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Maimaitiyiming A, An H, Xing C, Li X, Li Z, Bai J, Luo C, Zhuo T, Huang X, Maimaiti A, Aikemu A, Wang Y. Machine learning-driven mast cell gene signatures for prognostic and therapeutic prediction in prostate cancer. Heliyon 2024; 10:e35157. [PMID: 39170129 PMCID: PMC11336432 DOI: 10.1016/j.heliyon.2024.e35157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background The role of Mast cells has not been thoroughly explored in the context of prostate cancer's (PCA) unpredictable prognosis and mixed immunotherapy outcomes. Our research aims to employs a comprehensive computational methodology to evaluate Mast cell marker gene signatures (MCMGS) derived from a global cohort of 1091 PCA patients. This approach is designed to identify a robust biomarker to assist in prognosis and predicting responses to immunotherapy. Methods This study initially identified mast cell-associated biomarkers from prostate adenocarcinoma (PRAD) patients across six international cohorts. We employed a variety of machine learning techniques, including Random Forest, Support Vector Machine (SVM), Lasso regression, and the Cox Proportional Hazards Model, to develop an effective MCMGS from candidate genes. Subsequently, an immunological assessment of MCMGS was conducted to provide new insights into the evaluation of immunotherapy responses and prognostic assessments. Additionally, we utilized Gene Set Enrichment Analysis (GSEA) and pathway analysis to explore the biological pathways and mechanisms associated with MCMGS. Results MCMGS incorporated 13 marker genes and was successful in segregating patients into distinct high- and low-risk categories. Prognostic efficacy was confirmed by survival analysis incorporating MCMGS scores, alongside clinical parameters such as age, T stage, and Gleason scores. High MCMGS scores were correlated with upregulated pathways in fatty acid metabolism and β-alanine metabolism, while low scores correlated with DNA repair mechanisms, homologous recombination, and cell cycle progression. Patients classified as low-risk displayed increased sensitivity to drugs, indicating the utility of MCMGS in forecasting responses to immune checkpoint inhibitors. Conclusion The combination of MCMGS with a robust machine learning methodology demonstrates considerable promise in guiding personalized risk stratification and informing therapeutic decisions for patients with PCA.
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Affiliation(s)
- Abudukeyoumu Maimaitiyiming
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hengqing An
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Xinjiang Clinical Research Center of Urogenital Diseases, Urumqi, China
| | - Chen Xing
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Xinjiang Clinical Research Center of Urogenital Diseases, Urumqi, China
| | - Xiaodong Li
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Xinjiang Clinical Research Center of Urogenital Diseases, Urumqi, China
| | - Zhao Li
- Department of Abdominal Ultrasonography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Junbo Bai
- Department of Pediatric Urology, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cheng Luo
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tao Zhuo
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xin Huang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aierpati Maimaiti
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | | | - Yujie Wang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
- Department of Urological, Urology Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Xinjiang Clinical Research Center of Urogenital Diseases, Urumqi, China
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Palumbo P, Martinese A, Antenucci MR, Granata V, Fusco R, De Muzio F, Brunese MC, Bicci E, Bruno A, Bruno F, Giovagnoni A, Gandolfo N, Miele V, Di Cesare E, Manetta R. Diffusion kurtosis imaging and standard diffusion imaging in the magnetic resonance imaging assessment of prostate cancer. Gland Surg 2023; 12:1806-1822. [PMID: 38229839 PMCID: PMC10788566 DOI: 10.21037/gs-23-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 11/09/2023] [Indexed: 01/18/2024]
Abstract
Background and Objective In recent years, magnetic resonance imaging (MRI) has shown excellent results in the study of the prostate gland. MRI has indeed shown to be advantageous in the prostate cancer (PCa) detection, as in guiding targeting biopsy, improving its diagnostic yield. Although current acquisition protocols provide for multiparametric acquisition, recent evidence has shown that biparametric protocols can be non-inferior in PCa detection. Diffusion-weighted imaging (DWI) sequence, in particular, plays a key role, particularly in the peripheral zone which accounts for the larger part of the prostate. High b-values are generally recommended, although with the possibility of obtaining non-Gaussian diffusion effects, which requires a more sophisticated model for the analysis, namely through the diffusion kurtosis imaging (DKI). Purpose of this narrative review was to analyze the current applications and clinical evidence regarding the use of DKI with a main focus on PCa detection, also in comparison with DWI. Methods This narrative review synthesized the findings of literature retrieved from main researches, narrative and systematic reviews, and meta-analyses obtained from PubMed. Key Content and Findings DKI analyses the non-Gaussian water diffusivity and describe the effect of signal intensity decay related to high b-value through two main metrics (Dapp and Kapp). Differently from DWI-apparent diffusion coefficient (DWI-ADC) which reflects only water restriction outside of cells, DKI metrics are supposed to represent also the direct interaction of water molecules with cell membranes and intracellular compounds. This review describes current evidence on ADC and DKI metrics in clinical imaging, and finally collect the results derived from the main articles focused on DWI and DKI models in detecting PCa. Conclusions DKI advantages, compared to conventional ADC analysis, still remain controversial. Wider application and greater technical knowledge of DKI, however, may help in proving its intrinsic validity in the field of oncology and therefore in the study of clinically significant PCa. Finally, a deep understanding of DKI is important for radiologists to better understand what Kapp and Dapp mean in the context of different cancer and how these metrics may vary specifically in PCa imaging.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L’Aquila, Italy
| | - Andrea Martinese
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Maria Rosaria Antenucci
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, Naples, Italy
| | | | - Federica De Muzio
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, Campobasso, Italy
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, Campobasso, Italy
| | - Eleonora Bicci
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Ancona, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Genoa, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, Abruzzo Health Unit 1, L’Aquila, Italy
- Prostate Unit, San Salvatore Hospital, Abruzzo Health Unit 1, L’Aquila, Italy
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3
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Francolini G, Carnevale MG, Di Cataldo V, Loi M, Detti B, Orsatti C, Caprara L, Bertini N, Lorenzetti V, Olmetto E, Becherini C, Visani L, Salvestrini V, Simontacchi G, Greto D, Bonomo P, Doro R, Masi L, Desideri I, Meattini I, Serni S, Livi L. Stereotactic reirradiation with Cyberknife R for locally recurrent prostate cancer, long-term toxicity and clinical outcomes from a monocentric cohort. LA RADIOLOGIA MEDICA 2023; 128:1580-1588. [PMID: 37728816 DOI: 10.1007/s11547-023-01721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Up to 47% of patients with localized prostate cancer (PCa) treated with radiotherapy (EBRT) eventually develop local recurrence. To date, no clear consensus exists on optimal management. A growing body of interest supports the use of stereotaxic re-irradiation (rSBRT), with promising oncological outcomes and low toxicity profile. We collected a single-center case series of locally recurrent PCa who underwent re-irradiation after a previous course of postoperative or definitive radiotherapy. METHODS AND MATERIALS Data from 101 patients treated at our institution for locally recurrent PCa from June 2012 to June 2021 were retrospectively collected. Patients underwent rSBRT with CyberKnife system (Accuray Inc., Sunnyvale, CA, USA), delivered to intraprostatic or macroscopic recurrences within the prostate bed, for a total dose of 30 Gy in 5 fractions. RESULTS All patients received prior EBRT. The median EQD2 total dose was 75.0 Gy (range, 60-80 Gy). Thirty-two (32%) patients were receiving androgen deprivation therapy (ADT) after prior biochemical recurrence. After a median follow-up of 57.8 months, BR occurred in 55 patients (54.5%), with a median BR-free survival (BRFS) of 40.4 months (95% C.I. 34.3-58.3). Thirty-two patients (31.7%) developed metastatic disease, with a median metastasis-free survival (MFS) not reached. PSA ≥ 2.5 ng/ml and ADT were associated with worst BRFS (26.06 vs. 39.3 months, p = 0.03 and 22.7 vs. 27 months, p = 0.01, respectively). Castration-resistant status and ADT were found to be predictive of worst MFS (34.1 vs. 50.5 months, p = 0.02 and 33.5 vs. 53.1 months, p = 0.002, respectively). Concomitant ADT was confirmed as an independent factor for MFS (HR 4.8, 95% CI 1.5-10.6, p = 0.007). No grade > /2 adverse were recorded. CONCLUSIONS After almost 5 years of follow-up, with a median BRFS of 40.4 months and no grade ≥ 2 AEs, CyberknifeR rSBRT proved effective and safe in a cohort of 101 patients affected by locally recurrent PCa.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Mauro Loi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carolina Orsatti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Luisa Caprara
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Victoria Lorenzetti
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Daniela Greto
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50100, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
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4
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Francolini G, Garlatti P, Di Cataldo V, Triggiani L, Simoni N, Detti B, Lorenzetti V, Colombo F, Morelli V, Ganovelli M, Caprara L, Orsatti C, Burchini L, Frosini G, Bertini N, Loi M, Simontacchi G, Greto D, Desideri I, Meattini I, Livi L. Pattern of recurrence after stereotactic body radiotherapy for para-aortic oligo-recurrent prostate cancer, a multicentric analysis. LA RADIOLOGIA MEDICA 2023; 128:1423-1428. [PMID: 37597125 DOI: 10.1007/s11547-023-01701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND M1a disease represents an intermediate status between loco-regional relapse and bone metastatic disease. Metastasis directed therapy (MDT), through stereotactic body RT (SBRT) may be offered to patients, aiming to exclusively treat sites of macroscopic relapse and avoiding wide prophylactic treatment volumes. This appears as a viable treatment, especially after the rise of PSMA tailored treatment approaches. MATERIALS AND METHODS Data about patients treated in two different institutions were retrieved from a prospectively collected dataset. All included patients were affected by oligo-recurrent M1a disease after definitive RT or radical prostatectomy, defined as ≤ 3 nodal lesions situated above aortic bifurcation and below renal arteries. Both castration resistant PCa (CRPC) and castration sensitive (CSPC) PCa patients were included. All imaging methods were allowed to detect recurrence (CT scan, Choline or PSMA PET/CT).All sites of recurrences were treated with SBRT. RESULTS Median PFS was 10 months (95% CI 8-17). Twelve patients died, with a median OS of 114 months (95% CI 85-114). Out of the 83 recurrences, 2 (2.4%), 11 (13.25%), 36 (43.37%) and 15 (18%) patients had respectively prostate bed only, pelvic nodal, para-aortic or distant relapse. Furthermore, 19 (22.9%) patients experienced a biochemical only relapse with negative imaging at re-staging. DISCUSSION MDT conferred a remarkable PFS outcome in a mixed cohort of CSPC and CRPC patients with m1a disease, with an optimal safety profile. Prospective trials are needed in order to compare MDT and ENRT for these patients, allowing to select the best treatment option.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Pietro Garlatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Nicola Simoni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126, Parma, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Victoria Lorenzetti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Federico Colombo
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126, Parma, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Michele Ganovelli
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Luisa Caprara
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carolina Orsatti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giulio Frosini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Three Months' PSA and Toxicity from a Prospective Trial Investigating STereotactic sAlvage Radiotherapy for Macroscopic Prostate Bed Recurrence after Prostatectomy-STARR (NCT05455736). Cancers (Basel) 2023; 15:cancers15030992. [PMID: 36765948 PMCID: PMC9913280 DOI: 10.3390/cancers15030992] [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: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Biochemical recurrences after radical prostatectomy (RP) can be managed with curative purpose through salvage radiation therapy (SRT). RT dose escalation, such as stereotactic RT (SSRT), may improve relapse-free survival in this setting. STARR trial (NCT05455736) is a prospective multicenter study including patients affected by macroscopic recurrence within the prostate bed after RP treated with SSRT. Recurrence was detected with a Choline or PSMA CT-PET. In the current analysis, the early biochemical response (BR) rate and toxicity profile after three months of follow-up were assessed. Twenty-five patients were enrolled, and data about BR and toxicity at three months after treatment were available for 19 cases. Overall, BR was detected after three months in 58% of cases. Four G1-G2 adverse events were recorded; no G ≥ 3 adverse events were detected. SSRT appears feasible and safe, with more than half of patients experiencing BR and an encouraging toxicity profile. The STARR trial is one of the few prospective studies aimed at implementing this promising treatment strategy in this scenario.
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Chen JJ, Weg E, Liao JJ. Prostate and metastasis-directed focal therapy in prostate cancer: hype or hope? Expert Rev Anticancer Ther 2023; 23:163-176. [PMID: 36718727 DOI: 10.1080/14737140.2023.2171991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The paradigm of focal therapy's role in metastatic patients is being challenged by evolving attitudes and emerging data. At the current time, specifically regarding prostate cancer, does the evidence indicate this is more hype or hope? AREAS COVERED We searched the literature via PubMed, MEDLINE, and Embase for studies from 2014 to the present addressing focal therapy with non-palliative intent in metastatic prostate cancer patients, emphasizing prospective trials when available. We sought to address all common clinical scenarios: de novo synchronous diagnosis, oligorecurrence, oligoprogression, and mCRPC disease. EXPERT OPINION Current evidence is strongest, and in our opinion practice-changing, for prostate-directed RT in de novo metastatic patients with low metastatic burden. Metastasis-directed therapy with SBRT is consistently shown to have low rates of toxicity, and promising rates of ADT-free survival and progression-free survival. These can be utilized on a patient-by-patient basis with these endpoints in mind, but do not yet show sufficient benefit to be standard of care. This is a rich area of ongoing research, and many trials should publish in the coming years to shed light on many unanswered questions, including the role of cytoreductive prostatectomy, systemic therapy combined with MDT, and the integration of modern PET imaging.
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Affiliation(s)
- Jonathan J Chen
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Emily Weg
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
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7
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Detti B, Carnevale MG, Lucidi S, Burchini L, Caini S, Orsatti C, Bertini N, Roghi M, di Cataldo V, Fondelli S, Ingrosso G, Francolini G, Scartoni D, Sardaro A, Pisani A, Scoccianti S, Aristei C, Livi L. Choline PET/CT in recurrent prostate cancer. Front Oncol 2023; 13:1079808. [PMID: 37025599 PMCID: PMC10070677 DOI: 10.3389/fonc.2023.1079808] [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: 10/25/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose Biochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patients Patients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes. Results Data from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyzed. One hundred seventy-six (42.9%) patients had a negative choline PET/CT, and 234 (57.1%) patients resulted positive. In the multivariate analysis, only chemotherapy and PSA at recurrence were significant independent prognostic factors on overall survival (OS). In the PET-positive subgroup, the number of relapses, PSA post-prostatectomy, and chemotherapy impacted on OS. PSA (post-surgery and at recurrence) affected progression-free survival (PFS) in the univariate analysis. In the multivariate analysis, GS, the number of relapse sites, and PSA (post-surgery and at recurrence) were significant prognostic factors for disease-free survival (DFS). Conclusion Choline PET/CT provides better accuracy than conventional imaging for the assessment of nmPCa with BR after prostatectomy, thereby enabling salvage strategies and improving quality of life.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Sara Lucidi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Luca Burchini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Saverio Caini
- Institute for Cancer Research, Prevention and Clinical Network - Istituto per lo Studio e la Prevenzione Oncologia (ISPRO), Florence, Italy
| | - Carolina Orsatti
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
| | - Manuele Roghi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- *Correspondence: Manuele Roghi,
| | - Vanessa di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simona Fondelli
- Struttura Organizzativa Complessa (SOC) Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze, Azienda Unità Sanitaria Locale (USL) Toscana Centro, Florence, Italy
| | - Gianluca Ingrosso
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniele Scartoni
- Proton Therapy Center-Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | | | - Silvia Scoccianti
- Struttura Organizzativa Complessa (SOC) Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze, Azienda Unità Sanitaria Locale (USL) Toscana Centro, Florence, Italy
| | - Cynthia Aristei
- Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
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