pelvis IMPT for prostate cancer.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.K.); (A.G.)
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (I.K.C.J.); (H.L.); (C.D.J.)
| | - Hao Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (I.K.C.J.); (H.L.); (C.D.J.)
| | - Ian K. Cruickshank
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (I.K.C.J.); (H.L.); (C.D.J.)
| | - Andrew Koempel
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.K.); (A.G.)
| | - Aarush Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.K.); (A.G.)
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (I.K.C.J.); (H.L.); (C.D.J.)
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (I.K.C.J.); (H.L.); (C.D.J.)
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von Eyben FE, Kairemo K, Kapp DS. Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low Shall We Go? A Systematic Review. Biomedicines 2024; 12:822. [PMID: 38672176 PMCID: PMC11048591 DOI: 10.3390/biomedicines12040822] [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: 09/15/2023] [Revised: 12/25/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
Serum prostate-specific antigen (PSA) needs to be monitored with ultrasensitive PSA assays (uPSAs) for oncologists to be able to start salvage radiotherapy (SRT) while PSA is <0.5 µg/L for patients with prostate cancer (PCa) relapsing after a radical prostatectomy (RP). Our systematic review (SR) aimed to summarize uPSAs for patients with localized PCa. The SR was registered as InPLASY2023110084. We searched for studies on Google Scholar, PUBMED and reference lists of reviews and studies. We only included studies on uPSAs published in English and excluded studies of women, animals, sarcoidosis and reviews. Of the 115 included studies, 39 reported PSA assay methods and 76 reported clinical findings. Of 67,479 patients, 14,965 developed PSA recurrence (PSAR) and 2663 died. Extremely low PSA nadir and early developments of PSA separated PSAR-prone from non-PSAR-prone patients (cumulative p value 3.7 × 1012). RP patients with the lowest post-surgery PSA nadir and patients who had the lowest PSA at SRT had the fewest deaths. In conclusion, PSA for patients with localized PCa in the pre-PSAR phase of PCa is strongly associated with later PSAR and survival. A rising but still exceedingly low PSA at SRT predicts a good 5-year overall survival.
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Affiliation(s)
| | - Kalevi Kairemo
- Department of Molecular Radiotherapy & Nuclear Medicine, Docrates Cancer Center, FI-00185 Helsinki, Finland;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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3
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Sigg S, Arnold W, Grossmann NC, Baumeister P, Fankhauser CD, Wenzel M, Mattei A, Würnschimmel C. Why Do Men Reject Adjuvant Radiotherapy following Radical Prostatectomy? A Systematic Survey. Urol Int 2024; 108:211-218. [PMID: 38325350 DOI: 10.1159/000536609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION The aim of this study was to investigate non-adherence rates to adjuvant radiotherapy (aRT) after radical prostatectomy (RP) and to obtain patient reported reasons for rejecting aRT despite recommendation by a multidisciplinary team discussion (MTD). METHODS In a retrospective monocentric analysis, we identified 1,197 prostate cancer patients who underwent RP between 2014 and 2022 at our institution, of which 735 received a postoperative MTD recommendation. Patients with a recommendation for aRT underwent a structured phone interview with predefined standardised qualitative and quantitative questions and were stratified into "adherent" (aRT performed) and "non-adherent" groups (aRT not performed). RESULTS Of 55 patients receiving a recommendation for aRT (7.5% of all RP patients), 24 (44%) were non-adherent. Baseline tumour characteristics were comparable among the groups. "Fear of radiation damage" was the most common reason for rejection, followed by "lack of information," "feeling that the treating physician does not support the recommendation" and "the impression that aRT is not associated with improved oncological outcome." Salvage radiotherapy was performed in 25% of non-adherent patients. CONCLUSION High rates of non-adherence to aRT after RP were observed, and reasons for this phenomenon are most likely multifactorial. Multidisciplinary and individualized patient counselling might be a key for increasing adherence rates.
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Affiliation(s)
- Silvan Sigg
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Winfried Arnold
- Department of Radio-oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Nico Christian Grossmann
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Philipp Baumeister
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Christian Daniel Fankhauser
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe Universität Frankfurt, Frankfurt, Germany
| | - Agostino Mattei
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Christoph Würnschimmel
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Narrative Review of the Post-Operative Management of Prostate Cancer Patients: Is It Really the End of Adjuvant Radiotherapy? Cancers (Basel) 2022; 14:cancers14030719. [PMID: 35158986 PMCID: PMC8833528 DOI: 10.3390/cancers14030719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Among patients with prostate cancer who have been operated on, a subset harboring high-risk features will present with a biochemical recurrence (BCR). Adjuvant radiotherapy (aRT) was proven to significantly reduce the risk of BCR when compared to salvage radiotherapy (SRT) but suffered from several limitations: a lack of patient selection criteria, a higher treatment-related morbidity and an uncertain benefit for long-term clinical endpoints. In the same clinical setting, early SRT (eSRT) appears as non-inferior to aRT with a lower morbidity, replacing aRT as the preferred option. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient. Abstract Despite three randomized trials indicating a significant reduction in biochemical recurrence (BCR) in high-risk patients, adjuvant radiotherapy (aRT) was rarely performed, even in patients harboring high-risk features. aRT is associated with a higher risk of urinary incontinence and is often criticized for the lack of patient selection criteria. With a BCR rate reaching 30–70% in high-risk patients, a consensus between urologists and radiation oncologists was needed, leading to three different randomized trials challenging aRT with early salvage radiotherapy (eSRT). In these three different randomized trials with event-free survival as the primary outcome and a planned meta-analysis, eSRT appeared as non-inferior to aRT, answering, for some, this never-ending question. For many, however, the debate persists; these results raised several questions among urologists and radiation oncologists. BCR is thought to be a surrogate for clinically meaningful endpoints such as overall survival and cancer-specific survival but may be poorly efficient in comparison with metastasis-free survival. Imaging of rising prostate-specific antigen (PSA), post-operative persistent PSA and BCR was revolutionized by the broader use of MRI and nuclear imaging such as PET-PSMA; these imaging modalities were not analyzed in the previous randomized trials. A sub-group of very high-risk patients could possibly benefit from an adjuvant radiotherapy; but their usual risk factors such as high Gleason score or invaded surgical margins mean they are unable to be selected. More precise biomarkers of early BCR or even metastatic-relapse were developed in this setting and could be useful for the patients’ stratification. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.
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Zhou X, Qiu S, Jin K, Yuan Q, Jin D, Zhang Z, Zheng X, Li J, Wei Q, Yang L. Predicting Cancer-Specific Survival Among Patients With Prostate Cancer After Radical Prostatectomy Based on the Competing Risk Model: Population-Based Study. Front Surg 2021; 8:770169. [PMID: 34901145 PMCID: PMC8660757 DOI: 10.3389/fsurg.2021.770169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: We aimed to develop an easy-to-use individual survival prognostication tool based on competing risk analyses to predict the risk of 5-year cancer-specific death after radical prostatectomy for patients with prostate cancer (PCa). Methods: We obtained the data from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). The main variables obtained included age at diagnosis, marital status, race, pathological extension, regional lymphonode status, prostate specific antigen level, pathological Gleason Score. In order to reveal the independent prognostic factors. The cumulative incidence function was used as the univariable competing risk analyses and The Fine and Gray's proportional subdistribution hazard approach was used as the multivariable competing risk analyses. With these factors, a nomogram and risk stratification based on the nomogram was established. Concordance index (C-index) and calibration curves were used for validation. Results: A total of 95,812 patients were included and divided into training cohort (n = 67,072) and validation cohort (n = 28,740). Seven independent prognostic factors including age, race, marital status, pathological extension, regional lymphonode status, PSA level, and pathological GS were used to construct the nomogram. In the training cohort, the C-index was 0.828 (%95CI, 0.812–0.844), and the C-index was 0.838 (%95CI, 0.813–0.863) in the validation cohort. The results of the cumulative incidence function showed that the discrimination of risk stratification based on nomogram is better than that of the risk stratification system based on D'Amico risk stratification. Conclusions: We successfully developed the first competing risk nomogram to predict the risk of cancer-specific death after surgery for patients with PCa. It has the potential to help clinicians improve post-operative management of patients.
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Affiliation(s)
- Xianghong Zhou
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Kun Jin
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiming Yuan
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Di Jin
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Zilong Zhang
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaonan Zheng
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiakun Li
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, National Clinical Research Center for Geriatrics and Center of Biomedical Big Data, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
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Martins FE, Holm HV, Lumen N. Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life. J Clin Med 2021; 10:4920. [PMID: 34768438 PMCID: PMC8584541 DOI: 10.3390/jcm10214920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1-8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients' quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.
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Affiliation(s)
- Francisco E. Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria/CHULN, 1649-035 Lisbon, Portugal
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium;
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7
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Leo P, Janowczyk A, Elliott R, Janaki N, Bera K, Shiradkar R, Farré X, Fu P, El-Fahmawi A, Shahait M, Kim J, Lee D, Yamoah K, Rebbeck TR, Khani F, Robinson BD, Eklund L, Jambor I, Merisaari H, Ettala O, Taimen P, Aronen HJ, Boström PJ, Tewari A, Magi-Galluzzi C, Klein E, Purysko A, Nc Shih N, Feldman M, Gupta S, Lal P, Madabhushi A. Computer extracted gland features from H&E predicts prostate cancer recurrence comparably to a genomic companion diagnostic test: a large multi-site study. NPJ Precis Oncol 2021; 5:35. [PMID: 33941830 PMCID: PMC8093226 DOI: 10.1038/s41698-021-00174-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/05/2021] [Indexed: 01/04/2023] Open
Abstract
Existing tools for post-radical prostatectomy (RP) prostate cancer biochemical recurrence (BCR) prognosis rely on human pathologist-derived parameters such as tumor grade, with the resulting inter-reviewer variability. Genomic companion diagnostic tests such as Decipher tend to be tissue destructive, expensive, and not routinely available in most centers. We present a tissue non-destructive method for automated BCR prognosis, termed "Histotyping", that employs computational image analysis of morphologic patterns of prostate tissue from a single, routinely acquired hematoxylin and eosin slide. Patients from two institutions (n = 214) were used to train Histotyping for identifying high-risk patients based on six features of glandular morphology extracted from RP specimens. Histotyping was validated for post-RP BCR prognosis on a separate set of n = 675 patients from five institutions and compared against Decipher on n = 167 patients. Histotyping was prognostic of BCR in the validation set (p < 0.001, univariable hazard ratio [HR] = 2.83, 95% confidence interval [CI]: 2.03-3.93, concordance index [c-index] = 0.68, median years-to-BCR: 1.7). Histotyping was also prognostic in clinically stratified subsets, such as patients with Gleason grade group 3 (HR = 4.09) and negative surgical margins (HR = 3.26). Histotyping was prognostic independent of grade group, margin status, pathological stage, and preoperative prostate-specific antigen (PSA) (multivariable p < 0.001, HR = 2.09, 95% CI: 1.40-3.10, n = 648). The combination of Histotyping, grade group, and preoperative PSA outperformed Decipher (c-index = 0.75 vs. 0.70, n = 167). These results suggest that a prognostic classifier for prostate cancer based on digital images could serve as an alternative or complement to molecular-based companion diagnostic tests.
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Grants
- National Cancer Institute under award numbers 1U24CA199374-01, R01CA249992-01A1 R01CA202752-01A1 R01CA208236-01A1 R01CA216579-01A1 R01CA220581-01A1 1U01CA239055-01 1U01CA248226-01 1U54CA254566-01 National Heart, Lung and Blood Institute 1R01HL15127701A1, National Institute for Biomedical Imaging and Bioengineering 1R43EB028736-01, National Center for Research Resources 1 C06 RR12463-01, VA Merit Review Award IBX004121A from the United States Department of Veterans Affairs Biomedical Laboratory Research and Development Service, the Office of the Assistant Secretary of Defense for Health Affairs, through the Breast Cancer Research Program (W81XWH-19-1-0668), the Prostate Cancer Research Program (W81XWH-15-1-0558, W81XWH-20-1-0851), the Lung Cancer Research Program (W81XWH-18-1-0440, W81XWH-20-1-0595), the Peer Reviewed Cancer Research Program (W81XWH-18-1-0404), the Kidney Precision Medicine Project Glue Grant, the Ohio Third Frontier Technology Validation Fund, the Clinical and Translational Science Collaborative of Cleveland (UL1TR0002548) from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, The Wallace H. Coulter Foundation Program in the Department of Biomedical Engineering at Case Western Reserve University,
- Sigrid Jusélius Foundation The Finnish Cancer Foundation
- Department of Defense Prostate Cancer Disparity Award (W81XWH-19-1-0720),
- National Science Foundation Graduate Research Fellowship Program (CON501692)
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Affiliation(s)
- Patrick Leo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Andrew Janowczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nafiseh Janaki
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Rakesh Shiradkar
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Xavier Farré
- Public Health Agency of Catalonia, Lleida, Catalonia, Spain
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Ayah El-Fahmawi
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Mohammed Shahait
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Jessica Kim
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - David Lee
- Department of Urology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
| | - Kosj Yamoah
- Moffitt Cancer Center, Department of Radiation Oncology, University of South Florida, Tampa, FL, USA
| | - Timothy R Rebbeck
- T.H. Chan School of Public Health and Dana Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Francesca Khani
- Departments of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY, USA
| | - Brian D Robinson
- Departments of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, NY, USA
| | - Lauri Eklund
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
- Department of Diagnostic Radiology, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Pathology, University of Turku, Institute of Biomedicine and Turku University Hospital, Turku, Finland
- Turku University Hospital, Medical Imaging Centre of Southwest Finland, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eric Klein
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Andrei Purysko
- Cleveland Clinic, Imaging Institute, Section of Abdominal Imaging, Cleveland, OH, USA
| | - Natalie Nc Shih
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Feldman
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjay Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | - Priti Lal
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA.
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8
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Cunneen C, Kelly M, Nason G, Ryan E, Creavin B, Winter D. The Role of Exenterative Surgery in Advanced Urological Neoplasms. Curr Urol 2020; 14:57-65. [PMID: 32774229 DOI: 10.1159/000499258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/11/2019] [Indexed: 01/22/2023] Open
Abstract
Pelvic exenterative surgery is both complex and challenging, especially in the setting of locally recurrent disease. In recent decades, improved surgical techniques have facilitated more extensive resection of both locally advanced and recurrent pelvic malignancies, but its role in urological cancer surgery is highly selective. However, it remains an important part of the armamentarium for the management of bladder and prostate cancer cases where there is local invasion into adjacent organs or localized recurrence. Better diagnostics, reconstructive options and centralized care have reduced associated morbidity considerably, and it is still used rarely in palliative settings. Despite this, there is sparse prospective evidence reporting on long-term oncological or quality of life outcomes.
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Affiliation(s)
- Colla Cunneen
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Michael Kelly
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Gregory Nason
- Department of Urology, Mater University Hospital, Dublin, Ireland
| | - Eanna Ryan
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Ben Creavin
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Des Winter
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
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9
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Bratu OG, Diaconu CC, Mischianu DLD, Constantin T, Stanescu AMA, Bungau SG, Ionita-Radu F, Marcu RD. Therapeutic options in patients with biochemical recurrence after radical prostatectomy. Exp Ther Med 2019; 18:5021-5025. [PMID: 31798723 DOI: 10.3892/etm.2019.7916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer is the second most common form of cancer in men in Europe. The primary treatment of this type of cancer is radical prostatectomy, which has shown good oncological results. Radical prostatectomy (open, laparoscopic or robotic) has high success and low morbidity rates in patients with localized prostate cancer. The life expectancy is >10 years after radical prostatectomy. Studies have shown that ~20%-30% of the patients who have undergone radical prostatectomy can develop biochemical recurrence, which is monitored by using the value of the prostate-specific antigen (PSA). In some cases (patients with high-risk prostate cancer), adjuvant therapy after radical prostatectomy, such as radiotherapy or androgen deprivation therapy, can significantly reduce the risk of biochemical recurrence. The optimal management of recurrent disease remains uncertain. Recent literature was systematically reviewed regarding the management of biochemical recurrence and to compare clinical experience in literature studies.
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Affiliation(s)
- Ovidiu Gabriel Bratu
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.,Urology Department, Emergency University Central Military Hospital, 010825 Bucharest, Romania.,Academy of Romanian Scientists, 030167 Bucharest, Romania
| | - Camelia Cristina Diaconu
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.,Internal Medicine Department, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Dan Liviu Dorel Mischianu
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.,Urology Department, Emergency University Central Military Hospital, 010825 Bucharest, Romania.,Academy of Romanian Scientists, 030167 Bucharest, Romania
| | - Traian Constantin
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.,Urology Department, 'Prof. Th. Burghele' Clinical Hospital, 050659 Bucharest, Romania
| | | | - Simona Gabriela Bungau
- University of Oradea, Faculty of Medicine and Pharmacy, Department of Pharmacy, 410073 Oradea, Romania
| | - Florentina Ionita-Radu
- Gastroenterology Department, Emergency University Central Military Hospital, 010825 Bucharest, Romania
| | - Radu Dragos Marcu
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.,Urology Department, Emergency University Central Military Hospital, 010825 Bucharest, Romania
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10
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Huang QX, Xiao CT, Chen Z, Lu MH, Pang J, Di JM, Luo ZH, Gao X. Combined analysis of CRMP4 methylation levels and CAPRA-S score predicts metastasis and outcomes in prostate cancer patients. Asian J Androl 2019; 20:56-61. [PMID: 28382925 PMCID: PMC5753555 DOI: 10.4103/aja.aja_3_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The present study analyzed the predictive value of combined analysis of collapsin response mediator protein 4 (CRMP4) methylation levels and the Cancer of the Prostate Risk Assessment (CAPRA-S) Postsurgical score of patients who required adjuvant hormone therapy (AHT) after radical prostatectomy (RP). We retrospectively analyzed 305 patients with prostate cancer (PCa) who received RP and subsequent androgen deprivation therapy (ADT). Two hundred and thirty patients with clinically high-risk PCa underwent immediate ADT, and 75 patients with intermediate risk PCa underwent deferred ADT. CRMP4 methylation levels in biopsies were determined, and CAPRA-S scores were calculated. In the deferred ADT group, the values of the hazard ratios for tumor progression and cancer-specific mortality (CSM) in patients with ≥15% CRMP4 methylation were 6.81 (95% CI: 2.34–19.80) and 12.83 (95% CI: 2.16–26.10), respectively. Receiver-operating characteristic curve analysis indicated that CRMP4 methylation levels ≥15% served as a significant prognostic marker of tumor progression and CSM. In the immediate ADT group, CAPRA-S scores ≥6 and CRMP4 methylation levels ≥15% were independent predictors of these outcomes (uni- and multi-variable Cox regression analyses). The differences in the 5-year progression-free survival between each combination were statistically significant. Combining CAPRA-S score and CRMP4 methylation levels improved the area under the curve compared with the CRMP4 or CAPRA-S model. Therefore, CRMP4 methylation levels ≥15% were significantly associated with a poor prognosis and their combination with CAPRA-S score accurately predicted tumor progression and metastasis for patients requiring AHT after RP.
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Affiliation(s)
- Qun-Xiong Huang
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Chu-Tian Xiao
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Zheng Chen
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Min-Hua Lu
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Jun Pang
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Jin-Ming Di
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Zi-Huan Luo
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
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11
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Surgical Management of Localized and Locally Advanced Prostate Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Tailored postoperative treatment of prostate cancer: final results of a phase I/II trial. Prostate Cancer Prostatic Dis 2018; 21:564-572. [PMID: 30038390 PMCID: PMC6283858 DOI: 10.1038/s41391-018-0064-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/27/2018] [Accepted: 05/24/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUD The European Organization for Research and Treatment of Cancer (EORTC) trial 22,911 reported 74% 5-year biochemical disease-free survival (bDFS) in patients with prostate carcinoma treated with radical prostatectomy (RP) followed by postoperative radiotherapy (RT). This study aimed to improve these outcomes by using a combined-intensified-modulated-adjuvant treatment, including RT and hormone therapy (HT) after RP. MATERIALS AND METHODS This phase I/II trial treatment was designed to improve 5-year bDFS from ~ 75 to 90%. Patients were consecutively enrolled using the following inclusion criteria: age < 80 years, histological diagnosis of prostate adenocarcinoma without known metastases, stage pT2-4N0-1, and Eastern Cooperative Oncology Group performance status of 0-2. All patients had at least one of these pathologic features: capsular perforation, positive surgical margins, seminal vesicle invasion, and pelvic lymph nodes involvement. A minimum dose of 64.8 Gy to the tumor bed was delivered in all patients. Depending on tumor characteristics at diagnosis, patients received a higher dose (70.2 Gy; 85.4%) and/or prophylactic pelvic lymph nodes irradiation (57.7%) and/or HT (69.1%). Biochemical relapse was defined as two consecutive rising prostate-specific antigen (PSA) values > 0.2 ng/ml. RESULTS A total of 123 patients were enrolled in the study and completed the scheduled treatment. Median preoperative and postoperative PSA were: 8.8 and 0.06 ng/mL, respectively. The percentages of patients with pathologically involved nodes and positive resection margins were: 14.6% and 58.5%, respectively. With a median follow-up of 67 months (range: 37-120 months), the actuarial 5-year bDFS, local control, metastasis-free survival, and overall survival (OS) were: 92.9%, 98.7%, 96.1%, and 95.1%, respectively. CONCLUSION A higher 5-year bDFS (92.9%) was recorded compared to studies based on standard adjuvant RT, even though patients with nodal disease and detectable postoperative PSA were enrolled. Clinical end points, as long-term disease-free survival and OS, will require further assessments. (ClinicalTrials.gov: NCT03169933).
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13
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Aljubran A, Abusamra A, Alkhateeb S, Alotaibi M, Rabah D, Bazarbashi S, Alkushi H, Al-Mansour M, Alharbi H, Eltijani A, Alghamdi A, Alsharm A, Ahmad I, Murshid E. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for prostate cancer 2017. Urol Ann 2018. [PMID: 29719323 DOI: 10.4103/ua.ua-177-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence levels based on a comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.
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Affiliation(s)
- Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Dammam, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Dammam, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussain Alkushi
- Department of Pathology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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14
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Browne BM, Vanni AJ. Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer. Curr Urol Rep 2018; 18:76. [PMID: 28776126 DOI: 10.1007/s11934-017-0729-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses the incidence, evaluation, and treatment of bladder outlet obstruction from urethral stricture, vesicourethral anastomotic stricture, and bladder neck contracture following primary and salvage treatment of prostate cancer. RECENT FINDINGS Rates of stenosis after prostate cancer treatment appear similar across all primary treatment modalities including radical prostatectomy, radiation therapy, cryoablation, and high-intensity focused ultrasound in contemporary series. Urethral dilation and urethrotomy continue to report moderate patency rates. Urethroplasty achieves high patency rates even for long strictures, but more extensive reconstruction increases the risk of postoperative urinary incontinence. Recent AUA guidelines on urethral strictures provide new recommendations for management of these patients. All treatment options for prostate cancer carry a risk for bladder outlet obstruction, and intervention is often necessary to relieve long-lasting morbidity. Careful preoperative evaluation should be completed to assess location and extent of the stricture in order to choose optimal therapy. Endoscopic treatments, open reconstruction, and urinary diversion all play a role in relief of stenosis depending on stricture length, location, characteristics, and patient comorbidities.
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Affiliation(s)
- Brendan Michael Browne
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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15
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Ki-67 expression predicts biochemical recurrence after radical prostatectomy in the setting of positive surgical margins. BMC Urol 2018; 18:13. [PMID: 29506507 PMCID: PMC5838874 DOI: 10.1186/s12894-018-0330-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/28/2018] [Indexed: 01/09/2023] Open
Abstract
Background Positive surgical margin (PSM) is a predictor of biochemical recurrence (BCR) following radical prostatectomy (RP). Attempts to stratify PSM based on linear length, Gleason score, location and number have failed to add to predictive models using margin status alone. We evaluated the prognostic significance of Ki-67 expression in this setting. Methods Immunohistochemical staining for Ki-67 was done on prostatectomy specimens from 117 patients who had a PSM. Ki67 expression was measured at the margin and in the index lesion. Patients were dichotomized based on Ki-67 expression into three groups. Group 1 with no Ki-67 expression, Group 2 with Ki-67 ≤ 2%, and Group 3 with Ki-67 ≥ 3%. To eliminate the impact of the adjuvant treatment (AT) on the outcome, data were analyzed by the Cox proportional hazards in which AT was Considered as a time-dependent covariate. Results The discordance rate of Ki-67 expression between matched index lesion and margin specimens was 44/117 (37.6%). There was a trend for higher risk of BCR (HR:2.06, (0.97–4.43), P = 0.06) in patients expressing high Ki67 at the surgical margin although this was not statistically significant. However High Ki-67 expression in the index lesion was an independent predictive factor for BCR in this subset of patients. (HR:4, (1.64–9.80), P = 0.002). Conclusion High Ki67 expression in the index prostate cancer lesion is an independent predictor of BCR in patients with positive surgical margin following radical prostatectomy. Our findings need to be validated in a larger cohort.
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16
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Buergy D, Sertdemir M, Weidner A, Shelan M, Lohr F, Wenz F, Schoenberg SO, Attenberger UI. Detection of Local Recurrence with 3-Tesla MRI After Radical Prostatectomy: A Useful Method for Radiation Treatment Planning? In Vivo 2018; 32:125-131. [PMID: 29275309 PMCID: PMC5892648 DOI: 10.21873/invivo.11214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Salvage radiotherapy improves biochemical control in patients with recurrence of prostate cancer after prostatectomy. Radiotherapy target volumes of the prostatic fossa are based on empirical data and differ between different guidelines. Localization of recurrence with multiparametric magnetic resonance imaging (MRI) might be a feasible approach to localize recurrent lesions. PATIENTS AND METHODS Twenty-one patients with biochemical recurrence after radical prostatectomy were included (median prostate-specific antigen (PSA) =0.17 ng/ml). Multi-parametric MRI was performed using a 3-T MR system. RESULTS Lesions were detected in seven patients with a median PSA of 0.86 ng/ml (minimum= 0.31 ng/ml). Patients without detectable recurrence had a median PSA of 0.12 ng/ml. All patients with detectable lesions responded to radiotherapy. Eleven out of 14 patients without detectable recurrence also responded. Plasma flow in suspicious lesions was correlated with PSA level. CONCLUSION Detection of recurrence at the prostatic fossa with our approach was possible in a minority of patients with a low PSA level. Clinical relevance of plasma flow in suspicious lesions should be further investigated.
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Affiliation(s)
- Daniel Buergy
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Metin Sertdemir
- Medical Care Center Radiology Karlsruhe West, Karlsruhe, Germany
| | - Anja Weidner
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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17
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Aljubran A, Abusamra A, Alkhateeb S, Alotaibi M, Rabah D, Bazarbashi S, Alkushi H, Al-Mansour M, Alharbi H, Eltijani A, Alghamdi A, Alsharm A, Ahmad I, Murshid E. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for prostate cancer 2017. Urol Ann 2018; 10:138-145. [PMID: 29719323 PMCID: PMC5907320 DOI: 10.4103/ua.ua_177_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence levels based on a comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.
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Affiliation(s)
- Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Dammam, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Dammam, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussain Alkushi
- Department of Pathology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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18
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Resection of Metastatic Cancer in Castration-Resistant Patients. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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19
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Markovina S, Meeks MW, Badiyan S, Vetter J, Gay HA, Paradis A, Michalski J, Sandhu G. Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis. Adv Radiat Oncol 2017; 3:190-196. [PMID: 29904744 PMCID: PMC6000029 DOI: 10.1016/j.adro.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/18/2017] [Accepted: 12/06/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose For high-risk prostate cancer (HR-PCa) in men with a life expectancy of at least 10 years, the National Comprehensive Cancer Network recommends radiation therapy (RT) plus androgen deprivation therapy (ADT) with category 1 evidence or radical prostatectomy (RP) as an acceptable initial therapy. Randomized evidence regarding which therapy is optimal for disease control is lacking for men with HR-PCa. We performed a propensity-score-matched comparison of outcomes for men with localized HR-PCa treated with primary RT or RP. Methods and materials The medical records of patients with localized HR-PCa who were treated at our institution between 2002 and 2011 were reviewed. Patient and disease characteristics, treatment details, and outcomes were collected. A combination of nearest-neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 comorbidity index, prostate-specific antigen, biopsy Gleason scores, and clinical T-stage as well as exact matching on prostate-specific antigen, biopsy Gleason scores, and clinical T-stage was performed. Outcomes were measured from diagnosis. Multivariate Cox proportional hazards regression was used to compare metastasis-free and overall survival. Results A total of 246 patients were identified with 62 propensity-score-matched pairs. ADT was administered to 6.5% and 80.6% of patients receiving RP and RT, respectively. Five-year rates of metastasis for RP and RT were 33% and 8.9%, respectively (P = .003). Overall survival was not different. Delay of salvage therapy was longer for patients undergoing primary RT (P < .001). Findings were similar when only those patients who did not receive ADT were compared. Conclusions At our institution, treatment with primary RT resulted in superior metastasis-free survival over RP. This was not accompanied by an improvement in OS.
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Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Marshall W Meeks
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joel Vetter
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Alethea Paradis
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Gurdarshan Sandhu
- Division of Urologic Surgery, Washington University, St. Louis, Missouri
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20
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Older cancer patients in cancer clinical trials are underrepresented. Systematic literature review of almost 5000 meta- and pooled analyses of phase III randomized trials of survival from breast, prostate and lung cancer. Cancer Epidemiol 2017; 51:113-117. [DOI: 10.1016/j.canep.2017.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 01/24/2023]
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21
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Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S. Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review. Urol Int 2017; 100:251-262. [PMID: 29161715 DOI: 10.1159/000481438] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/12/2017] [Indexed: 12/27/2022]
Abstract
How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Importantly, this prostate-specific antigen (PSA)-only recurrence is a surrogate neither of PCa-specific survival nor of overall survival. Physicians are therefore challenged with preventing or delaying the onset of clinical progression in those deemed at risk, while avoiding over-treating patients whose disease may never progress beyond PSA-only recurrence. Adjuvant therapy for radical prostatectomy (RP) or local radiotherapy (RT) has a role in certain at-risk patients, although it is not recommended in low-risk PCa owing to the significant side-effects associated with RT and androgen deprivation therapy (ADT). The recommendations for salvage therapy differ depending on whether BCR occurs after RP or primary RT, and in either case, definitive evidence regarding the best strategy is lacking. Options for treatment of BCR after RP are RT at least to the prostatic bed, complete or intermittent ADT, or observation; for BCR after RT, salvage RP, cryotherapy, complete or intermittent ADT, brachytherapy, high-intensity focused ultrasound (HIFU), or observation can be considered. Many patient- and cancer-specific factors need to be taken into account when deciding on the best strategy, and optimal management depends on the involvement of a multidisciplinary team, consultation with the patient themselves, and the adoption of an individualised approach. Improvements in imaging techniques may enable earlier detection of metastases, which will hopefully refine future management decisions.
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22
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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.
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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
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23
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Nyarangi-Dix JN, Steimer J, Bruckner T, Jakobi H, Koerber SA, Hadaschik B, Debus J, Hohenfellner M. Post-prostatectomy radiotherapy adversely affects urinary continence irrespective of radiotherapy regime. World J Urol 2017; 35:1841-1847. [PMID: 28861691 DOI: 10.1007/s00345-017-2081-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/10/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To investigate the influence of different postoperative radiotherapy (RT) regimes on post-prostatectomy continence and QoL. METHODS Men after prostatectomy (RP) and RT were assigned in adjuvant (ART), early salvage (ESRT) and salvage radiotherapy (SRT) groups depending on time of initiation, indication and pre-RT-PSA (≤/>0.5 ng/ml). Continence and QoL outcomes were evaluated by validated questionnaire. Statistical analysis included students t test, Chi square, Fisher's test, ROC- and McNemar-Bowker-Analyses. RESULTS The mean follow-up was 5.1 years. 33.5, 38.2 and 28.3% received ART, ESRT and SRT, respectively. Mean time to RT was 0.3 (±0.4), 1.8 (±2.5) and 3.3 (±3.6) years respectively. Differences in age at RP (p = 0.54) and RT (p = 0.47) between groups were not significant. Mean-RT-dose was similar (p = 0.70). Differences in continence distribution between groups before (p = 0.56) and after RT (p = 0.38) were not significant. No significant differences were observed for frequency (p = 0.58) or amount (p = 0.88) of urine loss, impact on QoL (p = 0.13) and ICIQ-SF scores (p = 0.69) between groups. Even though no significant difference in post-RT-continence (p = 0.89) was observed in the direct comparison between groups, a significant worsening of long-term continence was observed in all groups (p < 0.001). We found no cutoff and no time-point after RP at which this negative effect of RT on continence became insignificant (AUC = 0.474). A subgroup with apparent local recurrence showed no differences for ICIQ-SF-score (p = 0.155), QoL (0.077), incontinence grade (p = 0.387), frequency (p = 0.182) and amount (p = 0.415) of urine loss. Proportionally more men in this subgroup remembered deterioration of continence after RT (p = 0.029). CONCLUSION Postoperative RT adversely affects long-term continence; this negative effect is irrespective of time of initiation or indication for RT. These results suggest a need for innovative strategies of prostate cancer therapy with lasting oncological, functional and QoL outcomes.
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Affiliation(s)
- J N Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - J Steimer
- Ruprecht-Karls University of Heidelberg, Medical Faculty, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry & Informatics, University of Heidelberg, Heidelberg, Germany
| | - H Jakobi
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S A Koerber
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - B Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - M Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Nicholls L, Winter A, Harwood A, Plank A, Bagga P, Wong W, Khoo E. Outcomes of post-prostatectomy radiotherapy at a Regional Cancer Centre. J Med Radiat Sci 2017; 64:259-265. [PMID: 28805047 PMCID: PMC5715341 DOI: 10.1002/jmrs.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/01/2017] [Accepted: 07/08/2017] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To investigate the efficacy and toxicity of radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer at Radiation Oncology Centres, Toowoomba. METHODS The electronic medical records of 130 consecutive patients with histologically proven prostate adenocarcinoma who underwent post-prostatectomy RT between January 2008 and December 2014 were analysed. Primary endpoint was Biochemical Recurrence (BCR) after RT. BCR was defined by PSA > 0.2 ng/mL and BCR endpoints were analysed using Kaplan-Meier methods. The impact of RT technique and the rates of acute and late toxicities are also reported. Toxicities were graded according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS Median follow-up time after RT (regardless of technique) was 28 months. BCR occurred in 32 of the 126 patients (25%) whose prostate specific antigen (PSA) levels have been monitored post-RT. At 24 and 36 months, 85% and 75% of patients were BCR-free, respectively. Patients with a pre-RT PSA above 0.2 ng/mL had a higher probability of recurrence than patients with values below 0.2 ng/mL (P = 0.03). RT technique, pelvic nodal irradiation, androgen deprivation therapy, T staging or surgical margin did not significantly impact BCR results. No patient experienced acute toxicities greater than grade 2. Grade 1 or 2 late gastrointestinal (GI) toxicity occurred in 11% and 1 patient experienced a grade 3 event. 12% of patients developed grade 1 or 2 late genitourinary (GU) toxicity, with evidence of grade 3 severity in only 1 patient. Evidence of a trend in reduction in late GI toxicity with the use of intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) was apparent but not with late GU toxicity. CONCLUSION At our regional centre, early RT (PSA < 0.2 ng/mL) was associated with significant improvement in BCR-free survival. Rates of toxicity mirror those of landmark trials which suggest no detriment for our regional prostate cancer patients. The use of IMRT/VMAT techniques was associated with a trend towards reduced rates of GI toxicity.
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Affiliation(s)
- Luke Nicholls
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Amber Winter
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia
| | - Ashley Harwood
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia
| | - Ashley Plank
- Oncology Research Australia, St Andrews Cancer Care, Toowoomba, Queensland, Australia
| | - Preeti Bagga
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia
| | - Winnie Wong
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia
| | - Eric Khoo
- Radiation Oncology Centres, St Andrews Cancer Care, Toowoomba, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Lipman D, Pieters BR, De Reijke TM. Improving postoperative radiotherapy following radical prostatectomy. Expert Rev Anticancer Ther 2017; 17:925-937. [PMID: 28787182 DOI: 10.1080/14737140.2017.1364994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.
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Affiliation(s)
- D Lipman
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - B R Pieters
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Theo M De Reijke
- b Department of Urology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
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Evaluation of the preimplantation worksheet in determining Calypso eligibility for men prescribed postprostatectomy radiotherapy with electromagnetic transponder guidance. Med Dosim 2017. [PMID: 28648818 DOI: 10.1016/j.meddos.2017.05.003] [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] [Indexed: 11/23/2022]
Abstract
This study aimed to assess the design and performance of the preimplant suitability worksheet in determining Calypso eligibility for prostate cancer patients prescribed postprostatectomy radiotherapy with electromagnetic transponder guidance. The medical records and radiotherapy planning datasets of 75 patients prospectively recruited between June 2015 and September 2016 to a Phase 2 trial evaluating electromagnetic transponder-guided postprostatectomy radiotherapy were retrospectively examined. Correlation and differences between computed tomography (CT)-defined greater trochanter and prostatic fossa landmarks were evaluated. Receiver operating characteristic curves were also generated to assess the expected and observed accuracy of the worksheet in determining Calypso eligibility. Strong correlation was demonstrated between anterior surface to planning CT-defined greater trochanter and prostate bed center distances (r = 0.95, p <0.001), with a mean difference between measurements of 1.1 cm (95% confidence interval [CI]: 0.9 to 1.3). A similar correlation coefficient was found for surface to greater trochanter location and posterior beacon location (r = 0.92, p <0.001) but with a reduced mean difference of 0.4 cm (95% CI: 0.1 to 0.6). Performance of the worksheet as assessed by planning CT data demonstrated excellent accuracy as a test to determine eligibility (area under the curve: 0.97; 95% CI: 0.92 to 1.00); however, this was not replicated using the same data captured clinically (area under the curve 0.83; 95% CI: 0.68 to 0.98). Although the greater trochanter is a good surrogate for the prostate bed center, it is better associated with the posterior beacon location. As a result, the worksheet will underestimate the truly eligible population if performed accurately and according to manufacturer guidelines. Theoretically, the worksheet could be improved if a cut off of 20 cm is used and the greater trochanter is accurately identified; however, the latter appears to be difficult to achieve in practice.
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Broe MP, Forde JC, Inder MS, Galvin DJ, Mulvin DW, Quinlan DM. The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes? Ir J Med Sci 2017; 186:583-588. [PMID: 28281040 DOI: 10.1007/s11845-017-1583-2] [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: 08/18/2016] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP). METHODS A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4 + 3 versus G3 + 4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage. RESULTS In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4 + 3 and 97 graded G3 + 4). Since the introduction of RAPC the proportion of G4 + 3 compared to G3 + 4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4 + 3 treated before and after the introduction of RAPC. G4 + 3 was associated with higher rates of BCR (24.4 vs. 0%, p < 0.0001, radiotherapy (41.1 vs. 4.8%, p < 0.0001) and worse histological features than G3 + 4. CONCLUSION Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4 + 3 disease.
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Affiliation(s)
- M P Broe
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - J C Forde
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - M S Inder
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D J Galvin
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D W Mulvin
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D M Quinlan
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
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Abdul Rahim MR, James ML, Hickey BE. Intervention quality is not routinely assessed in Cochrane systematic reviews of radiation therapy interventions. J Med Imaging Radiat Oncol 2017; 61:662-665. [PMID: 28102003 DOI: 10.1111/1754-9485.12589] [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: 09/26/2016] [Accepted: 12/17/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to maximise the benefits from clinical trials involving technological interventions such as radiation therapy. High compliance to the quality assurance protocols is crucial. We assessed whether the quality of radiation therapy intervention was evaluated in Cochrane systematic reviews. METHODS We searched 416 published Cochrane systematic reviews and identified 67 Cochrane systematic reviews that investigated radiation therapy or radiotherapy as an intervention. For each systematic review, either quality assurance or quality control for the intervention was identified by a description of such processes in the published systematic reviews. RESULTS Of the 67 Cochrane systematic reviews studied, only two mentioned quality assurance or quality control. CONCLUSIONS Our findings revealed that 65 of 67 (97%) Cochrane systematic reviews of radiation therapy interventions failed to consider the quality of the intervention. We suggest that advice about the evaluation of intervention quality be added to author support materials.
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Affiliation(s)
- Mohamad R Abdul Rahim
- Christchurch Regional Cancer and Blood Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Melissa L James
- Christchurch Regional Cancer and Blood Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Brigid E Hickey
- Radiation Oncology Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Simple vs six-branches autologous suburethral sling during robot-assisted radical prostatectomy to improve early urinary continence recovery: prospective randomized study. J Robot Surg 2017; 11:415-421. [PMID: 28078523 DOI: 10.1007/s11701-017-0672-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
We have recently described the use of a retropubic suburethral autologous sling created and placed during robotic radical prostatectomy (RARP). In this study, we assess the effectiveness of newly designed six-branches compared to two-branches suburethral autologous sling in improving early urinary continence (UC) recovery. 120 patients submitted to RARP were prospectively randomized according to the intraoperative positioning of six-branches (group 1, n = 60) or two-branches autologous sling (group 2, n = 60) obtained by different configuration of a same tract of vas deferens removed. Early UC recovery was assessed at 5 (catheter removal), 10 and 30 days postoperatively through the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. UC was defined as the non-use of pad. Chi square test and Wilcoxon test were used to investigate UC recovery between the two groups. Moreover, post-voiding residual was evaluated in each patient at the same time. At catheter removal, UC rate was in groups 1 and 2, 60 and 35% (p = 0.02); at 10 days 70 and 46% (p = 0.03); at 30 days 87 and 70% (p = 0.04), respectively. One patient in group 1 experienced acute urinary retention at the time of catheter removal and was treated uneventfully with a further 7-day catheterization. These preliminary data indicate that newly designed six-branches suburethral autologous sling is able to increase the rate of early UC recovery compared to the two-arms sling previously described by us.
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Surgical Management of Localized and Locally Advanced Prostate Cancer. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_73-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - D Böhmer
- Klinik für Radioonkologie und Strahlentherapie, Charité Campus Benjamin Franklin, Berlin, Deutschland
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Volumetric image-guided highly conformal radiotherapy of the prostate bed: Toxicity analysis. Rep Pract Oncol Radiother 2016; 22:64-70. [PMID: 27920610 DOI: 10.1016/j.rpor.2016.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/24/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate toxicity of high conformal image-guided radiotherapy of the prostate bed. BACKGROUND Radiotherapy of the prostate bed has a pivotal role in the post-operative and salvage settings, but few clinical data are available on the use of daily image guidance in combination with highly conformal techniques, and data on long-term results are lacking. MATERIALS AND METHODS We analyzed 118 patients irradiated on the prostate bed using conformal plans processed with a micro-multileaf collimator, and daily checking treatment set-up with a cone-beam CT system. Correlation between toxicity and clinical-dosimetric parameters was assessed by the Cox regression model and log-rank test. Survival analyses were performed with the Kaplan-Meier method. RESULTS Median follow-up was 54.08 months. Late grade ≥2 gastro-intestinal (GI) and genito-urinary (GU) toxicity were 3.4% and 4.2%, respectively. Actuarial 4-year late grade ≥2 GI and GU toxicities were 4% and 6%, respectively. Four-year relapse-free survival was 87%. At log-rank test, acute grade ≥2 GI toxicity is associated with the use of antihypertensives (p = 0.03), and there is a trend toward significance between the use of anticoagulants and late grade ≥2 GI toxicity (p = 0.07). At Cox analysis, acute grade ≥2 GU toxicity is correlated with the percentage of bladder volume receiving more than 65 Gy (p = 0.02, HR 1.87 CI 1.25-2.8), and the maximal dose to the rectum is correlated to the development of late grade ≥2 GI toxicity (p = 0.03, HR 2.75 CI 1.10-6.9). CONCLUSIONS Conformal volumetric image-guided radiotherapy of the prostate bed leads to low toxicity rates.
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Taggar A, Alghamdi M, Tilly D, Kostaras X, Kerba M, Husain S, Gotto G, Sia M. Assessing guideline impact on referral patterns of post-prostatectomy patients to radiation oncologists. Can Urol Assoc J 2016; 10:314-318. [PMID: 27800051 DOI: 10.5489/cuaj.3539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adjuvant radiotherapy (aRT) can improve biochemical progression-free survival in patients with high-risk features (HRF) after radical prostatectomy (RP). Guidelines from Alberta and the Genitourinary Radiation Oncologists of Canada (GUROC) recommend that patients with HRF be referred to radiation oncologists (RO) based on the findings from three randomized, controlled trials (RCT). Our study examines the impact of these recommendations both pre- (2005) and post- (2012) publication of RCT and GUROC guideline establishment. METHODS Patients undergoing RP during 2005 and 2012 were identified from the provincial cancer registry. Charts were retrospectively reviewed and variables of interest were linked to the registry data. RO referral patterns for each year were determined and variables influencing referral (extracapsular extension, positive margin, seminal vesicle invasion, and post-RP prostate-specific antigen [PSA]) were compared. RESULTS Median time to referral was 26.4 months in 2005 compared to 3.7 months 2012 (p<0.001). Among patients referred post-RP, a higher proportion was referred within six months in 2012 (21%) as compared to 2005 (13%) (p=0.003). Among eligible patients in 2012, 30% were referred for discussion of aRT compared to 24% in 2005 (p=0.003). There was a marked drop in patients referred for salvage radiation therapy beyond six months and a rise in the number of patients who are never referred. CONCLUSIONS Despite an increase in referral rates to RO post-RP from 2005-2012, more than 50% of those patients with HRF did not receive a referral. Initiatives aimed at improving multidisciplinary care and guideline adherence should be undertaken.
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Affiliation(s)
- Amandeep Taggar
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Majed Alghamdi
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Derek Tilly
- Guideline Resource Unit, Cancer Control Alberta, Calgary, AB, Canada
| | | | - Marc Kerba
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Siraj Husain
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Geoff Gotto
- Department of Surgery, Division of Urology, University of Calgary, AB, Canada
| | - Michael Sia
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
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Herrera FG, Berthold DR. Radiation Therapy after Radical Prostatectomy: Implications for Clinicians. Front Oncol 2016; 6:117. [PMID: 27242957 PMCID: PMC4860423 DOI: 10.3389/fonc.2016.00117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Depending on the pathological findings, up to 60% of prostate cancer patients who undergo radical prostatectomy (RP) will develop biochemical relapse and require further local treatment. Radiotherapy (RT) immediately after RP may potentially eradicate any residual localized microscopic disease in the prostate bed, and it is associated with improved biochemical, clinical progression-free survival, and overall survival in patients with high-risk pathological features according to published randomized trials. Offering immediate adjuvant RT to all men with high-risk pathological factors we are over-treating around 50% of patients who would anyway be cancer-free, exposing them to unnecessary toxicity and adding costs to the health-care system. The current dilemma is, thus, whether to deliver adjuvant immediate RT solely on the basis of high-risk pathology, but in the absence of measurable prostate-specific antigen, or whether early salvage radiotherapy would yield equivalent outcomes. Randomized trials are ongoing to definitely answer this question. Retrospective analyses suggest that there is a dose–response favoring doses >70 Gy to the prostate bed. The evidence regarding the role of androgen deprivation therapy is emerging, and ongoing randomized trials are underway.
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Affiliation(s)
- Fernanda G Herrera
- Radiation Oncology Services, Department of Oncology, Lausanne University Hospital , Lausanne , Switzerland
| | - Dominik R Berthold
- Medical Oncology Services, Department of Oncology, Lausanne University Hospital , Lausanne , Switzerland
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Shakespeare TP. Adjuvant radiotherapy after radical prostatectomy: A failure of marketing-based medicine? J Med Imaging Radiat Oncol 2016; 60:239-43. [PMID: 27062263 DOI: 10.1111/1754-9485.12431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Abusamra A, Murshid E, Kushi H, Alkhateeb S, Al-Mansour M, Saadeddin A, Rabah D, Bazarbashi S, Alotaibi M, Alghamdi A, Alghamdi K, Alsharm A, Ahmad I. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2016; 8:123-30. [PMID: 27141178 PMCID: PMC4839225 DOI: 10.4103/0974-7796.176872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.
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Affiliation(s)
- Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Hussain Kushi
- Department of Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Murray JR, McNair HA, Dearnaley DP. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care? Cancer Manag Res 2015; 7:331-44. [PMID: 26635484 PMCID: PMC4646477 DOI: 10.2147/cmar.s51955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.
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Affiliation(s)
- Julia R Murray
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Helen A McNair
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David P Dearnaley
- Academic Urology Unit, Institute of Cancer Research, London
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
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Gandaglia G, Cozzarini C, Mottrie A, Bossi A, Fossati N, Montorsi F, Briganti A. The Role of Radiotherapy After Radical Prostatectomy in Patients with Prostate Cancer. Curr Oncol Rep 2015; 17:53. [DOI: 10.1007/s11912-015-0478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Duchesne GM, Haworth A, Bone E, Carter H, Ebert MA, Gagliardi F, Gibbs A, Hornby C, Martin A, Sidhom M, Wood M, Jackson M. Testing the Assessment of New Radiation Oncology Technology and Treatments framework using the evaluation of post-prostatectomy radiotherapy techniques. J Med Imaging Radiat Oncol 2015; 60:129-37. [PMID: 26439588 DOI: 10.1111/1754-9485.12390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We tested the ability of the Assessment of New Radiation Oncology Technology and Treatments framework to determine the clinical efficacy and safety of intensity-modulated radiation therapy (IMRT) compared with 3-dimensional radiation therapy (3DCRT) for post-prostatectomy radiation therapy (PPRT) to support its timely health economic evaluation. METHODS Treatment plans produced using FROGG guidelines provided dosimetry parameters for both techniques at 64 Gy and 70 Gy and were also used to model early and late outcome probabilities. Clinical parameters were derived from early toxicity and quality of life patient data, systematic literature review and expert opinion. Dosimetry parameters were correlated with the measures of clinical efficacy and safety. RESULTS Data from two patient cohorts (29 and 27 respectively) were collected within the project timeframe, providing evidence for acute toxicity and quality of life, and dosimetric comparisons. Relative rates of tumour control probability (TCP) and normal tissue control probability (NTCP) modelling were readily derived from the planning exercise and demonstrated advantages in uncomplicated TCP for IMRT over 3DCRT, predominantly due to normal tissue sparing. The safety of IMRT delivery was demonstrated with TCP uncompromised by IMRT protocol violations, which achieved rectal sparing only by reducing minimum target dose and coverage. CONCLUSION Sources of desk-top and patient-based evidence were successfully used to demonstrate potential improved clinical efficacy and safety of applying dose escalation using IMRT instead of 3DCRT in PPRT.
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Affiliation(s)
- Gillian M Duchesne
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Annette Haworth
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric Bone
- TROG, Consumer Representative, Newcastle, New South Wales, Australia
| | - Hannah Carter
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Martin A Ebert
- Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Perth, Western Australia, Australia
| | - Frank Gagliardi
- William Buckland Radiotherapy Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adrian Gibbs
- Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Colin Hornby
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Sidhom
- Liverpool Cancer Therapy Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Maree Wood
- Coffs Harbour Health Campus, North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Michael Jackson
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Den RB, Yousefi K, Trabulsi EJ, Abdollah F, Choeurng V, Feng FY, Dicker AP, Lallas CD, Gomella LG, Davicioni E, Karnes RJ. Genomic classifier identifies men with adverse pathology after radical prostatectomy who benefit from adjuvant radiation therapy. J Clin Oncol 2015; 33:944-51. [PMID: 25667284 PMCID: PMC4884273 DOI: 10.1200/jco.2014.59.0026] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The optimal timing of postoperative radiotherapy (RT) after radical prostatectomy (RP) is unclear. We hypothesized that a genomic classifier (GC) would provide prognostic and predictive insight into the development of clinical metastases in men receiving post-RP RT and inform decision making. PATIENTS AND METHODS GC scores were calculated from 188 patients with pT3 or margin-positive prostate cancer, who received post-RP RT at Thomas Jefferson University and Mayo Clinic between 1990 and 2009. The primary end point was clinical metastasis. Prognostic accuracy of the models was tested using the concordance index for censored data and decision curve analysis. Cox regression analysis tested the relationship between GC and metastasis. RESULTS The cumulative incidence of metastasis at 5 years after RT was 0%, 9%, and 29% for low, average, and high GC scores, respectively (P = .002). In multivariable analysis, GC and pre-RP prostate-specific antigen were independent predictors of metastasis (both P < .01). Within the low GC score (< 0.4), there were no differences in the cumulative incidence of metastasis comparing patients who received adjuvant or salvage RT (P = .79). However, for patients with higher GC scores (≥ 0.4), cumulative incidence of metastasis at 5 years was 6% for patients treated with adjuvant RT compared with 23% for patients treated with salvage RT (P < .01). CONCLUSION In patients treated with post-RP RT, GC is prognostic for the development of clinical metastasis beyond routine clinical and pathologic features. Although preliminary, patients with low GC scores are best treated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy. These findings provide the first rational selection of timing for post-RP RT.
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Affiliation(s)
- Robert B Den
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada.
| | - Kasra Yousefi
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Edouard J Trabulsi
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Firas Abdollah
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Voleak Choeurng
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Felix Y Feng
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Adam P Dicker
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Costas D Lallas
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Leonard G Gomella
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - Elai Davicioni
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
| | - R Jeffrey Karnes
- Robert B. Den, Edouard J. Trabulsi, Adam P. Dicker, Costas D. Lallas, and Leonard G. Gomella, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Firas Abdollah, Vattikuti Urology Institute, Henry Ford Hospital, Detroit; Felix Y. Feng, University of Michigan, Ann Arbor, MI; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; and Kasra Yousefi, Voleak Choeurng, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada
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Leite KRM, Hartmann C, Reis ST, Viana N, Dall'Oglio MF, Sant'Anna AC, Nesrallah A, Nesrallah L, Antunes AA, Camara-Lopes LH, Srougi M. Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a. Int Braz J Urol 2014; 40:146-53. [PMID: 24856481 DOI: 10.1590/s1677-5538.ibju.2014.02.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy. MATERIALS AND METHODS Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence. RESULTS 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7. CONCLUSION Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.
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Affiliation(s)
- Katia R M Leite
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School and Genoa Biotechnology, Sao Paulo, Brazil
| | | | - Sabrina T Reis
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Nayara Viana
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcos F Dall'Oglio
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alexandre C Sant'Anna
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Adriano Nesrallah
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Luciano Nesrallah
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School and Genoa Biotechnology, Sao Paulo, Brazil
| | - Alberto A Antunes
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Miguel Srougi
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Ravier E, Fassi-Fehri H, Crouzet S, Gelet A, Abid N, Martin X. Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int 2014; 115:300-7. [PMID: 24731208 DOI: 10.1111/bju.12777] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy (RT). PATIENTS AND METHODS Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurological and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and those lost to follow-up. In all, 122 patients were included in the study, 61 with prior RT and 61 without prior RT. All patients underwent the same surgical technique by two different surgeons. All AUS were implanted with a bulbar urethral cuff position. The mean (range) follow-up was 37.25 (1-126) months. RESULTS In the patients without prior RT and those with prior RT, revision rates were 32.8% vs 29.5%, respectively (P = 0.59). The median time to first revision was 11.7 months. Early complications were similar in the two groups (4.9% vs 6.5%, P = 1). Erosion rates were not significantly different (4.9% vs 13.1%, P = 0.13). However, infection and explantation were more prevalent in patients with prior RT [two (3.2%) vs 10 (16.3%), P = 0.018 and three (4.9%) vs 12 (19.6%), P = 0.016, respectively]. Finally, continence rates were not significantly different [75.4% (without prior RT) vs 63.9% (with prior RT), P = 0.23]. CONCLUSION AUS is the 'gold standard' treatment of male urinary incontinence after re-education failure in patients with or without prior RT. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior RT.
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Affiliation(s)
- Emmanuel Ravier
- Edouard Herriot Hospital, Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Lyon, France
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Akakura K. Editorial Comment from Dr Akakura to Early radiotherapy after radical prostatectomy improves cancer-specific survival only in patients with highly aggressive prostate cancer: validation of recently released criteria. Int J Urol 2014; 22:97. [PMID: 25187069 DOI: 10.1111/iju.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization, Tokyo Shinjuku Medical Center, Tokyo, Japan.
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Mantini G, Fersino S, Alitto AR, Frascino V, Massaccesi M, Fionda B, Iorio V, Luzi S, Balducci M, Mattiucci GC, Di Nardo F, De Belvis A, Morganti AG, Valentini V. Intensified adjuvant treatment of prostate carcinoma: feasibility analysis of a phase I/II trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:480725. [PMID: 25093169 PMCID: PMC4100352 DOI: 10.1155/2014/480725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/31/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To perform a preliminary feasibility acute and late toxicity evaluation of an intensified and modulated adjuvant treatment in prostate cancer (PCa) patients after radical prostatectomy. MATERIAL AND METHODS A phase I/II has been designed. Eligible patients were 79 years old or younger, with an ECOG of 0-2, previously untreated, histologically proven prostate adenocarcinoma with no distant metastases, pT2-4 N0-1, and with at least one of the following risk factors: capsular perforation, positive surgical margins, and seminal vesicle invasion. All patients received a minimum dose on tumor bed of 64.8 Gy, or higher dose (70.2 Gy; 85.4%), according to the pathological stage, pelvic lymph nodes irradiation (57.7%), and/or hormonal therapy (69.1%). RESULTS 123 patients were enrolled and completed the planned treatment, with good tolerance. Median follow-up was 50.6 months. Grade 3 acute toxicity was only 2.4% and 3.3% for genitourinary (GU) and gastrointestinal (GI) tract, respectively. No patient had late grade 3 GI toxicity, and the GU grade 3 toxicity incidence was 5.8% at 5 years. 5-year BDSF was 90.2%. CONCLUSIONS A modulated and intensified adjuvant treatment in PCa was feasible in this trial. A further period of observation can provide a complete assessment of late toxicity and confirm the BDSF positive results.
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Affiliation(s)
- Giovanna Mantini
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Sergio Fersino
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Anna Rita Alitto
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Vincenzo Frascino
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Mariangela Massaccesi
- Unità Operativa di Radioterapia, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Crt. Tappino 35, 86100 Campobasso, Italy
| | - Bruno Fionda
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Vincenzo Iorio
- Dipartimento di Diagnostica per Immagini e Radioterapia, Policlinico Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Stefano Luzi
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Mario Balducci
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Gian Carlo Mattiucci
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Francesco Di Nardo
- Istituto di Igiene e Medicina Preventiva, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Antonio De Belvis
- Istituto di Igiene e Medicina Preventiva, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessio Giuseppe Morganti
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
- Unità Operativa di Radioterapia, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Crt. Tappino 35, 86100 Campobasso, Italy
| | - Vincenzo Valentini
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
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Carter HE, Martin A, Schofield D, Duchesne G, Haworth A, Hornby C, Sidhom M, Jackson M. A decision model to estimate the cost-effectiveness of intensity modulated radiation therapy (IMRT) compared to three dimensional conformal radiation therapy (3DCRT) in patients receiving radiotherapy to the prostate bed. Radiother Oncol 2014; 112:187-93. [PMID: 24929702 DOI: 10.1016/j.radonc.2014.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy. METHODS A Markov decision model was developed to calculate the incremental quality adjusted life years (QALYs) and costs of IMRT compared with three dimensional conformal radiation therapy (3DCRT). Costs were estimated from the perspective of the Australian health care system. RESULTS IMRT was both more effective and less costly than 3DCRT over 20 years, with an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated. This result was robust to plausible levels of uncertainty. CONCLUSIONS IMRT was estimated to have a modest long term advantage over 3DCRT in terms of both improved effectiveness and reduced cost. This result was reliant on clinical judgement and interpretation of the existing literature, but provides quantitative guidance on the cost effectiveness of IMRT whilst long term trial evidence is awaited.
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Affiliation(s)
- Hannah E Carter
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Deborah Schofield
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Gillian Duchesne
- Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia
| | - Annette Haworth
- Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia; Dept Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Colin Hornby
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Australia
| | | | - Michael Jackson
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D, Persad R, Koupparis A. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11:342-51. [DOI: 10.1038/nrurol.2014.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Senescent remodeling of the innate and adaptive immune system in the elderly men with prostate cancer. Curr Gerontol Geriatr Res 2014; 2014:478126. [PMID: 24772169 PMCID: PMC3977481 DOI: 10.1155/2014/478126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/26/2014] [Accepted: 02/10/2014] [Indexed: 01/04/2023] Open
Abstract
Despite years of intensive investigation that has been made in understanding prostate cancer, it remains a major cause of death in men worldwide. Prostate cancer emerges from multiple alterations that induce changes in expression patterns of genes and proteins that function in networks controlling critical cellular events. Based on the exponential aging of the population and the increasing life expectancy in industrialized Western countries, prostate cancer in the elderly men is becoming a disease of increasing significance. Aging is a progressive degenerative process strictly integrated with inflammation. Several theories have been proposed that attempt to define the role of chronic inflammation in aging including redox stress, mitochondrial damage, immunosenescence, and epigenetic modifications. Here, we review the innate and adaptive immune systems and their senescent remodeling in elderly men with prostate cancer.
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Contemporary issues in radiotherapy for clinically localized prostate cancer. Hematol Oncol Clin North Am 2013; 27:1137-62, vii. [PMID: 24188256 DOI: 10.1016/j.hoc.2013.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Radiotherapy is a valid curative alternative to surgery for prostate cancer. However, patient selection is critical to ensure patients obtain benefits from therapy delivered with curative intent. Dose-escalated radiation has been shown to improve patient outcomes, facilitated by development of robust image guidance and better target delineation imaging technologies. These concepts have also rekindled interest in hypofractionated radiotherapy in the forms of stereotactic body radiotherapy and brachytherapy. Postprostatectomy radiotherapy also improves long-term biochemical outcome in men at high risk of local recurrence.
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Jilg CA, Rischke HC, Reske SN, Henne K, Grosu AL, Weber W, Drendel V, Schwardt M, Jandausch A, Schultze-Seemann W. Salvage lymph node dissection with adjuvant radiotherapy for nodal recurrence of prostate cancer. J Urol 2012; 188:2190-7. [PMID: 23083862 DOI: 10.1016/j.juro.2012.08.041] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE We evaluated the impact of salvage lymph node dissection with adjuvant radiotherapy in patients with nodal recurrence of prostate cancer. By default, nodal recurrence of prostate cancer is treated with palliative antihormonal therapy, which causes serious side effects and invariably leads to the development of hormone refractory disease. MATERIALS AND METHODS A total of 47 patients with nodal recurrence of prostate cancer based on evidence of (11)C-choline/(18)F-choline ((18)F-fluorethylcholine) positron emission tomography-computerized tomography underwent primary (2 of 52), secondary (45 of 52), tertiary (4 of 52) and quaternary (1 of 52) salvage lymph node dissection with histological confirmation. Of 52 salvage lymph node dissections 27 were followed by radiotherapy. Biochemical response was defined as a prostate specific antigen less than 0.2 ng/ml after salvage therapy. The Kaplan-Meier method, binary logistic regression and Cox regression were used to analyze survival as well as predictors of biochemical response and clinical progression. RESULTS Mean prostate specific antigen at salvage lymph node dissection was 11.1 ng/ml. A mean of 23.3 lymph nodes were removed per salvage lymph node dissection. Median followup was 35.5 months. Of 52 salvage lymph node dissections 24 resulted in complete biochemical response followed by 1-year biochemical recurrence-free survival of 71.8%. Gleason 6 or less (OR 7.58, p = 0.026), Gleason 7a/b (OR 5.91, p = 0.042) and N0 status at primary therapy (OR 8.01, p = 0.011) were identified as independent predictors of biochemical response. Gleason 8-10 (HR 3.5, p = 0.039) as a preoperative variable, retroperitoneal positive lymph nodes (HR 3.76, p = 0.021) and incomplete biochemical response (HR 4.0, p = 0.031) were identified as postoperative predictors of clinical progression. Clinical progression-free survival was 25.6% and cancer specific survival was 77.7% at 5 years. CONCLUSIONS Based on (11)C/(18)F-choline positron emission tomography-computerized tomography as a diagnostic tool, salvage lymph node dissection is feasible for the treatment of nodal recurrence of prostate cancer. Most patients experience biochemical recurrence after salvage lymph node dissection. However, a specific population has a lasting complete prostate specific antigen response.
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Affiliation(s)
- C A Jilg
- Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany.
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Evaluation of Postprostatectomy Incontinence: Determining Candidacy for the Transobturator Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0145-8] [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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