1
|
Wu X, Ma L, Zhang Y, Liu S, Cheng L, You C, Dong Z. Application progress of nanomaterials in the treatment of prostate cancer. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00131-7. [PMID: 39187009 DOI: 10.1016/j.pharma.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Prostate cancer is one of the most common malignant tumors in men, which seriously threatens the survival and quality of life of patients. At present, there are serious limitations in the treatment of prostate cancer, such as drug tolerance, drug resistance and easy recurrence. Sonodynamic therapy and chemodynamic therapy are two emerging tumor treatment methods, which activate specific drugs or sonosensitizers through sound waves or chemicals to produce reactive oxygen species and kill tumor cells. Nanomaterials are a kind of nanoscale materials with many excellent physical properties such as high targeting, drug release regulation and therapeutic monitoring. Sonodynamic therapy and chemodynamic therapy combined with the application of nanomaterials can improve the therapeutic effect of prostate cancer, reduce side effects and enhance tumor immune response. This article reviews the application progress of nanomaterials in the treatment of prostate cancer, especially the mechanism, advantages and challenges of nanomaterials in sonodynamic therapy and chemodynamic therapy, which provides new ideas and prospects for research in this field.
Collapse
Affiliation(s)
- Xuewu Wu
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China
| | - Longtu Ma
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China
| | - Yang Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Shuai Liu
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China
| | - Long Cheng
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China
| | - Chengyu You
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China
| | - Zhilong Dong
- The Second Hospital & Clinical Medical School, Lanzhou University, Gansu 730030, China.
| |
Collapse
|
2
|
Wagner C, Witt JH, Nolte S, van der Poel HG, Aaronson NK, Kolvatzis M, Tian Z, Mendrek M, Liakos N, Gratzke C, Leyh-Bannurah SR. Differences in Quality of Life between German and Dutch Patients with Prostate Cancer Treated with Robot-assisted Radical Prostatectomy: Implications for International Multicenter Randomized Controlled Trials. Eur Urol Focus 2024; 10:454-460. [PMID: 36863963 DOI: 10.1016/j.euf.2023.02.007] [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: 11/09/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND As a local treatment for prostate cancer (PCa), robot-assisted radical prostatectomy (RARP) may have a quality of life (QoL) benefit over open surgery. Recent analyses revealed substantial between-country differences in the function and symptom scale scores for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), which is typically used to assess patient-reported QoL. Such differences could have implications for multinational studies in PCa. OBJECTIVE To examine whether nationality is significantly associated with patient-reported QoL. DESIGN, SETTING, AND PARTICIPANTS The study cohort comprised Dutch and German patients with PCa treated with RARP in a single high-volume prostate center from 2006 to 2018. Analyses were restricted to patients who were preoperatively continent with at least one follow-up time point. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS QoL was measured in terms of the global Quality of Life (QL) scale score and the overall summary score for the EORTC QLQ-C30. Linear mixed models for repeated-measures multivariable analyses (MVAs) were used to examine the association between nationality and both the global QL score and the summary score. MVAs were further adjusted for QLQ-C30 baseline values, age, Charlson comorbidity index, preoperative prostate-specific antigen, surgical expertise, pathological tumor and nodal stage, Gleason grade, degree of nerve-sparing, surgical margin status, 30-d Clavien-Dindo grade complications, urinary continence recovery, and biochemical recurrence/postoperative radiotherapy. RESULTS AND LIMITATIONS For Dutch (n = 1938) versus German (n = 6410) men, the mean baseline scores were 82.8 versus 71.9 for the global QL scale score and 93.4 versus 89.7 for the QLQ-C30 summary score. Urinary continence recovery (QL: +8.9, 95% confidence interval [CI] 8.1-9.8; p < 0001) and Dutch nationality (QL: +6.9, 95% CI 6.1-7.6; p < 0001) were the strongest positive contributors to the global QL and summary scores, respectively. The main limitation is the retrospective study design. In addition, our Dutch cohort may not be representative of the general Dutch population and reporting bias cannot be ruled out. CONCLUSIONS Our findings provide observational evidence under specific conditions involving the same setting for patients of two different nationalities suggesting that cross-national patient-reported QoL differences appear to be real and may need to be taken into consideration in multinational studies. PATIENT SUMMARY We observed differences in the quality-of-life scores reported by Dutch and German patients with prostate cancer after they underwent robot-assisted removal of the prostate. These findings should be taken into consideration in cross-national studies.
Collapse
Affiliation(s)
- Christian Wagner
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Merkourios Kolvatzis
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany; Second Department of Urology Clinic, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Mikolaj Mendrek
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, Faculty of Medicine, Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany.
| |
Collapse
|
3
|
El-Karak F, Shamseddine A, Omar A, Haddad I, Abdelgawad M, Naqqash MA, Kaddour MA, Sharaf M, Abdo E. Prostate cancer across four countries in the Middle East: a multi-centre, observational, retrospective and prognostic study. Ecancermedicalscience 2024; 18:1695. [PMID: 38774566 PMCID: PMC11108050 DOI: 10.3332/ecancer.2024.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Indexed: 05/24/2024] Open
Abstract
Prostate cancer (PC) is the second most prevalent cancer in males, with a steadily increasing incidence in the Middle East (ME). The aim of this study was to capture real-world data on the characteristics, disease progression, and treatment patterns among PC patients in the ME. This was a retrospective, observational, multi-centre study conducted across ten hospitals/research centers in Lebanon, Kingdom of Saudi Arabia, Iraq and Kuwait. Data were abstracted from medical records of 615 male patients who were diagnosed with PC between January 2012 and the site initiation date (December 2018-May 2019) and received at least one PC treatment/intervention. The observation period ranged between 84 and 88 months. Data were collected on demographics, clinical characteristics, time to progression to the subsequent clinical state or therapy (progression from localised/locally advanced PC to castration and to metastatic PC (metastatic castration-sensitive PC (mCSPC) or metastatic castration-resistant PC (mCRPC)), progression from mCSPC to mCRPC, and mCRPC patients' progression to first subsequent line of therapy), treatment patterns, and mortality. Most patients had localised/locally advanced PC (57.7%), followed by mCSPC (37.4%), and mCRPC (4.1%) at the time of inclusion in the study. Most patients were at tumours, nodes and metastases (TNM) stage IIIa (40.1%) or TNM stage IVb (27.8%) at study entry. Median time to metastatic disease, castration-resistance and next line therapy was 84 months (95% CI: 68-84), 41 months (95% CI: 30-56) and 7 months (95% CI: 0-41), respectively. The mortality rate was 3.6%. Disease progression was most common among patients with mCSPC (35.1%) or mCRPC (14.8%), and treatment discontinuation was most common among patients with mCRPC (36.6% treatments discontinued). The results show that most patients were at an advanced TNM stage at study entry, suggestive of a lack of awareness regarding PC. Disease progression was most common among patients with metastatic disease, reflecting the challenge of treating metastatic disease and highlighting the need for novel treatments.
Collapse
Affiliation(s)
- Fadi El-Karak
- Hematology and Medical Oncology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- https://orcid.org/0000-0002-9266-591X
| | - Ali Shamseddine
- Clinical Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayman Omar
- Clinical Oncology and Nuclear Medicine Department, Suez Canal University, Ismailia, Egypt
- Oncology Department, King Faisal Specialist Hospital and Research Center, Faculty of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | |
Collapse
|
4
|
Sugino F, Nakane K, Kawase M, Ueda S, Tomioka M, Takeuchi Y, Tomioka-Inagawa R, Yamada T, Namiki S, Kumada N, Takeuchi S, Kawase K, Kato D, Takai M, Iinuma K, Tobisawa Y, Koie T. Efficacy and Safety of Neoadjuvant Luteinizing Hormone-Releasing Hormone Antagonist and Tegafur-Uracil Chemohormonal Therapy for High-Risk Prostate Cancer. Life (Basel) 2023; 13:life13051072. [PMID: 37240717 DOI: 10.3390/life13051072] [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: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This retrospective single-center cohort study evaluated the efficacy and safety of a combination of neoadjuvant luteinizing hormone-releasing hormone (LHRH) antagonist and tegafur-uracil (UFT) therapy (NCHT) and investigated the medical records of patients with high-risk PCa who underwent robot-assisted radical prostatectomy (RARP). The therapy was followed by RARP for high-risk PCa. MATERIALS AND METHODS The enrolled patients were divided into two groups: low-intermediate-risk PCa patients who underwent RARP without neoadjuvant therapy (non-high-risk) and those who underwent NCHT followed by RARP (high-risk group). This study enrolled 227 patients (126: non-high-risk and 101: high-risk group). Patients in the high-risk-group had high-grade cancer compared to those in the non-high-risk-group. RESULTS At the median follow-up period of 12.0 months, there were no PCa deaths; two patients (0.9%) died of other causes. Twenty patients developed biochemical recurrence (BCR); the median time until BCR was 9.9 months after surgery. The 2-year biochemical recurrence-free survival rates were 94.2% and 91.1% in the non-high-risk and high-risk-group, respectively (p = 0.465). Grade ≥3 NCHT-related adverse events developed in nine patients (8.9%). CONCLUSIONS This study indicates that combining neoadjuvant LHRH antagonists and UFT followed by RARP may improve oncological outcomes in patients with high-risk PCa.
Collapse
Affiliation(s)
- Fumiya Sugino
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shota Ueda
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama 5068550, Japan
| | - Masayuki Tomioka
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
| | - Yasumichi Takeuchi
- Department of Urology, Japanese Red Cross Gifu Hospital, Gifu 5028511, Japan
| | - Risa Tomioka-Inagawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Toyohiro Yamada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Sanae Namiki
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Naotaka Kumada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shinichi Takeuchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 0358562, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| |
Collapse
|
5
|
Gongora M, Stranne J, Johansson E, Bottai M, Thellenberg Karlsson C, Brasso K, Hansen S, Jakobsen H, Jäderling F, Lindberg H, Lilleby W, Meidahl Petersen P, Mirtti T, Olsson M, Rannikko A, Røder MA, Henrik Vincent P, Akre O. Characteristics of Patients in SPCG-15—A Randomized Trial Comparing Radical Prostatectomy with Primary Radiotherapy plus Androgen Deprivation Therapy in Men with Locally Advanced Prostate Cancer. EUR UROL SUPPL 2022; 41:63-73. [PMID: 35813256 PMCID: PMC9257646 DOI: 10.1016/j.euros.2022.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is no high-grade evidence for surgery as primary treatment for locally advanced prostate cancer. The SPCG-15 study is the first randomized trial comparing surgical treatment with radiotherapy. Objective To describe the baseline characteristics of the first 600 randomized men in the SPCG-15 study. The study will compare mortality and functional outcomes. Design, setting, and participants This study is a Scandinavian prospective, open, multicenter phase III randomized clinical trial aiming to randomize 1200 men. Intervention Radical prostatectomy with or without consecutive radiotherapy (experimental) and radiotherapy with neoadjuvant androgen deprivation therapy (standard of care). Outcome measurements and statistical analysis Cause-specific survival, metastasis-free survival, overall survival, and patient-reported bowel function, sexual health, and lower urinary tract symptoms were measured. Results and limitations The distribution of characteristics was similar in the two study arms. The median age was 67 yr (range 45–75 yr). Among the operated men, 36% had pT3a stage of disease and 39% had pT3b stage. International Society of Urological Pathology grades 2, 3, 4, and 5 were prevalent in 21%, 35%, 7%, and 27%, respectively. Half of the men (51%) in the surgery arm had no positive lymph nodes. The main limitation is the pragmatic design comparing the best available practice at each study site leading to heterogeneity of treatment regimens within the study arms. Conclusions We have proved that randomization between surgery and radiotherapy for locally advanced prostate cancer is feasible. The characteristics of the study population demonstrate a high prevalence of advanced disease, well-balanced comparison groups, and a demography mirroring the Scandinavian population of men with prostate cancer at large. Patient summary This study, which has recruited >600 men, compares radiotherapy with surgery for prostate cancer, and an analysis at the time of randomization indicates that the study will be informative and generalizable to most men with locally advanced but not metastasized prostate cancer.
Collapse
Affiliation(s)
- Magdalena Gongora
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Corresponding author. Department of Molecular Molecule and Surgery, Karolinska Institutet, Solna, GKS D1:05, 171 76 Stockholm, Sweden. Tel. +46733018726.
| | - Johan Stranne
- Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Johansson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Klaus Brasso
- Department of Urology, Center for Cancer and Organ Diseases, Copenhagen Prostate Cancer Center, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steinbjørn Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Henrik Jakobsen
- Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital − Herlev and Gentofte, Herlev, Denmark
| | | | | | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland
| | - Mats Olsson
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Antti Rannikko
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, Faculty of Medicine and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Martin Andreas Røder
- Department of Urology, Center for Cancer and Organ Diseases, Copenhagen Prostate Cancer Center, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
6
|
Sjoberg HT, Philippou Y, Magnussen AL, Tullis IDC, Bridges E, Chatrian A, Lefebvre J, Tam KH, Murphy EA, Rittscher J, Preise D, Agemy L, Yechezkel T, Smart SC, Kinchesh P, Gilchrist S, Allen DP, Scheiblin DA, Lockett SJ, Wink DA, Lamb AD, Mills IG, Harris A, Muschel RJ, Vojnovic B, Scherz A, Hamdy FC, Bryant RJ. Tumour irradiation combined with vascular-targeted photodynamic therapy enhances antitumour effects in pre-clinical prostate cancer. Br J Cancer 2021; 125:534-546. [PMID: 34155340 PMCID: PMC8367986 DOI: 10.1038/s41416-021-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a need to improve the treatment of prostate cancer (PCa) and reduce treatment side effects. Vascular-targeted photodynamic therapy (VTP) is a focal therapy for low-risk low-volume localised PCa, which rapidly disrupts targeted tumour vessels. There is interest in expanding the use of VTP to higher-risk disease. Tumour vasculature is characterised by vessel immaturity, increased permeability, aberrant branching and inefficient flow. FRT alters the tumour microenvironment and promotes transient 'vascular normalisation'. We hypothesised that multimodality therapy combining fractionated radiotherapy (FRT) and VTP could improve PCa tumour control compared against monotherapy with FRT or VTP. METHODS We investigated whether sequential delivery of FRT followed by VTP 7 days later improves flank TRAMP-C1 PCa tumour allograft control compared to monotherapy with FRT or VTP. RESULTS FRT induced 'vascular normalisation' changes in PCa flank tumour allografts, improving vascular function as demonstrated using dynamic contrast-enhanced magnetic resonance imaging. FRT followed by VTP significantly delayed tumour growth in flank PCa allograft pre-clinical models, compared with monotherapy with FRT or VTP, and improved overall survival. CONCLUSION Combining FRT and VTP may be a promising multimodal approach in PCa therapy. This provides proof-of-concept for this multimodality treatment to inform early phase clinical trials.
Collapse
Affiliation(s)
- Hanna T Sjoberg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Anette L Magnussen
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Esther Bridges
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrea Chatrian
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Joel Lefebvre
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ka Ho Tam
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Emma A Murphy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Target Discovery Institute, NDM Research Building, University of Oxford, Headington, UK
| | - Dina Preise
- Department of Core Facilities, The Weizmann Institute of Science, Rehovot, Israel
| | - Lilach Agemy
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Tamar Yechezkel
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Sean C Smart
- Department of Oncology, University of Oxford, Oxford, UK
| | - Paul Kinchesh
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Danny P Allen
- Department of Oncology, University of Oxford, Oxford, UK
| | - David A Scheiblin
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Stephen J Lockett
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - David A Wink
- Cancer and Inflammation Program, Centre for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ian G Mills
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Adrian Harris
- Department of Oncology, University of Oxford, Oxford, UK
| | - Ruth J Muschel
- Department of Oncology, University of Oxford, Oxford, UK
| | - Boris Vojnovic
- Department of Oncology, University of Oxford, Oxford, UK
| | - Avigdor Scherz
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
| |
Collapse
|
7
|
Rehman A, El-Zaatari ZM, Han SH, Shen SS, Ayala AG, Miles B, Divatia MK, Ketcham MS, Chung BM, Rogers JT, Ro JY. Seminal vesicle invasion combined with extraprostatic extension is associated with higher frequency of biochemical recurrence and lymph node metastasis than seminal vesicle invasion alone: Proposal for further pT3 prostate cancer subclassification. Ann Diagn Pathol 2020; 49:151611. [PMID: 32956915 DOI: 10.1016/j.anndiagpath.2020.151611] [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: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system subdivides prostatic pT3 tumors into pT3a, which includes cases with extraprostatic extension (EPE) and pT3b, which is defined by the presence of seminal vesicle invasion (SVI) with or without EPE. Yet, it is not established whether combined SVI and EPE impart a worse prognosis compared to SVI alone. We studied a cohort of 69 prostatectomy patients with SVI with or without EPE. Patient age at the time of radical prostatectomy was documented and Gleason score and presence or absence of EPE and/or SVI were determined. Biochemical recurrence (BCR) was defined as a PSA rise >0.2 ng/mL. The frequency of BCR was 33.9% in cases with combined EPE and SVI versus 12.5% in cases with SVI alone (relative risk = 2.71). An additional cohort of 88 patients also showed a higher frequency of lymph node metastasis of 29% in patients with combined SVI and EPE at the time of radical prostatectomy versus a 10% frequency of lymph node metastasis in patients with SVI alone (relative risk = 2.9). Based on our data, we propose further subdividing pT3 prostate cancers into three groups: EPE alone (pT3a), SVI alone (pT3b), and combined EPE and SVI (pT3c). This classification system would more accurately identify patients with pT3 prostate cancer who are more likely to experience worse outcomes and provide clinicians with additional information to aid in follow-up and postoperative treatment decisions.
Collapse
Affiliation(s)
- Aseeb Rehman
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Ziad M El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Sang H Han
- Department of pathology, Chuncheon Sacred Heart Hospital, Hallym University, Republic of Korea
| | - Steven S Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Alberto G Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Brian Miles
- Department of Urology, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Mukul K Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Megan S Ketcham
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Betty M Chung
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - John T Rogers
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas, USA.
| |
Collapse
|
8
|
Deng Y, Bi R, Zhu Z, Li S, Xu B, Rather WA, Wang C. A Surveillance, Epidemiology and End Results database analysis of the prognostic value of organ-specific metastases in patients with advanced prostatic adenocarcinoma. Oncol Lett 2019; 18:1057-1070. [PMID: 31423166 PMCID: PMC6607368 DOI: 10.3892/ol.2019.10461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 04/02/2019] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) survival markedly decreases with the occurrence of distant metastasis, and treatment decisions can be influenced by metastasis site, and affect patient survival outcomes. The aim of the present study was to evaluate the potential prognostic value of metastasis to specific sites and the prognostic value of prostatectomy in patients with only bone metastasis, and to determine potential risk factors for bone metastasis in prostatic adenocarcinoma using large scale clinical data. The Surveillance, Epidemiology and End Results (SEER) database (2010–2013) was queried via the SEER*Stat (version 8.3.4) program. A total of 210,730 prostatic adenocarcinoma patients were identified from the SEER database between January 2010 and December 2013. Univariate and multivariate Cox regression analysis and Kaplan-Meier curves were used for survival comparisons with corresponding 95% confidence intervals. Patients with PCa with only liver metastatic lesions had worse overall and cancer-specific survival rates compared with those patients with only bone or lung metastasis. Multivariate Cox regression analysis revealed that age <50 years, married status, T1 and T3 tumor stage according to Tumor-Node-Metastasis (TNM) staging system from the 7th AJCC cancer staging manual, and prostatectomy were associated with better overall survival and cancer-specific survival in patients with only bone metastasis. Binary logistic regression analysis revealed that unmarried status, African descent and undifferentiated histological grade were risk factors for PCa bone metastasis. Prostatic adenocarcinoma patients with only liver metastasis had worse prognostic outcomes compared with patients with other distant organ metastases. Prostatectomy improved the 3-year survival rate in stage IV PCa patients and stage IV PCa patients with only bone metastasis. These findings were based on large-scale clinical data and can provide novel perspectives for the treatment of patients with advanced prostate adenocarcinoma.
Collapse
Affiliation(s)
- Yuyou Deng
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Ran Bi
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Zhenhua Zhu
- Department of Orthopedic Trauma, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Shengxian Li
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Bo Xu
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Wakeel Ahmad Rather
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Chunxi Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| |
Collapse
|
9
|
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]
|
10
|
Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature. Prog Urol 2018; 28:875-889. [DOI: 10.1016/j.purol.2018.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 11/21/2022]
|
11
|
Migration in last decade to high-risk prostate cancer after radical prostatectomy. Prog Urol 2018; 29:29-35. [PMID: 30337057 DOI: 10.1016/j.purol.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/05/2018] [Accepted: 09/17/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There is controversy around prostate cancer (PCa) screening through the use of PSA, due to the risk of overtreatment. The current trend observed in various European and American studies is a decrease in the number of radical prostatectomy (RP) in low-risk PCa and an increase for intermediate or locally advanced diseases. The objective of this study was to observe the migration of the pathological stages from radical prostatectomy (RP) over 10 years in France through 2 French centers. METHODS It was a multicentric retrospective study, where all the RP realized in 2 French tertiary centers, in a laparoscopic or retropubic approach for each of the years 2005, 2010 and 2015 were included. Preoperative data (age, PSA, clinical stage, number of positive biopsies, Gleason biopsy score) and postoperative data (pTNM, pathological Gleason score (pGS)) were analyzed and compared. RESULTS In all, 1282 RP were realized (503 in 2005, 403 in 2010, 376 in 2015). Respectively between 2005, 2010, 2015 the average number of positive biopsy increased significantly from 2.30 vs. 2.88 vs. 5.3 (P=0.0001). The distribution of D'Amico's risk evolves with time: low-risk: 49.9 vs. 44.4 vs. 15.7% (P=0.0001); intermediate risk: 40.95 vs. 43.92 vs. 64.1% (P=0.0001) and high-risk: 9.15 vs. 11.66 vs. 20.2% (P=0.0001) between 2005, 2010 and 2015 respectively. pGS evolved to higher score with SG<7: 22.8 vs. 29.9 vs. 7.1% et SG≥7: 77.2 vs. 70.1 vs. 92.9% (P=0.001). Also, pTNM increased to non-organ-confined disease: pT2: 66.9 vs. 51.9 vs. 48.7%; pT3: 33.1 vs. 48.1 vs. 51.3% (P=0.0001). CONCLUSION This study showed a change in the management of PCa since new recommendations from medical authorities about PSA screening and evolving of conservative treatment. Number of RP increase for higher risk PCa. This change corresponds to better patient selection for RP: decrease for low-risk and increase for high-risk organ-confined disease. LEVEL OF EVIDENCE 3.
Collapse
|
12
|
Jang TL, Patel N, Faiena I, Radadia K, Moore DF, Elsamra SE, Singer EA, Stein MN, Lin Y, Kim IY, Eastham JA, Scardino PT, Lu-Yao GL. Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer. Cancer 2018; 124:4010-4022. [PMID: 30252932 PMCID: PMC6234085 DOI: 10.1002/cncr.31726] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Men with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) are at high risk for death from their disease. Clinical guidelines support multimodal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) and XRT plus androgen deprivation therapy (ADT). However, there are limited data comparing these substantially different treatment approaches. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study compared survival outcomes and adverse effects associated with RP plus XRT versus XRT plus ADT in these men. METHODS SEER-Medicare data were queried for men with cT3-T4N0M0 (LAPCa) or cT3-T4N1M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between the treatment arms. Survival analyses were analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS From 1992 to 2009, 13,856 men (≥65 years old) were diagnosed with LAPCa or RAPCa: 6.1% received RP plus XRT, and 23.6% received XRT plus ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Regardless of the tumor stage or the Gleason score, the adjusted 10-year prostate cancer-specific survival and 10-year overall survival favored men who underwent RP plus XRT over men who underwent XRT plus ADT. However, RP plus XRT versus XRT plus ADT was associated with higher rates of erectile dysfunction (28% vs 20%; P = .0212) and urinary incontinence (49% vs 19%; P < .001). CONCLUSIONS Men with LAPCa or RAPCa treated initially with RP plus XRT had a lower risk of prostate cancer-specific death and improved overall survival in comparison with those men treated with XRT plus ADT, but they experienced higher rates of erectile dysfunction and urinary incontinence.
Collapse
Affiliation(s)
- Thomas L. Jang
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Neal Patel
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Izak Faiena
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kushan Radadia
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dirk F. Moore
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E. Elsamra
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Mark N. Stein
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y. Kim
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - James A. Eastham
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, Weill Cornell Medical College, New York, NY
| | - Peter T. Scardino
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, Weill Cornell Medical College, New York, NY
| | - Grace L. Lu-Yao
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Department of Medical Oncology, Sidney Kimmel Medical College, Jefferson College of Population Health, Philadelphia, PA (GLY)
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Although cytoreductive surgery is accompanied with prolonged survival in many other malignancies in a metastatic stage, its role in oligometastatic prostate cancer is unclear. RECENT FINDINGS Radical prostatectomy (RP) in patients with oligometastatic prostate cancer seems to be feasible. Perioperative complication rates vary between 20 and 50% (Clavien 1-3) and are comparable to patients with locally advanced tumors. Postoperative functional outcomes (urinary continence and erectile function) can be slightly worse than in patients with locally advanced tumor. In literature, an oncological benefit of surgery is so far only described for retrospective multiinstitutional databases and a case-control study but not for prospective studies. Still, men undergoing RP clearly seem to develop severe local complications less frequently than patients receiving best systemic therapy (up to more than 50% versus less than10%). SUMMARY Patients should be counseled about the potential significant reduction of local complications whenever undergoing RP for oligometastatic prostate cancer. Nevertheless, as complication rates are relatively high, functional outcome can be slightly worse compared with RP with curative intent and especially as oncological benefit so far is shown using retrospective but not prospective data, patients should only undergo surgery within the ongoing prospective, randomized trials.
Collapse
|
14
|
Kasuya G, Ishikawa H, Tsuji H, Haruyama Y, Kobashi G, Ebner DK, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Makishima H, Nomiya T, Kamada T, Tsujii H. Cancer-specific mortality of high-risk prostate cancer after carbon-ion radiotherapy plus long-term androgen deprivation therapy. Cancer Sci 2017; 108:2422-2429. [PMID: 28921785 PMCID: PMC5715357 DOI: 10.1111/cas.13402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
The treatment outcomes of patients with high‐risk localized prostate cancer (PC) after carbon‐ion radiotherapy (CIRT) combined with long‐term androgen deprivation therapy (LTADT) were analyzed, and compared with those of other treatment modalities, focusing on PC‐specific mortality (PCSM). A total of 1247 patients were enrolled in three phase II clinical trials of fixed‐dose CIRT between 2000 and 2013. Excluding patients with T4 disease, 608 patients with high‐risk or very‐high‐risk PC, according to the National Comprehensive Cancer Network classification system, who received CIRT with LTADT were evaluated. The median follow‐up time was 88.4 months, and the 5‐/10‐year PCSM rates were 1.5%/4.3%, respectively. T3b disease, Gleason score of 9–10 and percentage of positive biopsy cores >75% were associated with significantly higher PCSM on univariate and multivariate analyses. The 10‐year PCSM rates of patients having all three (n = 16), two (n = 74) or one of these risk factors (n = 217) were 27.1, 11.6 and 5.7%, respectively. Of the 301 patients with none of these factors, only 1 PCSM occurred over the 10‐year follow‐up (10‐year PCSM rate, 0.3%), and significant differences were observed among the four stratified groups (P <0.001). CIRT combined with LTADT yielded relatively favorable treatment outcomes in patients with high‐risk PC and very favorable results in patients without any of the three abovementioned factors for PCSM. Because a significant difference in PCSM among the high‐risk PC patient groups was observed, new categorization and treatment intensity adjustment may be required for high‐risk PC patients treated with CIRT.
Collapse
Affiliation(s)
- Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, Graduate School of Medicine, Tsukuba University, Ibaraki, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Daniel K Ebner
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Brown University Alpert Medical School, Providence, RI, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hirohiko Tsujii
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | |
Collapse
|
15
|
Abstract
BACKGROUND Due to an inverse stage migration, the proportion of patients with more aggressive and locally advanced prostate cancer (PCa) has increased over the last few years. The natural history in these patients shows a higher risk of local complications and worse oncologic outcome. OBJECTIVES To analyze the impact of radical prostatectomy (RP) in patients with locally advanced PCa. MATERIALS AND METHODS A review of the literature was performed using PubMed and MEDLINE databases focusing on articles addressing locally advanced PCa. RESULTS Current guidelines recommend local therapy in patients with locally advanced PCa among other treatment options. Thereby no strong evidence favoring radiotherapy or RP is present. Compared to patients without local treatment, RP may improve oncologic outcome and decrease the risk of local complications. Due to more difficult surgery and an increased need of multimodal therapy, higher perioperative morbidity and worse functional outcomes compared to patients with localized PCa are reported. No reliable prospective data indicating a widespread use of neoadjuvant treatment exists. Indication for further adjuvant or salvage therapies depends on pathologic results and postoperative course. CONCLUSIONS RP is one of the treatment options with good long-term results which can be offered to patients with locally advanced PCa. Nevertheless, patients need to be counselled especially about the worse postoperative functional outcome compared to patients with localized PCa.
Collapse
Affiliation(s)
- P Mandel
- Martini-Klinik Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - D Tilki
- Martini-Klinik Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Graefen
- Martini-Klinik Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| |
Collapse
|
16
|
Saika T, Miura N, Fukumoto T, Yanagihara Y, Miyauchi Y, Kikugawa T. Role of robot-assisted radical prostatectomy in locally advanced prostate cancer. Int J Urol 2017; 25:30-35. [PMID: 28901630 DOI: 10.1111/iju.13441] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 12/12/2022]
Abstract
Locally advanced prostate cancer is regarded as a very high-risk disease with a poor prognosis. Although there is no definitive consensus on the definition of locally advanced prostate cancer, radical prostatectomy for locally advanced prostate cancer as a primary treatment or part of a multimodal therapy has been reported. Robot-assisted radical prostatectomy is currently carried out even in high-risk prostate cancer because it provides optimal outcomes. However, limited studies have assessed the role of robot-assisted radical prostatectomy in patients with locally advanced prostate cancer. Herein, we summarize and review the current knowledge in terms of the definition and surgical indications of locally advanced prostate cancer, and the surgical procedure and perisurgical/oncological outcomes of robot-assisted radical prostatectomy and extended pelvic lymphadenectomy for locally advanced prostate cancer.
Collapse
Affiliation(s)
- Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Noriyoshi Miura
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tetsuya Fukumoto
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yutaka Yanagihara
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yuki Miyauchi
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tadahiko Kikugawa
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| |
Collapse
|
17
|
Kaushik D, Boorjian SA, Thompson RH, Eisenberg MS, Carlson RE, Bergstralh EJ, Frank I, Gettman MT, Tollefson MK, Karnes RJ. Oncological outcomes following radical prostatectomy for patients with pT4 prostate cancer. Int Braz J Urol 2017; 42:1091-1098. [PMID: 27649109 PMCID: PMC5117964 DOI: 10.1590/s1677-5538.ibju.2016.0290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022] Open
Abstract
Objectives: Radical prostatectomy (RP) for locally advanced prostate cancer may reduce the risk of metastasis and cancer-specific death. Herein, we evaluated the outcomes for patients with pT4 disease treated with RP. Materials and methods: Among 19,800 men treated with RP at Mayo Clinic from 1987 to 2010, 87 were found to have pT4 tumors. Biochemical recurrence (BCR)-free survival, systemic progression (SP) free survival and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to assess the association of clinic-pathological features with outcome. Results: Median follow-up was 9.8 years (IQR 3.6, 13.4). Of the 87 patients, 50 (57.5%) were diagnosed with BCR, 30 (34.5%) developed SP, and 38 (43.7%) died, with 11 (12.6%) dying of prostate cancer. Adjuvant androgen deprivation therapy was administered to 77 men, while 32 received adjuvant external beam radiation therapy. Ten-year BCR-free survival, SP-free survival, and OS was 37%, 64%, and 70% respectively. On multivariate analysis, the presence of positive lymph nodes was marginally significantly associated with patients' risk of BCR (HR: 1.94; p=0.05), while both positive lymph nodes (HR 2.96; p=0.02) and high pathologic Gleason score (HR 1.95; p=0.03) were associated with SP. Conclusions: Patients with pT4 disease may experience long-term survival following RP, and as such, when technically feasible, surgical resection should be considered in the multimodal treatment approach to these men.
Collapse
Affiliation(s)
- Dharam Kaushik
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | | | | | - Rachel E Carlson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Bergstralh
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | |
Collapse
|
18
|
Srivatsa N, Nagaraja H, Shweta S, Raghunath SK. Radical Prostatectomy for Locally Advanced Prostate Cancers-Review of Literature. Indian J Surg Oncol 2017; 8:175-180. [PMID: 28546714 PMCID: PMC5427032 DOI: 10.1007/s13193-016-0599-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 10/20/2022] Open
Abstract
Twenty-five to thirty percent of patients with prostate cancer present with locally advanced disease. While risk stratification remains the same with high incidence of upstaging of disease on imaging and histopathological evaluation; there have been progressive refinements in surgical therapy. With availability of reasonably robust data, radical prostatectomy in men with locally advanced prostate cancers seems to effect improvement in both cancer specific and overall survival rates in comparison to the current standard of care of radiation with androgen deprivation therapy. Studies using radical prostatectomy as a part of multimodality approach have also shown promising results. There is an imminent need for well-designed prospective studies of benefits of radical prostatectomy over radiation and androgen deprivation as well as benefits of multimodality therapy over monotherapy. Surgery for patients with locally advanced prostate cancer is technically challenging. Surgical outcomes are comparable to those of organ-confined disease when performed in high-volume centers. Neoadjuvant therapies prior to radical prostatectomy might improve surgical outcomes, but whether they will translate into a better cancer specific and overall survival are yet to be ascertained.
Collapse
Affiliation(s)
- N Srivatsa
- Department of Uro-Oncology, HCG Bangalore Institute of Oncology, Bangalore, India
| | - H Nagaraja
- Department of Uro-Oncology, HCG Bangalore Institute of Oncology, Bangalore, India
| | - S Shweta
- Department of Uro-Oncology, HCG Bangalore Institute of Oncology, Bangalore, India
| | - SK Raghunath
- Department of Uro-Oncology, HCG Bangalore Institute of Oncology, Bangalore, India
| |
Collapse
|
19
|
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]
|
20
|
Furukawa J, Miyake H, Inoue TA, Ogawa T, Tanaka H, Fujisawa M. Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer. Curr Urol 2016; 9:67-72. [PMID: 27390578 DOI: 10.1159/000442856] [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: 03/25/2015] [Accepted: 07/20/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). PATIENTS AND METHODS This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. RESULTS The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. CONCLUSIONS Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity.
Collapse
Affiliation(s)
- Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taka-Aki Inoue
- Department of Urology, Hyogo Cancer Center, Akashi, Japan
| | - Takayoshi Ogawa
- Department of Urology, Himeji Red Cross Hospital, Himeji, Japan
| | | | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
21
|
Sanyal C, Aprikian AG, Cury FL, Chevalier S, Dragomir A. Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality-adjusted life-year analysis. Cancer 2016; 122:1085-96. [PMID: 26828716 DOI: 10.1002/cncr.29892] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND To the authors' knowledge, the literature to date lacks studies examining lifetime costs and quality-adjusted life-years (QALYs) of prostate cancer (PCa) management strategies that integrate localized and advanced disease. The objective of the current study was to assess lifetime costs and QALYs associated with contemporary PCa management strategies across risk groups by integrating localized and advanced disease. METHODS The authors' validated Markov chain Monte Carlo model was used to predict lifetime direct costs and QALYs. The health states modeled were active surveillance, initial treatments (radical prostatectomy or radiotherapy), PCa recurrence, PCa recurrence free, metastatic castration-resistant prostate cancer, and death (cause specific/other causes). Data regarding treatment distribution, state transition probabilities, adverse effects of management options, costs, utilities, and disutilities were derived from the published literature. RESULTS The total cost per patient for the overall cohort increased from $18,503 at 5 years to $28,032 and $39,143, respectively, at 10 years and 15 years. Furthermore, the results indicated the influence of risk group on total cost, with the high-risk group accruing the maximum per patient cost followed by the intermediate-risk and low-risk groups. Active surveillance was found to confer the most QALYs (12.5 years) and was the least costly strategy ($18,452) for individuals at low risk. For all risk groups, radical prostatectomy was less costly and conferred modestly more QALYs compared with intensity-modulated radiotherapy modalities. CONCLUSIONS Public health care systems in Canada and elsewhere are operating under budget constraints to allocate finite resources. The findings of the current study might inform discussions concerning budget planning to provide health care services.
Collapse
Affiliation(s)
| | - Armen G Aprikian
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Fabio L Cury
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Division of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Simone Chevalier
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Alice Dragomir
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Hussein AA, Cooperberg MR. Is Surgery Still Necessary for Prostate Cancer? Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
23
|
Nezolosky MD, Dinh KT, Muralidhar V, Mahal BA, Chen YW, Beard CJ, Choueiri TK, Martin NE, Sweeney CJ, Trinh QD, Nguyen PL. Significant increase in prostatectomy and decrease in radiation for clinical T3 prostate cancer from 1998 to 2012. Urol Oncol 2015; 34:57.e15-22. [PMID: 26476663 DOI: 10.1016/j.urolonc.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to describe changes in treatment patterns for clinical T3 prostate cancer (PCa) from 1998 to 2012, specifically investigating what factors influence receipt of prostatectomy or radiation. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, we studied 11,604 men with clinical T3N0M0 PCa from 1998 to 2012, with treatment categorized as radiation, radical prostatectomy (RP), or no curative therapy. We calculated rate of treatment type by year of diagnosis to investigate trends in treatment patterns, further stratifying by clinical T3a, defined as unilateral and bilateral extracapsular extension (n = 3,842), vs. T3b (defined as extension to seminal vesicles (n = 3,665). Finally, a multivariable logistic regression analysis measured association of demographic and clinical variables with type of treatment received for years 2010 to 2011. RESULTS Rates of prostatectomy increased significantly from 1998 to 2012 (12.5% vs. 44.4%), radiation decreased significantly (55.8% vs. 38.4%), and receipt of no treatment also decreased (31.7% vs. 17.2%, all P<0.001). These trends were similar for clinical T3a and T3b. Rates of prostatectomy surpassed radiation by 2008 in clinical T3a, reaching 49.8% vs. 37.1%, respectively, in 2012 (P = 0.002), and were statistically similar to radiation in 2012 for clinical T3b, reaching 41.6% vs. 42.1% (P = 0.92). Multivariable logistic regression analysis demonstrated that patients were less likely to receive prostatectomy than radiation if biopsy Gleason scores of 8 to 10 (adjusted odds ratio [AOR] = 0.41, 0.32-0.53), higher initial prostate-specific antigen (AOR = 0.97, 0.97-0.98), and older age (AOR = 0.92, 0.90-0.03, all P<0.01). The likelihood of RP was similar among cT3b vs. cT3a (AOR = 0.95, 0.71-1.26, P = 0.74). CONCLUSIONS Since 1998, there has been a significant increase in the use of RP for clinical T3 PCa and a significant decrease in the use of radiation such that in 2012, the use of prostatectomy exceeded the use of radiation.
Collapse
Affiliation(s)
- Michelle D Nezolosky
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA
| | | | | | - Brandon A Mahal
- Department of Internal Medicine, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Yu-Wei Chen
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher J Sweeney
- Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| |
Collapse
|
24
|
A population-based study of progression to metastatic prostate cancer in Australia. Cancer Epidemiol 2015; 39:617-22. [DOI: 10.1016/j.canep.2015.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/18/2022]
|
25
|
Nazim SM, Abbas F. Role of Surgery in locally advanced prostate cancer. Pak J Med Sci 2015; 31:710-6. [PMID: 26150873 PMCID: PMC4485300 DOI: 10.12669/pjms.313.7103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/09/2015] [Accepted: 03/28/2015] [Indexed: 11/30/2022] Open
Abstract
A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a part of multi-modality treatment (with neo-adjuvant hormonal therapy (HT) and with adjuvant or salvage radiation therapy (RT)/HT) can provide long term overall and cancer specific survival. Surgical treatment (such as transurethral resection (TUR), JJ stenting and percutaneous nephrostomy (PCN) placement etc.) can also provide symptomatic improvement and palliative care to improve quality of life of patients with advanced prostate cancer.
Collapse
Affiliation(s)
- Syed Muhammad Nazim
- Syed Muhammad Nazim, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan
| | - Farhat Abbas
- Farhat Abbas, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan
| |
Collapse
|
26
|
Lightfoot AJ, Su YK, Sehgal SS, Lee Z, Greaves GH, Yu SJS, Llukani E, Su YC, Lee DI. Positive Surgical Margin Trends in Patients with Pathologic T3 Prostate Cancer Treated with Robot-Assisted Radical Prostatectomy. J Endourol 2015; 29:634-9. [DOI: 10.1089/end.2014.0242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew J. Lightfoot
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Kai Su
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shailen S. Sehgal
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ziho Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giovanni H. Greaves
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue-Jean S. Yu
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elton Llukani
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Chen Su
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I. Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
27
|
Zhao B, Yerram NK, Gao T, Dreicer R, Klein EA. Long-term survival of patients with locally advanced prostate cancer managed with neoadjuvant docetaxel and radical prostatectomy. Urol Oncol 2015; 33:164.e19-23. [DOI: 10.1016/j.urolonc.2015.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/11/2014] [Accepted: 01/04/2015] [Indexed: 12/14/2022]
|
28
|
Gözen AS, Akin Y, Ates M, Hruza M, Rassweiler J. Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long-term follow-up. BJU Int 2015; 116:102-8. [DOI: 10.1111/bju.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ali S. Gözen
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Yigit Akin
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Mutlu Ates
- Department of Urology; Memorial Antalya Hospital; Antalya Turkey
| | - Marcel Hruza
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jens Rassweiler
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| |
Collapse
|
29
|
Evangelista L, Cimitan M, Zattoni F, Guttilla A, Zattoni F, Saladini G. Comparison between conventional imaging (abdominal-pelvic computed tomography and bone scan) and [(18)F]choline positron emission tomography/computed tomography imaging for the initial staging of patients with intermediate- tohigh-risk prostate cancer: A retrospective analysis. Scand J Urol 2015; 49:345-53. [PMID: 25649494 DOI: 10.3109/21681805.2015.1005665] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficiency of [(18)F]fluorocholine positron emission tomography/computed tomography (FCH PET/CT) in detecting lymph-node and bone involvement in comparison with conventional imaging, such as abdominal-pelvic CT and bone scan, in the initial staging of prostate cancer (PCa). MATERIALS AND METHODS The study retrospectively evaluated 48 patients who had FCH PET/CT for the initial staging of PCa. At the same time, 32 of the 48 patients had a bone scan and 26 of the 48 patients had abdominal-pelvic diagnostic CT. Diagnostic performance of FCH PET/CT, i.e. sensitivity, specificity and accuracy, was evaluated on a per-patient basis for the whole population and then separately on a per-risk classification, and later in comparison with conventional imaging. Histological specimens or follow-up data were used as the standard of reference. RESULTS The overall accuracy of FCH PET/CT for lymph-node involvement was 83.3%. The sensitivity of FCH was higher in the high-risk subset (83.3%) than in the intermediate-risk group (33.3%), whereas FCH specificity was similar. In comparison with dedicated CT scan, FCH PET/CT showed a higher sensitivity and a similar specificity (46.2% vs 69.2% and 92.3% vs 92.3%, respectively). Moreover, the sensitivity and specificity of PET/CT were higher than those of bone scan (100% vs 90% and 86.4% vs 77.2%, respectively). In contrast with conventional imaging, PET/CT changed the staging of the PCa in 33.3% patients. CONCLUSIONS The efficiency of FCH PET/CT in detecting both bone and lymph-node involvement of PCa at initial staging was found to be higher than that of conventional imaging. Prospective clinical trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Laura Evangelista
- a 1 Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS , Padua, Italy
| | - Marino Cimitan
- b 2 Nuclear Medicine Unit, National Cancer Institute CRO-IRCCS , Aviano (PN), Italy , and
| | - Fabio Zattoni
- c 3 Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua , Italy
| | - Andrea Guttilla
- c 3 Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua , Italy
| | - Filiberto Zattoni
- c 3 Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua , Italy
| | - Giorgio Saladini
- a 1 Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS , Padua, Italy
| |
Collapse
|
30
|
Guo Z, Si T, Yang X, Xu Y. Oncological outcomes of cryosurgery as primary treatment in T3 prostate cancer: experience of a single centre. BJU Int 2015; 116:79-84. [PMID: 25168692 DOI: 10.1111/bju.12914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the oncological outcomes and determine prognostic factors for overall survival (OS), cancer-specific survival (CSS), and biochemical progression-free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer. PATIENTS AND METHODS Between 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan-Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. RESULTS Clinical stage T3a (cT3a) was detected in 60% (45/75) of patients and cT3b detected in 40% (30/75). The 5-year OS, CSS, and BPFS rates were 85.3%, 92.0%, and 48%, respectively. There was a significant difference when comparing the pT3a with the pT3b group for 5-year OS (88.9% vs 80%, P = 0.02) and BPFS (55.6% vs 36.7%, P = 0.01), but there was no difference in CSS (93.3% vs 90%, P = 0.63). Stage, Gleason score, and nadir prostate-specific antigen (PSA) were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. CONCLUSIONS Cryosurgery can offer good 5-year OS, CSS, and BPFS rates for cT3 prostate cancer, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.
Collapse
Affiliation(s)
- Zhi Guo
- Department of Interventional Therapy, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China
| | - Tongguo Si
- Department of Interventional Therapy, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China
| | - Yan Xu
- Department of Interventional Therapy, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China
| |
Collapse
|
31
|
Stratification of High-risk Prostate Cancer into Prognostic Categories: A European Multi-institutional Study. Eur Urol 2015; 67:157-164. [DOI: 10.1016/j.eururo.2014.01.020] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/16/2014] [Indexed: 01/23/2023]
|
32
|
WITHDRAWN: Locally advanced and high risk prostate cancer: The best indication for initial radical prostatectomy? Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
33
|
Lightfoot AJ, Su YK, Sehgal SS, Lee Z, Greaves GH, Yu SJS, Llukani E, Su YC, Lee D. Positive Surgical Margin Trends In Patients With Pathologic T3 Prostate Cancer Treated With Robot Assisted Radical Prostatectomy. J Endourol 2014. [DOI: 10.1089/end.2014.0242.ecc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
34
|
Kang HW, Lee JY, Kwon JK, Jeh SU, Jung HD, Choi YD. Current status of radical prostatectomy for high-risk prostate cancer. Korean J Urol 2014; 55:629-35. [PMID: 25324944 PMCID: PMC4198760 DOI: 10.4111/kju.2014.55.10.629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/16/2014] [Indexed: 01/17/2023] Open
Abstract
Despite the wide application of prostate-specific antigen-based screening leading to a profound stage migration in prostate cancer (PC), a significant percentage of men are still being diagnosed with clinically high-risk disease that requires aggressive treatment. Optimal management in these patients remains challenging, and strong advocates for radical prostatectomy (RP), radiotherapy, androgen deprivation therapy, and, increasingly, a multimodal approach abound. Currently, surgery for high-risk PC is frequently applied. RP offers an attractive opportunity for tumor excision either as a definitive management or as a first step in multimodal therapy. Nevertheless, this approach is still controversial. In this review, we discuss the current evidence for the role of RP in this clinical setting, including surgical considerations and outcomes. The role of robot-assisted RP, which is increasingly utilized in Korea in this clinical scenario, is discussed.
Collapse
Affiliation(s)
- Ho Won Kang
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Uk Jeh
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Do Jung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. ; Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
35
|
van Poppel H. Locally advanced and high risk prostate cancer: The best indication for initial radical prostatectomy? Asian J Urol 2014; 1:40-45. [PMID: 29511636 PMCID: PMC5832883 DOI: 10.1016/j.ajur.2014.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/19/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
High risk prostate cancer is a deadly disease that needs aggressive treatment. High risk prostate cancer is often treated with androgen deprivation therapy or combined radiohormonotherapy while there is a place for surgery in cases of operable and resectable locally advanced or high risk disease. This review summarises the results of the different treatment strategies for locally advanced and high risk prostate cancer. Radical prostatectomy monotherapy or in combination with radiotherapy and/or hormonal treatment are analysed. They show that radical prostatectomy is an effective treatment modality for these tumours. After surgery, the results of the pathology and the follow-up of serum PSA may indicate the need of additional adjuvant or salvage treatment strategies.
Collapse
|
36
|
Faiena I, Singer EA, Pumill C, Kim IY. Cytoreductive prostatectomy: evidence in support of a new surgical paradigm (Review). Int J Oncol 2014; 45:2193-8. [PMID: 25340386 PMCID: PMC4215584 DOI: 10.3892/ijo.2014.2656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/13/2014] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) remains the second ranked cause of cancer deaths in the United States. The current standard of care for metastatic prostate cancer (mPCa) includes systemic therapies with no option for surgery. In contrast, in other malignancies such as breast and kidney cancer, cyto-reduction plays an integral role in the treatment of metastatic disease. In this framework, there are emerging data that suggest a potential oncologic benefit to cytoreduction in mPCa. The majority of the data are retrospective in nature suggesting that patients with mPCa who had prior radical prostatectomy (RP) had a better survival, as well as improved response to systemic therapy. Similarly, patients who presented with metastatic disease and received definitive local therapy (RP or radiation) had greater survival than patients who received no treatment. In order to confer maximum potential benefit, operating in the setting of mPCa must be technically feasible with acceptable morbidity. It has been demonstrated in many studies that operating on locally advanced disease (T3a/b) does have similar morbidity as lower stage cancer. This may be applicable in the metastatic setting, because although PCa may have metastasized, it may remain locally advanced. On the molecular level there are a number of explanations concerning the potential benefit of cytoreduction. However, these ideas remain speculative with no concrete evidence to date.
Collapse
Affiliation(s)
- Izak Faiena
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Chris Pumill
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| |
Collapse
|
37
|
Gandaglia G, Sun M, Trinh QD, Becker A, Schiffmann J, Hu JC, Briganti A, Montorsi F, Perrotte P, Karakiewicz PI, Abdollah F. Survival benefit of definitive therapy in patients with clinically advanced prostate cancer: estimations of the number needed to treat based on competing-risks analysis. BJU Int 2014; 114:E62-E69. [DOI: 10.1111/bju.12645] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Department of Urology; Urological Research Institute; Vita Salute San Raffaele University; San Raffaele Scientific Institute; Milan Italy
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
| | - Quoc-Dien Trinh
- Department of Surgery; Division of Urology; Brigham and Women's Hospital; Boston USA
- Dana-Farber Cancer Institute; Harvard Medical School; Boston USA
| | - Andreas Becker
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Martiniclinic; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Jonas Schiffmann
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Martiniclinic; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - Alberto Briganti
- Department of Urology; Urological Research Institute; Vita Salute San Raffaele University; San Raffaele Scientific Institute; Milan Italy
| | - Francesco Montorsi
- Department of Urology; Urological Research Institute; Vita Salute San Raffaele University; San Raffaele Scientific Institute; Milan Italy
| | - Paul Perrotte
- Department of Urology; University of Montreal Health Center; Montreal Canada
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Department of Urology; University of Montreal Health Center; Montreal Canada
| | - Firas Abdollah
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Canada
- Department of Urology; Urological Research Institute; Vita Salute San Raffaele University; San Raffaele Scientific Institute; Milan Italy
| |
Collapse
|
38
|
Castelli T, Russo GI, Favilla V, Urzi D, Spitaleri F, Reale G, Giardina R, Saita A, Madonia M, Cimino S, Morgia G. Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study. Int Braz J Urol 2014; 40:322-9. [PMID: 25010298 DOI: 10.1590/s1677-5538.ibju.2014.03.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/05/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT). MATHERIALS AND METHODS 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse. RESULTS After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p < 0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference. CONCLUSIONS Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up.
Collapse
Affiliation(s)
| | | | | | - Daniele Urzi
- Department of Urology, University of Catania, Catania, Italy
| | - Fabio Spitaleri
- Department of Urology, University of Catania, Catania, Italy
| | - Giulio Reale
- Department of Urology, University of Catania, Catania, Italy
| | | | - Alberto Saita
- Department of Urology, University of Catania, Catania, Italy
| | - Massimo Madonia
- Department of Urology, University of Sassari, Sassari, Italy
| | | | - Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
| |
Collapse
|
39
|
Abstract
Surgery remains a mainstay in the management of localized prostate cancer. This article addresses surgical aspects germane to the management of men with prostate cancer, including patient selection for surgery, nerve-sparing approaches, minimization of positive surgical margins, and indications for pelvic lymph node dissection. Outcomes for men with high-risk prostate cancer following surgery are reviewed, and the present role of neoadjuvant therapy before radical prostatectomy is discussed. In addition, there is a review of the published literature on surgical ablative therapies for prostate cancer.
Collapse
|
40
|
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]
|
41
|
Ward JF, DiBlasio CJ, Williams C, Given R, Jones JS. Cryoablation for locally advanced clinical stage T3 prostate cancer: a report from the Cryo-On-Line Database (COLD) Registry. BJU Int 2014; 113:714-8. [PMID: 24112776 DOI: 10.1111/bju.12476] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the oncological and functional outcomes of primary prostate cryoablation for men with clinical stage T3 (cT3) prostate cancer, as although radical prostatectomy (RP) or external beam radiotherapy (EBRT) are the standard treatments for locally advanced cT3 prostate cancer some patients opt for nonextirpative prostate cryoablation instead. PATIENTS AND METHODS The Cryo-On-Line Database (COLD) Registry was queried to identify patients with cT3 prostate cancer treated with whole-gland cryoablation (366 patients). We assessed biochemical disease-free survival (bDFS) using the Phoenix definition and determined reported rates of urinary incontinence and retention, sexual activity, and rectourethral fistulisation after treatment. Patients were subsequently assessed according to whether they were administered neoadjuvant androgen-deprivation therapy or not (ADT; 115 patients, 31.4%). RESULTS For the entire cohort, the 36- and 60-month bDFS rates were 65.3% and 51.9%, respectively. Patients who received neoadjuvant ADT had statistically nonsignificantly higher 36- and 60-month bDFS rates (68.0% and 55.4%, respectively) than patients who did not receive neoadjuvant ADT (55.3% and 36.9%, respectively). The after treatment urinary incontinence rate was 2.6%; urinary retention rate, 6.0%; sexual activity rate, 30.4%; and rectourethral fistulisation rate, 1.1%. CONCLUSIONS Cryoablation for patients with cT3 prostate cancer leads to less favourable bDFS than that after RP or RT for the same group of men. The after treatment rectourethral fistulisation rates for patients with cT3 disease are higher than in those with organ-confined prostate cancer treated with cryoablation; however, urinary dysfunction and sexual activity rates are similar for men with cT3 to those reported from this same registry in men with cT2 disease. The addition of neoadjuvant ADT (though not studied prospectively here) should be strongly considered if a patient with cT3 prostate cancer is to be treated with cryoablation.
Collapse
Affiliation(s)
- John F Ward
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | |
Collapse
|
42
|
Abern MR, Terris MK, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Freedland SJ. The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer. Cancer 2014; 120:1656-62. [PMID: 24647966 DOI: 10.1002/cncr.28647] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/07/2013] [Accepted: 12/11/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the prostate-specific antigen (PSA) screening era, approximately 15% of US men still present with clinically high-risk prostate cancer (PC). However, high-risk PC may be downgraded/downstaged at radical prostatectomy (RP), making additional therapy unnecessary. The authors tested the oncologic outcomes in men with clinically high-risk disease stratified on RP pathology. METHODS A total of 611 men with high-risk PC (PSA level > 20 ng/mL, biopsy Gleason sum [bGS] ≥ 8, or clinical classification of ≥ T3) underwent RP and pelvic lymphadenectomy between 1998 and 2011. Outcomes included biochemical disease recurrence (BCR), receipt of androgen deprivation therapy (ADT), metastases, and PC-specific and overall survival. RP pathology was classified as unfavorable (pathologic Gleason sum ≥ 8, pathologic classification of ≥ T3, or lymph node-positive disease), or favorable (no unfavorable features). Multivariable analyses tested oncologic outcomes stratified by pathologic classification. RESULTS Overall, 527 men had complete pathologic data and were included in the current analysis. Of the cohort, 206 of 527 men (39%) had favorable pathology. This finding was more common in men with only 1 clinical high-risk feature, and a lower body mass index, PSA level, bGS, and percentage positive biopsy cores. Favorable pathology was associated with decreased BCR (hazards ratio [HR], 0.34), metastases (HR, 0.17), and PC death (HR, 0.17). After a median follow-up of 82 months (range, 49 months-131 months), 193 of the 527 men (37%) received ADT, including only 35 of the 206 men with favorable pathology (17%). Unfavorable pathology was associated with early (≤ 5 years) but not late treatment with ADT. CONCLUSIONS In a large cohort of men with high-risk PC who were managed with RP, 39% had favorable pathology and superior oncologic outcomes.
Collapse
Affiliation(s)
- Michael R Abern
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | | | | | | | | | | | | |
Collapse
|
43
|
Morgan SC, Dearnaley DP. Additional therapy for high-risk prostate cancer treated with surgery: what is the evidence? Expert Rev Anticancer Ther 2014; 9:939-51. [DOI: 10.1586/era.09.60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
44
|
Abstract
PURPOSE OF REVIEW Surgery for high-risk prostate cancer (PCa) is applied frequently nowadays. Nevertheless, this approach is still surrounded by many controversies. The present review discusses the most recent literature regarding surgery for high-risk PCa. RECENT FINDINGS As there is no standard definition of high-risk PCa, outcome comparison between series and treatment approaches is hampered. Nevertheless, recent radical prostatectomy series have shown excellent cancer-specific survival in patients with high-risk PCa. Even for very-high-risk PCa (cT3b-T4 or any cT, N1), surgery may be applied to highly selected patients as a first step of a multimodality approach. Recent experience with robot-assisted surgery opens new possibilities for a minimally invasive approach in this field.Patient selection for surgery was also addressed in recent studies. Excellent cancer-specific survival is seen when specimen-confined PCa is found at final histopathology; a recently published nomogram enables the prediction of specimen-confined disease. Another issue in high-risk PCa is the impact of age and comorbidities on cancer-specific and overall mortality. In a recent study, it was shown that patients with low comorbidity scores, even when at least 70 years old, had a significant risk of dying from their cancer and may benefit most from a surgical approach. A modified extended pelvic lymphadenectomy template was presented, providing optimal removal of positive lymph nodes. SUMMARY Radical prostatectomy with extended pelvic lymphadenectomy delivers very good cancer-related outcomes in high-risk and very-high-risk PCa, often within a multimodal approach. Minimally invasive surgery and improved patient selection will be key to further improve oncological and functional outcomes.
Collapse
|
45
|
Rozet F, Audenet F, Sanchez-Salas R, Galiano M, Barret E, Cathelineau X. Accurate patient selection and multimodal treatment offer the best therapeutic option in high-risk prostate cancer. Expert Rev Anticancer Ther 2014; 13:811-8. [DOI: 10.1586/14737140.2013.811149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
46
|
Yamamoto S, Kawakami S, Yonese J, Fujii Y, Urakami S, Kitsukawa S, Masuda H, Ishikawa Y, Kozuka T, Oguchi M, Kohno A, Fukui I. Long-term oncological outcome in men with T3 prostate cancer: radical prostatectomy versus external-beam radiation therapy at a single institution. Int J Clin Oncol 2013; 19:1085-91. [DOI: 10.1007/s10147-013-0654-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
|
47
|
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.
Collapse
|
48
|
Vora AA, Marchalik D, Kowalczyk KJ, Nissim H, Bandi G, McGeagh KG, Lynch JH, Ghasemian SR, Verghese M, Venkatesan K, Borges P, Uchio EM, Hwang JJ. Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes. Prostate Int 2013; 1:31-6. [PMID: 24223399 PMCID: PMC3821519 DOI: 10.12954/pi.12001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/21/2013] [Indexed: 12/05/2022] Open
Abstract
Purpose: Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa. Methods: Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy. Results: From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%). Conclusions: Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons.
Collapse
Affiliation(s)
- Anup A Vora
- Department of Urology, Washington Hospital Center, Washington, DC, USA ; Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ischia J, Gleave M. Radical prostatectomy in high-risk prostate cancer. Int J Urol 2013; 20:290-300. [DOI: 10.1111/iju.12069] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph Ischia
- Vancouver Prostate Centre; Vancouver General Hospital; Vancouver; British Columbia; Canada
| | - Martin Gleave
- Vancouver Prostate Centre; Vancouver General Hospital; Vancouver; British Columbia; Canada
| |
Collapse
|
50
|
Ghadjar P, Thalmann GN. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU Int 2013; 110:E431-2; author reply E432. [PMID: 23106765 DOI: 10.1111/j.1464-410x.2012.11624.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|