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Lim Joon D, Berry C, Harris B, Tacey M, Smith D, Lawrentschuk N, Schneider ME, Fraser O, Hall M, Chao M, Foroudi F, Jenkins T, Angus D, Wada M, Sengupta S, Khoo V. A clinical study comparing polymer and gold fiducials for prostate cancer radiotherapy. Front Oncol 2023; 12:1023288. [PMID: 36818674 PMCID: PMC9930895 DOI: 10.3389/fonc.2022.1023288] [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: 08/19/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Image guidance with gold fiducials improves outcomes of prostate radiotherapy. However, gold produces artefact on CT imaging, interfering with contouring and verification. The purpose of this study was to compare polymer to standard gold fiducials using radiotherapy imaging modalities to assess the visibility and artefact. Methods Twenty eight patients with locally advanced prostate cancer were enrolled, half had three polymer fiducials implanted into the prostate and half underwent insertion of gold fiducials. Patients were imaged with CT, T2 weighted MRI, cone-beam CT (CBCT) and planar KV images. Fiducials were scored for visibility and assessed for CT artefact in surrounding prostate tissue. The artefact was quantified from Hounsfield number histograms and separated into percentile ranges and proportion of voxels in HU normal tissue range of a 2cm sphere surrounding the fiducial. Results Gold and polymer fiducials were sufficiently visible for CT and CBCT verification. The gold fiducials could be visualized well on KV planar imaging; however, the polymer markers were obscured by pelvic bones. Neither polymer nor gold fiducials could be visualized on MRI. The polymer fiducial produced less artefact than gold on CT, having less voxel spread for the HU percentile ranges and a greater proportion of voxels in the normal tissue range. Conclusions Polymer fiducials are a more suitable fiducial than gold for CT/CBCT in prostate cancer radiotherapy, demonstrating minimal artefact and good visibility on CT. However, they were not well seen on MRI or KV imaging and thus not suitable for co-registration or planar KV verification.
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Affiliation(s)
- Daryl Lim Joon
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia,*Correspondence: Daryl Lim Joon,
| | - Colleen Berry
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Benjamin Harris
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Mark Tacey
- Office of Research, The Northern Hospital, Epping, VIC, Australia,Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - Drew Smith
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | | | | | - Olivia Fraser
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Megan Hall
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Michael Chao
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Farshad Foroudi
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Trish Jenkins
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - David Angus
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Morikatsu Wada
- Radiation Oncology Department, Olivia Newton-John Cancer Centre, Heidelberg, VIC, Australia
| | - Shomik Sengupta
- Austin Health, University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Daryl Lim Joon,
| | - Vincent Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, London, United Kingdom,*Correspondence: Daryl Lim Joon,
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Tan WC, Kanesvaran R. Current standards and practice changing studies in genitourinary (GU) cancers-a review of studies in localized/early GU cancers. ESMO Open 2022; 7:100432. [PMID: 35272133 PMCID: PMC8961274 DOI: 10.1016/j.esmoop.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
Optimizing treatment of genitourinary cancers in the early-stage setting continues to remain an area of need, given that the development of distant metastases is often the life-limiting factor in the natural history of these cancers. The use of perioperative therapies in the treatment of these cancers deemed to be at high risk of recurrence has shown considerable benefits in outcomes in recent studies. In this article, we review the recently published studies in early-stage genitourinary cancers (renal cell, urothelial and prostate carcinomas), and their impact on disease outcomes and treatment practices. The results of subgroup analysis from some of these trials, with Asian patients enrolled, give assurance of the clinical efficacy and safety of these therapies in early-stage urological malignancies in the Asian setting. Optimizing treatment of genitourinary cancers in the early-stage setting remains an area of need. Development of distant metastases is often the life-limiting factor in the natural history of these cancers. Recent studies of perioperative systemic therapy have shown considerable benefits in outcomes. Subgroup analyses of trials assure of the efficacy and safety of these therapies in the Asian setting.
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Affiliation(s)
- W C Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - R Kanesvaran
- National Cancer Centre Singapore, Singapore, Singapore.
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3
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George DJ, Dearnaley DP. Relugolix, an oral gonadotropin-releasing hormone antagonist for the treatment of prostate cancer. Future Oncol 2021; 17:4431-4446. [PMID: 34409852 DOI: 10.2217/fon-2021-0575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Androgen deprivation therapy using gonadotropin-releasing hormone (GnRH) analogues is standard treatment for intermediate and advanced prostate cancer. GnRH agonist therapy results in an initial testosterone flare, and increased metabolic and cardiovascular risks. The GnRH antagonist relugolix is able to reduce serum testosterone levels in men with prostate cancer without inducing testosterone flare. In the HERO Phase III trial, relugolix was superior to leuprolide acetate at rapidly reducing testosterone and continuously suppressing testosterone, with faster post-treatment recovery of testosterone levels. Relugolix was associated with a 54% lower incidence of major adverse cardiovascular events than leuprolide acetate. As the first oral GnRH antagonist approved for the treatment of advanced prostate cancer, relugolix offers a new treatment option.
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Affiliation(s)
- Daniel J George
- Department of Medicine & Surgery, Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - David P Dearnaley
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
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Sandhu S, Moore CM, Chiong E, Beltran H, Bristow RG, Williams SG. Prostate cancer. Lancet 2021; 398:1075-1090. [PMID: 34370973 DOI: 10.1016/s0140-6736(21)00950-8] [Citation(s) in RCA: 239] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
The management of prostate cancer continues to evolve rapidly, with substantial advances being made in understanding the genomic landscape and biology underpinning both primary and metastatic prostate cancer. Similarly, the emergence of more sensitive imaging methods has improved diagnostic and staging accuracy and refined surveillance strategies. These advances have introduced personalised therapeutics to clinical practice, with treatments targeting genomic alterations in DNA repair pathways now clinically validated. An important shift in the therapeutic framework for metastatic disease has taken place, with metastatic-directed therapies being evaluated for oligometastatic disease, aggressive management of the primary lesion shown to benefit patients with low-volume metastatic disease, and with several novel androgen pathway inhibitors significantly improving survival when used as a first-line therapy for metastatic disease. Research into the molecular characterisation of localised, recurrent, and progressive disease will undoubtedly have an impact on clinical management. Similarly, emerging research into novel therapeutics, such as targeted radioisotopes and immunotherapy, holds much promise for improving the lives of patients with prostate cancer.
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Affiliation(s)
- Shahneen Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Edmund Chiong
- Department of Urology and Department of Surgery, National University of Singapore, Singapore
| | | | - Robert G Bristow
- Manchester Cancer Research Centre and University of Manchester, Manchester, UK
| | - Scott G Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
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5
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Fukunaga A, Maejima A, Shinoda Y, Matsui Y, Komiyama M, Fujimoto H, Miyagi Maeshima A. Prognostic implication of staging of seminal vesicle invasion in patients with prostatic adenocarcinoma after prostatectomy. Int J Urol 2021; 28:1039-1045. [PMID: 34291506 DOI: 10.1111/iju.14643] [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: 02/07/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether the extent of seminal vesicle invasion of prostatic adenocarcinoma can stratify the risk of biochemical recurrence after radical prostatectomy. METHODS We carried out radical prostatectomy for 1309 patients with prostatic adenocarcinoma between 2006 and 2019; 135 (10.3%) patients had seminal vesicle invasion. After excluding patients with neo-/adjuvant therapy, we reviewed 105 patients. We analyzed the correlation of the extent of seminal vesicle invasion and biochemical recurrence-free survival after prostatectomy and adjusted by various clinicopathological factors in multivariate analyses. Seminal vesicle invasion was stratified into three groups; the proximal part from the base was defined as level 1, followed by level 2 and the distal part as level 3. RESULTS Among the 105 patients, 30 (29%), 54 (51%) and 21 patients (20%) had seminal vesicle invasion at levels 1, 2 and 3, respectively. Median times to biochemical recurrence were 110, 67 and 12 months in patients with levels 1, 2 and 3, respectively (P = 0.002). The extent of seminal vesicle invasion was the independent risk factor for biochemical recurrence in univariate (level 3 vs 1, P = 0.001; level 3 vs 2, P = 0.015) and multivariate analyses (level 3 vs 1, P = 0.025; level 3 vs 2, P = 0.030). CONCLUSIONS The extent of seminal vesicle invasion might be a significant predictor of biochemical recurrence in prostate cancer patients undergoing radical prostatectomy.
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Affiliation(s)
- Arinobu Fukunaga
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Aiko Maejima
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuo Shinoda
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Matsui
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Motokiyo Komiyama
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Fujimoto
- Departments of, Department of, Urology, National Cancer Center Hospital, Tokyo, Japan
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Nayak AL, Flaman AS, Mallick R, Lavallée LT, Fergusson DA, Cagiannos I, Morash C, Breau RH. Do androgen-directed therapies improve outcomes in prostate cancer patients undergoing radical prostatectomy? A systematic review and meta-analysis. Can Urol Assoc J 2021; 15:269-279. [PMID: 33443481 DOI: 10.5489/cuaj.7041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Approximately 50% of patients with non-metastatic prostate cancer are treated with radical prostatectomy (RP). While some men will be cured with surgery alone, a substantial proportion will experience cancer recurrence. Androgen-directed therapy (ADT) is an effective adjuvant therapy for patients treated with prostate radiation. Comparatively, the efficacy of ADT in surgical patients has not been well-studied. METHODS A systematic search of MEDLINE, Embase, and the Cochrane Library from inception to July 2020 was performed. Randomized trials comparing ADT with RP vs. prostatectomy alone in patients with clinically localized prostate cancer were included. Neoadjuvant ADT and adjuvant ADT interventions were assessed separately. The primary outcomes were cancer recurrence-free survival (RFS) and overall survival (OS). Pathological outcomes following neoadjuvant ADT were also evaluated. RESULTS Fifteen randomized trials met eligibility criteria; 11 evaluated neoadjuvant ADT (n=2322) and four evaluated adjuvant ADT (n=5205). Neoadjuvant ADT (three months of treatment) did not improve RFS (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.74-1.11) or OS (HR 1.22, 95% CI 0.62-2.41). Neoadjuvant ADT significantly decreased the risk of positive surgical margins (relative risk [RR] 0.48, 95% CI 0.41-0.56) and extraprostatic tumor extension (RR 0.75, 95% CI 0.64-0.89). Adjuvant ADT improved RFS (HR 0.65, 95% CI 0.45-0.93) but did not improve OS (HR 1.02, 95% CI 0.84-1.24). CONCLUSIONS Neoadjuvant ADT causes a pathological downstaging of prostate tumors but has not been found to delay cancer recurrence nor extend survival. Few studies have evaluated adjuvant ADT. Trials are needed to determine the benefits and harms of intermediate- or long-term adjuvant ADT for RP patients.
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Affiliation(s)
- Ameeta L Nayak
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Ranjeeta Mallick
- Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Luke T Lavallée
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dean A Fergusson
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rodney H Breau
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review. Support Care Cancer 2020; 28:2079-2093. [PMID: 31912360 DOI: 10.1007/s00520-019-05255-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Androgen deprivation therapy (ADT) has broad application in the treatment of prostate cancer (PC) and is associated with numerous, debilitating adverse effects. Increasing use of ADT for PC, longer timeframe for treatment (increased uptake of PSA testing and earlier diagnosis), as well as improved survival and an ageing population, means patients can live for a considerable period of time on or after ADT, experiencing these adverse effects. A number of systematic reviews of adverse effects of ADT for PC exist; however, no single systematic review has previously examined the evidence for all adverse effects, including newer forms of ADT. METHODS A systematic review of existing systematic reviews of ADT for PC was conducted (2010-February 2019), as per Cochrane guidelines, to identify the highest level of risk/incidence evidence available, supplemented by evidence drawn from individual studies where no systematic review existed. RESULTS Incidence data was generated for 19 adverse effect subgroups, classified according to the common terminology criteria for adverse events (CTCAE). CONCLUSION Incidence of adverse effects provides valuable information for future burden of disease studies. This information can better guide clinical management to reduce symptoms for patients and assist patients to make more informed decisions about their treatment, potentially improving disease outcomes. It also highlights the importance of supportive care for PC patients receiving ADT and their carers. For analysts conducting economic evaluations, the inclusion of adverse effects in PC decision analytic models can provide more comprehensive and accurate information for decision makers.
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Pan J, Chi C, Qian H, Zhu Y, Shao X, Sha J, Xu F, Wang Y, Karnes RJ, Dong B, Xue W. Neoadjuvant chemohormonal therapy combined with radical prostatectomy and extended PLND for very high risk locally advanced prostate cancer: A retrospective comparative study. Urol Oncol 2019; 37:991-998. [PMID: 31466813 DOI: 10.1016/j.urolonc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Docetaxel has been shown to be an effective chemotherapy agent when combined with androgen deprivation therapy for hormone sensitive metastatic prostate cancer (CaP). Since very high risk CaP has a high rate of occult metastatic disease and early recurrence, we hypothesize that patients with very high risk locally advanced CaP may benefit from docetaxel-based neoadjuvant chemohormonal therapy (NCHT). Thus, we conducted a retrospective study to identify the outcome of these patients treated with NCHT followed by radical prostatectomy (RP). PATIENTS AND METHODS We retrospectively analyzed data from 177 consecutive patients who had very high risk locally advanced CaP between March 2014 and July 2017. Patients received 3 different therapies: (i) 60 men in NCHT group, (ii) 73 men in neoadjuvant hormonal therapy (NHT) group, and (iii) 44 men received immediate RP without neoadjuvant therapy (No-NT group). Surgical outcomes were analyzed and survival differences were compared by the Kaplan-Meier method. RESULTS The NCHT group had statistically significant higher preoperative Prostate-Specific Antigen (PSA) (P < 0.002), higher Gleason score (P < 0.002), and more advanced clinical stage (P < 0.001) than other groups. After RP, 81% (42/52) of patients in NCHT group, 73% (51/70) of patients in NHT group, and 48% (21/44) of patients in No-NT group achieved an undetectable PSA (P < 0.001). A total of 14% (6/42) patients achieving a postoperative undetectable PSA experienced biochemical recurrence in the NCHT group, with median biochemical progression-free survival (bPFS) time of 19 months; 47% (24/51) experienced biochemical recurrence in the NHT group, with median bPFS time of 13 months; 81% (17/21) experienced biochemical recurrence in the No-NT group, with median bPFS time of 9 months (P < 0.001). The median follow-up time of 3 groups was 12.5 months in the NCHT group, 18.3 months in the NHT group, and 22.8 months in the No-NT group (P = 0.01). CONCLUSION Despite having poorer prognostic factors, the NCHT group had better bPFS time after surgery compared to NHT and No-NT groups. Randomized controlled investigations are needed to validate these results and further follow-up is required for survival endpoints.
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Affiliation(s)
- Jiahua Pan
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chenfei Chi
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hongyang Qian
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaoguang Shao
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jianjun Sha
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Fan Xu
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yanqing Wang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Robert J Karnes
- Department of Urology, Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN
| | - Baijun Dong
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Effect of Neoadjuvant Hormone Therapy on Resection Margin and Survival Prognoses in Locally Advanced Prostate Cancer after Prostatectomy Using Propensity-Score Matching. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4307207. [PMID: 30627554 PMCID: PMC6304638 DOI: 10.1155/2018/4307207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate the effect of neoadjuvant hormone therapy (NHT) on resection margin positivity, biochemical-recurrence- (BCR-) free survival, and overall survival (OS) in 176 patients with locally advanced prostate cancer (LAPC) treated with radical prostatectomy using propensity-score matching, including 79 (44.9%) patients treated with the NHT. Fifty pairs of one-to-one propensity-score matching were matched to investigate the pure effect of NHT on resection margin positivity, BCR, and OS with a statistical significance of p<0.050. Before matching, NHT, tumor volume percentage, and extracapsular extension were significant factors for resection margin positivity (p≤0.001); however, after matching, NHT became insignificant in the multivariate analysis (p=0.084). In the survival analysis, NHT was not associated with BCR or OS before and after matching (BCR: hazard ratio, 1.35 and 0.84, respectively; OS: hazard ratio, 1.05 and 0.77, respectively; p≥0.539 for all). Conversely, PSA level (HR, 2.23), extracapsular extension (HR, 2.10), and lymphovascular invasion (HR, 1.85) were significant factors for BCR (p≤0.001 for all), but none were significant factors for OS in the propensity-score matching analysis (p≥0.948). Therefore, NHT was not a significant factor for resection margin positivity, BCR-free survival, and OS before and after propensity-score matching in patients with LAPC.
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10
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Liu F, Sun D, Zhou X, Ding Y, Ma Y, Hou Y, Kong X, Wang Z. Effect of adjuvant hormone therapy in patients with prostate cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13145. [PMID: 30557966 PMCID: PMC6319968 DOI: 10.1097/md.0000000000013145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To summarize the evidence regarding the treatment effect of adjuvant hormone therapy (AHT) in patients with prostate cancer (PCa). AHT following radiotherapy, chemotherapy, or surgery is widely used in patients with PCa. However, the treatment effect is inconsistent in individual trials. METHODS The electronic databases including PubMed, EmBase, and Cochrane Library were searched to identify randomized controlled trials (RCTs) in September 2016. RCTs that evaluated the effects of AHT in patients with PCa were included. Hazard ratio (HR) and relative risks (RR) were used to measure the treatment effects of AHT using a random effects model. The analyses were further stratified by factors that could affect the treatment efficacy. RESULTS A total of 14,594 potential studies were identified, and 27 RCTs were included. Compared with the control group, patients who received AHT were associated with a significant improvement in overall survival (OS) (HR: 0.78; 95% confidence interval [CI]: 0.71-0.85; P <.001), disease-free survival (DFS) (HR: 0.50; 95% CI: 0.39-0.65; P <.001), total mortality (RR: 0.90; 95% CI: 0.85-0.96; P = .001), recurrence (RR: 0.70; 95% CI: 0.60-0.81; P <.001), and disease-specific mortality (RR: 0.70; 95% CI: 0.56-0.87; P <.001). However, no significant difference was observed between AHT and control for response rate (RR: 1.75; 95% CI: 0.91-3.37; P = .095). CONCLUSIONS The findings of this meta-analysis confirmed that patients who received AHT had a significant improvement in OS, DFS, total mortality, recurrence, and disease-specific mortality. Further, large-scale RCTs are required to evaluate the treatment effect in specific subpopulations.
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Affiliation(s)
| | | | | | - Youpeng Ding
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Yanan Ma
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Yi Hou
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
| | - Zhixin Wang
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, P.R.China
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11
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Targeting luteinizing hormone-releasing hormone: A potential therapeutics to treat gynecological and other cancers. J Control Release 2018; 269:277-301. [DOI: 10.1016/j.jconrel.2016.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 01/05/2023]
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12
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Kakehi Y, Sugimoto M, Taoka R. Evidenced-based clinical practice guideline for prostate cancer (summary: Japanese Urological Association, 2016 edition). Int J Urol 2017; 24:648-666. [PMID: 28667698 DOI: 10.1111/iju.13380] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022]
Abstract
These guidelines cover a wide range of topics from prostate cancer epidemiology to palliative care. Questions arising in daily clinical practice have been extracted and formulated as clinical questions. In the 4 years since the previous edition, there have been major changes - for example, robot-assisted prostatectomy has rapidly come into widespread use, and new hormones and anticancer drugs have been developed for castration-resistant prostate cancer. In response to these developments, the number of fields included in this guideline was increased from 11 in the 2012 edition to 16, and the number of clinical questions was increased from 63 to 70. The number of papers identified in searches of the existing literature increased from 4662 in the first edition, published in 2006, to 10 490 in the 2012 edition. The number of references has reached 29 448 just during this review period, indicating the exponential increase in research on the topic of prostate cancer. Clinical answers have been prepared based on the latest evidence. Recommendation grades for the clinical answers were determined by radiologists, pathologists, and other specialists in addition to urologists in order to reflect the recent advances and diversity of prostate cancer treatment. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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14
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Amiya Y, Yamada Y, Sugiura M, Sasaki M, Shima T, Suzuki N, Nakatsu H, Murakami S, Shimazaki J. Treatment of locally advanced prostate cancer (Stage T3). Jpn J Clin Oncol 2017; 47:257-261. [PMID: 28096182 DOI: 10.1093/jjco/hyw186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 01/10/2023] Open
Abstract
Objective Formerly, locally advanced prostate cancer exhibited poorly prognosis. In the late 1990s, new surgical and radiation technologies were introduced in combination with androgen deprivation. To evaluate respective strategies, outcomes were examined. Patients and methods Between 2001 and 2010, 224 patients with T3N0M0 (10.9% of all prostate cancer cases) were treated with prostatectomy, external beam radiation therapy with/without androgen deprivation or hormone alone. Complete records were obtained by the end of 2015. Results Operation group first started without adjuvant treatment and prostate-specific antigen (PSA) relapse occurred in 39% of cases. Radiation therapy group was alternatively divided into two subgroups, that received either monotherapy or combination with androgen deprivation, and PSA relapse rates were 65 and 16%, respectively. High rates of PSA relapse in both the operation and radiation therapy groups were observed in patients without adjuvant therapy, but after relapse androgen deprivation proceeded favorable outcomes. In the radiation subgroups, PSA relapse rates were different, but both subsequent survival rates were the same. This may be due to the effect of androgen deprivation after relapse, indicating effect of delayed therapy. PSA relapse rate in the hormone therapy group was 25% and after relapse, patients applied to treatment with other hormonal and anticancer drugs. Overall survival rates were 91, 88 and 67% in the operation, radiation therapy and hormone therapy groups, respectively. Conclusion Aggressive treatment with short-term androgen deprivation for locally advanced prostate cancer could be beneficial and not harmful when suitable candidates are selected. Delayed androgen deprivation was effective for no adjuvant patients after PSA relapse.
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Affiliation(s)
| | | | | | - Makoto Sasaki
- Department of Urology, Asahi General Hospital, Asahi
| | | | | | | | | | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Baker H, Wellman S, Lavender V. Functional Quality-of-Life Outcomes Reported by Men Treated for Localized Prostate Cancer: A Systematic Literature Review. Oncol Nurs Forum 2016; 43:199-218. [DOI: 10.1188/16.onf.199-218] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Mitchell DL, Tracy CR, Buatti JM, Smith MC, Snow AN, Henry MD, Vaena DA, Tewfik HH, Watkins JM. Individualization of Adjuvant Therapy After Radical Prostatectomy for Clinically Localized Prostate Cancer: Current Status and Future Directions. Clin Genitourin Cancer 2016; 14:12-21. [PMID: 26341039 DOI: 10.1016/j.clgc.2015.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022]
Abstract
Radiation therapy indications in the postprostatectomy setting are evolving. Several retrospective series have identified a number of "high-risk" pathologic features associated with an elevated risk of disease recurrence after radical prostatectomy. More recently, several randomized phase III trials demonstrated superior biochemical relapse-free survival for adjuvant radiation therapy after prostatectomy for patients with these high-risk pathologic features, including positive margin status, extraprostatic extension, and/or seminal vesicle invasion. These series further suggested improvement in distant metastasis control and overall survival after 15 years. However, not all patients with high-risk features experience disease recurrence after surgery alone, and some subsets of patients experience suboptimal disease control and survival despite immediate postoperative radiotherapy. Furthermore, some patients without high-risk features will develop recurrence. The present review discusses the current data and potential future directions to improve individualization of therapy after prostatectomy.
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Affiliation(s)
- Darrion L Mitchell
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Chad R Tracy
- Department of Urology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Mark C Smith
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Anthony N Snow
- Department of Pathology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Michael D Henry
- Department of Molecular Physiology and Biophysics and Holden Comprehensive Cancer Center, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Daniel A Vaena
- Department of Hematology and Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | | | - John M Watkins
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
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Leisser A, Pruscha K, Ubl P, Wadsak W, Mayerhöfer M, Mitterhauser M, Hacker M, Kramer G, Shariat S, Karanikas G, Hartenbach M, Haug AR. Evaluation of fatty acid synthase in prostate cancer recurrence: SUV of [(11) C]acetate PET as a prognostic marker. Prostate 2015; 75:1760-7. [PMID: 26282590 DOI: 10.1002/pros.23061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 07/28/2015] [Indexed: 11/12/2022]
Abstract
AIM High levels of fatty acid synthase have shown to correlate with the aggressiveness of prostate cancer. As [(11) C]acetate exhibits a close correlation with the level of fatty acid synthase, we aimed to assess whether the SUV in [(11) C]acetate PET serves as a suitable prognostic marker in patients with recurrent prostate cancer. MATERIALS AND METHODS In 123 consecutive patients, examined between 2010 and 2014, the maximum standardized uptake value (SUVmax) of local recurrences as well as lymph node and bone metastases was measured. Choosing the spleen as a standard for relatively high physiological uptake, a ratio of tumor to spleen uptake (SUVts) was calculated for standardizing the uptake, too. The corresponding initial Gleason scores (GS) and serum-PSA levels around the time of the performed PET/CT for each patient were retrospectively collected and PSA doubling together with PSA velocity were determined. For further analysis patients were divided with regard to their initial Gleason score (≤3 + 4 and ≥ 4 + 3). The median of PSA velocity was calculated to separate patients with a high and low PSA velocity and Mann-Whitney U or Student's t-test were used, testing for significant differences. For correlation Spearmen-Rho test was used. RESULTS PET was positive for recurrence in 82/123 patients. PSA was significantly higher in PET-positive than in negative patients (5.9 vs. 3.2 ng/ml; P = 0.006). Initial Gleason score did not differ in PET negative and positive patients (P = 0.3), whereas PSA velocity was markedly higher in PET positive patients (0.4 vs. 0.1 ng/ml/month; P = 0.01). Median SUVmax of PET positive patients was 5.23 (mean 5.78; range 0.9-16.8) and meadian SUVts was 0.78 (mean 0.84, range 0.14-2.50). SUVts was significantly higher in patients with high PSA velocity (SUVts 0.76 vs. 0.92; P = 0.009), whereas SUVmax failed statistical significance (5.4 vs. 6.3 ng/ml/month; P = 0.08). Patients with a high SUVmax proved to have a significantly higher median Gleason score compared to low uptake 8.0 vs. 7.0; P = 0.004). Vice versa both SUVmax (GS 6: 5.0; GS 7: 5.6; GS 8: 5.7; GS 9: 6.5; r = 0.30, P = 0.008) and SUVts (GS 6: 0.63; GS 7: 0.68; GS 8: 0.85; GS 9: 0.89; r = 0.30, P = 0.006) significantly correlated with Gleason score. Patients with a Gleason score ≤ 3 + 4 had a significantly lower SUVmax (4.8 vs. 5.7; P = 0.02) and SUVts (0.67 vs. 0.85; P = 0.02) as compared to a Gleason score ≥ 4 + 3. CONCLUSION [(11) C]acetate uptake demonstrated to correlate with initial Gleason score. Furthermore, patients with a high PSA velocity proved to have higher [(11) C]acetate uptake in tumor lesions.
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Affiliation(s)
- Asha Leisser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Konstatin Pruscha
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Ubl
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Marius Mayerhöfer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Paediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Hartenbach
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
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Survival benefit of early androgen receptor inhibitor therapy in locally advanced prostate cancer: long-term follow-up of the SPCG-6 study. Eur J Cancer 2015; 51:1283-92. [PMID: 25892647 DOI: 10.1016/j.ejca.2015.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/05/2015] [Accepted: 03/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The optimal timing of endocrine therapy in non-metastatic prostate cancer (PCa) is still an issue of debate. METHODS A randomised, double-blind, parallel-group trial comparing bicalutamide 150mg once daily with placebo in addition to standard care in patients with hormone-naïve, non-metastatic PCa. Kaplan-Meier analysis was used to estimate overall survival (OS) and multivariate Cox proportional hazard model was performed to analyse time-to-event (death). FINDINGS A total of 1218 patients were included into the Scandinavian Prostate Cancer Group (SPCG)-6 study of which 607 were randomised to receive bicalutamide in addition to their standard care and 611 to receive placebo. Median follow-up was 14.6years. Overall, 866 (71.1%) patients died, 428 (70.5%) in the bicalutamide arm and 438 (71.7%) in the placebo arm, p=0.87. Bicalutamide significantly improved OS in patient with locally advanced disease (hazard ratios (HR)=0.77 (95% confidence interval (CI): 0.63-0.94, p=0.01), regardless of baseline prostate-specific antigen (PSA), with a survival benefit which was apparent throughout the study period. In contrast, survival favoured randomisation to the placebo arm in patients with localised disease (HR=1.19 (95% CI: 1.00-1.43), p=0.056). However, a survival gain from bicalutamide therapy was present in patients with localised disease and a baseline PSA greater than 28ng/mL at randomisation. In multivariate Cox proportional hazard model, only including patients managed on watchful waiting as their standard of care (n=991) OS depended on age, World Health Organisation (WHO) grade, baseline PSA, clinical stage and randomised treatment. INTERPRETATION Throughout the 14.6year follow-up period the addition of early bicalutamide to standard of care resulted in a significant OS benefit in patients with locally advanced PCa. In contrast, patients with localised PCa and low PSA derived no survival benefit from early bicalutamide. The optimal timing for initiating bicalutamide in non-metastatic PCa patients is dependent on disease stage and baseline PSA.
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Milecki T, Antczak A, Kwias Z, Milecki P. Hormone therapy in combination with radiotherapy in the treatment of prostate cancer: why and in which group of patients? Contemp Oncol (Pozn) 2015; 19:1-5. [PMID: 26199563 PMCID: PMC4507889 DOI: 10.5114/wo.2015.50010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/22/2014] [Accepted: 11/19/2014] [Indexed: 01/22/2023] Open
Abstract
In recent years, significant development in the treatment of prostate cancer has taken place. One of the most documented methods of treatment in patients characterised by a high risk of progression is a combination of radiotherapy (RT) with long-term hormone therapy (HT). In this group of patients, neither RT alone nor HT alone allows satisfactory outcomes to be achieved, and therefore as monotherapy they are not recommended as optimal methods of treatment. In this review, we summarise arguments for combining radiotherapy with hormonal therapy in high-risk prostate cancer, with an emphasis on the results of phase III trials.
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Affiliation(s)
- Tomasz Milecki
- Department and Clinic of Urology and Urologic Oncology, Poznan University of Medical Science, Poznan, Poland
| | - Andrzej Antczak
- Department and Clinic of Urology and Urologic Oncology, Poznan University of Medical Science, Poznan, Poland
| | - Zbigniew Kwias
- Department and Clinic of Urology and Urologic Oncology, Poznan University of Medical Science, Poznan, Poland
| | - Piotr Milecki
- Chair and Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Radiotherapy, Greater Poland Cancer Centre, Poznan, Poland
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20
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Lam ET, Glodé LM. Neoadjuvant and Adjuvant Hormonal and Chemotherapy for Prostate Cancer. Hematol Oncol Clin North Am 2013; 27:1189-204, viii. [DOI: 10.1016/j.hoc.2013.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Creak A, Hall E, Horwich A, Eeles R, Khoo V, Huddart R, Parker C, Griffin C, Bidmead M, Warrington J, Dearnaley D. Randomised pilot study of dose escalation using conformal radiotherapy in prostate cancer: long-term follow-up. Br J Cancer 2013; 109:651-7. [PMID: 23880826 PMCID: PMC3738135 DOI: 10.1038/bjc.2013.394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/10/2013] [Accepted: 06/22/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Radical three-dimensional conformal radiotherapy (CFRT) with initial androgen suppression (AS) is a standard management for localised prostate cancer (PC). This pilot study evaluated the role of dose escalation and appropriate target volume margin. Here, we report long-term follow-up. METHODS Eligible patients had T1b-T3b N0 M0 PC. After neoadjuvant AS, they were randomised to CFRT, giving (a) 64 Gy with either a 1.0- or 1.5-cm margin and (b) ±10 Gy boost to the prostate alone. RESULTS One hundred and twenty-six men were randomised and treated. Median follow-up was 13.7 years. The median age was 66.6 years at randomisation. Median presenting prostate-specific antigen (PSA) was 14 ng ml(-1). Sixty-four out of 126 patients developed PSA failure. Forty-nine out of 126 patients restarted AS, 34 out of 126 developed metastases and 28 out of 126 developed castrate-resistant prostate cancer (CRPC). Fifty-one out of 126 patients died; 19 out of 51 died of PC. Median overall survival (OS) was 14.4 years. Although escalated dose results were favourable, no statistically significant differences were seen between the randomised groups; PSA control (hazard ratio (HR): 0.77 (95% confidence interval (CI): 0.47-1.26)), development of CRPC (HR: 0.81 (95% CI: 0.40-1.65)), PC-specific survival (HR: 0.59 (95% CI:0.23-1.49)) and OS (HR: 0.81 (95% CI: 0.47-1.40)). There was no evidence of a difference in PSA control according to margin size (HR: 1.01 (95% CI: 0.61-1.66)). INTERPRETATION Long-term follow-up of this small pilot study is compatible with a benefit from dose escalation, but confirmation from larger trials is required. There was no obvious detriment using the smaller radiotherapy margin.
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Affiliation(s)
- A Creak
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - E Hall
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - A Horwich
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - R Eeles
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - V Khoo
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - R Huddart
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - C Parker
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - M Bidmead
- Joint Department of Physics, Royal Marsden Hospital Trust and The Institute of Cancer Research, Sutton and London, UK
| | - J Warrington
- Joint Department of Physics, Royal Marsden Hospital Trust and The Institute of Cancer Research, Sutton and London, UK
| | - D Dearnaley
- Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK
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Tree A, Alexander E, Van As N, Dearnaley D, Khoo V. Biological Dose Escalation and Hypofractionation: What is There to be Gained and How Will it Best be Done? Clin Oncol (R Coll Radiol) 2013; 25:483-98. [DOI: 10.1016/j.clon.2013.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/09/2013] [Indexed: 12/12/2022]
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23
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Gakis G, Boorjian SA, Briganti A, Joniau S, Karazanashvili G, Karnes RJ, Mattei A, Shariat SF, Stenzl A, Wirth M, Stief CG. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol 2013; 66:191-9. [PMID: 23735200 DOI: 10.1016/j.eururo.2013.05.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
CONTEXT Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. OBJECTIVE To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach using local radiotherapy and/or androgen-deprivation therapy (ADT), in LN-positive PCa. EVIDENCE ACQUISITION A systematic Medline search for studies reporting on treatment regimens and outcomes in patients with LN-positive PCa undergoing RP between 1993 and 2012 was performed. EVIDENCE SYNTHESIS RP can improve progression-free and overall survival in LN-positive PCa, although there is a lack of high-level evidence. Therefore, the former practice of aborting surgery in the presence of positive nodes might no longer be supported by current evidence, especially in those patients with a limited LN tumor burden. Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum, in which the internal and the common iliac nodes represent critical landmarks in the metastatic distribution. Sophisticated imaging technologies are still under investigation to improve the prediction of LN-positive PCa. Nonetheless, extended PLND including the common iliac arteries should be offered to intermediate- and high-risk patients to improve nodal staging with a possible benefit in prostate-specific antigen progression-free survival by removing significant metastatic load. Adjuvant ADT has the potential to improve overall survival after RP; the therapeutic role of a trimodal approach with adjuvant local radiotherapy awaits further elucidation. Age is a critical parameter for survival because cancer-specific mortality exceeds overall mortality in younger patients (<60 yr) with high-risk PCa and should be an impetus to treat as thoroughly as possible. CONCLUSIONS Increasing evidence suggests that RP and extended PLND improve survival in LN-positive PCa. Our understanding of surgery of the primary tumor in LN-positive PCa needs a conceptual change from a palliative option to the first step in a multimodal approach with a significant improvement of long-term survival and cure in selected patients.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany.
| | | | - Alberto Briganti
- Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospital K.U. Leuven, Leuven, Belgium
| | | | | | - Agostino Mattei
- Department of Urology, Kantonsspital Lucerne, Lucerne, Switzerland
| | | | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard-Karls University Tübingen, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich-Grosshadern, Germany
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Horwich A, Hugosson J, de Reijke T, Wiegel T, Fizazi K, Kataja V, Parker C, Bellmunt J, Berthold D, Bill-Axelson A, Carlsson S, Daugaard G, De Meerleer G, de Reijke T, Dearnaley D, Fizazi K, Fonteyne V, Gillessen S, Heinrich D, Horwich A, Hugosson J, Kataja V, Kwiatkowski M, Nilsson S, Padhani A, Papandreou C, Parker C, Roobol M, Sella A, Valdagni R, Van der Kwast T, Verhagen P, Wiegel T. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013; 24:1141-62. [DOI: 10.1093/annonc/mds624] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Dost RJ, Glaudemans AWJM, Breeuwsma AJ, de Jong IJ. Influence of androgen deprivation therapy on choline PET/CT in recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 40 Suppl 1:S41-7. [PMID: 23564037 DOI: 10.1007/s00259-013-2398-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Recurrent prostate cancer is usually treated by combining radiotherapy and androgen deprivation therapy. To stage the cancer, choline positron emission tomography (PET)/CT can be performed. It is generally thought that androgen deprivation therapy does not influence choline PET/CT. In this article we focus on the molecular backgrounds of choline and androgens, and the results of preclinical and clinical studies performed using PET/CT. METHODS Using PubMed, we looked for the relevant articles about androgen deprivation therapy and choline PET/CT. RESULTS During ADT, a tendency of decreased uptake of choline in prostate cancer was observed, in particular in hormone-naïve patients. CONCLUSION We conclude that in order to prevent false-negative choline PET/CT scans androgen deprivation should be withheld prior to scanning, especially in hormone-naïve patients.
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Affiliation(s)
- Rutger J Dost
- Department of Urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Treatment of locally advanced prostate cancer: a case report and narrative review. Case Rep Urol 2012; 2012:402513. [PMID: 23346453 PMCID: PMC3533609 DOI: 10.1155/2012/402513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction. Treatment of locally advanced prostate cancer is under discussion. Differences between clinical and pathological staging and risk factors such as positive surgical margins and seminal vesicle involvement challenge the individual treatment decisions. Case Presentation. Clinical tumor stage before treatment was assessed to be T2. After radical prostatectomy, pathological examination revealed the stage pT3b N0 M0 including positive surgical margin and seminal vesicle involvement. Early adjuvant androgen deprivation therapy and late adjuvant radiation therapy were added in response to the pathological risk factors. No evidence of disease was observed for 15 years after the treatment. The unexpected pathological findings were not explained by the physicians in charge. Discussion. A narrative review of the recent literature showed that multiple treatment modalities including adjuvant radiotherapy following radical prostatectomy are consistent with current recommendations. The multimodal approach has possibly cured a high-risk patient and may also work successfully in other patients. An alternative treatment option with better preservation of health-related quality of life might have also achieved a similar good overall survival.
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Conteduca V, Di Lorenzo G, Tartarone A, Aieta M. The cardiovascular risk of gonadotropin releasing hormone agonists in men with prostate cancer: an unresolved controversy. Crit Rev Oncol Hematol 2012; 86:42-51. [PMID: 23092636 DOI: 10.1016/j.critrevonc.2012.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/19/2012] [Accepted: 09/25/2012] [Indexed: 12/22/2022] Open
Abstract
Gonadotropin-releasing hormone agonists (GnRH) play an important role in the treatment of prostate cancer, improving significantly overall survival. GnRH agonists belong to androgen deprivation therapy (ADT) together with surgical castration and, recently, GnRH antagonists. ADT has several side effects, such as sexual dysfunction and osteoporosis. Recently, changes in body composition, obesity, insulin resistance, hyperglycemia, dyslipidemia, and hypertension have emerged as complications of ADT, perhaps responsible for cardiovascular events, but discussion is still open. Since the majority of men with prostate cancer die of conditions other than their malignancy, recognition of these adverse effects is important. This review serves to focus attention on the pathogenetic mechanisms of ADT-related cardiovascular toxicity with also reference to the possible direct role of GnRH agonist on the cardiac receptors. Furthermore, this paper would generate recommendations for the management of patients treated with GnRH agonists balancing the potential benefits against the possible risks in prostate cancer men.
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Affiliation(s)
- Vincenza Conteduca
- Centro di Riferimento Oncologico della Basilicata, IRCCS, Rionero in Vulture, Italy.
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Schröder F, Crawford ED, Axcrona K, Payne H, Keane TE. Androgen deprivation therapy: past, present and future. BJU Int 2012; 109 Suppl 6:1-12. [PMID: 22672120 DOI: 10.1111/j.1464-410x.2012.11215.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since Huggins and Hodges demonstrated the responsiveness of prostate cancer to androgen deprivation therapy (ADT), androgen-suppressing strategies have formed the cornerstone of management of advanced prostate cancer. Approaches to ADT have included orchidectomy, oestrogens, luteinizing hormone-releasing hormone (LHRH) agonists, anti-androgens and more recently the gonadotrophin-releasing hormone antagonists. The most extensively studied antagonist, degarelix, avoids the testosterone surge and clinical flare associated with LHRH agonists, offering more rapid PSA and testosterone suppression, improved testosterone control and improved PSA progression-free survival compared with agonists. The clinical profile of degarelix appears to make it a particularly suitable therapeutic option for certain subgroups of patients, including those with metastatic disease, high baseline PSA (>20 ng/mL) and highly symptomatic disease. As well as forming the mainstay of treatment for advanced prostate cancer, ADT is increasingly used in earlier disease stages. While data from clinical trials support the use of ADT neoadjuvant/adjuvant to radiotherapy for locally advanced or high-risk localized prostate cancer, it remains to be established whether specific ADT classes/agents provide particular benefits in this clinical setting.
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Affiliation(s)
- F Schröder
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Sfoungaristos S, Perimenis P. A systematic review of the role of adjuvant and neoadjuvant pharmacotherapy in patients undergoing radical prostatectomy. Expert Opin Pharmacother 2012; 13:1421-36. [PMID: 22646741 DOI: 10.1517/14656566.2012.690398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Between 25 and 30% of patients with newly diagnosed prostate cancer are classified as high risk for an adverse prognosis. A significant number of these will progress to biochemical or clinical relapse. As there is no consensus regarding the optimal treatment of these cases, a multimodal therapeutic approach, including radical prostatectomy, remains an option. AREAS COVERED The Pubmed/Medline database was searched to identify trials that have evaluated adjuvant and neoadjuvant pharmaceutical protocols combined with radical prostatectomy and provided information regarding efficacy and safety. EXPERT OPINION Improvements in adverse pathological findings, following operations in patients who received neoadjuvant treatment, have been reported in the majority of the reviewed studies. Furthermore, the addition of pharmacotherapy to radical prostatectomy has produced beneficial results in survival surrogates. However, no benefits in overall survival were observed with adjuvant or neoadjuvant protocols and toxicity was a concern, especially in combination regimens. New studies on the effects of current pharmacotherapy and of new agents on overall survival and quality of life, after defining well-established criteria for patient stratification and inclusion, are required urgently.
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Soriano-Hernández AD, Galvan-Salazar HR, Montes-Galindo DA, Rodriguez-Hernandez A, Martinez-Martinez R, Guzman-Esquivel J, Valdez-Velazquez LL, Baltazar-Rodriguez LM, Espinoza-Gómez F, Rojas-Martinez A, Ortiz-Lopez R, Gonzalez-Alvarez R, Delgado-Enciso I. Antitumor effect of meclofenamic acid on human androgen-independent prostate cancer: a preclinical evaluation. Int Urol Nephrol 2011; 44:471-7. [DOI: 10.1007/s11255-011-0012-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/24/2011] [Indexed: 01/11/2023]
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Milecki P, Martenka P, Antczak A, Kwias Z. Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art. Cancer Manag Res 2010; 2:243-53. [PMID: 21188116 PMCID: PMC3004567 DOI: 10.2147/cmr.s8912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Indexed: 11/23/2022] Open
Abstract
Androgen-deprivation therapy (ADT) is used routinely in combination with definitive external beam radiation therapy (EBRT) in patients with high-risk clinically localized or locally advanced disease. The combined treatment (ADT-EBRT) also seems to play a significant role in improving treatment results in the intermediate-risk group of prostate cancer patients. On the other hand, there is a growing body of evidence that treatment with ADT can be associated with serious and lifelong adverse events including osteoporosis, cardiovascular disease, diabetes, and many others. Almost all ADT adverse events are time dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, it is crucial to clearly state the optimal schedule for ADT in combination with EBRT, that maintaining the positive effect on treatment efficacy would keep the adverse events risk at reasonable level. To achieve this goal, treatment schedule may have to be highly individualized on the basis of the patient-specific potential vulnerability to adverse events. In this study, the concise and evidence-based review of current literature concerning the general rationales for combining radiotherapy and hormonal therapy, its mechanism, treatment results, and toxicity profile is presented.
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Affiliation(s)
- Piotr Milecki
- Department of Radiotherapy, Greater Poland Cancer Center, Poznan, Poland
- Department of Electroradiology, Medical University, Poznan, Poland
| | - Piotr Martenka
- Department of Radiotherapy, Greater Poland Cancer Center, Poznan, Poland
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Spahn M, Kneitz B, Gontero P, van Poppel H, Joniau S. Reply to Endre Zoltan Neulander and Zev Wejsman’s Letter to the Editor re: Martin Spahn, Steven Joniau, Paolo Gontero, et al. Outcome Predictors of Radical Prostatectomy in Patients With Prostate-Specific Antigen Greater Than 20 ng/ml: A European Multi-Institutional Study of 712 Patients. Eur Urol 2010;58:1–7. Eur Urol 2010. [DOI: 10.1016/j.eururo.2010.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The biochemical efficacy of primary cryoablation combined with prolonged total androgen suppression compared with radiotherapy on high-risk prostate cancer: a 3-year pilot study. Asian J Androl 2010; 12:827-34. [PMID: 20711215 DOI: 10.1038/aja.2010.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
To gain beneficial effects in the management of high-risk prostate cancer, an integrated approach that combines local therapy and androgen deprivation therapy (ADT) was used. We compared biochemical responses between primary cryosurgical ablation of the prostate (CSAP) combined with prolonged ADT and radiation combined with ADT, which is the established modality in high-risk disease. A total of 33 high-risk patients received CSAP combined with ADT for 3 months before and up to 24 months after treatment. This patient group was matched with another 33 patients who had undergone three-dimensional conformal radiation therapy (3D-CRT) with the same protocol for ADT. Biochemical recurrence (BCR) was assessed by the American Society for Therapeutic Radiation Oncology (ASTRO) definition, the Phoenix definition and a prostate-specific antigen (PSA) cutoff of 0.5 ng mL(-1). Median follow-up was 61.0 ± 11.9 months for the CSAP + ADT group and 86.0 ± 15.8 months for the 3D-CRT + ADT group. In the CSAP group, major complications including rectourethral fistula and incontinence were not noted. In the CSAP + ADT group, 57.0% had BCR using the ASTRO definition, 21.2% using the Phoenix definition and 54.5% using a PSA cutoff of 0.5 ng mL(-1). In the 3D-CRT + ADT group, 54.5%, 21.2% and 54.5% had BCR using the ASTRO, Phoenix and PSA definition, respectively. In the CSAP + ADT group, the BCR-free survival (BRFS) was 54 ± 10 months using the ASTRO definition, 65 ± 5 months using the Phoenix definition and 51 ± 4 months using a PSA cutoff of 0.5 ng mL(-1). In the 3D-CRT + ADT group, the BRFS was 68 ± 12, 93 ± 19 and 70 ± 18 months using the ASTRO, Phoenix and PSA definition, respectively. By the log-rank test, the BRFS values for each group were not statistically different. This intermediate-term result indicated that primary CSAP combined with prolonged ADT offers a parallel biochemical response compared with radiotherapy in high-risk prostate cancer.
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Gomella LG, Singh J, Lallas C, Trabulsi EJ. Hormone therapy in the management of prostate cancer: evidence-based approaches. Ther Adv Urol 2010; 2:171-81. [PMID: 21789093 PMCID: PMC3126080 DOI: 10.1177/1756287210375270] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hormonal therapy has been the standard for advanced prostate cancer for over 60 years. Recently, the utility of androgen ablation through various means has been demonstrated for earlier stages of disease. In particular, the strongest evidence to date involves the use of hormonal therapy in combination with radiation therapy. In this article we review the basic concepts in hormonal ablation for prostate cancer and review the evidence-based studies that support the use of hormonal therapy in early stage prostate cancer.
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Affiliation(s)
- Leonard G Gomella
- Chairman, Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1112, Philadelphia, PA 19107, USA
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Drouin S, Rouprêt M, Bossi A, Bolla M. Hormonothérapie combinée à la radiothérapie externe dans le cancer de prostate localement avancé : les effets secondaires contrecarrent-ils les bénéfices ? Prog Urol 2010; 20 Suppl 3:S186-91. [DOI: 10.1016/s1166-7087(10)70037-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pinto F, Calamo A, Totaro A, Sacco E, Volpe A, Racioppi M, D'Addessi A, Bassi P. Androgen-Deprivation Therapy in Prostate Cancer: Clinical Evidence and Future Perspectives. Urologia 2010. [DOI: 10.1177/039156031007700201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Androgens are involved in the development and progression of prostate cancer even if the mechanism is not well-recognized. For this reason androgen-deprivation therapy remains a milestone for the treatment of patients with advanced and metastatic disease and, in the last years, in conjunction with radiotherapy and surgery in locally advanced tumors. Alternative options, such as intermittent deprivation suppression, seem to be promising in terms of clinical benefits and toxicity profile. However, current therapies present side effects, such as testosterone surge with consequent clinical flare-up, metabolic syndrome and hormone-resistance, which develops after a variable number of years. Novel therapies such as LH-RH antagonists and prolonged depot LH-RH analogues have been developed in order to avoid clinical flare-up and testosterone microsurges. Novel androgen synthesis inhibitors, such as abiraterone acetate and MDV3100, have been recently discovered and tested as promising hormonal second-line agents in patients with castration-resistant prostate cancer. Finally, long-term side effects from androgen deprivation, such as osteoporosis, sarcopenic obesity and cardiovascular morbidity should be carefully monitored and properly treated.
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Affiliation(s)
- F. Pinto
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Calamo
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Totaro
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - E. Sacco
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. Volpe
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - M. Racioppi
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - A. D'Addessi
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - P.F. Bassi
- Urologia, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma
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