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Kang W, Ye C, Yang Y, Lou YR, Zhao M, Wang Z, Gao Y. Identification of anoikis-related gene signatures and construction of the prognosis model in prostate cancer. Front Pharmacol 2024; 15:1383304. [PMID: 38957390 PMCID: PMC11217483 DOI: 10.3389/fphar.2024.1383304] [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: 02/07/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024] Open
Abstract
Background One of the primary reasons for tumor invasion and metastasis is anoikis resistance. Biochemical recurrence (BCR) of prostate cancer (PCa) serves as a harbinger of its distant metastasis. However, the role of anoikis in PCa biochemical recurrence has not been fully elucidated. Methods Differential expression analysis was used to identify anoikis-related genes based on the TCGA and GeneCards databases. Prognostic models were constructed utilizing LASSO regression, univariate and multivariate Cox regression analyses. Moreover, Gene Expression Omnibus datasets (GSE70770 and GSE46602) were applied as validation cohorts. Gene Ontology, KEGG and GSVA were utilized to explore biological pathways and molecular mechanisms. Further, immune profiles were assessed using CIBERSORT, ssGSEA, and TIDE, while anti-cancer drugs sensitivity was analyzed by GDSC database. In addition, gene expressions in the model were examined using online databases (Human Protein Atlas and Tumor Immune Single-Cell Hub). Results 113 differentially expressed anoikis-related genes were found. Four genes (EEF1A2, RET, FOSL1, PCA3) were selected for constructing a prognostic model. Using the findings from the Cox regression analysis, we grouped patients into groups of high and low risk. The high-risk group exhibited a poorer prognosis, with a maximum AUC of 0.897. Moreover, larger percentage of immune infiltration of memory B cells, CD8 Tcells, neutrophils, and M1 macrophages were observed in the high-risk group than those in the low-risk group, whereas the percentage of activated mast cells and dendritic cells in the high-risk group were lower. An increased TIDE score was founded in the high-risk group, suggesting reduced effectiveness of ICI therapy. Additionally, the IC50 results for chemotherapy drugs indicated that the low-risk group was more sensitive to most of the drugs. Finally, the genes EEF1A2, RET, and FOSL1 were expressed in PCa cases based on HPA website. The TISCH database suggested that these four ARGs might contribute to the tumor microenvironment of PCa. Conclusion We created a risk model utilizing four ARGs that effectively predicts the risk of BCR in PCa patients. This study lays the groundwork for risk stratification and predicting survival outcomes in PCa patients with BCR.
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Affiliation(s)
- Wanying Kang
- School of Pharmacy, Fudan University, Shanghai, China
- Life Science and Biopharmaceutical College, Shenyang Pharmaceutical University, Shenyang, China
| | - Chen Ye
- Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yunyun Yang
- Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yan-Ru Lou
- School of Pharmacy, Fudan University, Shanghai, China
| | - Mingyi Zhao
- Life Science and Biopharmaceutical College, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhuo Wang
- Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yuan Gao
- School of Pharmacy, Fudan University, Shanghai, China
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Latorzeff I, Le Guevelou J, Sargos P. Radiation therapy post radical prostatectomy: who, when and why? Curr Opin Support Palliat Care 2023; 17:47-54. [PMID: 36367534 DOI: 10.1097/spc.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW During decades, adjuvant radiotherapy (ART) has been the standard of care after surgery, based on four randomized clinical trials (RCTs). As early salvage radiotherapy (SRT) recently challenged the ART paradigm, the optimal timing to initiate radiotherapy remains a matter of debate. RECENT FINDINGS Three RCTs evaluated ART or SRT for postprostatectomy patients, with pathological risk factors (Gleason score > 8, pT3, positive margins). The ARTISTIC meta-analysis demonstrated similar 5-year biochemical recurrence-free survival for ART and SRT (89 vs. 88%). Lower rates of late genitourinary toxicity were demonstrated within the SRT arm, favouring early SRT in clinical practice.The addition of pelvic lymph node radiotherapy recently demonstrated an improvement in freedom from progression within the randomized RTOG 0534 trial, especially for patients with pretreatment prostate serum antigen (PSA) levels more than 0.35 ng/ml. The most appropriate androgen deprivation therapy duration remains a point of controversy. SUMMARY The SRT approach can be favoured for the vast majority of patients, provided close monitoring of PSA and early treatment in the event of biochemical recurrence. Radiotherapy dose and volumes and ADT use might be correlated to SRT timing (early vs. late). Results from trials including genomic tests and metabolic imaging will probably help to refine these criteria.
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Affiliation(s)
- Igor Latorzeff
- Department of Radiation Oncology, Clinique Pasteur, Toulouse, France
| | - Jennifer Le Guevelou
- Department of Radiation Oncology, Geneva University Hospital, and Faculty of Medicine, Geneva, Switzerland
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
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Muniyan S, Li B, Batra SK. Editorial: Metastatic Castration Resistant Prostate Cancer: Prognosis and Treatment. Front Oncol 2022; 12:913630. [PMID: 35646644 PMCID: PMC9136391 DOI: 10.3389/fonc.2022.913630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Benyi Li
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, United States
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Surinder K. Batra,
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Post-prostatectomy adjuvant androgen deprivation therapy- Current opinions and practices of Canadian urologists. Urol Oncol 2021; 40:57.e9-57.e14. [PMID: 34303596 DOI: 10.1016/j.urolonc.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the proven benefit of adjuvant androgen deprivation therapy (ADT) for patients receiving primary radiation, there are few studies evaluating adjuvant ADT after prostatectomy. In the absence of evidence, opinions and practice patterns vary. We surveyed Canadian prostate cancer surgeons about their use of adjuvant ADT and their opinions on the design of a potential adjuvant ADT trial. METHODS An electronic survey was devised and distributed using a modified Dillman approach. The survey was sent to 38 Canadian urologists that perform radical prostatectomy and representing all 17 major academic institutions in Canada and all 10 Canadian provinces. Reminders were sent three and four weeks following the original request. In addition to demographic information, we asked surgeons about their current use of postoperative adjuvant ADT and their opinion about the need for a clinical trial. To inform trial design, we asked respondents their opinions about which patients should be eligible, what duration of ADT was most appropriate, and which outcomes are clinically meaningful. The survey was sent in February 2020 and all responses were received by March 2020. RESULTS All 38 (100%) invited urologists completed the survey. Only 3 (7%) respondents currently offer postoperative adjuvant ADT as an option for patients without metastases. 35 (92%) urologists believed that a trial is needed before short-term adjuvant treatment should be offered to prevent recurrence. 15 (45%) urologists believed an adjuvant ADT trial was most appropriate for patients with an estimated PSA recurrence risk of >25% and 16 (42%) believed a recurrence risk of >50% was most appropriate. 25 (66%) respondents believed 12-month was the optimal duration of treatment with adjuvant ADT for a randomized trial. 37 (97%) respondents felt that prolonging the time to PSA recurrence and/or pelvic radiation was a clinically important outcome. The majority (20; 53%) of respondents would recommend 12 months of adjuvant ADT in their practice if a randomized trial showed a 50% relative risk reduction in PSA recurrence at 5-year postoperative. CONCLUSION The vast majority of Canadian prostate cancer surgeons do not offer adjuvant ADT following prostatectomy in patients without metastases. Based on the results from this survey, a randomized trial was considered warranted and feasible, and would influence patient care.
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Murgic J, Jaksic B, Prpic M, Kust D, Bahl A, Budanec M, Prgomet Secan A, Franco P, Kruljac I, Spajic B, Babic N, Kruslin B, Zovak M, Zubizarreta E, Rosenblatt E, Fröbe A. Comparison of hypofractionation and standard fractionation for post-prostatectomy salvage radiotherapy in patients with persistent PSA: single institution experience. Radiat Oncol 2021; 16:88. [PMID: 33980277 PMCID: PMC8115388 DOI: 10.1186/s13014-021-01808-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hypofractionated post-prostatectomy radiotherapy is emerging practice, however with no randomized evidence so far to support it's use. Additionally, patients with persistent PSA after prostatectomy may have aggressive disease and respond less well on standard salvage treatment. Herein we report outcomes for conventionally fractionated (CFR) and hypofractionated radiotherapy (HFR) in patients with persistent postprostatectomy PSA who received salvage radiotherapy to prostate bed. METHODS Single institution retrospective chart review was performed after Institutional Review Board approval. Between May 2012 and December 2016, 147 patients received salvage postprostatectomy radiotherapy. PSA failure-free and metastasis-free survival were calculated using Kaplan-Meier method. Cox regression analysis was performed to test association of fractionation regimen and other clinical factors with treatment outcomes. Early and late toxicity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. RESULTS Sixty-nine patients who had persistent PSA (≥ 0.1 ng/mL) after prostatectomy were identified. Median follow-up was 67 months (95% CI 58-106 months, range, 8-106 months). Thirty-six patients (52.2%) received CFR, 66 Gy in 33 fractions, 2 Gy per fraction, and 33 patients (47.8%) received HFR, 52.5 Gy in 20 fractions, 2.63 Gy per fraction. Forty-seven (68%) patients received androgen deprivation therapy (ADT). 5-year PSA failure- and metastasis-free survival rate was 56.9% and 76.9%, respectively. Thirty patients (43%) experienced biochemical failure after salvage radiotherapy and 16 patients (23%) experienced metastatic relapse. Nine patients (13%) developed metastatic castration-resistant disease and died of advanced prostate cancer. Median PSA failure-free survival was 72 months (95% CI; 41-72 months), while median metastasis-free survival was not reached. Patients in HFR group were more likely to experience shorter PSA failure-free survival when compared to CFR group (HR 2.2; 95% CI 1.0-4.6, p = 0.04). On univariate analysis, factors significantly associated with PSA failure-free survival were radiotherapy schedule (CFR vs HFR, HR 2.2, 95% CI 1.0-4.6, p = 0.04), first postoperative PSA (HR 1.02, 95% CI 1.0-1.04, p = 0.03), and concomitant ADT (HR 3.3, 95% CI 1.2-8.6, p = 0.02). On multivariate analysis, factors significantly associated with PSA failure-free survival were radiotherapy schedule (HR 3.04, 95% CI 1.37-6.74, p = 0.006) and concomitant ADT (HR 4.41, 95% CI 1.6-12.12, p = 0.004). On univariate analysis, factors significantly associated with metastasis-free survival were the first postoperative PSA (HR 1.07, 95% CI 1.03-1.12, p = 0.002), seminal vesicle involvement (HR 3.48, 95% CI 1.26-9.6,p = 0.02), extracapsular extension (HR 7.02, 95% CI 1.96-25.07, p = 0.003), and surgical margin status (HR 2.86, 95% CI 1.03-7.97, p = 0.04). The first postoperative PSA (HR 1.04, 95% CI 1.00-1.08, p = 0.02) and extracapsular extension (HR 4.24, 95% CI 1.08-16.55, p = 0.04) remained significantly associated with metastasis-free survival on multivariate analysis. Three patients in CFR arm (8%) experienced late genitourinary grade 3 toxicity. CONCLUSIONS In our experience, commonly used hypofractionated radiotherapy regimen was associated with lower biochemical control compared to standard fractionation in patients with persistent PSA receiving salvage radiotherapy. Reason for this might be lower biological dose in HFR compared to CFR group. However, this observation is limited due to baseline imbalances in ADT use, ADT duration and Grade Group distribution between two radiotherapy cohorts. In patients with persistent PSA post-prostatectomy, the first postoperative PSA is an independent risk factor for treatment failure. Additional studies are needed to corroborate our observations.
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Affiliation(s)
- Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Blanka Jaksic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Marin Prpic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000, Zagreb, Croatia
| | - Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS13NU, UK
| | - Mirjana Budanec
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Angela Prgomet Secan
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, 28100, Novara, Italy
- Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, 28100, Novara, Italy
| | - Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center Sestre Milosrdnice, University of Zagreb School of Medicine, Vinogradska 29, 10000, Zagreb, Croatia
| | - Borislav Spajic
- Department of Urology, University Hospital Center Sestre Milosrdnice, 10000, Zagreb, Croatia
| | - Nenad Babic
- Department of Radiology, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Bozo Kruslin
- Ljudevit Jurak Department of Pathology and Cytology, Sestre Milosrdnice University Hospital Centre, Vinogradska 29, 10000, Zagreb, Croatia
| | - Mario Zovak
- Department of Surgery, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency (IAEA), Wagramer Str. 5, 1220, Vienna, Austria
| | - Eduardo Rosenblatt
- Division of Human Health, International Atomic Energy Agency (IAEA), Wagramer Str. 5, 1220, Vienna, Austria
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Vinogradska 29, 10000, Zagreb, Croatia.
- School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000, Zagreb, Croatia.
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Jamaspishvili T, Patel PG, Niu Y, Vidotto T, Caven I, Livergant R, Fu W, Kawashima A, How N, Okello JB, Guedes LB, Ouellet V, Picanço C, Koti M, Reis RB, Saad F, Mes-Masson AM, Lotan TL, Squire JA, Peng YP, Siemens DR, Berman DM. Risk Stratification of Prostate Cancer Through Quantitative Assessment of PTEN Loss (qPTEN). J Natl Cancer Inst 2021; 112:1098-1104. [PMID: 32129857 DOI: 10.1093/jnci/djaa032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 12/25/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Phosphatase and tensin homolog (PTEN) loss has long been associated with adverse findings in early prostate cancer. Studies to date have yet to employ quantitative methods (qPTEN) for measuring of prognostically relevant amounts of PTEN loss in postsurgical settings and demonstrate its clinical application. METHODS PTEN protein levels were measured by immunohistochemistry in radical prostatectomy samples from training (n = 410) and validation (n = 272) cohorts. PTEN loss was quantified per cancer cell and per tissue microarray core. Thresholds for identifying clinically relevant PTEN loss were determined using log-rank statistics in the training cohort. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards) analyses on various subpopulations were performed to assess biochemical recurrence-free survival (BRFS) and were independently validated. All statistical tests were two-sided. RESULTS PTEN loss in more than 65% cancer cells was most clinically relevant and had statistically significant association with reduced BRFS in training (hazard ratio [HR] = 2.48, 95% confidence interval [CI] = 1.59 to 3.87; P < .001) and validation cohorts (HR = 4.22, 95% CI = 2.01 to 8.83; P < .001). The qPTEN scoring method identified patients who recurred within 5.4 years after surgery (P < .001). In men with favorable risk of biochemical recurrence (Cancer of the Prostate Risk Assessment - Postsurgical scores <5 and no adverse pathological features), qPTEN identified a subset of patients with shorter BRFS (HR = 5.52, 95% CI = 2.36 to 12.90; P < .001) who may be considered for intensified monitoring and/or adjuvant therapy. CONCLUSIONS Compared with previous qualitative approaches, qPTEN improves risk stratification of postradical prostatectomy patients and may be considered as a complementary tool to guide disease management after surgery.
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Affiliation(s)
- Tamara Jamaspishvili
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Palak G Patel
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Yi Niu
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,School of Mathematical Sciences, Dalian University of Technology, Dalian, Liaoning 116024, China
| | - Thiago Vidotto
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 2V7, Canada.,Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Isabelle Caven
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Rachel Livergant
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Winnie Fu
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Atsunari Kawashima
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.,Department of Urology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | - Nathan How
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - John B Okello
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Liana B Guedes
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Veronique Ouellet
- Institut du Cancer de Montréal and Centre de Recherche du Centre hospitalier de l, 'Université de Montréal, Montréal, Québec H2X 0A9, Canada
| | - Clarissa Picanço
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Madhuri Koti
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 2V7, Canada.,Urology, Queen's University, Kingston, ON K7L 2V7, Canada
| | - Rodolfo B Reis
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Fred Saad
- Institut du Cancer de Montréal and Centre de Recherche du Centre hospitalier de l, 'Université de Montréal, Montréal, Québec H2X 0A9, Canada.,Department of Surgery, Université de Montréal, Montréal, Québec H2X 0A9, Canada
| | - Anne-Marie Mes-Masson
- Institut du Cancer de Montréal and Centre de Recherche du Centre hospitalier de l, 'Université de Montréal, Montréal, Québec H2X 0A9, Canada.,Department of Medicine, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Jeremy A Squire
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Yingwei P Peng
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.,Mathematics and Statistics, Queen's University, Kingston, ON K7L 3N6, Canada
| | | | - David M Berman
- Division of Cancer Biology & Genetics, Queen's Cancer Research Institute, Kingston, ON K7L 3N6, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.,Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 2V7, Canada
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Liu CY, Chen YT, Su SH, Yu KJ, Chang YH, Lin PH, Shao IH, Kan HC, Chu YC, Huang LK, Chuang CK, Pang ST. Is immediate adjuvant radiotherapy necessary for men with positive surgical margin after robotic-assisted radical prostatectomy? FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Slevin F, Beasley M, Cross W, Scarsbrook A, Murray L, Henry A. Patterns of Lymph Node Failure in Patients With Recurrent Prostate Cancer Postradical Prostatectomy and Implications for Salvage Therapies. Adv Radiat Oncol 2020; 5:1126-1140. [PMID: 33305073 PMCID: PMC7718540 DOI: 10.1016/j.adro.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is increasing use of radical prostatectomy to treat patients with high-risk prostate cancer. This has contributed toward a pathologic stage migration, and a greater number of patients are subsequently being diagnosed with biochemical failure. There is increasing use of advanced imaging techniques in the setting of biochemical failure, including positron emission tomography-computed tomography (PET-CT). METHODS AND MATERIALS This critical literature review highlights the evidence for PET-CT in postprostatectomy biochemical failure and identifies sites of pelvic lymph node relapse in the setting of biochemical failure and the potential implications that the locations of these relapses may have for salvage therapies. Potential future directions are then considered. RESULTS The optimal PET-CT tracer remains uncertain but there is increasing use of prostate-specific membrane antigen PET-CT for investigating sites of nodal metastasis at low prostate-specific antigen levels, and this is leading to a blurring of the biochemical and radiologic recurrence phases. The optimal therapeutic approach remains undefined, with current trials investigating postoperative radiation therapy to the whole pelvis in addition to the prostatic fossa, the use of PET-CT in the setting of biochemical recurrence to guide delivery of salvage radiation therapy, and, for patients with node-only relapsed prostate cancer, the addition of whole pelvis radiation therapy to metastasis-directed therapies such as stereotactic ablative radiotherapy. CONCLUSIONS The most appropriate target volume for salvage radiation therapy remains uncertain, and the findings of studies using PET-CT to map nodal recurrences suggest that there could be a role for extending whole pelvis radiation therapy volumes to increase coverage of superior nodal regions. The emerging fields of radiomics and radiogenomics could provide important prognostic information and aid decision making for patients with relapsed prostate cancer.
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Affiliation(s)
- Finbar Slevin
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - Matthew Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew Scarsbrook
- University of Leeds, Leeds, United Kingdom
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Louise Murray
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
| | - Ann Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, United Kingdom
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9
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Spratt DE. The Finnish Randomized Trial of Adjuvant Radiotherapy Versus Observation After Prostatectomy: Almost a Trial of Adjuvant Versus Late Salvage Radiotherapy. Eur Urol 2019; 76:596-598. [PMID: 31378435 DOI: 10.1016/j.eururo.2019.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
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10
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Travel Distance as a Barrier to Receipt of Adjuvant Radiation Therapy After Radical Prostatectomy. Am J Clin Oncol 2019; 41:953-959. [PMID: 29045266 DOI: 10.1097/coc.0000000000000410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Following radical prostatectomy (RP), adjuvant radiation therapy (RT) decreases biochemical recurrence and potentially improves metastasis-free and overall survival for patients with high-risk pathologic features. Since adjuvant RT typically occurs daily over several weeks, the logistical challenges of extensive traveling may be a significant barrier to its use. We examined the association between distance to treatment facility and use of adjuvant RT. MATERIALS AND METHODS We identified 97,568 patients in the National Cancer Database diagnosed from 2004 through 2011 with cT1-4N0-xM0-x prostate cancer and found to have high-risk pathologic features (pT3-4 stage and/or positive surgical margins) at RP. Multivariable logistic regression adjusting for sociodemographic and clinicopathologic factors was used to examine the association between travel distance and receipt of adjuvant RT, defined as radiotherapy initiated within 12 months after RP. RESULTS Overall, 10.6% (10,346) of the study cohort received adjuvant RT. On multivariable analysis, increasing travel distance was significantly associated with decreased use of adjuvant RT, with adjusted odds ratios of 1.0 (reference), 0.67, 0.46, 0.39, and 0.32 (all P<0.001) and prevalence of use at 12.6%, 8.8%, 6.3%, 4.9%, and 3.7% for patients living ≤25.0, 25.1 to 50.0, 50.1 to 75.0, 75.1 to 100.0, and >100.0 miles away, respectively. CONCLUSIONS Increasing travel distance was strongly associated with decreased use of adjuvant RT in this national cohort of postprostatectomy patients with high-risk pathologic features. These results strongly suggest that the logistical challenges of extensive travel are a significant barrier to the use of adjuvant RT. Efforts aimed at improving access to radiotherapy and reducing treatment time are urgently needed.
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Afferi L, Baumeister P, Mordasini L, Mattei A, Moschini M. Editorial Comment to How does 68 Ga-prostate-specific membrane antigen positron emission tomography/computed tomography impact the management of patients with prostate cancer recurrence after surgery? Int J Urol 2019; 26:812. [PMID: 31087465 DOI: 10.1111/iju.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
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Spratt DE, McHugh DJ, Morris MJ, Morgans AK. Management of Biochemically Recurrent Prostate Cancer: Ensuring the Right Treatment of the Right Patient at the Right Time. Am Soc Clin Oncol Educ Book 2018; 38:355-362. [PMID: 30231323 DOI: 10.1200/edbk_200319] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Biochemically recurrent prostate cancer is an increasingly common disease state, with more than 25,000 cases occurring annually in the United States. Fortunately, progress continues to be made to more effectively identify metastatic disease, optimize existing therapies, and develop new technologies and therapeutic strategies for the timing and delivery of systemic treatments to improve outcomes. This review covers three topics related to the diagnosis and treatment of men with biochemical recurrence (BCR). First, we provide an update on the state of the rapidly evolving field of molecular imaging and its place in practice. Second, we describe validated clinicopathologic methods to risk stratify patients with biochemically recurrent disease, including new gene expression classifiers, to personalize postoperative radiotherapy (RT) timing. Last, we define our approach to optimal management with systemic therapy, including identifying the patients who may benefit most and balancing the duration and timing of treatment with consideration of the effect of therapy on quality of life (QOL) and medical complications associated with treatment.
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Affiliation(s)
- Daniel E Spratt
- From the University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deaglan J McHugh
- From the University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael J Morris
- From the University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alicia K Morgans
- From the University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Northwestern University Feinberg School of Medicine, Chicago, IL
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Adjuvant Radiation Therapy for High-Risk Post-prostatectomy Patients. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Grignon DJ. Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens. Mod Pathol 2018; 31:S96-109. [PMID: 29297497 DOI: 10.1038/modpathol.2017.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/19/2022]
Abstract
Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted.
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Affiliation(s)
- David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA
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