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Kitson-Mills D, Donkor A, Amoako YA, Kyei KA, Bonsu EBO, Vanderpuye V, Wiafe YA. Outcomes and Toxicities After Treatment for Men Diagnosed With Localized Prostate Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Adv Radiat Oncol 2025; 10:101670. [PMID: 39758977 PMCID: PMC11699425 DOI: 10.1016/j.adro.2024.101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 10/21/2024] [Indexed: 01/07/2025] Open
Abstract
Purpose Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs. Methods and Materials The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval. Results A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively. Conclusions This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.
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Affiliation(s)
- Doris Kitson-Mills
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yaw Ampem Amoako
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Adesi Kyei
- Department of Radiography, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Yaw Amo Wiafe
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Porcaro AB, Orlando R, Panunzio A, Tafuri A, Baielli A, Artoni F, Brancelli C, Roggero L, Costantino S, Franceschini A, Boldini M, Treccani LP, Montanaro F, Gallina S, Bianchi A, Serafin E, Mazzucato G, Ditonno F, Finocchiaro M, Veccia A, Rizzetto R, Brunelli M, De Marco V, Siracusano S, Cerruto MA, Bertolo R, Antonelli A. Preoperative Briganti Nomogram Score and Risk of Prostate Cancer Progression After Robotic Surgery Beyond EAU Risk Categories. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1763. [PMID: 39596948 PMCID: PMC11596480 DOI: 10.3390/medicina60111763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/03/2024] [Accepted: 10/25/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: We sought to investigate whether the 2012 Briganti nomogram may represent a potential prognostic factor of prostate cancer (PCa) progression after surgical treatment beyond European Association of Urology (EAU) risk categories. Materials and Methods: From January 2013 to December 2021, data on PCa patients treated with robot-assisted radical prostatectomy at a single tertiary referral center were extracted. The 2012 version of the Briganti nomogram assessing the risk of pelvic lymph node invasion was used. Here, the nomogram score was evaluated both as a continuous and a categorical variable. The association between variables and disease progression after surgery was evaluated through Cox regression models. Results: Overall, 1047 patients were identified. According to the EAU classification system, 297 (28.4%) patients were low-risk, 527 (50.3%) intermediate-risk, and 223 (21.3%) high-risk. The median (interquartile range) 2012 Briganti nomogram score within the investigated population was 3% (2-8%). Median (95% Confidence Interval [CI]) follow-up was 95 (91.9-112.4) months. Disease progression occurred in 237 (22.6%) patients, who were more likely to have an increasing 2012 Briganti nomogram score (Hazard Ratio [HR]: 1.03; 95%CI: 1.01-1.81; p = 0.015), independently of unfavorable issues at clinical presentation. Moreover, the nomogram score stratified according to tertiles (<3% vs. 3-8% vs. ≥8%) hold significance beyond EAU risk categories: accordingly, the risk of disease progression increased as the score increased from the first (reference) to the second (HR: 1.50; 95%CI: 1.67-3.72; p < 0.001) up to the third (HR: 3.26; 95%CI: 2.26-4.72; p < 0.001) tertile. Conclusions: Beyond EAU risk categories, the 2012 Briganti nomogram represented an independent predictor of PCa progression after surgery. Likewise, as the nomogram score increased so patients were more likely to experience disease progression. Accordingly, it may allow further stratification of patients within each risk category to modulate appropriate treatment paradigms.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Rossella Orlando
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Andrea Panunzio
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy; (A.P.); (A.T.)
| | - Alessandro Tafuri
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy; (A.P.); (A.T.)
| | - Alberto Baielli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesco Artoni
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Claudio Brancelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Luca Roggero
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Sonia Costantino
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Andrea Franceschini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Michele Boldini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Lorenzo Pierangelo Treccani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesca Montanaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Sebastian Gallina
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alberto Bianchi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Emanuele Serafin
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Giovanni Mazzucato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Mariana Finocchiaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Matteo Brunelli
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy;
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
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Gustavsen EM, Haug ES, Haukland E, Heimdal R, Stensland E, Myklebust TÅ, Hauglann B. Geographic and socioeconomic variation in treatment of elderly prostate cancer patients in Norway - a national register-based study. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:8. [PMID: 39177854 PMCID: PMC11281769 DOI: 10.1007/s43999-024-00044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/08/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The aim of this study was to examine geographic and socioeconomic variation in curative treatment and choice of treatment modality among elderly prostate cancer (PCa) patients. METHODS This register-based cohort study included all Norwegian men ≥ 70 years when diagnosed with non-metastatic, high-risk PCa in 2011-2020 (n = 10 807). Individual data were obtained from the Cancer Registry of Norway, the Norwegian Prostate Cancer Registry, and Statistics Norway. Multilevel logistic regression analysis was used to model variation across hospital referral areas (HRAs), incorporating clinical, demographic and socioeconomic factors. RESULTS Overall, 5186 (48%) patients received curative treatment (radical prostatectomy (RP) (n = 1560) or radiotherapy (n = 3626)). Geographic variation was found for both curative treatment (odds ratio 0.39-2.19) and choice of treatment modality (odds ratio 0.10-2.45). Odds of curative treatment increased with increasing income and education, and decreased for patients living alone, and with increasing age and frailty. Patients with higher income had higher odds of receiving RP compared to radiotherapy. CONCLUSIONS This study showed geographic and socioeconomic variation in treatment of elderly patients with non-metastatic, high-risk PCa, both in relation to overall curative treatment and choice of treatment modality. Further research is needed to explore clinical practices, the shared decision process and how socioeconomic factors influence the treatment of elderly patients with high-risk PCa.
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Affiliation(s)
- Elin Marthinussen Gustavsen
- Department of Community Medicine, The Arctic University of Norway (UiT), Tromsø, Norway.
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
| | | | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
- SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Ragnhild Heimdal
- Geriatric Department, Akershus University Hospital, Lørenskog, Norway
| | - Eva Stensland
- Department of Community Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Beate Hauglann
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
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Konoshenko M, Laktionov P, Bryzgunova O. Prostate cancer therapy outcome prediction: are miRNAs a suitable guide for therapeutic decisions? Andrology 2024; 12:705-718. [PMID: 37750354 DOI: 10.1111/andr.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Radical prostatectomy, radiotherapy, chemotherapy, and androgen-deprivation therapy are among the most common treatment options for different forms of prostate cancer (PCa). However, making therapeutic decisions is difficult due to the lack of reliable prediction markers indicating therapy outcomes in clinical practice. The involvement of miRNAs in all mechanisms of the PCa development and their easy detection characterize them as attractive PCa biomarkers. Although there are extensive data on the role of miRNAs in PCa therapy resistance and sensitivity development, the issues of whether they could be used as a guide for therapy choice and, if so, how we can progress toward this goal, remain unclear. Thus, generalizable reviews and studies which summarize, compare, and analyze data on miRNA involvement in responses to different types of PCa therapies are required. OBJECTIVES Data on the involvement of miRNAs in therapy responses, on the role of cross-miRNA expression in different therapies, and on miRNA targets were analyzed in order to determine the miRNA-related factors which can lend perspective to the future development of personalized predictors of PCa sensitivity/resistance to therapies. MATERIALS AND METHODS The data available on the miRNAs associated with different PCa therapies (resistance and sensitivity therapies) are summarized and analyzed in this study, including analyses using bioinformatics resources. Special attention was dedicated to the mechanisms of the development of therapy resistance. RESULTS AND DISCUSSION A comprehensive combined analysis of the current data revealed a panel of miRNAs that were shown to be most closely associated with the PCa therapy response and were found to regulate the genes involved in PCa development via cell proliferation regulation, epithelial-mesenchymal transition (EMT), apoptosis, cell-cycle progression, angiogenesis, metastasis and invasion regulation, androgen-independent development, and colony formation. CONCLUSION The selected miRNA-based panel has the potential to be a guide for therapeutic decision making in the effective treatment of PCa.
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Affiliation(s)
- MariaYu Konoshenko
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
| | - Pavel Laktionov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
| | - Olga Bryzgunova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, Russia
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Porcaro AB, Panunzio A, Orlando R, Tafuri A, Gallina S, Bianchi A, Serafin E, Mazzucato G, Montanaro F, Baielli A, Artoni F, Ditonno F, Roggero L, Franceschini A, Boldini M, Treccani LP, Veccia A, Rizzetto R, Brunelli M, De Marco V, Siracusano S, Cerruto MA, Bertolo R, Antonelli A. The 2012 Briganti nomogram predicts disease progression after surgery in high-risk prostate cancer patients. Arab J Urol 2024; 22:227-234. [PMID: 39355796 PMCID: PMC11441050 DOI: 10.1080/20905998.2024.2339062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/30/2024] [Indexed: 10/03/2024] Open
Abstract
Objectives We tested whether the 2012 Briganti nomogram for the risk of pelvic lymph node invasion (PLNI) may represent a predictor of disease progression after surgical management in high-risk (HR) prostate cancer (PCa) patients according to the European Association of Urology. Methods Between January 2013 and December 2021, HR PCa patients treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) were identified. The 2012 Briganti nomogram was evaluated as a continuous and categorical variable, which was dichotomized using the median. The risk of disease progression, defined as the event of biochemical recurrence and/or local recurrence/distant metastases was assessed by Cox regression models. Results Overall, 204 patients were identified. The median 2012 Briganti nomogram score resulted 12.0% (IQR: 6.0-22.0%). PLNI was detected in 57 (27.9%) cases. Compared to patients who had preoperatively a 2012 Briganti nomogram score ≤12%, those with a score >12% were more likely to present with higher percentage of biopsy positive cores, palpable tumors at digital rectal examination, high-grade cancers at prostate biopsies, and unfavorable pathology in the surgical specimen. At multivariable Cox regression analyses, disease progression, which occurred in 85 (41.7%) patients, was predicted by the 2012 Briganti nomogram score (HR: 1.02; 95%CI: 1.00-1.03; p = 0.012), independently by tumors presenting as palpable (HR: 1.78; 95%CI: 1.10.2.88; p = 0.020) or the presence of PLNI in the surgical specimen (HR: 3.73; 95%CI: 2.10-5.13; p = 0.012). Conclusions The 2012 Briganti nomogram represented an independent predictor of adverse prognosis in HR PCa patients treated with RARP and ePLND. As the score increased, so patients were more likely to experience disease progression, independently by the occurrence of PLNI. The association between the nomogram, unfavorable pathology and tumor behavior might turn out to be useful for selecting a subset of patients needing different treatment paradigms in HR disease.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Rossella Orlando
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Baielli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Artoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Roggero
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Franceschini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Boldini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Sugino F, Nakane K, Kawase M, Ueda S, Tomioka M, Takeuchi Y, Yamada T, Namiki S, Kumada N, Kawase K, Kato D, Takai M, Iinuma K, Tobisawa Y, Ito T, Koie T. Biochemical recurrence after chemohormonal therapy followed by robot-assisted radical prostatectomy in very-high-risk prostate cancer patients. J Robot Surg 2023; 17:2441-2449. [PMID: 37466903 DOI: 10.1007/s11701-023-01670-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
Robot-assisted radical prostatectomy (RARP) has become one of the standard radical treatments for prostate cancer (PCa). A retrospective single-center cohort study was conducted on patients with PCa who underwent RARP at Gifu University Hospital between September 2017 and September 2022. In this study, patients were classified into three groups based on the National Comprehensive Cancer Network risk classification: low/intermediate-risk, high-risk, and very-high-risk groups. Patients with high- and very-high-risk PCa who were registered in the study received neoadjuvant chemohormonal therapy prior to RARP. Biochemical recurrence-free survival (BRFS) after RARP in patients with PCa was the primary endpoint of this study. The secondary endpoint was the relationship between biochemical recurrence (BCR) and clinical covariates. We enrolled 230 patients with PCa in our study, with a median follow-up of 17.0 months. When the time of follow-up was over, 19 patients (8.3%) had BCR, and the 2 years BRFS rate for the enrolled patients was 90.9%. Although there was no significant difference in BRFS between the low- and intermediate-risk group and the high/very-high-risk group, the 2 years BRFS rate was 100% in the high-risk group and 68.3% in the very-high-risk group (P = 0.0029). Multivariate analysis showed that positive surgical margins were a significant predictor of BCR in patients with PCa treated with RARP. Multimodal therapies may be necessary to improve the BCR in patients with very-high-risk PCa.
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Affiliation(s)
- Fumiya Sugino
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shota Ueda
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan
| | | | | | - Toyohiro Yamada
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Sanae Namiki
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Naotaka Kumada
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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7
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Zhu XH, Zhang F, Liu ZN, He JD, Li ZA, Ma LL, Huang Y, Lu J. Outcome comparison of radical prostatectomy versus seed brachytherapy for clinically localized prostate cancer using two biochemical recurrence definitions. BMC Surg 2023; 23:253. [PMID: 37635216 PMCID: PMC10464079 DOI: 10.1186/s12893-023-02121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE We compared the outcome of radical prostatectomy (RP) with seed brachytherapy (BT) in clinically localized prostate cancer (LPCa) using two different biochemical recurrence (BCR) definitions. METHODS Clinical data of 1117 patients with non-metastatic prostate cancer (PCa) treated with either RP or BT as the basis of the multimodal therapy from a single tertiary hospital between 2007 and 2021 were retrospectively analyzed. 843 LPCa patients (RP = 737, BT = 106) with at least one prostate-specific antigen (PSA) test after treatment were finally included. The BCR survival was evaluated by direct comparison and one-to-one propensity score matching (PSM) analysis using surgical definition (PSA ≥ 0.2ng/ml) for RP and surgical/Phoenix definition (PSA nadir + 2ng/ml ) for BT. The propensity score (PS) was calculated by multivariable logistic regression based on the clinicopathological parameters. RESULTS Median follow-up was 43 months for RP patients and 45 months for BT patients. Kaplan-Meier analysis did not show any statistically significant differences in terms of BCR-free survival (BFS) between the two groups when using Phoenix definition for BT (P > 0.05). Similar results were obtained in all D'Amico risk groups when stratified analyses were conducted. However, RP achieved improved BFS compared to BT in the whole cohort and all risk groups with the surgical definition for BT(P < 0.05). After adjusting PS, 192 patients were divided into RP and BT groups (96 each). RP presented a better BFS than BT when using the surgical definition (P < 0.001), but no significant difference was found when using the Phoenix definition (P = 0.609). CONCLUSION Inconsistent BCR-free survival outcomes were acquired using two different BCR definitions for BT patients. RP provided comparable BFS with BT using the Phoenix definition but better BFS using the surgical definition, regardless of whether the PSM was performed. Our findings indicated that an exact BCR definition was critical for prognostic assessment. The corresponding results will assist physicians in pretreatment consultation and treatment selection.
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Affiliation(s)
- Xue-Hua Zhu
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Urology, Shandong Cancer Hospital and Institude, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fan Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ze-Nan Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ji-de He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zi-Ang Li
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China.
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China.
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Heesterman BL, Aben KKH, de Jong IJ, Pos FJ, van der Hel OL. Radical prostatectomy versus external beam radiotherapy with androgen deprivation therapy for high-risk prostate cancer: a systematic review. BMC Cancer 2023; 23:398. [PMID: 37142955 PMCID: PMC10157926 DOI: 10.1186/s12885-023-10842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To summarize recent evidence in terms of health-related quality of life (HRQoL), functional and oncological outcomes following radical prostatectomy (RP) compared to external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) for high-risk prostate cancer (PCa). METHODS We searched Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial Register and the International Standard Randomized Controlled Trial Number registry on 29 march 2021. Comparative studies, published since 2016, that reported on treatment with RP versus dose-escalated EBRT and ADT for high-risk non-metastatic PCa were included. The Newcastle-Ottawa Scale was used to appraise quality and risk of bias. A qualitative synthesis was performed. RESULTS Nineteen studies, all non-randomized, met the inclusion criteria. Risk of bias assessment indicated low (n = 14) to moderate/high (n = 5) risk of bias. Only three studies reported functional outcomes and/or HRQoL using different measurement instruments and methods. A clinically meaningful difference in HRQoL was not observed. All studies reported oncological outcomes and survival was generally good (5-year survival rates > 90%). In the majority of studies, a statistically significant difference between both treatment groups was not observed, or only differences in biochemical recurrence-free survival were reported. CONCLUSIONS Evidence clearly demonstrating superiority in terms of oncological outcomes of either RP or EBRT combined with ADT is lacking. Studies reporting functional outcomes and HRQoL are very scarce and the magnitude of the effect of RP versus dose-escalated EBRT with ADT on HRQoL and functional outcomes remains largely unknown.
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Affiliation(s)
- Berdine L Heesterman
- Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
- Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Olga L van der Hel
- Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
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9
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Oncological and functional outcomes of high-risk and very high-risk prostate cancer patients after robot-assisted radical prostatectomy. PLoS One 2023; 18:e0282494. [PMID: 36867638 PMCID: PMC9983825 DOI: 10.1371/journal.pone.0282494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE This study investigated the oncological and functional outcomes of robot-assisted radical prostatectomy (RaRP) in high-risk and very high-risk prostate cancer patients. MATERIALS AND METHODS One hundred localized prostate cancer patients receiving RaRP from August 2015 to December 2020 were retrospectively enrolled. According to NCCN risk classification, patients were classified into two groups, below high-risk group, and high-risk/very high-risk group, to analyze continence outcome within postoperative year one and biochemical recurrence-free survival. RESULTS The mean age of the cohort was 69.7 ± 7.4 years with a median follow-up of 26.4 (range 3.3-71.3) months. Among them, 53%, and 47% patients were below high-risk group, and high-risk/very high-risk group, respectively. The median biochemical recurrence-free survival of the entire cohort was 53.1 months. The high-risk/very high-risk group without adjuvant treatment had significantly worse biochemical recurrence-free survival than the high-risk/very high-risk group with adjuvant treatment (19.6 vs. 60.5 months, p = 0.029). Rates of postoperative stress urinary incontinence at 1 week, 1 month, and 12 months were 50.7%, 43.7%, and 8.5%, respectively. High-risk/very high-risk patients had significantly higher rates of stress urinary incontinence at postoperative week 1 (75.8% vs. 28.9%) and month 1 (63.6% vs. 26.3%) than the below high-risk group (both p < 0.01). Rates of stress urinary incontinence after RaRP did not differ between two groups from postoperative 3 months to 12 months. The factor of high-risk / very high-risk group was a predictor of immediate but not for long-term postoperative stress urinary incontinence. CONCLUSIONS High-risk and very high-risk prostate cancer patients receiving a combination of RaRP and adjuvant treatment had comparable biochemical recurrence-free survival to below high-risk prostate cancer patients. The high-risk/very high-risk factor impeded early but not long-term postoperative recovery of continence. RaRP can be considered a safe and feasible option for high-risk and very high-risk prostate cancer patients.
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10
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Lin J, Zhan X, Chen R, Chen T, Jiang M, Li Y, Liu X, Chen G, Fu B. Increased Burden of Second Bladder Cancer and Rectal Cancer in Prostate Cancer Treated With Radiotherapy: Results From Surveillance, Epidemiology, and End Results. Cancer Control 2023; 30:10732748231177544. [PMID: 37196346 DOI: 10.1177/10732748231177544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Previous studies have confirmed the higher risk of bladder cancer (BC) and rectal cancer (RC) development among prostate cancer (PCa) patients receiving radiotherapy. In this study, we intend to explore the long-term trend in second BC and RC incidence among PCa patients undergoing radiotherapy. METHOD We identified first primary PCa patients diagnosed between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER)-9 cancer registries. Standardized incidence ratios (SIRs) were calculated by calendar year of diagnosis among PCa patients receiving radiotherapy and not. P trends were evaluated using Poisson regression. 10-year cumulative incidence of BC and RC was calculated utilizing competing risk regression model. RESULT Of PCa patients treated with radiotherapy, SIRs of BC increased from .82 (95% CI: .35- 1.61) in 1980-1984 to 1.58 (95% CI: 1.48-1.68) in 2010-2014 (Ptrend=.003). SIRs of RC increased from 1.01 (95% CI: .27-2.58) in 1980-1984 to 1.54 (95% CI: 1.31-1.81) in 2010-2014 (Ptrend=.025). No statistically significant change in both BC and RC incidence was observed. The 10-year cumulative incidence of BC increased from 1975-1984 (.04%) to 2005-2014 (.15%) among PCa treated with radiotherapy. Simultaneously, the 10-year cumulative incidence of RC was demonstrated to range from 1975-1984 (.02%) to 2005-2014 (.11%). CONCLUSION we have observed an increasing trend in second BC and RC incidence in PCa patients receiving radiotherapy. There was no significant change in the incidence of second BC and RC in PCa without radiotherapy. These results reflect the increasing clinical burden of second malignant tumors in PCa patients undergoing radiotherapy.
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Affiliation(s)
- JinFang Lin
- Department of Urology, The First Hospital of Putian City, Putian, China
| | - Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ru Chen
- Department of Urology, The First Hospital of Putian City, Putian, China
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guoxian Chen
- Department of Urology, The First Hospital of Putian City, Putian, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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11
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Shih HJ, Chang SC, Hsu CH, Lin YC, Hung CH, Wu SY. Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer. Cancers (Basel) 2021; 13:cancers13235986. [PMID: 34885096 PMCID: PMC8656593 DOI: 10.3390/cancers13235986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary That the definitive optimal treatments for relatively young men (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC) are radical prostatectomy (RP) or radiation plus antiandrogen therapy (RT-ADT) is controversial. To the best of our knowledge, our study is the first and largest to examine biochemical failure (BF), all-cause death, locoregional recurrence, and distant metastasis in relatively young men with HR/VHR-LPC as defined by National Comprehensive Cancer Network risk strata. After head-to-head propensity score matching was used to balance the potential confounders, a multivariable Cox proportional hazards regression model was used to analyze oncologic outcomes. In relatively young men with HR/VHR-LPC, RP and RT-ADT yielded similar oncologic outcomes and RP reduced the risk of BF compared with RT-ADT. Abstract That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.
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Affiliation(s)
- Hung-Jen Shih
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Recreation and Holistic Wellness, MingDao University, Changhua 500, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shyh-Chyi Chang
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
| | - Chia-Hao Hsu
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
| | - Yi-Chu Lin
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
| | - Chu-Hsuan Hung
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan; (S.-C.C.); (C.-H.H.); (Y.-C.L.); (C.-H.H.)
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 242062, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan 262307, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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12
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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13
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Ye C, Wang H, Li Z, Xia C, Yuan S, Yan R, Yang X, Ma T, Wen X, Yang D. Comprehensive data analysis of genomics, epigenomics, and transcriptomics to identify specific biomolecular markers for prostate adenocarcinoma. Transl Androl Urol 2021; 10:3030-3045. [PMID: 34430406 PMCID: PMC8350225 DOI: 10.21037/tau-21-576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Multiomics data analysis based on high-throughput sequencing technology has become a hotspot in tumor investigation. The present study aimed to explore prognostic biomarkers via investigating DNA copy number variation (CNV) and methylation variation (MET) data in prostate cancer. Methods We obtained the messenger RNA (mRNA) expression, CNV, and methylated data of prostate adenocarcinoma (PRAD) samples via The Cancer Genome Atlas (TCGA)-PRAD cohort. We calculated and assessed the associations between CNV and RNA sequencing (RNA-seq), and between MET and RNA-seq via Pearson correlation coefficients. We then used the "iCluster" package to perform multigroup cluster analysis with CNVcor gene CNV data, METcor gene methylation data, and CNVcor and METcor gene mRNA data. The univariate Cox analysis was used to screen significant hub genes, and multivariate Cox analysis was used to construct risk a model. The nomogram was constructed based on "rms" package, and the immune infiltrating patterns were compared between high- and low-risk groups. Results A total of 477 PRAD samples with complete CNV, methylation, mRNA, and matched clinical information were included in our study. A list of 10,073 CNVcor genes and 9841 METcor genes were confirmed with a significance level of P<0.01. We found that CNVcor is more likely to appear on chromosome (chr)8, chr17, and chr10, while METcor is more likely to appear on chr1, chr19, and chr17. Based on the core genes, we finally classified the samples into 4 subtypes, incorporating iC1 (iCluster) (92 samples), iC2 (79 samples), iC3 (165 samples), and iC4 (141 samples). Furthermore, we constructed the prognostic model for PRAD based on the 5 genes (IER3, AOX1, PRKCDBP, UBD, and FBLN5). Nomograms incorporating risk score and other clinical variables were further constructed, and these nomograms exhibited superior predictive ability. We further compared the differential immune infiltrating patterns in 2 risk groups and found significantly low levels of infiltrating cluster of differentiation (CD)8+ T cells in high-risk samples. Conclusions Our study integrated the multi-omics data to elucidate the molecular features of PRAD and pivotal genes for predicting prognosis.
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Affiliation(s)
- Chunwei Ye
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhipeng Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chengxing Xia
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shunhui Yuan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruping Yan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaofang Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Ma
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xingqiao Wen
- Department of Urology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Delin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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14
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Comparative Survival Outcomes of High-risk Prostate Cancer Treated with Radical Prostatectomy or Definitive Radiotherapy Regimens. EUR UROL SUPPL 2021; 26:55-63. [PMID: 34337508 PMCID: PMC8317873 DOI: 10.1016/j.euros.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Observational data has indicated improved survival after radical prostatectomy (RP) compared with definitive radiotherapy (RT) in men with high-risk prostate cancer (PCa). Objective To compare PCa-specific mortality (PCSM) and overall mortality (OM) in men with high-risk PCa treated with RP or RT, providing information on target doses and fractionations. Design, setting, and participants This is an observational study from the Cancer Registry of Norway. Patients were diagnosed with high-risk PCa during 2006–2015, treated with RP ≤12 mo or RT ≤15 mo after diagnosis, and stratified according to RP or RT modality; external beam radiotherapy (EBRT; 70–<74, 74–<78, or 78 Gy), hypofractionated RT or EBRT combined with brachytherapy (BT-RT). Outcome measurements and statistical analysis Competing risk and Kaplan-Meier methods estimated PCSM and OM, respectively. Multivariable Cox regression models evaluated hazard ratios (HRs) for PCSM and OM. Results and limitations In total, 9254 patients were included (RP 47%, RT 53%). RT patients were older, had poorer performance status and more unfavorable disease characteristics. With a median follow-up time of seven and eight yrs, the overall 10-yr PCSM was 7.2% (95% confidence interval [CI] 6.4–8.0) and OM was 22.9% (95% CI 21.8–24.1). Compared with RP, EBRT 70–<74 Gy was associated with increased (HR 1.88, 95% CI 1.33–2.65, p < 0.001) and BT-RT with decreased (HR 0.49, 95% CI 0.24–0.96, p = 0.039) 10-yr PCSM. Patients treated with EBRT 70–78 Gy had higher adjusted 10-yr OM than those treated with RP. Conclusions In men with high-risk PCa, treatment with EBRT <74 Gy was associated with increased adjusted 10-yr PCSM and OM, and BT-RT with decreased 10-yr PCSM, compared with RP. Patient summary In this study, we compared mortality after radical prostatectomy (RP) and radiotherapy (RT) in men with high-risk prostate cancer (PCa); the results suggest that men receiving lower-dose RT have higher, and patients receiving brachytherapy may have lower, risk of death from PCa than patients treated with prostatectomy.
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Taylor JM, Chen VE, Miller RC, Greenberger BA. The Impact of Prostate Cancer Treatment on Quality of Life: A Narrative Review with a Focus on Randomized Data. Res Rep Urol 2020; 12:533-546. [PMID: 33150144 PMCID: PMC7605665 DOI: 10.2147/rru.s243088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023] Open
Abstract
Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best made in an informed and shared medical decision-making process between clinician and patient with respect to cancer control as well as adverse effects. We outline in this narrative review an understanding regarding implications of surgical and radiation treatment on quality of life after treatment, and how these data may be considered in the context of advising patients regarding the selection of therapy. This narrative review largely focuses on the quality of life data obtained from prospective randomized trials of men treated for prostate cancer. We believe this provides the best assessment of the quality of life and can be used to inform patients when making treatment decisions.
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Affiliation(s)
- James M Taylor
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Victor E Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan C Miller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
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16
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Taguchi S, Shiraishi K, Fukuhara H. Updated evidence on oncological outcomes of surgery versus external beam radiotherapy for localized prostate cancer. Jpn J Clin Oncol 2020; 50:963-969. [PMID: 32580211 DOI: 10.1093/jjco/hyaa105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/31/2020] [Indexed: 11/12/2022] Open
Abstract
Radical prostatectomy and external beam radiotherapy are recognized as comparable treatment options for localized prostate cancer. Previous studies of oncological outcomes of surgery versus radiotherapy have reported their comparability or possible superiority of surgery. However, the issue of which treatment is better remains controversial. Several factors make fair comparison of their outcomes difficult: different patient backgrounds caused by selection bias, different definitions of biochemical recurrence and different complication profiles between the treatment modalities. In 2016, the first large randomized controlled trial was published, which compared radical prostatectomy, external beam radiotherapy and active monitoring in localized prostate cancer. More recently, another study has reported comparative outcomes of robot-assisted radical prostatectomy and volumetric modulated arc therapy, as the leading surgery and radiotherapy techniques, respectively. Furthermore, there has been a trend toward combining external beam radiotherapy with brachytherapy boost, especially in patients with high-risk prostate cancer. This review summarizes the updated evidence on oncological outcomes of surgery versus external beam radiotherapy for localized prostate cancer.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
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17
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Ashrafi AN, Yip W, Aron M. Neoadjuvant Therapy in High-Risk Prostate Cancer. Indian J Urol 2020; 36:251-261. [PMID: 33376260 PMCID: PMC7759181 DOI: 10.4103/iju.iju_115_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023] Open
Abstract
High-risk prostate cancer (PCa) is associated with higher rates of biochemical recurrence, clinical recurrence, metastasis, and PCa-specific death, compared to low-and intermediate-risk disease. Herein, we review the various definitions of high-risk PCa, describe the rationale for neoadjuvant therapy prior to radical prostatectomy, and summarize the contemporary data on neoadjuvant therapies. Since the 1990s, several randomized trials of neoadjuvant androgen deprivation therapy (ADT) have consistently demonstrated improved pathological parameters, specifically tumor downstaging and reduced extraprostatic extension, seminal vesicle invasion, and positive surgical margins without improvements in cancer-specific or overall survival. These studies, however, were not exclusive to high-risk patients and were limited by suboptimal follow-up periods. Newer studies of neoadjuvant ADT in high-risk PCa show promising pathological and oncological outcomes. Recent level 1 data suggests neoadjuvant chemohormonal therapy (CHT) may improve longer-term survival in high-risk PCa. Immunologic neoadjuvant trials are in their infancy, and further study is required. Neoadjuvant therapies may be promising additions to the multimodal therapeutic landscape of high-risk and locally advanced PCa in the near future.
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Affiliation(s)
- Akbar N. Ashrafi
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, California, USA
- Division of Surgery, North Adelaide Local Health Network, SA Health, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Wesley Yip
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, California, USA
| | - Monish Aron
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, California, USA
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Zaorsky NG, Spratt DE, Kishan AU, Culp SH, Showalter TN. Editorial: Optimizing Local Therapy for High-Risk Prostate Cancer: Evidence and Emerging Options. Front Oncol 2020; 10:1616. [PMID: 32984028 PMCID: PMC7481351 DOI: 10.3389/fonc.2020.01616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | - Daniel E Spratt
- Department of Radiation Oncology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Stephen H Culp
- Department of Urology, University of Virginia, Charlottesville, VA, United States
| | - Timothy N Showalter
- Department of Radiation Oncology, School of Medicine, University of Virginia, Charlottesville, VA, United States
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Tilki D, Chandrasekar T. Localized Prostate Cancer: Exploring the Boundaries of Current Treatment Paradigms. Eur Urol Focus 2020; 6:199-200. [PMID: 32057738 DOI: 10.1016/j.euf.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
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