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Borkowetz A, Kwe J, Boehm K, Baunacke M, Herout R, Lucke M, Burcea A, Thomas C. Follow-up of vascular-targeted photodynamic therapy in a real-world setting. World J Urol 2024; 42:55. [PMID: 38244089 PMCID: PMC10799770 DOI: 10.1007/s00345-023-04738-9] [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: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Vascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa). METHODS Patients with unilateral low- or intermediate-risk PCa undergoing hemiablation by VTP were evaluated in a real-world setting. Oncological outcome after VTP was measured by MRI-based re-biopsy at 12 and 24 months. Functional outcome after 1 year was investigated by IIEF-5 and IPSS questionnaires. Progression was defined as the evidence3 of ISUP ≥ 2 PCa. RESULTS At any control biopsy (n = 46) after VTP, only 37% of patients showed no evidence of PCa. Recurrence-free survival was 20 months (95% CI 4.9-45.5) and progression-free survival was 38.5 months (95% CI 33.5-43.6 months). In-field and out-field recurrent PCa occurs in 37% (55% ISUP ≥ 2 PCa) and 35% (56% ISUP ≥ 2 PCa). Seventy-nine percent of patients preserved erectile function, respectively. Ten percent of patients presented long-term bladder outlet obstruction. None of the patients presented incontinence. CONCLUSION Due to the high-recurrence in- and out-field recurrence rate in a mainly low-risk prostate cancer cohort, VTP has to be regarded critically as a therapy option in these patients. Pre-interventional diagnostic evaluation is the main issue before focal therapy to reduce the risk of tumor recurrence and progression.
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Affiliation(s)
- Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Working Group Focal and Micro Therapy, German Association of Urology, Berlin, Germany.
| | - Jeremy Kwe
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marius Lucke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Adriana Burcea
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Saouli A, Ruffion A, Dariane C, Barret E, Fiard G, Hankard GF, Créhange G, Roubaud G, Beauval JB, Brureau L, Renard-Penna R, Gauthé M, Baboudjian M, Ploussard G, Rouprêt M. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Cancers (Basel) 2023; 15:5485. [PMID: 38001745 PMCID: PMC10670522 DOI: 10.3390/cancers15225485] [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: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n = 3240, 84%). Other first-line treatments included HIFU (n = 338, 9%), electroporation (n = 59, 2%), proton beam therapy (n = 54, 1.5%), cryotherapy (n = 34, 1%), focal vascular targeted photodynamic therapy (n = 22, 0.6%), and transurethral ultrasound ablation (n = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.
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Affiliation(s)
- Amine Saouli
- Department of Urology, CHU Souss Massa, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir 80000, Morocco
| | - Alain Ruffion
- Service D’urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France;
- Équipe 2, Centre D’innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, 69002 Lyon, France
- Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.)
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, AP-HP, Paris University, U1151 Inserm-INEM, F-75015 Paris, France;
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France; (E.B.); (L.B.)
| | - Gaëlle Fiard
- Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.)
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38400 Grenoble, France
| | | | - Gilles Créhange
- Department of Radiotherapy, Institut Curie, 75005 Paris, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | | | - Laurent Brureau
- Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France; (E.B.); (L.B.)
| | | | - Mathieu Gauthé
- Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.)
| | - Michael Baboudjian
- Service D’urologie et de Transplantation Rénale, CHU La Conception, 13005 Marseille, France;
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hôpital, 31130 Quint-Fonsegrives, France;
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013 Paris, France;
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Kotamarti S, Polascik TJ. Focal cryotherapy for prostate cancer: a contemporary literature review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:26. [PMID: 36760265 PMCID: PMC9906190 DOI: 10.21037/atm-21-5033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Abstract
Objective To perform a comprehensive review of the contemporary literature regarding both functional and oncologic outcomes after primary focal cryotherapy for prostate cancer (PCa), providing these results as a foundation for discussing recent developments in the realm of focal therapy. Background Traditional treatments for PCa are often associated with debilitating functional side effects for patients. Due to advances in imaging and biopsy strategies, focal ablative therapies recently have garnered much interest and offer an alternative primary treatment for PCa patients with localized disease. Focal cryoablation utilizes heat extraction from tissues to generate an iceball and cause tissue destruction while sparing uninvolved prostatic regions. Optimized patient selection and postoperative management continue to be areas of interest and study as the field continues to develop. Methods A search was performed of the PubMed and Embase databases to identify articles pertaining to primary focal PCa cryoablation since our group's last comprehensive review in 2016. Conclusions Primary focal cryoablation for PCa offers optimized functional outcomes and a favorable adverse event profile. True evaluation of oncologic outcomes is hampered by lack of long-term follow-up and highly variable clinical endpoints across these studies. Nonetheless, outcomes appear adequate in the short- to medium-term time frame. Utilization of focal cryoablation is expected to grow with continued refinement of patient selection and management options in cases of treatment failure.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
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Mesci A, Gouran-Savadkoohi M, Ribeiro D, Dayes I, Lukka H, Schnarr K, Quan K, Goldberg M, Hallock A, Tsakiridis T. Salvage radiotherapy following HiFU: An institutional series and literature review. J Med Imaging Radiat Oncol 2022; 66:847-852. [PMID: 35170226 DOI: 10.1111/1754-9485.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Algorithms for the treatment of prostate cancer (PrCa) rely on risk grouping, and those who fall into low (LR) and favourable intermediate risk (FIR) categories have multiple options for treatment. High-intensity focused ultrasound (HiFU) is a local treatment modality that uses ultrasound waves to ablate prostate cancer. In case of treatment failure, optimal salvage modality after HiFU remains unclear. METHODS Here, we describe a retrospective review of our regional cancer database for men who underwent salvage radiotherapy after failure of HiFU treatment for prostate cancer. Oncologic and toxicity outcomes of the men identified in our database are discussed. RESULTS We identified 14 men in our regional database who received salvage radiotherapy (70-74 Gy with or without androgen deprivation therapy (ADT) after primary HiFU, in the period of 2009-2017. No cases of any grade 3 or higher toxicity were observed. In our cohort, 50% (7/14) of patients developed secondary biochemical failure at a median follow-up of 54 months post-radiotherapy, with a mean time to biochemical failure of 39 months. We compare our data to other available reports to date consisting mostly of small, non-randomized studies. Our biochemical control rates are noticeably lower compared with those reported by other studies but our length of follow-up is longer, compared with other studies. CONCLUSION The available data to date suggest that salvage radiotherapy after HiFU failure is well-tolerated albeit with only modest efficacy.
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Affiliation(s)
- Aruz Mesci
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| | | | - Derek Ribeiro
- Radiotherapy, Juravinski Cancer Centre, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Ian Dayes
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Himanshu Lukka
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Kara Schnarr
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Kimmen Quan
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mira Goldberg
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Abhirami Hallock
- Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
| | - Theodoros Tsakiridis
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Radiation Oncology, Walker Family Cancer Centre, Niagara Health System, St. Catherines, Ontario, Canada
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