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Shee K, de la Calle CM, Chang AJ, Wong AC, Feng FY, Gottschalk AR, Carroll PR, Nguyen HG. Addition of Enzalutamide to Leuprolide and Definitive Radiotherapy is Tolerable and Effective in High-Risk Localized or Regional Non-Metastatic Prostate Cancer: Results from a Phase II Trial. Adv Radiat Oncol 2022; 7:100941. [PMID: 35847550 PMCID: PMC9280039 DOI: 10.1016/j.adro.2022.100941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background Enzalutamide is an antiandrogen used to treat both metastatic and nonmetastatic prostate cancer. Here we present results from a phase 2 trial designed to determine the safety, tolerability, and efficacy of adding enzalutamide to standard androgen deprivation therapy with radiation therapy in high-risk localized or regional, nonmetastatic patients with prostate cancer. Methods and Materials Enrollment criteria included at least 2 of the following: stage cT3a/b, prostate specific antigen (PSA) ≥20 ng/mL, Gleason grade 8 to 10, ≥33% core involvement on biopsy, or pelvic lymph node involvement on computed tomography or magnetic resonance imaging. Patients with metastatic disease were excluded. All patients received 24 months of leuprolide and enzalutamide, and 5 weeks of intensity modulated radiation therapy followed by a brachytherapy boost. Adverse events (AE), PSA, testosterone, and basic laboratory tests were then followed for up to 36 months. Primary outcomes were safety and tolerability and PSA complete response rate (PSA-CR, defined as PSA ≤0.3). Secondary outcomes included time to biochemical recurrence (BCR; nadir + 2 ng/mL). Results Sixteen patients were enrolled; 2 were ineligible and 3 withdrew before starting treatment. Median age at enrollment was 69.0 years (interquartile range [IQR] 11.5). Median treatment duration was 24.0 months (IQR 11.9). Median follow-up time was 35.5 months (IQR 11.2), and 9 of 11 (81.8%) patients completed the 36 months of follow-up. One of 11 (9%) patients had grade 4 AE (seizure), and no grade 5 AE were reported. Four of 11 (36.4%) patients had grade 3 AE, such as erectile dysfunction and hot flashes. All patients achieved PSA-CR, and median time to PSA-CR was 4.2 months (IQR 1.4). At 24 months follow-up, 0 of 11 (0%) patients had a biochemical recurrence. At 36 months, 1 of 9 (11.1%) patient had a biochemical recurrence. Of note, this patient did not complete the full 24 months of enzalutamide and leuprolide due to AEs. Conclusions Enzalutamide in combination with standard androgen deprivation therapy and radiation therapy was well-tolerated and effective warranting further study in a randomized controlled trial.
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2
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Koontz BF, Hoffman KE, Halabi S, Healy P, Anand M, George DJ, Harrison MR, Zhang T, Berry WR, Corn PG, Lee WR, Armstrong AJ. Combination of Radiation Therapy and Short-Term Androgen Blockade With Abiraterone Acetate Plus Prednisone for Men With High- and Intermediate-Risk Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 109:1271-1278. [PMID: 33259932 DOI: 10.1016/j.ijrobp.2020.11.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/21/2020] [Accepted: 11/22/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Long-term androgen-deprivation therapy (ADT) is the standard of care in combination with radiation therapy (RT) in high-risk prostate cancer (PC), despite substantial toxicity from the resulting hypogonadism. We hypothesized that a combination of more potent but shorter-term androgen inhibition in men with intermediate- or high-risk localized PC would synergize with definitive RT to provide short-term testosterone recovery and improve disease control. METHODS AND MATERIALS This prospective phase 2 single-arm trial enrolled men with low-volume unfavorable intermediate or high-risk localized PC. Treatment included 6 months of ADT concurrent with abiraterone acetate plus prednisone (AAP) once daily and RT to prostate and seminal vesicles. The primary endpoint was the proportion of men with an undetectable prostate-specific antigen (PSA) at 12-months; secondary objectives included biochemical progression-free survival (PFS), testosterone recovery, toxicity, and sexual and hormonal quality of life. RESULTS We enrolled 37 men between January 2014 and August 2016, 45% of whom were high risk. All patients had T1-2 disease and PSA < 20 ng/mL. Median follow-up is 37 months (95% confidence interval [CI], 35.7-39.1). Treatment noted 32% grade 3 toxicities related to AAP, predominantly hypertension, with no toxicities ≥G4. The rate of undetectable PSA at 12 months was 55% (95% CI, 36%-72%). With 46 months of median follow-up, 2 of 37 patients developed PSA progression (36-month PFS = 96%; 95% CI, 76%-99%), and 81% of patients recovered testosterone with a median time to recovery of 9.2 months. Hormonal or sexual function declined at 6 months with subsequent improvement by 24 months. CONCLUSIONS The combination of RT and 6 months of ADT and AAP demonstrated acceptable toxicity and a high rate of testosterone recovery with restoration of quality of life and excellent disease control in men with low-volume, intermediate- or high-risk localized prostate cancer. Prospective comparative studies are justified.
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Affiliation(s)
- Bridget F Koontz
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Radiation Oncology, Duke University, Durham, North Carolina.
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Susan Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Patrick Healy
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Monika Anand
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina; Department of Surgery, Division of Urology, Duke University, Durham, North Carolina
| | - Michael R Harrison
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina
| | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina
| | - William R Berry
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina
| | - Paul G Corn
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - W Robert Lee
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina; Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina; Department of Surgery, Division of Urology, Duke University, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
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Wondergem M, van der Zant FM, Broos WAM, Roeleveld TA, Donker R, Ten Oever D, Geenen RWF, Knol RJJ. 18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy. Eur J Nucl Med Mol Imaging 2020; 48:521-531. [PMID: 32719916 DOI: 10.1007/s00259-020-04782-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) PET/CT shows better diagnostic performance for detection of lymph node and bone metastases as compared to conventional imaging. Studies of PSMA PET/CT in primary staging comprise highly selected patient cohorts. This study evaluates 18F-DCFPyL PET/CT as first-line imaging modality for primary staging of high-risk prostate cancer. MATERIAL From February 2018 until April 2019, all patients with high-risk prostate cancer received 18F-DCFPyL PET/CT for staging of prostate cancer. Baseline characteristics, findings at 18F-DCFPyL PET/CT, number and type of required additional diagnostic procedures, findings at additional diagnostic procedures, and effects of therapy on PSA levels for all patients treated with curative intent were collected and evaluated. RESULTS One hundred-sixty patients were included in the study of which 90 (56%) had evidence of metastasized disease (N1, M1a, M1b and, M1c in 49%, 28%, 31%, and 3% respectively). Additional diagnostic imaging was needed in 2/160 patients (1%) because of equivocal findings on 18F-DCFPyL PET/CT. Eighty-one patients had evidence of PSMA-positive lymph node metastases, of whom 39 (48%) had no enlarged lymph nodes on CT; 18F-DCFPyL PET detected additional metastatic lymph nodes in 41/42 patients that had evidence of lymph node metastases on CT. 18F-DCFPyL PET altered patients' management in 17% of patients. CONCLUSION 18F-DCFPyL PET/CT can be used as first-line imaging modality for therapy selection in patients with primary high-risk prostate cancer, without need for further diagnostic imaging procedures in the majority of patients.
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Affiliation(s)
- M Wondergem
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - F M van der Zant
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - W A M Broos
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - T A Roeleveld
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R Donker
- Department of Radiation Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - D Ten Oever
- Department of Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R W F Geenen
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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4
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Hallemeier CL, Zhang P, Pisansky TM, Hanks GE, McGowan DG, Roach M, Zeitzer KL, Firat SY, Husain SM, D'Souza DP, Souhami L, Parliament MB, Rosenthal SA, Lukka HR, Rotman M, Horwitz EM, Miles EF, Paulus R, Sandler HM. Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2019; 104:1057-1065. [PMID: 30959123 DOI: 10.1016/j.ijrobp.2019.03.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE To validate whether prostate-specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external beam radiation therapy (RT) with concurrent short-term androgen suppression (AS) in patients with prostate cancer. METHODS AND MATERIALS This study included 2404 patients. The patients were treated with neoAS before RT and concurrent AS (without post-RT AS) and were pooled from NRG Oncology/RTOG trials 9202, 9408, 9413, and 9910. Multivariable models were used to test associations between the prespecified dichotomized post-neoAS, pre-RT PSA level (≤0.1 vs >0.1 ng/mL) groupings, and clinical outcomes. RESULTS The median follow-up for surviving patients was 9.4 years. The median post-neoAS, pre-RT PSA level was 0.3 ng/mL, with 32% of patients having levels ≤0.1 ng/mL. Race, Gleason score, tumor stage, node stage, pretreatment PSA level, and duration of neoAS were associated with the groups of patients with PSA levels ≤0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA level >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR], 2.04; P < .0001); local failure (HR, 2.51; P < .0001); distant metastases (HR, 1.73; P = .0006); cause-specific mortality (HR, 2.36; P < .0001); and all-cause mortality (HR, 1.24; P = .005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA level >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR, 2.00; P < .0001); local failure (HR, 2.33; P < .0001); and cause-specific mortality (HR, 1.75; P = .03). CONCLUSIONS Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. The role of post-neoAS, pre-RT PSA level relative to PSA levels obtained along the continuum of medical care is not presently defined but could be tested in future clinical trials.
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Affiliation(s)
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | - Mack Roach
- University of California, San Francisco, San Francisco, California
| | | | - Selim Y Firat
- Medical College of Wisconsin-Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Luis Souhami
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Himanshu R Lukka
- McMaster University, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Edward F Miles
- Naval Medical Center Accruals Dartmouth Hitchcock Medical Center, Portsmouth, Virginia
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Lazar AA, Schulte R, Faddegon B, Blakely EA, Roach M. Clinical trials involving carbon-ion radiation therapy and the path forward. Cancer 2018; 124:4467-4476. [PMID: 30307603 DOI: 10.1002/cncr.31662] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/22/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
To describe the international landscape of clinical trials in carbon-ion radiotherapy (CIRT), the authors reviewed the current status of 63 ongoing clinical trials (median, 47 participants) involving CIRT identified from the US clinicaltrials.gov trial registry and the World Health Organization International Clinical Trials Platform Registry. The objectives were to evaluate the potential for these trials to define the role of this modality in the treatment of specific cancer types and identify the major challenges and opportunities to advance this technology. A significant body of literature suggested the potential for advantageous dose distributions and, in preclinical biologic studies, the enhanced effectiveness for CIRT compared with photons and protons. In addition, clinical evidence from phase I/II trials, although limited, indicated the potential for CIRT to improve cancer outcomes. However, current high-level phase III randomized clinical trial evidence does not exist. Although there has been an increase in the number of trials investigating CIRT since 2010, and the number of countries and sites offering CIRT is slowly growing, this progress has excluded other countries. Several recommendations are proposed to study this modality to accelerate progress in the field, including: 1) increasing the number of multinational randomized clinical trials, 2) leveraging the existing CIRT facilities to launch larger multinational trials directed at common cancers combined with high-level quality assurance; and 3) developing more compact and less expensive next-generation treatment systems integrated with radiobiologic research and preclinical testing.
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Affiliation(s)
- Ann A Lazar
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco (UCSF), San Francisco, California.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, California
| | - Reinhard Schulte
- Department of Radiation Oncology, UCSF, San Francisco, California.,Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, California
| | - Bruce Faddegon
- Department of Radiation Oncology, UCSF, San Francisco, California
| | - Eleanor A Blakely
- Division of Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Mack Roach
- Department of Radiation Oncology, UCSF, San Francisco, California
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6
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Bryant AK, D'Amico AV, Nguyen PL, Einck JP, Kane CJ, McKay RR, Simpson DR, Mundt AJ, Murphy JD, Rose BS. Three-month posttreatment prostate-specific antigen level as a biomarker of treatment response in patients with intermediate-risk or high-risk prostate cancer treated with androgen deprivation therapy and radiotherapy. Cancer 2018; 124:2939-2947. [PMID: 29727915 DOI: 10.1002/cncr.31400] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/31/2018] [Accepted: 03/25/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) measurement after definitive radiotherapy (RT) and androgen deprivation therapy for localized prostate cancer has been proposed as an early prognostic biomarker. In the current study, the authors investigated the association between 3-month post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS). METHODS A total of 5783 patients with intermediate-risk or high-risk localized prostate cancer who were diagnosed between 2000 and 2015 and treated with RT and androgen deprivation therapy were identified from Veterans Affairs data. Patients were divided into groups based on 3-month post-RT PSA values: <0.10 ng/mL, 0.10 to 0.49 ng/mL, and ≥0.50 ng/mL. The effect of the 3-month PSA group on bPFS, PCSS, and OS was evaluated in multivariable Cox models adjusting for potential confounders. RESULTS There were 2651 patients with intermediate-risk and 3132 with high-risk disease; approximately 11% had a 3-month PSA level of ≥0.50 ng/mL. A higher 3-month PSA level was found to be strongly associated with each outcome; compared with patients in the group with a 3-month PSA value <0.10 ng/mL, the authors noted greater hazards for the patients with a 3-month PSA value ≥0.50 ng/mL (hazard ratio for bPFS: 5.23; PCSS: 3.97; and OS: 1.50 [P<.001 for all]) and the patients with a 3-month PSA value of 0.10 to 0.49 ng/mL (hazard ratio for bPFS: 2.41 [P<.001]; PCSS: 2.29 [P<.001]; and OS: 1.21 [P = .003]). When analyzed separately, the 3-month PSA level was found to be predictive of OS in the high-risk group (P<.001) but not the intermediate-risk group (P = .21). CONCLUSIONS The 3-month post-RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate-risk and high-risk prostate cancer, particularly those with high-risk disease. The 3-month PSA measurement may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials. Cancer 2018;124:2939-47. © 2018 American Cancer Society.
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Affiliation(s)
- Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - Christopher J Kane
- Department of Urology, University of California at San Diego, San Diego, California
| | - Rana R McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California at San Diego, San Diego, California
| | - Daniel R Simpson
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
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7
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Geara FB, Bulbul M, Khauli RB, Andraos TY, Abboud M, Al Mousa A, Sarhan N, Salem A, Ghatasheh H, Alnsour A, Ayoub Z, Gheida IA, Charafeddine M, Shahait M, Shamseddine A, Gheida RA, Khader J. Nadir PSA is a strong predictor of treatment outcome in intermediate and high risk localized prostate cancer patients treated by definitive external beam radiotherapy and androgen deprivation. Radiat Oncol 2017; 12:149. [PMID: 28882187 PMCID: PMC5590195 DOI: 10.1186/s13014-017-0884-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study is to investigate the effect of tumor characteristics and parameters of treatment response in predicting biochemical disease-free survival (BFS) for patients with intermediate or high risk prostate cancer treated by combined definitive external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). Methods Between June 1995 and January 2015, 375 patients with localized prostate cancer and a National Comprehensive Cancer Network (NCCN) intermediate or high risk categories were treated by definitive EBRT and ADT. Median duration of androgen blockade was 10 months (range: 3–36 months); Median radiation dose was 72 Gy (Range: 70–78 Gy). Median follow-up time was 5.8 years (range: 0.8–16.39 years). The main study endpoint was biochemical disease free survival (BFS). Results Forty seven patients (12.5%) developed biochemical recurrence (BCR) during the observation period. Monovariate analysis identified baseline PSA (bPSA) (p = 0.024), T-stage (p = 0.001), Gleason’s score (GS) (p = 0.042), radiation dose (p = 0.045), PSA pre-radiation therapy (p = 0.048), and nadir PSA (nPSA), (p < 0.001) as significant variables affecting BCR. The receiver operating characteristic (ROC) curve identified a nPSA of 0.06 ng/ml as optimal cut-off value significantly predicting the patients’ risk of BCR (p < 0.001). Multivariate cox regression analysis revealed T-stage, GS, and nPSA as independent variable affecting BFS, while bPSA, age, and radiation dose were not. Conclusion Nadir PSA at 0.06 is a strong independent predictor of BFS in patients with intermediate or high risk prostate cancer treated by definitive EBRT and ADT.
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Affiliation(s)
- Fady B Geara
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon.
| | - Muhammad Bulbul
- Division of Urology, the American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja B Khauli
- Division of Urology, the American University of Beirut Medical Center, Beirut, Lebanon
| | - Therese Y Andraos
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Mirna Abboud
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Abdelatif Al Mousa
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nasim Sarhan
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Salem
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hamza Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anoud Alnsour
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Zeina Ayoub
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Ibrahim Abu Gheida
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Maya Charafeddine
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Mohammed Shahait
- Department of Radiation Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Bliss Street, Riad El Solh, Beirut, 11072030, Lebanon
| | - Ali Shamseddine
- Division of Medical Oncology, The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Abu Gheida
- Division of Urology, the American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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8
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Moderate hypofractionated radiotherapy with volumetric modulated arc therapy and simultaneous integrated boost for pelvic irradiation in prostate cancer. J Cancer Res Clin Oncol 2017; 143:1301-1309. [DOI: 10.1007/s00432-017-2375-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
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9
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Narang AK, Trieu J, Radwan N, Ram A, Robertson SP, He P, Gergis C, Griffith E, Singh H, DeWeese TA, Honig S, Annadanam A, Greco S, DeVille C, McNutt T, DeWeese TL, Song DY, Tran PT. End-of-radiation PSA as a novel prognostic factor in patients undergoing definitive radiation and androgen deprivation therapy for prostate cancer. Prostate Cancer Prostatic Dis 2017; 20:203-209. [PMID: 28094250 PMCID: PMC5429233 DOI: 10.1038/pcan.2016.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/09/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
Background In men undergoing definitive radiation for prostate cancer, it is unclear whether early biochemical response can provide additional prognostic value beyond pre-treatment risk stratification. Methods Prostate cancer patients consecutively treated with definitive radiation at our institution by a single provider from 1993–2006 and who had an EOR PSA (n=688, median follow-up 11.2 years). We analyzed the association of an end-of-radiation (EOR) prostate-specific antigen (PSA) level, obtained during the last week of radiation, with survival outcomes. Multivariable-adjusted cox proportional hazards models were constructed to assess associations between a detectable EOR PSA (defined as ≥0.1 ng ml−1) and biochemical failure-free survival (BFFS), metastasis-free survival (MFS), prostate cancer-specific survival (PCSS), and overall survival (OS). Kaplan-Meier survival curves were constructed, with stratification by EOR PSA. Results At the end of radiation, the PSA level was undetectable in 30% of patients. Men with a detectable EOR PSA experienced inferior 10-year BFFS (49.7% vs. 64.4%, p<0.001), 10-year MFS (84.8% vs. 92.0%, p=0.003), 10-year PCSS (94.3% vs. 98.2%, p=0.007), and 10-year OS (75.8% vs. 82.5%, p=0.01), as compared to men with an undetectable EOR PSA. Among NCCN intermediate- and high-risk men who were treated with definitive radiation and androgen deprivation therapy (ADT), a detectable EOR PSA was more strongly associated with PCSS than initial NCCN risk level (EOR PSA: HR 5.89, 95% CI 2.37–14.65, p<0.001; NCCN risk level: HR 2.01, 95% CI 0.74–5.42, p=0.168). Main study limitations are retrospective study design and associated biases. Conclusions EOR PSA was significantly associated with survival endpoints in men who received treated with definitive radiation and ADT. Whether the EOR PSA can be used to modulate treatment intensity merits further investigation.
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Affiliation(s)
- A K Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Trieu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Ram
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S P Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P He
- Department of Biostatistics, Stanford University School of Medicine, Stanford, CA, USA
| | - C Gergis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Griffith
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Singh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T A DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Honig
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Annadanam
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Greco
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C DeVille
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Posttreatment Prostate-Specific Antigen 6 Months After Radiation With Androgen Deprivation Therapy Predicts for Distant Metastasis–Free Survival and Prostate Cancer–Specific Mortality. Int J Radiat Oncol Biol Phys 2016; 96:617-23. [DOI: 10.1016/j.ijrobp.2016.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/16/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022]
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11
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Zilli T, Dal Pra A, Kountouri M, Miralbell R. Prognostic value of biochemical response to neoadjuvant androgen deprivation before external beam radiotherapy for prostate cancer: A systematic review of the literature. Cancer Treat Rev 2016; 46:35-41. [DOI: 10.1016/j.ctrv.2016.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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12
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Bellefqih S, Hadadi K, Mezouri I, Maghous A, Marnouche E, Andaloussi K, Elmarjany M, Sifat H, Mansouri H, Benjaafar N. Association de radiothérapie et d’hormonothérapie dans la prise en charge des cancers localisés de la prostate : où en est-on ? Cancer Radiother 2016; 20:141-50. [DOI: 10.1016/j.canrad.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
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13
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Franca CADS, Vieira SL, Carvalho ACP, Bernabe AJS, Penna ABRC. Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherap. Radiol Bras 2015; 47:89-93. [PMID: 25741055 PMCID: PMC4337165 DOI: 10.1590/s0100-39842014000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/22/2013] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the relationship between two year PSA nadir (PSAn) after brachytherapy
and biochemical recurrence rates in prostate cancer patients. Materials and Methods In the period from January 1998 to August 2007, 120 patients were treated with
iodine-125 brachytherapy alone. The results analysis was based on the definition
of biochemical recurrence according to the Phoenix Consensus. Results Biochemical control was observed in 86 patients (71.7%), and biochemical
recurrence, in 34 (28.3%). Mean PSAn was 0.53 ng/ml. The mean follow-up was 98
months. The patients were divided into two groups: group 1, with two year PSAn
< 0.5 ng/ml after brachytherapy (74 patients; 61.7%), and group 2, with two
year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%). Group 1
presented biochemical recurrence in 15 patients (20.3%), and group 2, in 19
patients (43.2%) (p < 0.02). The analysis of biochemical
disease-free survival at seven years, stratified by the two groups, showed values
of 80% and 64% (p < 0.02), respectively. Conclusion Levels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly
correlated with a poor prognosis. This fact may help to identify patients at risk
for disease recurrence.
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Affiliation(s)
- Carlos Antônio da Silva Franca
- Master, MD, Radiation Oncology at Instituto Brasileiro de Oncologia (IBO), Radioterapia Botafogo, Universidade Federal do Rio de Janeiro (UFRJ) and Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Sérgio Lannes Vieira
- Full Professor, MD, Radiation Oncology at Instituto Brasileiro de Oncologia (IBO), Radioterapia Botafogo and Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | | | | | - Antonio Belmiro Rodrigues Campbell Penna
- PhD, MD, Radiation Oncology at Instituto Brasileiro de Oncologia (IBO), Radioterapia Botafogo and Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
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14
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High-risk Prostate Cancer Treated With Dose-escalated RT: An Analysis of Hormonal Therapy Use and Duration, and Prognostic Implications of PSA Nadir ≤0.2 to Select Men for Short-term Hormonal Therapy. Am J Clin Oncol 2014; 40:348-352. [PMID: 25436827 DOI: 10.1097/coc.0000000000000161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine prognostic factors to select high-risk men receiving dose-escalated radiation therapy (RT) who will have favorable outcomes with short-term (ST) or no androgen deprivation therapy (ADT). METHODS Medical records of 458 men treated with definitive RT for high-risk, nonmetastatic prostate cancer at 3 academic referral centers from 1988 to 2009 were examined. Median dose was 76.4 Gy. Men received no ADT (n=105), STADT (<12 mo, n=194), or long-term ADT (LTADT: ≥12 mo, n=160). Univariate and multivariable analysis for freedom from distant metastases (FFDM) and cause-specific survival (CSS) were performed. Median follow-up was 71 months. RESULTS Seven-year FFDM was 83% and CSS was 91%. Multivariable analysis demonstrated that prostate-specific antigen (PSA) nadir ≤0.2 (HR=0.36; 95% CI, 0.20-0.64) and Gleason score (GS) were associated with FFDM and CSS (all P<0.05). ADT duration was not associated (P>0.05). Those with PSA nadir ≤0.2 ng/mL had improved outcomes. Men with GS 9 disease did poorly despite a PSA nadir ≤0.2 ng/mL and had improved CSS with LTADT (95% vs. 71%, P<0.05). CONCLUSIONS Select men with high-risk disease treated with dose-escalated RT may not require LTADT. In men treated with ADT, PSA nadir ≤0.2 is an independent prognostic factor associated with FFDM and CSS. Men without GS 9 may have acceptable outcomes with STADT if PSA nadir is ≤0.2 ng/mL. Further investigation is necessary to elucidate the role of PSA nadir in determining the optimal length of adjuvant ADT.
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15
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Hamstra DA, Bae K, Hanks G, Hu C, Shipley WU, Pan CC, Roach M, Lawton CA, Sandler HM. Impact of biochemical failure classification on clinical outcome: a secondary analysis of Radiation Therapy Oncology Group 9202 and 9413. Cancer 2014; 121:844-52. [PMID: 25410885 DOI: 10.1002/cncr.29146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Biochemical failure (BF) after radiation therapy is defined on the basis of a rising prostate-specific antigen (PSA) level (A1 failure) or any event that prompts the initiation of salvage androgen-deprivation therapy without PSA failure (A2). It was hypothesized that A2 failure may have a different prognosis. METHODS Data for 2799 eligible patients from Radiation Therapy Oncology Group (RTOG) 9202 and RTOG 9413 were analyzed. BF was defined according to the 1997 American Society for Therapeutic Radiology and Oncology consensus definition as A1 for PSA failure or as A2 for the start of salvage hormone therapy before 3 consecutive PSA rises. RESULTS Rates of all-cause mortality (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-2.0; P < .0001) and distant metastasis (DM; HR, 1.6; 95% CI, 1.3-2.0; P < .0001) were greater with A2 failure. The 5-year overall survival (OS) rates were 88.2% and 74.6% for A1 and A2, respectively (P < .0001), and the DM rates were 15.7% and 29.0%, respectively (P < .0001). The DM rate was greater at 5 years for A2 patients with DM as the first sign of failure versus patients with other A2 failures (87.3% vs 11.7%, P < .001), and this also correlated with worse OS at 5 years: 81.1% for A2 failure without DM and 52.8% with DM (P < .001). After the removal of patients with DM, the difference between A1 and A2 BF persisted for OS (P = .002) but not for DM (P = .16) CONCLUSIONS: These results suggest that patients with rising PSA levels alone have less risk than those with A2 failures; although DM was the largest contributor of adverse risk to A2 failure, it did not account for all excess risk in A2 failure.
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Affiliation(s)
- Daniel A Hamstra
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
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16
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Roach M. Current trends for the use of androgen deprivation therapy in conjunction with radiotherapy for patients with unfavorable intermediate-risk, high-risk, localized, and locally advanced prostate cancer. Cancer 2014; 120:1620-9. [PMID: 24591080 DOI: 10.1002/cncr.28594] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/06/2022]
Abstract
Androgen deprivation therapy (ADT) is now a well-established standard of care in combination with definitive radiotherapy for patients with unfavorable intermediate-risk to high-risk locally advanced prostate cancer. It is also well established that combination modality treatment with ADT and radiotherapy is superior to either of these modalities alone for the treatment of patients with high-risk locally advanced disease. Current treatment guidelines for prostate cancer in the United States are based on the estimated risk of recurrence and death. This review examines the clinical evidence underpinning the use of ADT and radiotherapy among patients with high-risk localized and locally advanced disease in the United States. This review also considers the rationale for moving from traditional luteinizing hormone-releasing hormone agonists to more recently developed gonadotrophin-releasing hormone antagonists.
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Affiliation(s)
- Mack Roach
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, California; Department of Urology, University of California at San Francisco, San Francisco, California
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