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See AW, Conway P, Frydenberg M, Haxhimolla H, Costello AJ, Moon D, Ruljancich P, Grummet J, Pranavan G, Peters J, Smyth LML, Gwini SM, McKenzie DP, Bowden P. Five-year outcomes of fractionated stereotactic body radiotherapy for oligometastatic prostate cancer from the TRANSFORM phase II trial. Int J Cancer 2024; 155:1248-1256. [PMID: 38898626 DOI: 10.1002/ijc.35052] [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: 02/22/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
Metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa), including stereotactic body radiotherapy (SBRT), has shown promise but is still considered investigational. This is the 5-year analysis of the TRANSFORM trial, the largest prospective cohort of men with oligometastatic PCa treated with SBRT-based MDT. The primary endpoint was 5-year treatment escalation-free survival (TE-FS), defined as freedom from any new cancer therapy other than further SBRT. In total, 199 men received SBRT; 76.4% were hormone-naïve at baseline. The rate of 5-year TE-FS was 21.7% (95% confidence interval [CI]: 15.7%-28.7%) overall and 25.4% (95% CI: 18.1%-33.9%) in the hormone-naïve subgroup. The subgroups with International Society of Urological Pathology Grade Groups 4-5 disease (hazard ratio [HR] = 1.48, 95% CI: 1.05-2.01, p = .026), a higher baseline prostate-specific antigen (PSA) (HR = 1.06, 95% CI: 1.03-1.09, p < .001) and those who received prior androgen deprivation therapy (ADT) (HR = 2.13, 95% CI: 1.40-3.26, p < .001), were at greater risk of treatment escalation. Outcomes for participants with four or five initial lesions were comparable to those with one to three lesions. At last follow-up, 18.9% (95% CI: 13.2%-25.7%) of participants were free from treatment escalation (median follow-up of 67.9 months) and two participants had an undetectable PSA level. No treatment-related grade three or higher adverse events were reported. The findings of this study demonstrate that SBRT-based MDT is an effective option for delaying systemic treatment escalation in the context of oligometastatic PCa. Future randomised trials comparing SBRT-based MDT to standard-of-care ADT-based approaches are required to evaluate the impact of delaying ADT on survival.
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Affiliation(s)
- Andrew W See
- Icon Cancer Centre, Richmond, Victoria, Australia
| | - Paul Conway
- Icon Cancer Centre, Richmond, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Hodo Haxhimolla
- Department of Urology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony J Costello
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Moon
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| | | | - Jeremy Grummet
- Epworth HealthCare, Richmond, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ganes Pranavan
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Justin Peters
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Stella M Gwini
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Dean P McKenzie
- Epworth HealthCare, Richmond, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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Tilki D, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, Eberli D, De Meerleer G, De Santis M, Farolfi A, Gandaglia G, Gillessen S, Grivas N, Henry AM, Lardas M, J L H van Leenders G, Liew M, Linares Espinos E, Oldenburg J, van Oort IM, Oprea-Lager DE, Ploussard G, Roberts MJ, Rouvière O, Schoots IG, Schouten N, Smith EJ, Stranne J, Wiegel T, Willemse PPM, Cornford P. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Part II-2024 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol 2024; 86:164-182. [PMID: 38688773 DOI: 10.1016/j.eururo.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (PCa) have been updated. Here we provide a summary of the 2024 guidelines. METHODS The panel performed a literature review of new data, covering the time frame between 2020 and 2023. The guidelines were updated and a strength rating for each recommendation was added on the basis of a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. New treatment options, such as androgen receptor-targeted agents (ARTAs), ARTA + chemotherapy combinations, PARP inhibitors and their combinations, and prostate-specific membrane antigen-based therapy have become available for men with metastatic PCa. CONCLUSIONS AND CLINICAL IMPLICATIONS Evidence for relapsing, metastatic, and castration-resistant PCa is evolving rapidly. These guidelines reflect the multidisciplinary nature of PCa management. The full version is available online (http://uroweb.org/guideline/ prostate-cancer/). PATIENT SUMMARY This article summarises the 2024 guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are based on evidence and guide doctors in discussing treatment decisions with their patients. The guidelines are updated every year.
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Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.
| | | | | | | | | | - Julie Darraugh
- European Association of Urology, Arnhem, The Netherlands
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Maria De Santis
- Department of Urology, Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | | | - Matthew Liew
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | | | - Jan Oldenburg
- Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | | | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, Australia
| | - Olivier Rouvière
- Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon, France
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Emma J Smith
- European Association of Urology, Arnhem, The Netherlands
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
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3
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Nickols NG, Tsai S, Kane N, Tran S, Ghayouri L, Diaz-Perez S, Thein M, Anderson-Berman N, Eason J, Kishan AU, Steinberg ML, Reiter RE, Lee SP, Gin GE, Kwon R, Chang MG, Chao HH, Solanki AA, Sexton R, Lewis M, Lorentz W, Cheung MK, Gage DL, Duriseti S, Valle L, Berenji G, Aronson WJ, Garraway IP, Rettig MB. Systemic and Tumor-directed Therapy for Oligometastatic Prostate Cancer: The SOLAR Phase 2 Trial in De Novo Oligometastatic Prostate Cancer. Eur Urol 2024; 86:190-193. [PMID: 38490853 DOI: 10.1016/j.eururo.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Nicholas G Nickols
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sonny Tsai
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nathanael Kane
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samantha Tran
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Leila Ghayouri
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Silvia Diaz-Perez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - May Thein
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | - Jeanie Eason
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steve P Lee
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Greg E Gin
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Robert Kwon
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | | | - Abhiskek A Solanki
- Department of Radiation Oncology, Loyola University and Hines VA Medical Center, Chicago, IL, USA
| | | | - Michael Lewis
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - William Lorentz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael K Cheung
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Diana L Gage
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sai Duriseti
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Luca Valle
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gholam Berenji
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - William J Aronson
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Isla P Garraway
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matthew B Rettig
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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4
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Urso L, Cittanti C, Manco L, Ortolan N, Borgia F, Malorgio A, Scribano G, Mastella E, Guidoboni M, Stefanelli A, Turra A, Bartolomei M. ML Models Built Using Clinical Parameters and Radiomic Features Extracted from 18F-Choline PET/CT for the Prediction of Biochemical Recurrence after Metastasis-Directed Therapy in Patients with Oligometastatic Prostate Cancer. Diagnostics (Basel) 2024; 14:1264. [PMID: 38928679 PMCID: PMC11202947 DOI: 10.3390/diagnostics14121264] [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: 05/16/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Oligometastatic patients at [18F]F-Fluorocholine (18F-choline) PET/CT may be treated with metastasis-directed therapy (MDT). The aim of this study was to combine radiomic parameters extracted from 18F-choline PET/CT and clinical data to build machine learning (ML) models able to predict MDT efficacy. METHODS Oligorecurrent patients (≤5 lesions) at 18F-choline PET/CT and treated with MDT were collected. A per-patient and per-lesion analysis was performed, using 2-year biochemical recurrence (BCR) after MDT as the standard of reference. Clinical parameters and radiomic features (RFts) extracted from 18F-choline PET/CT were used for training five ML Models for both CT and PET images. The performance metrics were calculated (i.e., Area Under the Curve-AUC; Classification Accuracy-CA). RESULTS A total of 46 metastases were selected and segmented in 29 patients. BCR after MDT occurred in 20 (69%) patients after 2 years of follow-up. In total, 73 and 33 robust RFTs were selected from CT and PET datasets, respectively. PET ML Models showed better performances than CT Models for discriminating BCR after MDT, with Stochastic Gradient Descent (SGD) being the best model (AUC = 0.95; CA = 0.90). CONCLUSION ML Models built using clinical parameters and CT and PET RFts extracted via 18F-choline PET/CT can accurately predict BCR after MDT in oligorecurrent PCa patients. If validated externally, ML Models could improve the selection of oligorecurrent PCa patients for treatment with MDT.
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Affiliation(s)
- Luca Urso
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.U.); (C.C.); (N.O.); (F.B.); (M.G.)
- Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Corrado Cittanti
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.U.); (C.C.); (N.O.); (F.B.); (M.G.)
- Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Luigi Manco
- Medical Physics Unit, University Hospital of Ferrara, 44124 Ferrara, Italy; (E.M.); (A.T.)
| | - Naima Ortolan
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.U.); (C.C.); (N.O.); (F.B.); (M.G.)
- Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Francesca Borgia
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.U.); (C.C.); (N.O.); (F.B.); (M.G.)
- Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Antonio Malorgio
- U.O.C. Radiotherapy, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.M.); (A.S.)
| | - Giovanni Scribano
- Department of Physics and Earth Science, University of Ferrara, 44121 Ferrara, Italy;
| | - Edoardo Mastella
- Medical Physics Unit, University Hospital of Ferrara, 44124 Ferrara, Italy; (E.M.); (A.T.)
| | - Massimo Guidoboni
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.U.); (C.C.); (N.O.); (F.B.); (M.G.)
- U.O.C. Clinical Oncology, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Antonio Stefanelli
- U.O.C. Radiotherapy, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.M.); (A.S.)
| | - Alessandro Turra
- Medical Physics Unit, University Hospital of Ferrara, 44124 Ferrara, Italy; (E.M.); (A.T.)
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, 44124 Ferrara, Italy;
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Yoo GS, Park S, Rim CH, Cho WK, Chang AR, Kim YS, Ahn YC, Chie EK. Radiation Oncologists' Perspectives on Oligometastatic Prostate Cancer: A Survey from Korean Oligometastasis Working Group. Curr Oncol 2024; 31:3239-3251. [PMID: 38920729 PMCID: PMC11203304 DOI: 10.3390/curroncol31060245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/25/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists. METHODS We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6-9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0-29.9%, 30-49.9%, 50-69.9%, 70-79.9%, 80-89.9%, and 90-100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively. RESULTS Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume. CONCLUSION For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Sunmin Park
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Seoul 15355, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Seoul 15355, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology/Cyberknife Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, Ulsan University School of Medicine, Seoul 05505, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Wang B, Pan J, Zhang T, Ni X, Wei Y, Li X, Fang B, Hu X, Gan H, Wu J, Wang H, Ye D, Zhu Y. Protocol for CHAMPION study: a prospective study of maximal-cytoreductive therapies for patients with de novo metastatic hormone-sensitive prostate cancer who achieve oligopersistent metastases during systemic treatment with apalutamide plus androgen deprivation therapy. BMC Cancer 2024; 24:643. [PMID: 38796422 PMCID: PMC11127327 DOI: 10.1186/s12885-024-12395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND The proposed trial is to examine the feasibility of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided cytoreduction plus apalutamide and androgen deprivation therapy (ADT) for newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) at oligometastatic state. METHODS CHAMPION (NCT05717582) is an open-label, single-arm, phase II trial, planning to enroll newly diagnosed mHSPC cases with oligometastases (≤ 10 distant metastatic sites in conventional imaging). Patients will receive 6 cycles of apalutamide plus ADT. Patients with oligometastatic disease at PSMA PET/CT after 3 treatment cycles will receive cytoreductive radical prostatectomy. PSMA PET/CT-guided metastasis-directed external radiation therapy will be determined by the investigators. Apalutamide plus ADT will be continued for 2 weeks postoperatively. The primary endpoint is the proportion of patients with undetectable prostate-specific antigen (PSA), no disease progression, and no symptom deterioration after 6 cycles of apalutamide plus ADT. Secondary endpoints include the percentage of patients with PSA ≤ 0.2 ng/mL and oligometastases by the end of 3 treatment cycles, PSA response rate, and safety. Fleming's two-stage group sequential design will be adopted in the study, where the null hypothesis is that the rate of patients with an undetectable PSA is ≤ 40% after 6 cycles of treatment, while the alternate hypothesis is an undetectable PSA of > 60%; with one-sided α = 0.05, power = 0.80, and an assumed dropout rate of 10%, the required number of patients for an effective analysis is 47. Enrolment in the study commenced in May 2023. DISCUSSION The multi-modal therapy based on treatment response may improve the prognosis of newly diagnosed mHSPC patients with oligometastases. TRIAL REGISTRATION The study is registered with Clinical Trials.Gov (NCT05717582). Registered on 8th February 2023.
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Affiliation(s)
- Beihe Wang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Pan
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tingwei Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xudong Ni
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Wei
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomeng Li
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bangwei Fang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoxin Hu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hualei Gan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Junlong Wu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongkai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
- Shanghai Genitourinary Cancer Institute, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
- Shanghai Genitourinary Cancer Institute, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Sood A, Kishan AU, Evans CP, Feng FY, Morgan TM, Murphy DG, Padhani AR, Pinto P, Van der Poel HG, Tilki D, Briganti A, Abdollah F. The Impact of Positron Emission Tomography Imaging and Tumor Molecular Profiling on Risk Stratification, Treatment Choice, and Oncological Outcomes of Patients with Primary or Relapsed Prostate Cancer: An International Collaborative Review of the Existing Literature. Eur Urol Oncol 2024; 7:27-43. [PMID: 37423774 DOI: 10.1016/j.euo.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/06/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
CONTEXT The clinical introduction of next-generation imaging methods and molecular biomarkers ("radiogenomics") has revolutionized the field of prostate cancer (PCa). While the clinical validity of these tests has thoroughly been vetted, their clinical utility remains a matter of investigation. OBJECTIVE To systematically review the evidence to date on the impact of positron emission tomography (PET) imaging and tissue-based prognostic biomarkers, including Decipher, Prolaris, and Oncotype Dx, on the risk stratification, treatment choice, and oncological outcomes of men with newly diagnosed PCa or those with biochemical failure (BCF). EVIDENCE ACQUISITION We performed a quantitative systematic review of the literature using the MEDLINE, EMBASE, and Web of Science databases (2010-2022) following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. The validated Quality Assessment of Diagnostic Accuracy Studies 2 scoring system was used to assess the risk of bias. EVIDENCE SYNTHESIS A total of 148 studies (130 on PET and 18 on biomarkers) were included. In the primary PCa setting, prostate-specific membrane antigen (PSMA) PET imaging was not useful in improving T staging, moderately useful in improving N staging, but consistently useful in improving M staging in patients with National Comprehensive Cancer Network (NCCN) unfavorable intermediate- to very-high-risk PCa. Its use led to a management change in 20-30% of patients. However, the effect of these treatment changes on survival outcomes was not clear. Similarly, biomarkers in the pretherapy primary PCa setting increased and decreased the risk, respectively, in 7-30% and 32-36% of NCCN low-risk and 31-65% and 4-15% of NCCN favorable intermediate-risk patients being considered for active surveillance. A change in management was noted in up to 65% of patients, with the change being in line with the molecular risk-based reclassification, but again, the impact of these changes on survival outcomes remained unclear. Notably, in the postsurgical primary PCa setting, biomarker-guided adjuvant radiation therapy (RT) was associated with improved oncological control: Δ↓ 2-yr BCF by 22% (level 2b). In the BCF setting, the data were more mature. PSMA PET was consistently useful in improving disease localization-Δ↑ detection for T, N, and M staging was 13-32%, 19-58%, and 9-29%, respectively. Between 29% and 73% of patients had a change in management. Most importantly, these management changes were associated with improved survival outcomes in three trials: Δ↑ 4-yr disease-free survival by 24.3%, Δ↑ 6-mo metastasis-free survival (MFS) by 46.7%, and Δ↑ androgen deprivation therapy-free survival by 8 mo in patients who received PET-concordant RT (level 1b-2b). Biomarker testing in these patients also appeared to be helpful in risk stratifying and guiding the use of early salvage RT (sRT) and concomitant hormonal therapy. Patients with high-genomic-risk scores benefitted from treatment intensification: Δ↑ 8-yr MFS by 20% with the use of early sRT and Δ↑ 12-yr MFS by 11.2% with the use of hormonal therapy alongside early sRT, while low-genomic-risk score patients did equally well with initial conservative management (level 3). CONCLUSIONS Both PSMA PET imaging and tumor molecular profiling provide actionable information in the management of men with primary PCa and those with BCF. Emerging data suggest that radiogenomics-guided treatments translate into direct survival benefits for patients, however, additional prospective data are awaited. PATIENT SUMMARY In this review, we evaluated the utility of prostate-specific membrane antigen positron emission tomography and tumor molecular profiling in guiding the care of men with prostate cancer (PCa). We found that these tests augmented risk stratification, altered management, and improved cancer control in men with a new diagnosis of PCa or for those experiencing a relapse.
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Affiliation(s)
- Akshay Sood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Amar U Kishan
- Department of Radiation Oncology and Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher P Evans
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Declan G Murphy
- Department of Genitourinary Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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Milenkovic U, Kuijk J, Roussel E, Devos G, Van den Broeck T, Van Eecke H, Vanderstichele A, Duvillier T, Verhamme L, Van Haute W, Goeman L, Berghen C, Joniau S, De Meerleer G. Predictors of Recurrence After Metastasis-directed Therapy in Oligorecurrent Prostate Cancer Following Radical Prostatectomy. Eur Urol Oncol 2023; 6:582-589. [PMID: 36878753 DOI: 10.1016/j.euo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 01/12/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Metastasis-directed therapy (MDT) is performed to delay systemic treatments for oligorecurrent disease after primary prostate cancer (PCa) treatment. OBJECTIVE The aim of this study was to identify the predictors of therapeutic response of MDT for oligorecurrent PCa. DESIGN, SETTING, AND PARTICIPANTS bicentric, retrospective study, including consecutive patients who underwent MDT for oligorecurrent PCa after radical prostatectomy (RP; 2006-2020) was conducted. MDT encompassed stereotactic body radiation therapy (SBRT), salvage lymph node dissection (sLND), whole-pelvis/retroperitoneal radiation therapy (WP[R]RT), or metastasectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS ndpoints were 5-yr radiographic progression-free survival (rPFS), metastasis-free survival (MFS), palliative androgen deprivation treatment (pADT)-free survival, and overall survival (OS) together with prognostic factors for MFS following primary MDT. Survival outcomes were studied by Kaplan-Meier survival and univariable Cox regression (UVA). RESULTS AND LIMITATIONS A total of 211 MDT patients were included; 122 (58%) developed a secondary recurrence. Salvage lymph node dissection was performed in 119 (56%), SBRT in 48 (23%), and WP(R)RT in 31 (15%) of the cases. Two patients received sLND + SBRT and one received sLND + WPRT. Eleven (5%) patients received metastasectomies. The median follow-up since RP was 100 mo, while follow-up after MDT was 42 mo. The 5-yr rPFS, MFS, androgen deprivation treatment(-free survival, castration-resistant prostate cancer-free survival, CSS, and OS after MDT were 23%, 68%, 58%, 82%, 93%, and 87% respectively. There was a statistically significant difference between cN1 (n = 114) and cM+ (n = 97) for 5-yr MFS (83% vs 51%, p < 0.001), pADT-free survival (70% vs 49%, p = 0.014), and CSS (100% vs 86%, p = 0.019). UVA was performed to assess the risk factors (RFs) for MFS in cN1 and cM+. Alpha was set at 10%. RFs for MFS in cN1 were lower initial prostate-specific antigen (PSA) at the time of RP (hazard ratio [95% confidence interval] 0.15 [0.02-1.02], p = 0.053], pN stage at RP (2.91 [0.83-10.24], p = 0.096), nonpersisting PSA after RP (0.47 [0.19-1.12], p = 0.089), higher PSA at primary MDT (2.38 [1.07-5.24], p = 0.032), and number of positive nodes on imaging (1.65 [1.14-2.40], p < 0.01). RFs for MFS in cM+ were higher pathological Gleason score (1.86 [0.93-3.73], p = 0.078), number of lesions on imaging (0.77 [0.57-1.04], p = 0.083), and cM1b/cM1c (non-nodal metastatic recurrence; 2.62 [1.58-4.34], p < 0.001). CONCLUSIONS Following MDT, 23% of patients were free of a second recurrence at 5-yr follow-up. Moreover, cM+ patients had significantly worse outcomes in terms of MFS, pADT-free survival, and CSS. The RFs for a metastatic recurrence can be used for counseling patients, to inform prognosis, and potentially select candidates for MDT. PATIENT SUMMARY In this paper, we looked at the outcomes of using localized, patient-tailored treatment for imaging-detected recurrent prostate cancer in lymph nodes, bone, or viscera (maximum five recurrences on imaging). Our results showed that targeted treatment of the metastatic lesions could delay the premature use of hormone therapy.
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Affiliation(s)
- Uros Milenkovic
- Department of Urology, AZ Delta, Roeselare, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Joke Kuijk
- Department of Urology, AZ Delta, Roeselare, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Gaetan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Henri Van Eecke
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | - Charlien Berghen
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, AZ Delta, Roeselare, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
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Landen L, Devos G, Joniau S, Albersen M. Penile metastasis in prostate cancer patients: Two case reports, surgical excision technique, and literature review. Curr Urol 2023; 17:165-172. [PMID: 37448616 PMCID: PMC10337815 DOI: 10.1097/cu9.0000000000000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Two cases of penile metastasis from primary prostate cancer in a single center are presented, along with a literature review and description of the excision technique. Despite its rich vascularization, penile metastasis is rare, with 72 new cases from September 2006 to March 2021. There is a wide variety of diagnoses, treatments, and prognoses for penile metastatic lesions. Ga-68 prostatespecific membrane antigen positron emission tomography/computed tomography is the most sensitive imaging tool for detecting metastasis from primary prostate cancer. Magnetic resonance imaging of the penis is the most reliable technique for differentiating penile lesions. Histological diagnosis is mostly performed using fine-needle biopsy aspiration. Metastasis-directed treatment is not considered to contribute to prolonged survival. Local treatment is feasible and can be offered to symptomatic patients. Owing to a heterogeneous group, defining overall survival is difficult. Survival until 46months after detecting penile metastases is described.
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Affiliation(s)
- Lucas Landen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Varga L, Besenyi Z, Paczona VR, Farkas I, Urbán S, Sipka G, Pávics L, Varga Z, Fodor E, Hideghéty K, Olah J, Bajory Z, Maráz A. Prostate-specific membrane antigen-based imaging for stereotactic irradiation of low-volume progressive prostate cancer: a single-center experience. Front Oncol 2023; 13:1166665. [PMID: 37637070 PMCID: PMC10448522 DOI: 10.3389/fonc.2023.1166665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Prostate-specific membrane antigen (PSMA) is a transmembrane protein that may be expressed on the surface of prostate cancer (PC) cells. It enables a more sensitive and specific diagnosis PC, compared to conventional anatomical imaging. Aim The integration of PSMA-based imaging in the personalized radiotherapy of PC patients and the evaluation of its impact on target volume definition if stereotactic body radiotherapy (SBRT) is planned for locally recurrent or oligometastatic disease. Patients and methods The data from 363 examinations were analyzed retrospectively. Inclusion criteria were histologically verified PC and clinical data suggesting local recurrence or distant metastasis. Whole-body 99mTc-PSMA-I&S single-photon emission computed tomography (SPECT)/CT or 18F-JK-PSMA-7 positron emission tomography/computer tomography (PET/CT) was carried out, and the evaluation of the scans and biological tumor volume contouring was performed at the Department of Nuclear Medicine. The target volume delineation on topometric CT (TCT) scan was performed at the Department of Oncotherapy. The comparison of the two volumes was performed by image fusion and registration. Results From 363 PSMA isotope-based examinations, 84 lesions of 64 patients were treated with SBRT. In 50 patients, 70 lesions were examined for intermodality comparison. The target volume defined by the PSMA density was significantly smaller than the tumor size defined by the TCT scan: GTVCT (gross tumor volume on the TCT), 27.58 ± 46.07 cm3; BTVPSMA (biological target volume on the PSMA-based examination), 16.14 ± 29.87 cm3. During geometrical analyses, the Dice similarity coefficient (DSC) was 0.56 ± 0.20 (0.07-0.85). Prostate-specific antigen (PSA) control was performed to evaluate the response: mean pre-radiotherapy (pre-RT) PSA was 16.98 ng/ml ( ± SD: 33.81), and post-RT PSA at 3 months after SBRT was 11.19 ng/ml ( ± SD: 32.85). Three-month post-therapy PSMA-based imaging was performed in 14 cases, in which we observed a decrease or cessation of isotope uptake. Conventional imaging control was performed in 42 cases (65.6% of all cases): 22 (52.4%) complete remissions, 14 (33.3%) partial remissions, four (9.5%) stable diseases, and two (4.8%) progressive diseases were described. Conclusion PSMA-based imaging is a promising diagnostic method for specifying the stage and detecting the low-volume progression. Our results suggest that PSMA-based hybrid imaging can influence treatment decisions and target volume delineation for SBRT.
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Affiliation(s)
- Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | | | - István Farkas
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Urbán
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Sipka
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - László Pávics
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zoltan Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Judit Olah
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Bajory
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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11
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Metastatic Sites' Location and Impact on Patient Management After the Introduction of Prostate-specific Membrane Antigen Positron Emission Tomography in Newly Diagnosed and Biochemically Recurrent Prostate Cancer: A Critical Review. Eur Urol Oncol 2023; 6:128-136. [PMID: 36804735 DOI: 10.1016/j.euo.2023.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
CONTEXT The introduction of prostate-specific membrane antigen positron emission tomography (PSMA-PET) had a substantial impact on the management of prostate cancer (PCa) patients with a stage migration phenomenon and consequent treatment changes. OBJECTIVE To summarise the role of PSMA-PET to define the burden of disease through an accurate location of metastatic site(s) in PCa patients, describing the most common locations at PSMA-PET in the primary staging and recurrence setting, and to assess the clinical impact in the decision-making process. EVIDENCE ACQUISITION A comprehensive nonsystematic literature review was performed in April 2022. Literature search was updated until March 2022. The most relevant studies have been summarised, giving priority to registered clinical trials and multicentre collaborations. EVIDENCE SYNTHESIS PSMA-PET showed higher diagnostic accuracy than conventional imaging both in newly diagnosed PCa and in recurrent disease. This greater accuracy led to a migration of a higher proportion of patients identified with metastatic disease. Bone metastases were reported as the most frequent site of metastatic spread in staging (up to 17%) and restaging (up to 18%). In staging, considering the suboptimal sensitivity in lymph node metastasis detection prior to radical surgery, PSMA-PET should be performed in patients with high risk or unfavourable intermediate risk only, and it is not recommended to routinely avoid pelvic lymph node dissection in case of a negative scan. In case of prostate-specific antigen relapse, PSMA-PET had higher diagnostic accuracy than other diagnostic procedures in the early detection of the sites of recurrence, thus influencing the therapy decision-making process. CONCLUSIONS PSMA-PET detects a higher number of lesions than conventional imaging or other PET radiotracers, especially metastatic lesions unseen with other modalities. The high diagnostic accuracy of PSMA-PET leads to a significant patient upstage and thus an impact in clinical management, even if the overall impact on cancer mortality is still to be assessed. PATIENT SUMMARY Prostate-specific membrane antigen positron emission tomography (PSMA-PET) identifies metastatic lesions with higher accuracy than conventional imaging, both in primary prostate cancer and during disease recurrence. Skeletal metastasis and extrapelvic lymph nodes are the most common sites of metastatic spread. The high accuracy of PSMA-PET in the detection of metastatic disease led to a significant impact on patient management, even if the overall impact on cancer mortality is still to be assessed.
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12
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Prostate-specific Membrane Antigen Positron Emission Tomography in the Staging of Newly Diagnosed Prostate Cancer: Is More Sensitivity Always Better? Eur Urol 2023; 83:481-483. [PMID: 36774222 DOI: 10.1016/j.eururo.2023.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
Higher diagnostic accuracy, even if desirable, is not automatically associated with better outcomes. If used in settings validated with less sensitive imaging modalities, it is of paramount importance to prospectively ascertain that the higher sensitivity of prostate-specific antigen membrane-based imaging will benefit patients, and will probably not do harm.
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13
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Klusa D, Lohaus F, Franken A, Baumbach M, Cojoc M, Dowling P, Linge A, Offermann A, Löck S, Hušman D, Rivandi M, Polzer B, Freytag V, Lange T, Neubauer H, Kücken M, Perner S, Hölscher T, Dubrovska A, Krause M, Kurth I, Baumann M, Peitzsch C. Dynamics of CXCR4 positive circulating tumor cells in prostate cancer patients during radiotherapy. Int J Cancer 2023; 152:2639-2654. [PMID: 36733230 DOI: 10.1002/ijc.34457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
Ablative radiotherapy is a highly efficient treatment modality for patients with metastatic prostate cancer (PCa). However, a subset of patients does not respond. Currently, this subgroup with bad prognosis cannot be identified before disease progression. We hypothesize that markers indicative of radioresistance, stemness and/or bone tropism may have a prognostic potential to identify patients profiting from metastases-directed radiotherapy. Therefore, circulating tumor cells (CTCs) were analyzed in patients with metastatic PCa (n = 24) during radiotherapy with CellSearch, multicolor flow cytometry and imaging cytometry. Analysis of copy-number alteration indicates a polyclonal CTC population that changes after radiotherapy. CTCs were found in 8 out of 24 patients (33.3%) and were associated with a shorter time to biochemical progression after radiotherapy. Whereas the total CTC count dropped after radiotherapy, a chemokine receptor CXCR4-expressing subpopulation representing 28.6% of the total CTC population remained stable up to 3 months. At once, we observed higher chemokine CCL2 plasma concentrations and proinflammatory monocytes. Additional functional analyses demonstrated key roles of CXCR4 and CCL2 for cellular radiosensitivity, tumorigenicity and stem-like potential in vitro and in vivo. Moreover, a high CXCR4 and CCL2 expression was found in bone metastasis biopsies of PCa patients. In summary, panCK+ CXCR4+ CTCs may have a prognostic potential in patients with metastatic PCa treated with metastasis-directed radiotherapy.
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Affiliation(s)
- Daria Klusa
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Fabian Lohaus
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andre Franken
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University, Düsseldorf, Germany
| | - Marian Baumbach
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Monica Cojoc
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Paul Dowling
- Department of Biology, Maynooth University, Maynooth, Ireland
| | - Annett Linge
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anne Offermann
- Institute of Pathology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Mahdi Rivandi
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University, Düsseldorf, Germany
| | - Bernhard Polzer
- Division of Personalized Tumor Therapy, Fraunhofer-Institute for Toxicology and Experimental Medicine, Regensburg, Germany
| | - Vera Freytag
- Institute of Anatomy and Experimental Morphology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Lange
- Institute of Anatomy and Experimental Morphology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Neubauer
- Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Kücken
- Department for Innovative Methods of Computing, Center for Principal component Information Services and High-Performance Computing (ZIH), Technische Universität, Dresden, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Tobias Hölscher
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Dubrovska
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Mechthild Krause
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Ina Kurth
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Baumann
- Department of Radiation Oncology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Peitzsch
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
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Zilli T, Achard V, Dal Pra A, Schmidt-Hegemann N, Jereczek-Fossa BA, Lancia A, Ingrosso G, Alongi F, Aluwini S, Arcangeli S, Blanchard P, Conde Moreno A, Couñago F, Créhange G, Dirix P, Gomez Iturriaga A, Guckenberger M, Pasquier D, Sargos P, Scorsetti M, Supiot S, Tree AC, Zapatero A, Le Guevelou J, Ost P, Belka C. Recommendations for radiation therapy in oligometastatic prostate cancer: An ESTRO-ACROP Delphi consensus. Radiother Oncol 2022; 176:199-207. [PMID: 36228761 DOI: 10.1016/j.radonc.2022.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices. MATERIAL AND METHODS A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists' experts in prostate cancer was asked to answer a dedicated questionnaire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer. RESULTS The panel achieved consensus on patient selection and routine use of prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligoprogressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented. CONCLUSION These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of randomized trials are available.
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Affiliation(s)
- Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrea Lancia
- Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | - Gianluca Ingrosso
- Department of Radiation Oncology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar di Valpolicella, Italy; University of Brescia, Brescia, Italy
| | - Shafak Aluwini
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Pierre Blanchard
- Université Paris Saclay, Villejuif, France; Inserm U1018 Oncostat, Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Antonio Conde Moreno
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, CEU Cardenal Herrera University, Castellón, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Department of Radiation Oncology, Hospital La Luz, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea, Villaviciosa de Odón, Madrid, Spain
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Piet Dirix
- Department of Radiation-Oncology, Iridium Network, Antwerp, Belgium
| | - Alfonso Gomez Iturriaga
- Biocruces Health Research Institute, Cruces University Hospital, Basque Country University (UPV/EHU), Barakaldo, Bizkaia, Spain
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France
| | - Alison C Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Almudena Zapatero
- Department of Radiation Oncology, Health Research Institute, University Hospital La Princesa, Madrid, Spain
| | - Jennifer Le Guevelou
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Iridium Network, GZA ziekenhuizen, Wilrijk, Belgium
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
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15
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Jadvar H, Abreu AL, Ballas LK, Quinn DI. Oligometastatic Prostate Cancer: Current Status and Future Challenges. J Nucl Med 2022; 63:1628-1635. [PMID: 36319116 PMCID: PMC9635685 DOI: 10.2967/jnumed.121.263124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/15/2022] [Indexed: 12/13/2022] Open
Abstract
In accordance with the spectrum theory of metastatic disease, an oligometastatic clinical state has been proposed as an intermediary step along the natural history of cancer with few (typically 1-3) metastatic lesions identifiable on imaging that may be amenable to metastasis-directed therapy. Effective therapy of oligometastatic disease is anticipated to impact cancer evolution by delaying progression and improving patient outcome at a minimal or acceptable cost of toxicity. There has been increasing recognition of oligometastatic disease in prostate cancer with the advent of new-generation imaging agents, most notably the recently approved PET radiotracers based on targeting prostate-specific membrane antigen. Early clinical trials with metastasis-directed therapy of oligometastases have provided evidence for delaying the employment of systematic therapy and improving outcome in selected patients. Despite these encouraging results, much needs to be investigated and learned about the underlying biology of the oligometastatic state along the evolutionary clinical course of prostate cancer, the identification of relevant imaging and nonimaging predictive and prognostic biomarkers, and the development of treatment strategies to optimize short-term and long-term patient outcome. We provide a review of the current status and the lingering challenges of this rapidly evolving clinical space in prostate cancer.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Kenneth J. Norris, Jr., Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andre Luis Abreu
- Institute of Urology, Kenneth J. Norris, Jr., Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leslie K. Ballas
- Department of Radiation Oncology, Kenneth J. Norris, Jr., Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - David I. Quinn
- Division of Cancer Medicine, Department of Medicine, Kenneth J. Norris, Jr., Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, California
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16
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Rajwa P, Yanagisawa T, Gruber M, Heidenreich A, Joniau S, Briganti A, Shariat SF, Marra G, Gandaglia G. Surgical Metastasectomy for Visceral and Bone Prostate Cancer Metastases: A Mini-Review. Eur Urol Focus 2022; 9:232-235. [PMID: 36371377 DOI: 10.1016/j.euf.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Despite growing interest in metastasis-directed therapy (MDT) for prostate cancer (PCa), little is known regarding the feasibility and effectiveness of surgical metastasectomy for isolated lesions. We performed a narrative review of the available evidence supporting metastasectomy for M1b-c lesions in men diagnosed with oligometastatic or oligorecurrent PCa. The case series and case reports we identified indicate that surgical MDT is a safe and feasible treatment option for well-selected patients with a small number of PCa metastases diagnosed via molecular imaging. It is difficult to draw evidence-based conclusions regarding the survival benefit of metastasectomy; however, metastasectomy might lead to a prostate-specific antigen response and could potentially delay systemic therapy in patients with oligometastatic PCa. Prospective studies incorporating novel imaging are needed to better establish the role of metastasectomy for patients with metastatic PCa. PATIENT SUMMARY: We reviewed the evidence on surgical removal of prostate cancer lesions that have spread to the organs (eg, liver and lung) or bone, which are called metastases. Limited results show that this approach is feasible and has favorable outcomes in selected patients.
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17
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von Deimling M, Rajwa P, Tilki D, Heidenreich A, Pallauf M, Bianchi A, Yanagisawa T, Kawada T, Karakiewicz PI, Gontero P, Pradere B, Ploussard G, Rink M, Shariat SF. The current role of precision surgery in oligometastatic prostate cancer. ESMO Open 2022; 7:100597. [PMID: 36208497 PMCID: PMC9551071 DOI: 10.1016/j.esmoop.2022.100597] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 12/30/2022] Open
Abstract
Oligometastatic prostate cancer (omPCa) is a novel intermediate disease state characterized by a limited volume of metastatic cells and specific locations. Accurate staging is paramount to unmask oligometastatic disease, as provided by prostate-specific membrane antigen-positron emission tomography. Driven by the results of prospective trials employing conventional and/or modern staging modalities, the treatment landscape of omPCa has rapidly evolved over the last years. Several treatment-related questions comprising the concept of precision strikes are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) can confer a survival benefit in select patients with omPCa. More importantly, CRP has been consistently shown to improve long-term local symptoms when the tumor progresses across disease states due to resistance to systemic therapies. Metastasis-directed treatments have also emerged as a promising treatment option due to the visibility of oligometastatic disease and new technologies as well as treatment strategies to target the novel PCa colonies. Whether metastases are present at primary cancer diagnosis or detected upon biochemical recurrence after treatment with curative intent, targeted yet decisive elimination of disseminated tumor cell hotspots is thought to improve survival outcomes. One such strategy is salvage lymph node dissection in oligorecurrent PCa which can alter the natural history of progressive PCa. In this review, we will highlight how refinements in modern staging modalities change the classification and treatment of (oligo-)metastatic PCa. Further, we will also discuss the current role and future directions of precision surgery in omPCa.
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Affiliation(s)
- M von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - D Tilki
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A Heidenreich
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Cologne, Cologne, Germany
| | - M Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - A Bianchi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - T Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - T Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - P Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - B Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - G Ploussard
- Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, USA; Department of Urology, University of Texas Southwestern, Dallas, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
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18
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Velmurugan P, Mohanavel V, Shrestha A, Sivakumar S, Oyouni AAA, Al-Amer OM, Alzahrani OR, Alasseiri MI, Hamadi A, Alalawy AI. Developing a Multimodal Model for Detecting Higher-Grade Prostate Cancer Using Biomarkers and Risk Factors. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9223400. [PMID: 35722463 PMCID: PMC9205705 DOI: 10.1155/2022/9223400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Abstract
A technique to predict crucial clinical prostate cancer (PC) is desperately required to prevent diagnostic errors and overdiagnosis. To create a multimodal model that incorporates long-established messenger RNA (mRNA) indicators and conventional risk variables for identifying individuals with severe PC on prostatic biopsies. Urinary has gathered for mRNA analysis following a DRE and before a prostatic examination in two prospective multimodal investigations. A first group (n = 489) generated the multimodal risk score, which was then medically verified in a second group (n = 283). The reverse transcription qualitative polymerase chain reaction determined the mRNA phase. Logistic regression was applied to predict risk in patients and incorporate health risks. The area under the curve (AUC) was used to compare models, and clinical efficacy was assessed by using a DCA. The amounts of sixth homeobox clustering and first distal-less homeobox mRNA have been strongly predictive of high-grade PC detection. In the control subjects, the multimodal method achieved a total AUC of 0.90, with the most important aspects being the messenger riboneuclic acid features' PSA densities and previous cancer-negative tests as a nonsignificant design ability to contribute to PSA, aging, and background. An AUC of 0.86 was observed for one more model that added DRE as an extra risk component. Two methods were satisfactorily verified without any significant changes within the area under the curve in the validation group. DCA showed a massive net advantage and the highest decrease in inappropriate costs.
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Affiliation(s)
- Palanivel Velmurugan
- Centre for Materials Engineering and Regenerative Medicine, Bharath Institute of Higher Education and Research, Selaiyur, Chennai, Tamil Nadu, India
| | - Vinayagam Mohanavel
- Centre for Materials Engineering and Regenerative Medicine, Bharath Institute of Higher Education and Research, Chennai 600073, Tamil Nadu, India
- Department of Mechanical Engineering, Chandigarh University, Mohali 140413, Punjab, India
| | - Anupama Shrestha
- Department of Plant Protection, Himalayan College of Agricultural Sciences and Technology, Kalanki, Kathmandu, Nepal PO box 44600
- Research Institute of Agriculture and Applied Science, Tokha Kathmandu, Nepal 2356
| | - Subpiramaniyam Sivakumar
- Department of Bioenvironmental Energy, College of Natural Resources and Life Science, Pusan National University, Miryang-Si, Gyeongsangnam-do 50463, Republic of Korea
| | - Atif Abdulwahab A. Oyouni
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Osama M. Al-Amer
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Othman R. Alzahrani
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Mohammed I. Alasseiri
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Abdullah Hamadi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Adel Ibrahim Alalawy
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
- Department of Biochemistry, Faculty of Sciences, University of Tabuk, Tabuk, Saudi Arabia
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19
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Abdel-Aty H, James ND. The role of radiotherapy in oligometastatic hormone-sensitive prostate cancer. Curr Opin Urol 2022; 32:277-282. [PMID: 35249966 DOI: 10.1097/mou.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the role of radiotherapy in the management of oligometastatic hormone-sensitive prostate cancer (HSPC). RECENT FINDINGS The M1|RT STAMPEDE trial showed a survival advantage to prostate radiotherapy in newly diagnosed oligometastatic HSPC. The combination of prostate radiotherapy with systemic treatment is now the recommended standard of care. Metastases-directed therapy (MDT) with stereotactic ablative radiotherapy (SABR) in the STOMP and ORIOLE trial reported excellent local control and a survival advantage in metachronous oligometastatic HSPC. Results were consistent with prostate cancer outcomes in the SABR-COMET trial and the NHS England Commissioning through Evaluation scheme (CtE). SABR in synchronous oligometastatic HSPC will be evaluated in a new comparison within the STAMPEDE trial. Current definition of oligometastatic HSPC is based on the number of metastatic lesions on conventional imaging (CT/MRI and Isotope bone scan). Novel imaging, such as PSMA PET/CT provide superior accuracy to conventional imaging. However, limited data exists on the role of novel imaging in determining subsequent clinical outcomes. SUMMARY Prostate radiotherapy improves survival and is standard of care with systemic treatment in newly diagnosed oligometastatic HSPC. The role of SABR in newly diagnosed oligometastatic HSPC is yet to be determined.
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Affiliation(s)
- Hoda Abdel-Aty
- Division of Radiotherapy and Imaging, The Institute of Cancer Research
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicholas D James
- Division of Radiotherapy and Imaging, The Institute of Cancer Research
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
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Müller PJ, Dietlein M, Kobe C, Heidenreich A, Drzezga A. Oligometastatic disease in biochemical recurrence of prostate cancer: Prevalence on PSMA PET/CT and consecutive metastasis-directed therapy - Experience at a tertiary referral center. Nuklearmedizin 2022; 61:314-324. [PMID: 35388442 DOI: 10.1055/a-1697-8111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of our study was to address the prevalence of oligometastatic recurrent prostate cancer (PCa) on PSMA-PET and the associated practice of metastasis-directed therapy (MDT). Next, we aimed to determine a PSA threshold below which most patients had local and/or oligometastatic recurrence on PSMA-PET. METHODS One hundred and ten consecutive patients with biochemical recurrence (BCR) after radical prostatectomy (RP) ± radiation were referred for 68Ga-PSMA-11 or 18F-DCFPyL PET/CT. We correlated the location and number of PSMA-positive lesions against the treatment choice after imaging. Detection rates were stratified by PSA levels at the time of PET/CT. The study design was monocentric retrospective. RESULTS Thirty-four patients (30.9%) had a PSMA-negative scan, while 17 (15.5%) had local recurrence and 59 (53.6%) had metastatic recurrence on PSMA-PET. ROC analysis revealed a cut-off of ≤3 metastatic lesions on PSMA-PET for the steering of treatment decisions towards MDT rather than solely systemic therapy (AUC: 0.88). Defined as 3 or fewer metastatic lesions, oligometastatic recurrent PCa was found in up to 30% (33/110) of all patients. At PSA levels below 3.5 ng/ml, the rate of PSMA-positive disease that was locally confined or oligometastatic was 76% (45/59), dropping significantly to 29.4% (5/17) above this threshold (p<0.001) as polymetastatic findings became more frequent. CONCLUSION The detection of ≤3 oligometastases on PSMA-PET encouraged the consecutive pursuit of MDT instead of systemic therapy alone. PSMA-PET predominantly captured patients at recurrence stages amenable to localized treatment when initiated at PSA levels below 3.5 ng/ml.
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Affiliation(s)
- Peter J Müller
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital of Cologne, Köln, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital of Cologne, Köln, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital of Cologne, Köln, Germany
| | - Axel Heidenreich
- Department of Urology, Faculty of Medicine and University Hospital of Cologne, Köln, Germany.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital of Cologne, Köln, Germany
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21
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Gandaglia G, Montorsi F. Metastases-directed Therapies in the Prostate-specific Membrane Antigen Era: Not All That Glitters Is Curable. Eur Urol Oncol 2022; 5:52-53. [DOI: 10.1016/j.euo.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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22
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Connor MJ, Genie MG, Burns D, Bass EJ, Gonzalez M, Sarwar N, Falconer A, Mangar S, Dudderidge T, Khoo V, Winkler M, Ahmed HU, Watson V. A Systematic Review of Patients' Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer. EUR UROL SUPPL 2021; 36:9-18. [PMID: 34977691 PMCID: PMC8703228 DOI: 10.1016/j.euros.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development. OBJECTIVE To perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer. EVIDENCE ACQUISITION The MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420. EVIDENCE SYNTHESIS A total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment. CONCLUSIONS There is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks. PATIENT SUMMARY We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.
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Affiliation(s)
- Martin J. Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author at: Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
| | - Mesfin G. Genie
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David Burns
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Edward J. Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden Hospital & Institute of Cancer Research, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Connor MJ, Genie MG, Gonzalez M, Sarwar N, Thippu Jayaprakash K, Horan G, Hosking-Jervis F, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Robinson A, Beresford M, Rai B, Mangar S, Khoo V, Dudderidge T, Falconer A, Winkler M, Watson V, Ahmed HU. Metastatic prostate cancer men's attitudes towards treatment of the local tumour and metastasis evaluative research (IP5-MATTER): protocol for a prospective, multicentre discrete choice experiment study. BMJ Open 2021; 11:e048996. [PMID: 34794989 PMCID: PMC8603288 DOI: 10.1136/bmjopen-2021-048996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Systemic therapy with androgen deprivation therapy (ADT) and intensification with agents such as docetaxel, abiraterone acetate and enzalutamide has resulted in improved overall survival in men with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Novel local cytoreductive treatments and metastasis-directed therapy are now being evaluated. Such interventions may provide added survival benefit or delay the requirement for further systemic agents and associated toxicity but can confer additional harm. Understanding men's preferences for treatment options in this disease state is crucial for patients, clinicians, carers and future healthcare service providers. METHODS Using a prospective, multicentre discrete choice experiment (DCE), we aim to determine the attributes associated with treatment that are most important to men with mHSPC. Furthermore, we plan to determine men's preferences for, and trade-offs between, the attributes (survival and side effects) of different treatment options including systemic therapy, local cytoreductive approaches (external beam radiotherapy, cytoreductive radical prostatectomy or minimally invasive ablative therapy) and metastases-directed therapies (metastasectomy or stereotactic ablative body radiotherapy). All men with newly diagnosed mHSPC within 4 months of commencing ADT and WHO performance status 0-2 are eligible. Men who have previously consented to a cytoreductive treatment or have developed castrate-resistant disease will be excluded. This study includes a qualitative analysis component, with patients (n=15) and healthcare professionals (n=5), to identify and define the key attributes associated with treatment options that would warrant trade-off evaluation in a DCE. The main phase component planned recruitment is 300 patients over 1 year, commencing in January 2021, with planned study completion in March 2022. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority East of England, Cambridgeshire and Hertfordshire Research Ethics Committee (Reference: 20/EE/0194). Project information will be reported on the publicly available Imperial College London website and the Heath Economics Research Unit (HERU website including the HERU Blog). We will use the social media accounts of IP5-MATTER, Imperial Prostate London, HERU and the individual researchers to disseminate key findings following publication. Findings from the study will be presented at national/international conferences and peer-reviewed journals. Authorship policy will follow the recommendations of the International Committee of Medical Journal Editors. TRIAL REGISTRATION NUMBER NCT04590976.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mesfin G Genie
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
- Economics, Ca' Foscari University of Venice, Venezia, Italy
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kamalram Thippu Jayaprakash
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Department of Oncology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Tzveta Pokrovska
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Angus Robinson
- Department of Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Dietlein F, Kobe C, Munoz Vazquez S, Fischer T, Endepols H, Hohberg M, Reifegerst M, Neumaier B, Schomaecker K, Drzezga AE, Dietlein M. An 89Zr-labeled PSMA tracer for PET/CT imaging of prostate cancer patients. J Nucl Med 2021; 63:573-583. [PMID: 34326129 DOI: 10.2967/jnumed.121.262290] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
The short half-life of existing prostate-specific membrane antigen (PSMA) tracers limits their time for internalization into tumor cells after injection, which is an essential prerequisite for robust detection of tumor lesions with low PSMA expression on PET/CT scans. Due to its longer half-life, the 89Zr-labeled ligand 89Zr-PSMA-Df allows acquisition of PET scans up to 6 days after injection, thereby overcoming the above limitation. We investigated whether 89Zr-PSMA-Df allowed more sensitive detection of weak PSMA-positive prostate cancer lesions. Methods: We selected 14 prostate cancer patients with biochemical recurrence who exhibited no PSMA-positive lesions on a PET scan acquired with existing PSMA tracers (68Ga-PSMA-11, 18F-JK-PSMA-7). Within 5 weeks after the negative scan, we performed a second PSMA-PET scan using 89Zr-PSMA-Df (117±16 MBq, PET acquisition within 6 days of injection). Results: 89Zr-PSMA-Df detected 15 PSMA-positive lesions in 8/14 patients, who had a PET-negative reading of their initial PET scans with existing tracers. In these 8 patients, the new scans revealed localized recurrence of disease (3/8), metastases in lymph nodes (3/8), or lesions at distant sites (2/8). Based on these results, patients received lesion-targeted radiotherapies (5/8), androgen deprivation therapies (2/8), or no therapy (1/8). The plausibility of 14/15 lesions was supported by histology, clinical follow-up after radiotherapy or subsequent imaging. Furthermore, comparison of the 15 89Zr-PSMA-Df-positive lesions with their correlates on the original PET scan revealed that established tracers exhibited mild accumulation in 7/15 lesions but contrast-to-noise ratios (CNR) were too low for robust detection of these lesions (CNR 2.4±3.7 for established tracers vs. 10.2±8.5 for 89Zr-PSMA-Df, P = 0.0014). The SUVmax of the 15 89Zr-PSMA-Df-positive lesions (11.5±5.8) was significantly higher than the SUVmax on the original PET scans (4.7±2.8, P = 0.0001). Kidneys were the most exposed organ with doses of 3.3±0.7 mGy/MBq. The effective dose was 0.15±0.04 mSv/MBq. Conclusion: In patients with weak PSMA expression, a longer period of time might be needed for ligand internalization than that offered by existing PSMA tracers to make lesions visible on PET/CT scans. Hence, 89Zr-PSMA-Df might be of significant benefit to patients in whom the search for weak PSMA-positive lesions is challenging. Radiation exposure should be weighed against the potential benefit of metastasis-directed therapy or salvage radiotherapy, which we initiated in 36% (5/14) of our patients based on their 89Zr-PSMA-Df PET scans.
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Affiliation(s)
- Felix Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
| | | | - Thomas Fischer
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
| | - Heike Endepols
- Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Germany
| | - Melanie Hohberg
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
| | | | - Bernd Neumaier
- Institute of Neuroscience and Medicine INM-5, Forschungszentrum Jülich GmbH, Germany
| | - Klaus Schomaecker
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
| | | | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Germany
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Bravi CA, Droghetti M, Fossati N, Gandaglia G, Suardi N, Mazzone E, Cucchiara V, Scuderi S, Barletta F, Schiavina R, Osmonov D, Juenemann KP, Boeri L, Karnes RJ, Kretschmer A, Buchner A, Stief C, Hiester A, Nini A, Albers P, Devos G, Joniau S, Van Poppel H, Grubmüller B, Shariat SF, Heidenreich A, Pfister D, Tilki D, Graefen M, Gill IS, Mottrie A, Karakiewicz PI, Montorsi F, Briganti A. Definition and Impact on Oncologic Outcomes of Persistently Elevated Prostate-specific Antigen After Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer After Radical Prostatectomy: Clinical Implications for Multimodal Therapy. Eur Urol Oncol 2021; 5:285-295. [PMID: 34176768 DOI: 10.1016/j.euo.2021.06.003] [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: 02/07/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal definition and prognostic significance of persistently elevated prostate-specific antigen (PSA) after salvage lymph node dissection (sLND) for node-only recurrent prostate cancer (PCa) remain unknown. OBJECTIVE To assess the definition and clinical implications of persistently elevated PSA after sLND for node-only recurrent PCa after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS The study included 579 patients treated with sLND at 11 high-volume centers between 2000 and 2016. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the linear relationship between the first PSA after sLND and death from PCa. Different definitions of PSA persistence were included in a multivariable model predicting cancer-specific mortality (CSM) after surgery to identify the best cutoff value. We investigated the association between PSA persistence and oncologic outcomes using multivariable regression models. Moreover, the effect of early androgen deprivation therapy (ADT) after sLND was tested according to PSA persistence status and estimated risk of CSM. RESULTS AND LIMITATIONS We found an inverse relationship between the first PSA after sLND and the probability of cancer-specific survival. PSA persistence defined as first postoperative PSA ≥0.3 ng/ml provided the best discrimination accuracy (C index 0.757). According to this cutoff, 331 patients (57%) experienced PSA persistence. The median follow-up for survivors was 48 mo (interquartile range 27-74). After adjusting for confounders, men with persistently elevated PSA had higher risk of clinical recurrence (hazard ratio [HR] 1.61), overall mortality (HR 2.20), and CSM (HR 2.59; all p < 0.001) after sLND. Early ADT administration after sLND improved survival only for patients with PSA persistence after surgery (HR 0.49; p = 0.024). Similarly, when PSA persistence status was included in multivariable models accounting for pathologic features, early ADT use after sLND was beneficial only for patients with a predicted risk of CSM at 5 yr of >10%. CONCLUSIONS PSA persistence after sLND independently predicts adverse prognosis, with the best discrimination accuracy for CSM provided by a definition of PSA ≥ 0.3 ng/ml. We showed that when stratifying patients by final pathology results and PSA persistence status, early ADT use after sLND was beneficial only for patients with PSA persistence or with a calculated 5-yr risk of CSM of >10%, which could be useful as we await results from ongoing prospective trials. PATIENT SUMMARY We found that for patients with prostate cancer who had lymph nodes removed after their cancer recurred, persistently elevated prostate-specific antigen (PSA) levels predict poorer prognosis. We showed that a PSA level of ≥0.3 ng/ml provides the best accuracy in identifying patients with worse prognosis. This may help to improve risk stratification after lymph node removal and allow physicians to optimize treatment strategies after surgery.
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Affiliation(s)
- Carlo A Bravi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Klaus-Peter Juenemann
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, IRCCS Foundation Ca Granda, Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | | | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Andreas Hiester
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Alessandro Nini
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - David Pfister
- Department of Urology, University of Cologne, Cologne, Germany
| | - Derya Tilki
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Inderbir S Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Alexandre Mottrie
- Department of Urology, OLV Ziekenhuis Aalst, Aalst, Belgium; Orsi Academy, Melle, Belgium
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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26
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Triggiani L, Mazzola R, Tomasini D, Bruni A, Alicino G, Matrone F, Bortolus R, Francolini G, Detti B, Magli A, Bonù ML, Ingrosso G, Lancia A, Trippa F, Maranzano E, Franzese C, Ghirardelli P, Vavassori V, Scorsetti M, Alongi F, Magrini SM. Upfront metastasis-directed therapy in oligorecurrent prostate cancer does not decrease the time from initiation of androgen deprivation therapy to castration resistance. Med Oncol 2021; 38:72. [PMID: 34008151 PMCID: PMC8131275 DOI: 10.1007/s12032-021-01518-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/29/2021] [Indexed: 01/16/2023]
Abstract
The aim of the present study was to explore the potential impact of upfront metastases-directed therapy (MDT) in terms of prolongation of castration-sensitive phase in a series of oligorecurrent castration-sensitive prostate cancer (PC) patients. The present article is a multicenter retrospective study. The population of interest was castrate-sensitive oligorecurrent PC, defined as the presence of 1-3 uptakes in non-visceral sites such as bones or nodes detected by means of 18F-Choline PET/CT or 68-Gallium PSMA PET/CT. Primary endpoint was the time to castration resistance. Secondary endpoints were ADT-free survival, local progression-free survival, and overall survival. Eighty-two patients and 118 lesions were analyzed. The median time to castration resistance for the entire population of the study was 49 months (95% CI 43.6-54.4 months). The 1- and 2-year TTCR-free survival rates were 94% and 82%, respectively. At the time of analysis, 52 patients were still in the castration-sensitive phase of the disease. In this cohort of patients, the median ADT-free survival was 20 months (range 3-69 months). On the other hand, during follow-up 30 patients switched to the castration-resistant phase of disease. In this last group of patients, the median ADT-free survival was 20 months (range 4-50 months). After the ADT administration, the median castration-sensitive phase was 29 months (range 5-71 months). Castration resistance generally occurs at a median follow-up of 24-36 months following ADT. In the current study, upfront MDT does not decrease the time from initiation of ADT to castration resistance.
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Affiliation(s)
- Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Rosario Mazzola
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Davide Tomasini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Alessio Bruni
- Department of Oncology and Hematology, Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Giulia Alicino
- Department of Oncology and Hematology, Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - Fabio Matrone
- Department of Radiation Oncology, Centro Di Riferimento, Oncologico Di Aviano CRO-IRCCS, Aviano, Italy
| | - Roberto Bortolus
- Department of Radiation Oncology, Centro Di Riferimento, Oncologico Di Aviano CRO-IRCCS, Aviano, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, University of Florence, A.O.U Careggi, Florence, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, University of Florence, A.O.U Careggi, Florence, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, University Hospital of Udine, ASUIUD, Udine, Italy
| | - Marco Lorenzo Bonù
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Gianluca Ingrosso
- Radioterapia Oncologica, Dipartimento di Scienze Chirurgiche E Biomediche, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Fabio Trippa
- Department of Radiation Oncology, 'S. Maria' Hospital, Terni, Italy
| | | | - Ciro Franzese
- IRCCS, Radiotherapy and Radiosurgery Department, Humanitas University Hospital, Milan-Rozzano, Italy
| | | | | | - Marta Scorsetti
- IRCCS, Radiotherapy and Radiosurgery Department, Humanitas University Hospital, Milan-Rozzano, Italy
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Püllen L, Sprave T, Hadaschik B, Wiegel T. [Local and metastasis-directed therapy for oligometastatic prostate cancer]. Aktuelle Urol 2021; 52:149-154. [PMID: 33561877 DOI: 10.1055/a-1328-9975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
New developments of systemic therapy concepts for metastatic prostate carcinoma have led to a significant improvement in the prognosis in the recent past. It has long been unclear to what extent local and/or metastasis-directed therapies have an additional oncologic benefit in addition to palliation, local control and functional maintenance. For local therapy of the prostate, the highest evidence currently exists for radiotherapy and shows a significantly increased overall survival in "low- burden" oligometastatic patients. Metastasis-directed surgical or radio-oncological concepts may also improve prognosis but have not yet been sufficiently investigated and should therefore be discussed, documented and established on an individual and interdisciplinary basis.
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Affiliation(s)
- Lukas Püllen
- Universitätsklinikum Essen, Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie, Essen
| | - Tanja Sprave
- Universitätsklinikum Freiburg, Klinik für Radioonkologie, Freiburg
| | - Boris Hadaschik
- Universitätsklinikum Essen, Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie, Essen
| | - Thomas Wiegel
- Universitätsklinikum Ulm, Klinik für Radioonkologie und Strahlentherapie, Ulm
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28
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Connor MJ, Khoo V, Watson V, Ahmed HU. Radical Treatment Without Cure: Decision-making in Oligometastatic Prostate Cancer. Eur Urol 2021; 79:558-560. [PMID: 33549359 DOI: 10.1016/j.eururo.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Martin J Connor
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation and Institute of Cancer Research, London, UK
| | - Verity Watson
- Health Economics Research Unit, Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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29
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Connor MJ, Shah TT, Smigielska K, Day E, Sukumar J, Fiorentino F, Sarwar N, Gonzalez M, Falconer A, Klimowska-Nassar N, Evans M, Naismith OF, Thippu Jayaprakash K, Price D, Gayadeen S, Basak D, Horan G, McGrath J, Sheehan D, Kumar M, Ibrahim A, Brock C, Pearson RA, Anyamene N, Heath C, Shergill I, Rai B, Hellawell G, McCracken S, Khoubehi B, Mangar S, Khoo V, Dudderidge T, Staffurth JN, Winkler M, Ahmed HU. Additional Treatments to the Local tumour for metastatic prostate cancer-Assessment of Novel Treatment Algorithms (IP2-ATLANTA): protocol for a multicentre, phase II randomised controlled trial. BMJ Open 2021; 11:e042953. [PMID: 33632752 PMCID: PMC7908915 DOI: 10.1136/bmjopen-2020-042953] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Survival in men diagnosed with de novo synchronous metastatic prostate cancer has increased following the use of upfront systemic treatment, using chemotherapy and other novel androgen receptor targeted agents, in addition to standard androgen deprivation therapy (ADT). Local cytoreductive and metastasis-directed interventions are hypothesised to confer additional survival benefit. In this setting, IP2-ATLANTA will explore progression-free survival (PFS) outcomes with the addition of sequential multimodal local and metastasis-directed treatments compared with standard care alone. METHODS A phase II, prospective, multicentre, three-arm randomised controlled trial incorporating an embedded feasibility pilot. All men with new histologically diagnosed, hormone-sensitive, metastatic prostate cancer, within 4 months of commencing ADT and of performance status 0 to 2 are eligible. Patients will be randomised to Control (standard of care (SOC)) OR Intervention 1 (minimally invasive ablative therapy to prostate±pelvic lymph node dissection (PLND)) OR Intervention 2 (cytoreductive radical prostatectomy±PLND OR prostate radiotherapy±pelvic lymph node radiotherapy (PLNRT)). Metastatic burden will be prespecified using the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease (CHAARTED) definition. Men with low burden disease in intervention arms are eligible for metastasis-directed therapy, in the form of stereotactic ablative body radiotherapy (SABR) or surgery. Standard systemic therapy will be administered in all arms with ADT±upfront systemic chemotherapy or androgen receptor agents. Patients will be followed-up for a minimum of 2 years. PRIMARY OUTCOME PFS. Secondary outcomes include predictive factors for PFS and overall survival; urinary, sexual and rectal side effects. Embedded feasibility sample size is 80, with 918 patients required in the main phase II component. Study recruitment commenced in April 2019, with planned follow-up completed by April 2024. ETHICS AND DISSEMINATION Approved by the Health Research Authority (HRA) Research Ethics Committee Wales-5 (19/WA0005). Study results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03763253; ISCRTN58401737.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur Tariq Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Katarzyna Smigielska
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Emily Day
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | | | - Naveed Sarwar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Martin Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Olivia Frances Naismith
- Radiotherapy Trials Quality Assurance (RTTQA), Royal Marsden NHS Foundation Trust, London, UK
| | | | - Derek Price
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Shiva Gayadeen
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Denise Sheehan
- Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Manal Kumar
- Department of Urology, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Azman Ibrahim
- Department of Clinical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Cathryn Brock
- Department of Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachel A Pearson
- Department of Oncology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicola Anyamene
- Department of Oncology, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Catherine Heath
- Department of Radiotherapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Iqbal Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Giles Hellawell
- Department of Urology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Bijan Khoubehi
- Department of Urology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Nicholas Staffurth
- Research, Velindre Cancer Centre, Cardiff, UK
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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Role of 18F-Fluciclovine and Prostate-Specific Membrane Antigen PET/CT in Guiding Management of Oligometastatic Prostate Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 216:851-859. [PMID: 33206564 DOI: 10.2214/ajr.20.24711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Twenty-five years ago, oligometastatic disease was proposed as an intermediary clinical state of cancer with unique implications for therapies that may impact cancer evolution and patient outcome. Identification of limited metastases that are potentially amenable to targeted therapies fundamentally depends on the sensitivity of diagnostic tools, including new-generation imaging methods. For men with biochemical recurrence after definitive therapy of the primary prostate cancer, PET/CT using either the FDA-approved radiolabeled amino acid analogue 18F-fluciclovine or investigational radiolabeled agents targeting prostate-specific membrane antigen (PSMA) enables identification of early metastases at lower serum PSA levels than was previously feasible using conventional imaging. Evidence supports PSMA PET/CT as the most sensitive imaging modality available for identifying disease sites in oligometastatic prostate cancer. PSMA PET/CT will likely become the modality of choice after regulatory approval and will drive the development of trials of emerging metastasis-directed therapies such as stereotactic ablative body radiation and radioguided surgery. Indeed, numerous ongoing or planned clinical trials are studying advances in management of oligometastatic prostate cancer based on this heightened diagnostic capacity. In this rapidly evolving clinical environment, radiologists and nuclear medicine physicians will play major roles in facilitating clinical decision making and management of patients with oligometastatic prostate cancer.
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Francolini G, Loi M, Detti B, Desideri I, Mangoni M, Simontacchi G, Meattini I, Livi L. Integrating stereotactic body radiation therapy (SBRT) and systemic treatments in oligoprogressive prostate cancer: new evidence from the literature. Clin Exp Metastasis 2021; 38:227-230. [PMID: 33471291 DOI: 10.1007/s10585-021-10072-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Recent findings from literature evidenced that metastatic prostate cancer often shows heterogeneous response to therapy, with persistent sensibility to systemic treatments after biochemical, clinical, or radiographic progression. This highlights the advantage of integrated approaches in which local ablative treatments (e.g., stereotactic body radiation therapy) could prolong clinical benefit of systemic therapies beyond oligo-progression. Of course, development of predictive biomarker could be helpful in order to select patients who could much benefit from this treatment strategy. Circulating tumor cell detection and analysis could also have a crucial role in this field. A joint effort of two prospective ongoing trials (ARTO, clinical.gov identifier NCT03449719 and PRIMERA, clinical.gov identifier NCT04188275) might help to improve criteria to select patients in whom a local ablative approach might confer significant benefit. In this commentary, we summarized recent data from literature to support this thesis.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Mauro Loi
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Clinical Translation of Positive Metastases Identified on Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging in the Management of De Novo Synchronous Oligometastatic Prostate Cancer. Eur Urol Focus 2020; 7:951-954. [PMID: 33384271 DOI: 10.1016/j.euf.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/03/2020] [Accepted: 12/05/2020] [Indexed: 11/20/2022]
Abstract
Recent evidence from randomised trials supports the diagnostic superiority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) over conventional imaging in the detection of distant occult metastasis in men with newly diagnosed high-risk prostate cancer. This may result in a rise in the detection of de novo synchronous hormone-sensitive "oligometastatic" prostate cancer. We outline the evidence supporting PSMA PET/CT imaging in primary staging. We also discuss the translation of positive areas with a high probability of distant metastasis into clinical therapeutic targets for metastasis-directed interventions. Finally, we highlight the role of PSMA PET/CT as an imaging biomarker. This may have future utility in disease monitoring and prediction of response to systemic, local cytoreductive and metastasis-directed interventions. PATIENT SUMMARY: A new whole-body scan can accurately detect cancer deposits in men in whom distant prostate cancer spread is suspected. This may be useful for monitoring and predicting response to drug therapy, treatments to the prostate, and cancer deposits.
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Perineal recurrence of prostate ductal adenocarcinoma after transperineal brachytherapy: a case report and literature review. J Contemp Brachytherapy 2020; 12:612-617. [PMID: 33437311 PMCID: PMC7787201 DOI: 10.5114/jcb.2020.101696] [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: 07/11/2020] [Accepted: 10/01/2020] [Indexed: 12/04/2022] Open
Abstract
Perineal recurrence after brachytherapy is an exceedingly rare complication. Moreover, ductal adenocarcinoma is a rare histological variant of prostate cancer. Herein, we describe a case of perineal recurrence from ductal adenocarcinoma of prostate after low-dose-rate brachytherapy (LDR-BT) in a 65-year-old male patient. The patient had localized prostate cancer, for which he received LDR-BT; however, he experienced perineal recurrence 2 years after receiving LDR-BT. Surgical excision was attempted, but we were unable to remove the whole tumor, owing to invasion to surrounding tissue. Pathological examination of resected tumor showed ductal adenocarcinoma of the prostate. External beam radiation therapy and high-dose-rate brachytherapy (HDR-BT) were performed for residual tumor. Mild mediastinal lymph node swelling was observed during clinical course of the disease. Hence, androgen deprivation therapy was administered with abiraterone after radiation therapy, and prostate-specific antigen level decreased to undetectable level. Biochemical failure after transperineal brachytherapy for prostate cancer should be considered as a perineal recurrence.
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