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González-San Segundo C, López Campos F, Gómez Iturriaga A, Rodríguez A, Olivera J, Duque-Santana V, Sancho G, Henríquez I, Conde AJ, Valero J, Maldonado X, Glaria L, Caballero B, Sanmamed N, Mases J, Boladeras-Inglada AM, Montijano M, Santos M, Álvarez A, Martínez JI, Couñago F. A randomised trial of short- vs long-term androgen deprivation with salvage radiotherapy for biochemical failure following radical prostatectomy: URONCOR 06-24. BJU Int 2024; 134:568-577. [PMID: 39041411 DOI: 10.1111/bju.16484] [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] [Indexed: 07/24/2024]
Abstract
BACKGROUND Salvage radiotherapy (SRT) and androgen-deprivation therapy (ADT) are widely used in routine clinical practice to treat patients with prostate cancer who develop biochemical recurrence (BCR) after radical prostatectomy (RP). However, there is no standard-of-care consensus on optimal duration ADT. Investigators propose three distinct risk groups in patients with prostate cancer treated with SRT in order to better define the indications and duration of ADT combined with SRT. STUDY DESIGN The URONCOR 06-24 trial (ClinicalTrials.gov identifier NCT05781217) is a prospective, multicentre, randomised, open-label, phase III, clinical trial. The aim of the trial is to determine the impact of short-term (6 months) vs long-term (24 months) ADT in combination with SRT on distant metastasis-free survival (MFS) in patients with prostate cancer with BCR after RP (intermediate and high risk). ENDPOINTS The primary endpoint is 5-year MFS rates in patients with prostate cancer treated with long- vs short-term ADT in combination with SRT. Secondary objectives are biochemical-relapse free interval, pelvic progression-free survival, time to start of systemic treatment, time to castration resistance, cancer-specific survival, overall survival, acute and late toxicity, and quality of life. METHODS AND ANALYSIS Total of 534 patients will be randomised 1:1 to ADT 6 months or ADT 24 months with a luteinizing hormone-releasing hormone analogue in combination with SRT, stratified by risk group and pathological lymph node status. ETHICS AND DISSEMINATION The study is conducted under the guiding principles of the World Medical Association Declaration of Helsinki. The results will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT number 2021-006975-41.
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Affiliation(s)
| | - Fernando López Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Radiation Oncology, Genesis Care Hospital Vithas La Milagrosa, Madrid, Spain
| | - Alfonso Gómez Iturriaga
- Department of Radiation Oncology, Hospital Universitario Cruces, Biobizkaia Health Research Institute Basque Country University UPV/EHU, Barakaldo, Spain
| | - Aurora Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid, Spain
| | - Jesús Olivera
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Gemma Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Iván Henríquez
- Department of Radiation Oncology, Hospital Universitario Sant Joan, Reus, Tarragona, Spain
| | - Antonio José Conde
- Department of Radiation Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Jeannette Valero
- Department of Radiation Oncology, Hospital Universitario HM San Chinarro, Madrid, Spain
| | - Xavier Maldonado
- Department of Radiation Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Luis Glaria
- Department of Radiation Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Begoña Caballero
- Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Noelia Sanmamed
- Department of Radiation Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Joel Mases
- Department of Radiation Oncology, Hospital Universitario Clínic de Barcelona, Barcelona, Spain
| | | | - Miguel Montijano
- Department of Urology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marina Santos
- Department of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Álvarez
- Department of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan I Martínez
- Department of Urology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, GenesisCare Hospital San Francisco de Asís, Hospital Vithas La Milagrosa, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
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Romeo A, Martinez P, Compagnucci M, Tobia I, Giudice C, Villamil W. Oncologic and functional outcomes following robot assisted radical prostatectomy: 15-Year experience in a Latin American referral center. Surg Oncol 2024; 57:102138. [PMID: 39299027 DOI: 10.1016/j.suronc.2024.102138] [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: 06/09/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Prostate cancer is the most common cancer in men with more than 52,000 cases diagnosed every year on average. With the introduction of robotic surgery, robotic assisted radical prostatectomy (RARP) has become a popular treatment option in recent years. Achieving oncological control, urinary continence and satisfactory erectile sexual function after RP is the main goal also known as "trifecta". All these outcomes are highly influenced by surgical experience and caseload. The main objective of this study is to analyze oncological and functional outcomes in RARP after 15 years of experience. METHODS From 2008 until December 2023, 1790 RARP for localized prostate cancer were performed. A retrospective analysis was conducted based on prospectively collected data correlated with electronic medical records. RESULTS Subgroup analyses were conducted in order to evaluate oncological and functional outcomes (n: 1400). Red blood cell transfusion and conversion to open surgery rate was 1.9 % and 0.1 %, respectively. Mean surgical time was 194 min. Mean follow-up time was 69.5 months, 23.8 % patients experienced biochemical recurrence and 1 % died, primarily due to disease progression. Estimated 10-year recurrence-free survival was 68.7 % (95 % CI 67.2-72.2) while estimated 10-year overall survival was 97.9 % (95 % CI 96.3-99.4). Overall urinary continence rate at 2 years was 86.9 % while satisfactory erectile function rate at 18 months was 56.8 %. CONCLUSIONS Robotic-assisted radical prostatectomy has become a standard surgical technique in our urological practice for the management of clinically localized and locally advanced prostate tumors in selected cases. After 15 years since the inception of our robotic surgery program, we can conclude that our results are comparable to those published in the international literature, enabling patients to maintain satisfactory sexual function with a high continence rate within the first year of surgery.
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Affiliation(s)
- Agustin Romeo
- Urology Department, Hospital Italiano de Buenos Aires, Argentina.
| | - Pablo Martinez
- Urology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | - Ignacio Tobia
- Urology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Carlos Giudice
- Urology Department, Hospital Italiano de Buenos Aires, Argentina
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Santamaria R, Zaffaroni M, Vincini MG, Colombi L, Gaeta A, Mastroleo F, Corrao G, Zerini D, Villa R, Mazzola GC, Alessi S, Luzzago S, Mistretta FA, Musi G, De Cobelli O, Gandini S, Kuncman L, Cattani F, Ceci F, Petralia G, Marvaso G, Jereczek-Fossa BA. Image-Guided Stereotactic Body Radiotherapy on Detectable Prostate Bed Recurrence after Prostatectomy in RT-Naïve Patients. Life (Basel) 2024; 14:870. [PMID: 39063623 PMCID: PMC11277978 DOI: 10.3390/life14070870] [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: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Purpose or Objective-The aim of the study is to evaluate the efficacy and safety of SBRT on detectable prostate bed recurrence in RT-naïve prostate cancer patients. MATERIALS AND METHODS Eighty-six patients who underwent SBRT for macroscopic bed recurrence after prostatectomy were retrospectively included. Patients were treated based on mpMRI or choline/PSMA PET. RESULTS The median time to biochemical relapse (BCR) after RP was 46 months, with a median PSA at restaging of 1.04 ng/mL. Forty-six patients were staged with mpMRI and choline/PSMA PET, while ten and thirty were treated based on PET and MRI only, respectively. Only one late G ≥ 2 GI toxicity was observed. With a median BCR follow-up of 14 months, twenty-nine patients experienced a BCR with a median PSA at recurrence of 1.66 ng/mL and a median survival free from the event of 40.1 months. The median time to BCR was 17.9 months. Twenty-seven patients had clinical relapse (CR), with a median CR follow-up of 16.27 months and a median time to CR of 23.0 months. Biochemical recurrence-free survival at one and two years was 88% and 66%, respectively, while clinical recurrence-free survival at one and two years was 92% and 82%, respectively. Regarding local relapses, seven were in the field of treatment, while eight of them were outside the field of treatment. CONCLUSIONS Data showed that SBRT targeting only the macroscopic bed recurrence instead of the whole prostate bed is safe and effective. Additional data and longer follow-ups will provide a clearer indication of the appropriate treatment and staging methodology for these patients.
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Affiliation(s)
- Riccardo Santamaria
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Lorenzo Colombi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Riccardo Villa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Sarah Alessi
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
| | - Lukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
- Department of External Beam Radiotherapy, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, 93-513 Lodz, Poland
| | - Federica Cattani
- Medical Physics Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Nuclear Medicine, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
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Fukuda I, Aoki M, Kimura T, Ikeda K. Radiotherapy after radical prostatectomy for prostate cancer: clinical outcomes and factors influencing biochemical recurrence. Ir J Med Sci 2023; 192:2663-2671. [PMID: 37097540 DOI: 10.1007/s11845-023-03356-z] [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: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Radiotherapy (RT) after radical prostatectomy (RP) includes adjuvant radiotherapy (ART) and salvage radiotherapy (SRT), which can prevent or cure biochemical recurrence. AIMS To evaluate long-term outcomes of RT after RP and to examine factors affecting biochemical recurrence-free survival (bRFS). METHODS Sixty-six received ART and 73 received SRT between 2005 and 2012 were included. The clinical outcomes and late toxicities were evaluated. Univariate and multivariate analyses were performed to examine factors affecting bRFS. RESULTS Median follow-up from RP was 111 months. Five-year bRFS and 10-year distant metastasis-free survival from RP were 82.8% and 84.5% in ART, and 74.6% and 92.4% in SRT, respectively. The most frequent late toxicity was hematuria, which was higher in ART (p = .01). No recurrence within RT field was occurred. On univariate analysis, pelvic RT was associated with favorable bRFS in ART (p = .048). In SRT, post-RP prostate-specific antigen (PSA) level (< 0.05 ng/mL), PSA nadir after RT (≤ 0.01 ng/mL), and time to PSA nadir (≥ 10 months) were associated with favorable bRFS (p = .03, p < .001, and p = .002, respectively). On multivariate analysis, post-RP PSA level and time to PSA nadir were independent predictive factors for bRFS in SRT (p = .04 and p = .005). CONCLUSIONS ART and SRT had favorable outcomes with no recurrence within RT field. In SRT, the time to PSA nadir after RT (≥ 10 months) was found to be a new predictor for favorable bRFS and useful in assessing treatment efficacy.
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Affiliation(s)
- Ichiro Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koshi Ikeda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
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Faggion CM. Should informed consent and information related to patient recruitment in clinical trials be available to the reader of scientific articles? A case study in dentistry. Account Res 2023; 30:692-706. [PMID: 35576611 DOI: 10.1080/08989621.2022.2078711] [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] [Indexed: 10/18/2022]
Abstract
Ethical aspects in research should be transparently reported. This study aimed to investigate whether informed consent and information related to patient recruitment in clinical studies are well reported in the scientific literature. Randomized clinical trials (RCTs) on root coverage procedures published between November 2016 and November 2021 were selected from the PubMed database. Items/questions were used to guide the extraction of data related to patient recruitment, with a focus on the detailed report of informed consent used to clarify the research to the patient. Data were extracted from the published article and the respective research protocol published in a public registry. Information related to potential selective outcome reporting (SOR) was also extracted. In total, 187 documents were initially screened and 74 reports of RCTs were included. No informed consent was published in the article. Only one research protocol provided a link to the informed consent. Deviations from reporting in the research protocol and published article were found, suggesting SOR. Informed consent and information related to patient recruitment in RCTs on root covering procedures are severely underreported. The present findings may stimulate further discussion and debate on the need for making this information publicly available.
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Affiliation(s)
- Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
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San Francisco IF, Rojas PA, Bravo JC, Díaz J, Ebel L, Urrutia S, Prieto B, Cerda-Infante J. Can We Predict Prostate Cancer Metastasis Based on Biomarkers? Where Are We Now? Int J Mol Sci 2023; 24:12508. [PMID: 37569883 PMCID: PMC10420177 DOI: 10.3390/ijms241512508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The incidence of prostate cancer (PC) has risen annually. PC mortality is explained by the metastatic disease (mPC). There is an intermediate scenario in which patients have non-mPC but have initiated a metastatic cascade through epithelial-mesenchymal transition. There is indeed a need for more and better tools to predict which patients will progress in the future to non-localized clinical disease or already have micrometastatic disease and, therefore, will clinically progress after primary treatment. Biomarkers for the prediction of mPC are still under development; there are few studies and not much evidence of their usefulness. This review is focused on tissue-based genomic biomarkers (TBGB) for the prediction of metastatic disease. We develop four main research questions that we attempt to answer according to the current evidence. Why is it important to predict metastatic disease? Which tests are available to predict metastatic disease? What impact should there be on clinical guidelines and clinical practice in predicting metastatic disease? What are the current prostate cancer treatments? The importance of predicting metastasis is fundamental given that, once metastasis is diagnosed, quality of life (QoL) and survival drop dramatically. There is still a need and space for more cost-effective TBGB tests that predict mPC disease.
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Affiliation(s)
- Ignacio F. San Francisco
- Environ Innovation Laboratory, Avenida Providencia 1208 Oficina 207, Providencia, Santiago 7500000, Chile;
| | - Pablo A. Rojas
- Servicio de Urología, Complejo Asistencial Dr. Sotero del Río, Santiago 8150215, Chile;
| | - Juan C. Bravo
- Servicio de Urología, Hospital Regional Libertador Bernardo O’Higgins, Rancagua 2820000, Chile;
| | - Jorge Díaz
- Servicio de Urología, Instituto Oncológico Fundación Arturo López Pérez, Santiago 7500921, Chile;
| | - Luis Ebel
- Servicio de Urología, Hospital Base de Valdivia, Universidad Austral, Valdivia 5090000, Chile;
| | - Sebastián Urrutia
- Servicio de Urología, Hospital Dr. Hernán Henríquez Aravena, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Benjamín Prieto
- Environ Innovation Laboratory, Avenida Providencia 1208 Oficina 207, Providencia, Santiago 7500000, Chile;
| | - Javier Cerda-Infante
- Environ Innovation Laboratory, Avenida Providencia 1208 Oficina 207, Providencia, Santiago 7500000, Chile;
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ACCURATE PREDICTION OF LONG-TERM RISK OF BIOCHEMICAL FAILURE AFTER SALVAGE RADIOTHERAPY INCLUDING THE IMPACT OF PELVIC NODE IRRADIATION. Radiother Oncol 2022; 175:26-32. [DOI: 10.1016/j.radonc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
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Renzulli JF, Brito J, Kim IY, Broccoli I. A meta-analysis on the use of radiotherapy after prostatectomy: adjuvant versus early salvage radiation. Prostate Int 2022; 10:80-84. [PMID: 35510080 PMCID: PMC9043851 DOI: 10.1016/j.prnil.2022.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
To determine which method of radiotherapy proves more effective after prostatectomy: Adjuvant (ART) or early salvage (ESRT), we observed the pathologic and adverse risk factors of patients and their results from both treatments, looking specifically at biochemical-free survival rates, metastasis-free survival rates, and overall survival rates. Peer review articles containing their own data collected between 1986 and 2022 were reviewed. We reviewed 67 peer review articles and included 33 that met criteria. Studies focused on the adverse risk factors and the results of patients either before/after receiving adjuvant or early salvage/salvage radiotherapy were included in the analysis. Patient characteristics had an effect on what treatment a patient would receive; if a patient had more than one adverse risk factor such as a high Gleason score, prostate-specific antigen (PSA) level, T-stage, or positive margins, they would receive immediate radiation after prostatectomy, which would classify as ART. If the patient had no adverse risk factors after surgery, they would be placed in an observation period to follow their PSA and overall health, and only if necessary, undergo ESRT. Of the 33 studies, ART was proven to be only slightly more beneficial when relating to biochemical recurrence-free survival while ART and ESRT results were similar in metastasis-free survival and overall survival. ART and ESRT are overall comparable in their patient outcomes, despite their own unique pros and cons. The use of ESRT reduces overtreatment in men who may not experience biochemical recurrence. However, in those with very high-risk pathologic features, a multi-disciplinary approach should be utilized to best determine which mode of radiation therapy after surgery is recommended.
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Affiliation(s)
- Joseph F. Renzulli
- Yale Medicine, Department of Urology, Yale School of Medicine, New Haven, CT, USA
- Corresponding author.
| | - Joseph Brito
- Yale Medicine, Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Isaac Y. Kim
- Yale Medicine, Department of Urology, Yale School of Medicine, New Haven, CT, USA
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Narrative Review of the Post-Operative Management of Prostate Cancer Patients: Is It Really the End of Adjuvant Radiotherapy? Cancers (Basel) 2022; 14:cancers14030719. [PMID: 35158986 PMCID: PMC8833528 DOI: 10.3390/cancers14030719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Among patients with prostate cancer who have been operated on, a subset harboring high-risk features will present with a biochemical recurrence (BCR). Adjuvant radiotherapy (aRT) was proven to significantly reduce the risk of BCR when compared to salvage radiotherapy (SRT) but suffered from several limitations: a lack of patient selection criteria, a higher treatment-related morbidity and an uncertain benefit for long-term clinical endpoints. In the same clinical setting, early SRT (eSRT) appears as non-inferior to aRT with a lower morbidity, replacing aRT as the preferred option. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient. Abstract Despite three randomized trials indicating a significant reduction in biochemical recurrence (BCR) in high-risk patients, adjuvant radiotherapy (aRT) was rarely performed, even in patients harboring high-risk features. aRT is associated with a higher risk of urinary incontinence and is often criticized for the lack of patient selection criteria. With a BCR rate reaching 30–70% in high-risk patients, a consensus between urologists and radiation oncologists was needed, leading to three different randomized trials challenging aRT with early salvage radiotherapy (eSRT). In these three different randomized trials with event-free survival as the primary outcome and a planned meta-analysis, eSRT appeared as non-inferior to aRT, answering, for some, this never-ending question. For many, however, the debate persists; these results raised several questions among urologists and radiation oncologists. BCR is thought to be a surrogate for clinically meaningful endpoints such as overall survival and cancer-specific survival but may be poorly efficient in comparison with metastasis-free survival. Imaging of rising prostate-specific antigen (PSA), post-operative persistent PSA and BCR was revolutionized by the broader use of MRI and nuclear imaging such as PET-PSMA; these imaging modalities were not analyzed in the previous randomized trials. A sub-group of very high-risk patients could possibly benefit from an adjuvant radiotherapy; but their usual risk factors such as high Gleason score or invaded surgical margins mean they are unable to be selected. More precise biomarkers of early BCR or even metastatic-relapse were developed in this setting and could be useful for the patients’ stratification. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.
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Schmidt-Hegemann NS, Zamboglou C, Thamm R, Eze C, Kirste S, Spohn S, Li M, Stief C, Bolenz C, Schultze-Seemann W, Bartenstein P, Prasad V, Ganswindt U, Grosu AL, Belka C, Mayer B, Wiegel T. A Multi-Institutional Analysis of Prostate Cancer Patients With or Without 68Ga-PSMA PET/CT Prior to Salvage Radiotherapy of the Prostatic Fossa. Front Oncol 2021; 11:723536. [PMID: 34660290 PMCID: PMC8517476 DOI: 10.3389/fonc.2021.723536] [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] [Received: 06/10/2021] [Accepted: 09/14/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION 68Ga-PSMA PET/CT is associated with unprecedented sensitivity for localization of biochemically recurrent prostate cancer at low PSA levels prior to radiotherapy. Aim of the present analysis is to examine whether patients undergoing postoperative, salvage radiotherapy (sRT) of the prostatic fossa with no known nodal or distant metastases on conventional imaging (CT and/or MRI) and on positron emission tomography/computed tomography (68Ga-PSMA PET/CT) will have an improved biochemical recurrence-free survival (BRFS) compared to patients with no known nodal or distant metastases on conventional imaging only. MATERIAL AND METHODS This retrospective analysis is based on 459 patients (95 with and 364 without 68Ga-PSMA PET/CT). BRFS (PSA < post-sRT Nadir + 0.2 ng/ml) was the primary study endpoint. This was first analysed by Kaplan-Meier and uni- and multivariate Cox regression analysis for the entire cohort and then again after matched-pair analysis using tumor stage, Gleason score, PSA at time of sRT and radiation dose as matching parameters. RESULTS Median follow-up was 77.5 months for patients without and 33 months for patients with 68Ga-PSMA PET/CT. For the entire cohort, tumor stage (pT2 vs. pT3-4; p= <0.001), Gleason score (GS ≤ 7 vs. GS8-10; p=0.003), pre-sRT PSA (<0.5 vs. ≥0.5ng/ml; p<0.001) and sRT dose (<70 vs. ≥70Gy; p<0.001) were the only factors significantly associated with improved BRFS. This was not seen for the use of 68Ga-PSMA PET/CT prior to sRT (p=0.789). Matched-pair analysis consisted of 95 pairs of PCa patients with or without PET/CT and no significant difference in BRFS based on the use of PET/CT was evident (p=0.884). CONCLUSION This analysis did not show an improvement in BRFS using 68Ga-PSMA PET/CT prior to sRT neither for the entire cohort nor after matched-pair analysis after excluding patients with PET-positive lymph node or distant metastases a priori. As no improved BRFS resulted with implementation of 68Ga-PSMA PET in sRT planning, sRT should not be deferred until the best "diagnostic window" for 68Ga-PSMA PET/CT.
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Affiliation(s)
- Nina-Sophie Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians Universität (LMU) Munich, Munich, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard Thamm
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians Universität (LMU) Munich, Munich, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Spohn
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians Universität (LMU) Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians Universität (LMU) Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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Evangelista L, Cassarino G, Lauro A, Morlacco A, Sepulcri M, Nguyen AAL, Ietto F, Cecchin D, Lacognata C, Zucchetta P. Comparison of MRI, PET, and 18F-choline PET/MRI in patients with oligometastatic recurrent prostate cancer. Abdom Radiol (NY) 2021; 46:4401-4409. [PMID: 34047801 PMCID: PMC8346454 DOI: 10.1007/s00261-021-03131-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022]
Abstract
Objectives The aims of the study were (i) to examine the PCa detection rate of 18F-choline (FCH) PET/MRI and (ii) to assess the impact of PET/MRI findings in patients with PCa who develop OMD using PSA response as a biomarker. Methods We retrospectively analyzed a cohort of 103 patients undergoing FCH PET/MRI for biochemical recurrence of PCa. The inclusion criteria were (1) previous radical prostatectomy (RP) with or without adjuvant radiotherapy (RT); (2) PSA levels available at the time of PET; (3) OMD, defined as a maximum of 5 lesions on PET/MRI; and (4) follow-up data available for at least 6 months after PET. All images were reviewed by two nuclear medicine physicians and interpreted with the support of two radiologists. Results Seventy patients were eligible for the study: 52 patients had a positive FCH PET/MRI and 18 had a negative scan. The overall PCa detection rates for MRI, PET, and PET/MRI were 65.7%, 37.1%, and 74.3%, respectively. Thirty-five patients were treated with radiotherapy (RT), 16 received hormonal therapy (HT), 3 had a combined therapy (RT + HT), and 16 (23%) underwent PSA surveillance. At follow-up, PSA levels decreased in 51 patients (73%), most of whom had been treated with RT or RT + HT. Therapeutic management was guided by PET/MRI in 74% of patients, which performed better than MRI alone (68% of patients). Conclusion FCH PET/MRI has a higher detection rate than MRI or PET alone for PCa patients with OMD and PSA levels > 0.5 ng/mL, prompting a better choice of treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03131-7.
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Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Alberto Lauro
- Radiology Unit, University-Hospital of Padova, Padua, Italy
| | - Alessandro Morlacco
- Department of Surgical Oncological and Gastroenterological Sciences, Urology University of Padua, Padua, Italy
| | - Matteo Sepulcri
- Radiotherapy Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Alex Ahn Li Nguyen
- Department of Surgical Oncological and Gastroenterological Sciences, Urology University of Padua, Padua, Italy
| | - Francesco Ietto
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | | | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
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Alberts IL, Seifert R, Rahbar K, Afshar-Oromieh A. Prostate Cancer Theranostics: From Target Description to Imaging. PET Clin 2021; 16:383-390. [PMID: 34053582 DOI: 10.1016/j.cpet.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Prostate-specific membrane antigen-PET/computed tomography (PSMA-PET/CT) is the investigation of choice for imaging prostate cancer. Demonstrating high diagnostic accuracy, PSMA-PET/CT detects disease at very early stages of recurrence, where the chances of a definitive cure may be at their greatest. A number of PSMA-radioligands are in established clinical routine, and there are currently only limited data and no single tracer can clearly be advocated over the others at present. Further clinical trial data, comparing and contrasting radiotracers and reporting outcome-based data are necessary to further increase the implementation of this very promising imaging modality.
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Affiliation(s)
- Ian L Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Centre, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Germany; German Cancer Consortium (DKTK), German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Centre, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Shahait M, Dobbs RW, Kim JL, Eldred N, Liang K, Huynh LM, Ahlering TE, Patel V, Lee DI. Perioperative and Functional Outcomes of Robot-Assisted Radical Prostatectomy in Octogenarian Men. J Endourol 2021; 35:1025-1029. [PMID: 33267679 DOI: 10.1089/end.2020.0859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The functional and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in octogenarians are not well studied. We sought to study the perioperative, functional, and oncologic outcomes of RARP in octogenarian men. Methods: Between January 2009 and 2019, 46 patients ≥80 years with localized prostate cancer (PCa) underwent RARP in three high-volume robotic urologic practices in the United States. Clinical and pathologic features, and perioperative and postoperative complications were retrospectively evaluated. Functional outcomes for urinary and sexual function were collected via patient-reported questionnaires. Continence was defined as the use of zero or one safety pad per day. Results: The median (interquartile range) age was 81 (80-82), the mean (standard deviation [SD]) operative time was 116.5 (36.4) minutes, and the mean (SD) blood loss was 132 (35.6) mL. All cases were completed robotically, no intraoperative complications were encountered, and the mean length of stay was 1.21 (0.78) days. Regarding 30- and 90-day complication, nine patients had postoperative complications; seven were Clavien-Dindo grade I-II, and two were Clavien-Dindo grade ≥III. Post-RARP continence rates at 3 and 12 months were 68.4% and 84.8%, respectively. Conclusions: RARP represents a feasible option to treat PCa in well-selected octogenarian men. Careful patient selection and counseling are critical before offering surgical treatment for these men.
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Affiliation(s)
- Mohammed Shahait
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,King Hussein Cancer Center, Amman, Jordan
| | - Ryan W Dobbs
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica L Kim
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy Eldred
- Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Karren Liang
- Department Urology, University of California Irvine, Orange, California, USA
| | - Linda M Huynh
- Department Urology, University of California Irvine, Orange, California, USA
| | - Thomas E Ahlering
- Department Urology, University of California Irvine, Orange, California, USA
| | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - David I Lee
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Liu CY, Chen YT, Su SH, Yu KJ, Chang YH, Lin PH, Shao IH, Kan HC, Chu YC, Huang LK, Chuang CK, Pang ST. Is immediate adjuvant radiotherapy necessary for men with positive surgical margin after robotic-assisted radical prostatectomy? FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moderate hypofractionated radiotherapy for post-operative treatment of prostate cancer: long-term outcome and pattern of toxicity. Strahlenther Onkol 2020; 197:133-140. [PMID: 33006025 DOI: 10.1007/s00066-020-01691-z] [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: 05/26/2020] [Accepted: 09/07/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Postoperative radiotherapy (RT) is an established treatment for prostate cancer (PC). Though hypofractionation is commonly used for radical treatments, open issues still remain in the postoperative setting due to the lack of long-term data. Aim of this study was to evaluate long-term results of postoperative moderately hypofractionated RT (MHRT). METHODS We conducted a retrospective analysis including PC patients treated with prostatectomy and postoperative MHRT delivered with volumetric modulated arc therapy (VMAT). Endpoints of the analysis included biochemical relapse-free survival (BRFS), distant metastases free-survival (DMFS), overall survival (OS), and pattern of acute and late toxicity. RESULTS 181 patients were included. Pathological stage was classified as pT3a in 33.6% and pT3b in 30%. Median PSA value before RT was 0.23 ng/ml and median RT total dose was 70 Gy (65-74.2 Gy) in 25/28 fractions. With a median follow-up of 54.5 months, rates of BRFS at 3 and 5 years were 80.7 and 72.3%. ISUP grade group (HR 1.44, p = 0.015), pathological T stage (HR 2.03; p = 0.009), and pre-RT PSA >0.2 ng/ml (HR 2.64; p = 0.015) were correlated with BRFS. Three and 5‑year DMFS were 87.4 and 80.8%. ISUP grade group (HR 1.50; p = 0.011) and pre-RT PSA (HR 5.34; p = 0.001) were correlated with DMFS. Five (2.7%) and 3 (1.6%) patients reported late grade 3 GU and GI toxicity, respectively. CONCLUSION Our results confirm the long-term safety and efficacy of postoperative MHRT for PC. ADVANCES IN KNOWLEDGE The present paper demonstrates the long-term safety and efficacy of MHRT for postoperative prostate cancer. Reduction of treatment time in long-course radiotherapy has advantages in terms of both patients' quality of life and departmental organization.
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Saoud R, Heidar NA, Cimadamore A, Paner GP. Incorporating Prognostic Biomarkers into Risk Assessment Models and TNM Staging for Prostate Cancer. Cells 2020; 9:E2116. [PMID: 32957584 PMCID: PMC7564222 DOI: 10.3390/cells9092116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
In current practice, prostate cancer staging alone is not sufficient to adequately assess the patient's prognosis and plan the management strategies. Multiple clinicopathological parameters and risk tools for prostate cancer have been developed over the past decades to better characterize the disease and provide an enhanced assessment of prognosis. Herein, we review novel prognostic biomarkers and their integration into risk assessment models for prostate cancer focusing on their capability to help avoid unnecessary imaging studies, biopsies and diagnosis of low risk prostate cancers, to help in the decision-making process between active surveillance and treatment intervention, and to predict recurrence after radical prostatectomy. There is an imperative need of reliable biomarkers to stratify prostate cancer patients that may benefit from different management approaches. The integration of biomarkers panel with risk assessment models appears to improve prostate cancer diagnosis and management. However, integration of novel genomic biomarkers in future prognostic models requires further validation in their clinical efficacy, standardization, and cost-effectiveness in routine application.
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Affiliation(s)
- Ragheed Saoud
- Department of Surgery (Section of Urology), University of Chicago, Chicago, IL 60637, USA;
| | - Nassib Abou Heidar
- Department of Surgery (Division of Urology), American University of Beirut Medical Center, Beirut 11-0236, Lebanon;
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, 60126 Ancona, Italy;
| | - Gladell P. Paner
- Department of Surgery (Section of Urology), University of Chicago, Chicago, IL 60637, USA;
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
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Bartkowiak D, Thamm R, Siegmann A, Böhmer D, Budach V, Wiegel T. Lead-time bias does not falsify the efficacy of early salvage radiotherapy for recurrent prostate cancer. Radiother Oncol 2020; 154:255-259. [PMID: 32920006 DOI: 10.1016/j.radonc.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In prostate cancer (PCa) recurring after radical prostatectomy (RP), salvage radiotherapy (SRT) is recommended to be given at PSA <0.5 ng/ml. It has been speculated, that the advantage from early SRT is mainly caused by lead-time bias: Calculating from time of SRT, earlier treatment would per-se result in longer time to event/censoring compared with later treatment, but not extend the interval from RP to post-SRT failure. METHODS In 603 consecutive PCa patients receiving SRT between 1997 and 2017, we compared outcomes, calculating from time of irradiation vs. time of surgery. RESULTS In multivariable analysis, tumor stage pT3-4, pathological Gleason score GS ≤6 vs. GS 7 vs. GS ≥8, post-RP PSA persistence (nadir ≥0.1 ng/ml), and the pre-SRT PSA (continuous or with cutoff 0.4 ng/ml) were significant risk-factors for biochemical progression (BCR) and progression-free survival (PFS) post-SRT and post-RP. A pre-SRT PSA <0.4 ng/ml was a significant discriminator for Kaplan-Meier rates of BCR and PFS. The Cox model for overall survival (OS) included age at RP (continuous), pT2 vs. pT3-4, and pre-SRT PSA (continuous) as significant predictors. However, no significant cutoff for the pre-SRT PSA could be identified to differentiate Kaplan-Meier estimates of OS, possibly because there were too few events, as 88% of the patients were still alive at last follow-up. CONCLUSIONS The pre-SRT PSA has a significant impact on BCR, PFS and potentially on OS, calculating either from RP or from SRT to event/censoring, respectively. This contradicts the hypothesis of lead-time bias falsifying the advantage from early SRT.
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Affiliation(s)
| | - Reinhard Thamm
- Dept. Radiation Oncology, University Hospital Ulm, Germany
| | | | - Dirk Böhmer
- Dept. Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Volker Budach
- Dept. Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Thomas Wiegel
- Dept. Radiation Oncology, University Hospital Ulm, Germany.
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Huelster HL, Laviana AA, Joyce DD, Huang LC, Zhao Z, Koyama T, Hoffman KE, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg M, Hashibe M, O'Neil BB, Kaplan SH, Greenfield S, Penson DF, Barocas DA. Radiotherapy after radical prostatectomy: Effect of timing of postprostatectomy radiation on functional outcomes. Urol Oncol 2020; 38:930.e23-930.e32. [PMID: 32736934 DOI: 10.1016/j.urolonc.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND OBJECTIVE The timing of radiotherapy (RT) after prostatectomy is controversial, and its effect on sexual, urinary, and bowel function is unknown. This study seeks to compare patient-reported functional outcomes after radical prostatectomy (RP) and postprostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study of men with localized prostate cancer. Patient-reported sexual, urinary, and bowel functional outcomes were measured using the 26-item Expanded Prostate Index Composite at baseline and at 6, 12, 36, and 60 months after enrollment. Functional outcomes were compared among men undergoing RP alone, post-RP adjuvant radiation (RP + aRT), and post-RP salvage radiation (RP + sRT) using multivariable models controlling for baseline clinical, demographic, and functional characteristics. RESULTS Among 1,482 CEASAR participants initially treated with RP for clinically localized prostate cancer, 11.5% (N = 170) received adjuvant (aRT, N = 57) or salvage (sRT, N = 113) radiation. Men who received post-RP RT had worse scores in all domains (sexual function [-9.0, 95% confidence interval {-14.5, -3.6}, P < 0.001], incontinence [-8.8, {-14.0, -3.6}, P < 0.001], irritative voiding [-5.9, {-9.0, -2.8}, P < 0.001], bowel irritative [-3.5, {-5.8, -1.2}, P = 0.002], and hormonal function [-4.5, {-7.2, -1.7}, P = 0.001]) compared to RP alone at 5 years of follow-up. Compared to men treated with RP alone in an adjusted linear model, sRT was associated with significantly worse scores in all functional domains. aRT was associated with significantly worse incontinence, urinary irritation, and hormonal function domain scores compared to RP alone at 5 years of follow-up. On multivariable modeling, RT administered approximately 24 months after RP was associated with the smallest decline in sexual domain score, with an adjusted mean decrease of 8.85 points (95% confidence interval [-19.8, 2.1]) from post-RP, pre-RT baseline. CONCLUSIONS In men with localized prostate cancer, post-RP RT was associated with significantly worse sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Radiation delayed for approximately 24 months after RP may be optimal for preserving erectile function compared to radiation administered closer to the time of RP.
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Affiliation(s)
- Heather L Huelster
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron A Laviana
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA
| | - Lisa E Paddock
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | - Antoinette Stroup
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Brock B O'Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA
| | | | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
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Motterle G, Morlacco A, Zattoni F, Karnes RJ. Prostate cancer: more effective use of underutilized postoperative radiation therapy. Expert Rev Anticancer Ther 2020; 20:241-249. [PMID: 32182149 DOI: 10.1080/14737140.2020.1743183] [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] [Indexed: 01/28/2023]
Abstract
Introduction: Adverse pathological features at radical prostatectomy such as extracapsular extension, seminal-vesicle involvement, positive surgical margins and/or lymph node invasion define a particular subgroup of patients that might benefit from additional treatment after surgery, in particular radiation therapy.Areas covered: Post-prostatectomy radiation is intended as adjuvant, early-salvage or salvage depending on the timing and PSA levels at the treatment. After providing the most used definitions, the high-level evidence supporting adjuvant radiation is reviewed together with the limitations affecting its utilization. In recent years early-salvage radiation was hypothesized to be a non-inferior alternative based on good-quality retrospective data. Recently, preliminary results of ongoing trials provide additional evidence. In light of the need to identify patients that will truly benefit from adjuvant radiation, clinically based and molecular tools available for this purpose are reviewed.Expert opinion: In order to tailor treatment for the patient after radical prostatectomy, there is a need for a tool that could both improve the oncological outcomes and be cost-effective. To date, genomic testing provides the most promising results that will be reasonably improved in the coming years.
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Affiliation(s)
- Giovanni Motterle
- Department of Urology, Mayo Clinic, Rochester, MN, USA.,Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padova, Padova, Italy
| | - Alessandro Morlacco
- Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padova, Padova, Italy
| | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padova, Padova, Italy
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Hunter AJ, Hendrikse AS. Estimation of the effects of radiotherapy treatment delays on tumour responses: A review. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.4102/sajo.v4i0.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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21
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Baumgarten L, Borchert A, Sood A, Dalela D, Arora S, Keeley J, Rogers C, Peabody J, Menon M, Abdollah F. Impact of timing on salvage radiation therapy adverse events following radical prostatectomy: A secondary analysis of the RTOG 9601 cohort. Urol Oncol 2020; 38:38.e17-38.e22. [DOI: 10.1016/j.urolonc.2019.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/02/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022]
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González-San Segundo C, Gómez-Iturriaga A, Couñago F. Are all prostate cancer patients "fit" for salvage radiotherapy? World J Clin Oncol 2020; 11:1-10. [PMID: 31976305 PMCID: PMC6935690 DOI: 10.5306/wjco.v11.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
The indication for salvage radiotherapy (RT) (SRT) in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen (PSA) levels at the time of biochemical recurrence. Although there are clear criteria (pT3-pT4 disease and/or positive margins) for the use of adjuvant radiotherapy, no specific clinical or tumour-related criteria have yet been defined for SRT. In retrospective series, 5-year biochemical progression-free survival (PFS) ranges from 35%-85%, depending on the PSA level at the start of RT. Two phase 3 trials have compared SRT with and without androgen deprivation therapy (ADT), finding that combined treatment (SRT+ADT) improves both PFS and overall survival. Similar to adjuvant RT, the indication for ADT is based on tumour-related factors such as PSA levels, tumour stage, and surgical margins. The number of patients referred to radiation oncology departments for SRT continues to rise. In the present article, we define the clinical, therapeutic, and tumour-related factors that we believe should be evaluated before prescribing SRT. In addition, we propose a decision algorithm to determine whether the patient is fit for SRT. This algorithm will help to identify patients in whom radiotherapy is likely to improve survival without significantly worsening quality of life.
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Affiliation(s)
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28003, Spain
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Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy. Radiat Oncol 2019; 14:198. [PMID: 31711524 PMCID: PMC6849377 DOI: 10.1186/s13014-019-1391-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/02/2019] [Indexed: 01/20/2023] Open
Abstract
Background Adjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to compare outcome. Methods We evaluated 253 patients treated with postoperative RT with a median age of 66 years (range 42–85 years) treated between 2004 and 2014. Patients with additive radiotherapy due to PSA persistence and patients in the SRT group, who did not achieve a postoperative PSA level <0.1 ng/mL were excluded. Hence, data of 179 patients was evaluated. We used propensity score matching to build homogenous groups. A Cox regression model was used to determine differences between treatment options. Median follow-up was 32.5 months (range 1.4–128.0 months). Results Early SRT at PSA levels <0.3 ng/mL was associated with significant longer BCRFS than late SRT (HR: 0.32, 95%-CI: 0.14–0.75, p = 0.009). Multiple Cox regression showed pre-RT PSA level, tumor stage, and Gleason score as predictive factors for biochemical relapse. In the overall group, patients treated with either ART or early SRT showed no significant difference in BCRFS (HR: 0.17, 95%-CI: 0.02–1.44, p = 0.1). In patients with locally advanced PC (pT3/4) BCRFS was similar in both groups as well (HR: 0.21, 95%-CI:0.02–1.79, p = 0.15). Conclusion For patients with PSA-triggered follow-up, close observation is essential and early initiation of local treatment at low PSA levels (<0.3 ng/mL) is beneficial. Our data suggest, that SRT administered at early PSA rise might be equieffective to postoperative ART in patients with locally advanced PC. However, the individual treatment decision must be based on any adverse risk factors and the patients’ postoperative clinical condition. Study registration The present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14.
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Tao R, Dai J, Bai Y, Yang J, Sun G, Zhang X, Zhao J, Zeng H, Shen P. The prognosis benefits of adjuvant versus salvage radiotherapy for patients after radical prostatectomy with adverse pathological features: a systematic review and meta-analysis. Radiat Oncol 2019; 14:197. [PMID: 31706339 PMCID: PMC6842460 DOI: 10.1186/s13014-019-1384-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
Background The appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). Methods PubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3. Results A total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (p < 0.0001) and DMFS (p < 0.0001), when compared to SRT. The subgroup analysis of the 5-year OS rate demonstrated that the ART group still had survival advantages compared to the SRT group (p = 0.0006). However, ART and SRT were comparable in 10-year OS rate (p = 0.07). ART had advantages over SRT in both 5-year (p = 0.0003) and 10-year BRFS (p = 0.0003). The subgroup analysis with different follow-up starting points from RP or RT was essentially consistent with the above results. The pooled analysis also showed that ART was superior to ESRT on OS (p = 0.008) and DMFS (p = 0.03), and comparable to ESRT on BRFS (p = 0.1). Conclusions According to this meta-analysis, ART could be served as a preferential treatment for patients with APFs after RP to improve prognosis. Certainly, high-quality, multicenter randomized controlled trials (RCTs) are expecting to confirm the outcomes of our meta-analysis in the future.
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Affiliation(s)
- Ronggui Tao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jiyu Yang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
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Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy Versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension. Eur Urol 2019; 76:586-595. [DOI: 10.1016/j.eururo.2019.07.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/02/2019] [Indexed: 11/23/2022]
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26
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Heidenreich A, Pfister D. PSA persistence after radical prostatectomy needs more than standard therapeutic options to improve outcomes. BJU Int 2019; 124:716-718. [PMID: 31646759 DOI: 10.1111/bju.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Köln, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Köln, Germany
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Knipper S, Sadat-Khonsari M, Boehm K, Mandel P, Budäus L, Steuber T, Maurer T, Heinzer H, Schwarz R, Sauter G, Tilki D, Huland H, Graefen M. Impact of Adherence to Multidisciplinary Recommendations for Adjuvant Treatment in Radical Prostatectomy Patients With High Risk of Recurrence. Clin Genitourin Cancer 2019; 18:e112-e121. [PMID: 31648965 DOI: 10.1016/j.clgc.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate adherence to recommended adjuvant radiotherapy (aRT) in radical prostatectomy (RP) patients with adverse pathologic features and to analyse the outcome of patients who followed or denied this recommendation. PATIENTS AND METHODS We included 1140 consecutive RP patients (2006-2015) with non-organ confined (pT3) prostate cancer and either positive surgical margins (R1) and/or lymph node involvement (pN1) and non-detectable postoperative prostate-specific antigen who received multidisciplinary aRT recommendations. Patients were stratified into adherence versus non-adherence to recommendations. Additionally, subgroups within pathologic criteria (pT3R1N0, pT3R0N1, pT3R1N1) were analyzed. Kaplan-Meier, as well as multivariable Cox regression analyses were used to assess biochemical recurrence (BCR)-free survival, metastasis-free survival, cancer-specific survival, and overall survival. RESULTS Overall, 508 (44.6%) patients were non-adherent. Of those, 273 (53.6%) did not receive any RT, and 235 (46.4%) received salvage RT. At 8 years, BCR-free survival was 57.7 versus 20.1%, metastasis-free survival was 76.5 versus 75.4%, cancer-specific survival was 91.7 versus 87.4%, and overall survival was 80.4 versus 75.8% in adherent versus non-adherent patients, respectively (P < .001). In multivariable Cox regression predicting BCR, metastatic progression, cancer-specific mortality, and overall mortality, non-adherence to aRT recommendation represented an independent predictor (hazard ratio [HR], 3.8; 95% confidence interval [CI], 3.1-4.5; HR, 1.6; 95% CI, 1.2-2.2; HR, 2.8; 95% CI, 1.5-5.3; and HR, 1.8; 95% CI, 1.2-2.8, respectively). CONCLUSIONS Only about 55% of patients followed our multidisciplinary recommendations. Adherent patients were significantly less likely to experience BCR, metastatic progression, cancer-specific mortality, and overall mortality. Thus, patients with high risk of recurrence may be advised about the possibility of improved oncologic outcomes in case of adherence to aRT recommendations.
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Affiliation(s)
- Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
| | | | - Katharina Boehm
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Schwarz
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Department of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Prostate-Specific Membrane Antigen PET/Magnetic Resonance Imaging for the Planning of Salvage Radiotherapy in Patients with Prostate Cancer with Biochemical Recurrence After Radical Prostatectomy. PET Clin 2019; 14:487-498. [PMID: 31472746 DOI: 10.1016/j.cpet.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article presents an overview of the current literature on PET imaging with prostate-specific membrane antigen ligands, especially focusing on the potential role of simultaneous PET/magnetic resonance imaging for the planning of salvage radiotherapy in patients with prostate cancer with biochemical recurrence after radical prostatectomy.
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29
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Balakrishnan AS, Zhao S, Cowan JE, Broering JM, Cooperberg MR, Carroll PR. Trends and Predictors of Adjuvant Therapy for Adverse Features Following Radical Prostatectomy: An Analysis From Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 2019; 131:157-165. [DOI: 10.1016/j.urology.2019.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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Abstract
Multimodal regimens consist en more than one treatment to treat localized prostate cancer. They are now proposed routinely for high-risk diseases. Different approaches could be defined: In conclusion, multimodal regimens increase the risk of side effects compared to surgery or radiotherapy alone. Indications of these approaches muste be discussed with the patients after a careful evaluation of the benefit/risk ratio.
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Affiliation(s)
- C Hennequin
- Service d'oncologie radiothérapie, hôpital Saint-Louis, AP-HP, Paris France.
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31
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Van den Broeck T, van den Bergh RCN, Briers E, Cornford P, Cumberbatch M, Tilki D, De Santis M, Fanti S, Fossati N, Gillessen S, Grummet JP, Henry AM, Lardas M, Liew M, Mason M, Moris L, Schoots IG, van der Kwast T, van der Poel H, Wiegel T, Willemse PPM, Rouvière O, Lam TB, Mottet N. Biochemical Recurrence in Prostate Cancer: The European Association of Urology Prostate Cancer Guidelines Panel Recommendations. Eur Urol Focus 2019; 6:231-234. [PMID: 31248850 DOI: 10.1016/j.euf.2019.06.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/05/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022]
Abstract
Biochemical recurrence (BCR) after primary treatment of localized prostate cancer does not necessarily lead to clinically apparent progressive disease. To aid in prognostication, the European Association of Urology prostate cancer guidelines panel undertook a systematic review and successfully developed a novel BCR risk stratification system (groups with a low risk or high risk of BCR) based on disease and prostate-specific antigen characteristics. PATIENT SUMMARY: Following treatment to cure prostate cancer, some patients can develop recurrence of disease identified via a prostate-specific antigen blood test (ie, biochemical recurrence, or BCR). However, not every man who experiences BCR develops progressive disease (symptoms or evidence of disease progression on imaging). We conducted a review of the literature and developed a classification system for predicting which patients might progress to optimize treatment decisions.
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Affiliation(s)
| | | | | | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maria De Santis
- Charité University Hospital, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Stefano Fanti
- Nuclear Medicine Division, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and The Christie, Manchester, UK; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; University of Bern, Bern, Switzerland
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital, University of Leeds, Leeds, UK
| | | | - Matthew Liew
- Department of Urology, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Oncological Urology, University Medical Center, Utrecht Cancer Center, Utrecht, The Netherlands
| | - Olivier Rouvière
- Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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Martini A, Gandaglia G, Fossati N, Scuderi S, Bravi CA, Mazzone E, Stabile A, Scarcella S, Robesti D, Barletta F, Cucchiara V, Mirone V, Montorsi F, Briganti A. Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer. Eur Urol Oncol 2019; 4:42-48. [PMID: 31411971 DOI: 10.1016/j.euo.2019.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of positive surgical margins (PSMs) on the risk of metastases in prostate cancer (PCa) patients treated with radical prostatectomy (RP) is still debated. OBJECTIVE To identify PSM features associated with recurrence in a stage-by-stage analysis. DESIGN, SETTING, AND PARTICIPANTS A total of 1757 PCa patients treated with RP without neoadjuvant or adjuvant treatments between 2011 and 2017 were identified. Patients were stratified according to the presence of PSM and to margins characteristics in three groups: no versus favourable (single margin <3mm) versus unfavourable (≥3mm or multifocal margin) PSMs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictors of biochemical recurrence (BCR) and clinical recurrence (CR) were assessed using semiparametric Cox proportional hazard models. RESULTS AND LIMITATIONS Overall, 285 (16%) patients had PSMs; 146 (51%) had a unifocal PSM, while 139 (49%) had a multifocal PSM. The median length of a PSM was 1mm. Overall, 120 (42%) versus 165 (58%) patients had favourable versus unfavourable PSMs. In patients with ≤pT3a and pathologic grade group ≤3 disease (n=1351), favourable (hazard ratio [HR]: 2.24; 95% confidence interval [CI]: 1.19-4.22) and unfavourable (HR: 2.68; 95% CI: 1.49-4.84) PSMs significantly increased the risk of BCR (p<0.01). However, they were not associated with CR (all p>0.05). Conversely, in patients with pT3b/4 and/or pathologic grade group 4-5 and/or pN1 (n=406), only an unfavourable PSM was associated with both BCR (HR: 2.96; 95% CI: 1.19-4.22) and CR (HR: 2.60; 95% CI: 1.07-6.30; all p≤0.04). CONCLUSIONS Although the presence of PSMs was associated with an increased risk of BCR in all stages, only men with adverse pathologic characteristics and an unfavourable PSM were at an increased risk of experiencing metastases as compared with their counterparts with no or a single margin shorter than 3mm. PATIENT SUMMARY In this study, we defined a new category of unfavourable positive surgical margins (namely, ≥3mm and/or multifocal), which confers a higher risk of developing metastasis in men with more aggressive pathologic features.
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Affiliation(s)
- Alberto Martini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Andrea Bravi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scarcella
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Department of Urology, Università Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, Università Federico II, Naples, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Poelaert F, Joniau S, Roumeguère T, Ameye F, De Coster G, Dekuyper P, Quackels T, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Mottrie A, Lumen N. Current Management of pT3b Prostate Cancer After Robot-assisted Laparoscopic Prostatectomy. Eur Urol Oncol 2019; 2:110-117. [DOI: 10.1016/j.euo.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
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Sandler KA, McClelland III S, Degnin C, Chen Y, Mitin T. Dramatic polarization in genitourinary expert opinions regarding the clinical utility of positron emission tomography (PET) imaging in prostate cancer. Int Braz J Urol 2019; 45:23-31. [PMID: 30521167 PMCID: PMC6442122 DOI: 10.1590/s1677-5538.ibju.2018.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/29/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives: To ascertain the opinions of North American genitourinary (GU) experts regarding inclusion of technologies such as prostate - specific membrane antigen (PSMA) and C – 11 choline positron emission tomography (PET) into routine practice. Materials and Methods: A survey was distributed to North American GU experts. Questions pertained to the role of PSMA and C – 11 PET in PCa management. Participants were categorized as “supporters” or “opponents” of incorporation of novel imaging techniques. Opinions were correlated with practice patterns. Results: Response rate was 54% and we analyzed 42 radiation oncologist respondents. 17 participants (40%) have been in practice for > 20 years and 38 (90%) practice at an academic center. 24 (57%) were supporters of PSMA and 29 (69%) were supporters of C – 11. Supporters were more likely to treat pelvic nodes (88% vs. 56%, p < 01) and trended to be more likely to treat patients with moderate or extreme hypofractionation (58% vs. 28%, p = 065). Supporters trended to be more likely to offer brachytherapy boost (55% vs. 23%, p = 09), favor initial observation and early salvage over adjuvant radiation (77% vs. 55%, p = 09), and to consider themselves expert brachytherapists (69% vs. 39%, p = 09). Conclusions: There is a polarization among GU radiation oncology experts regarding novel imaging techniques. A correlation emerged between support of novel imaging and adoption of treatment approaches that are clinically superior or less expensive. Pre - existing biases among GU experts on national treatment - decision panels and leaders of cooperative group studies may affect the design of future studies and influence the adoption of these technologies in clinical practice.
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Affiliation(s)
| | | | | | - Yiyi Chen
- Oregon Health and Science University, USA
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Jiang W, Zhang L, Wu B, Zha Z, Zhao H, Jun Y, Jiang Y. The impact of lymphovascular invasion in patients with prostate cancer following radical prostatectomy and its association with their clinicopathological features: An updated PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13537. [PMID: 30544460 PMCID: PMC6310490 DOI: 10.1097/md.0000000000013537] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Numerous studies have shown that lymphovascular invasion (LVI) is linked to biochemical recurrence (BCR) in prostate cancer (PCa) patients following radical prostatectomy (RP). However, the actual clinicopathological impacts of LVI remain unclear. Thus, we performed a meta-analysis to evaluate the pathologic and prognostic impacts of LVI in PCa patients. METHODS Following the guidance of the PRISMA statement, relevant studies were collected systematically from the PubMed, EMBASE, and Web of Science databases to identify relevant studies published before June 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to investigate the association of LVI with BCR and clinicopathological features. RESULTS A total of 20 studies including 25,570 patients (106-6678 per study) with PCa were incorporated into this meta-analysis. Overall pooled analysis suggested that LVI was associated with a higher BCR risk both in univariate (pooled HR=1.50, 95% CI: 1.34-1.68, P <.001) and multivariate analyses (pooled HR=1.25, 95% CI: 1.17-1.34, P <.001). In addition, LVI was closely correlated with extraprostatic extension (yes vs no: OR = 4.23, 95% CI: 1.86-9.61, P <.001), pathological GS (≥7 vs <7: OR = 5.46, 95% CI: 2.25-13.27, P <.001), lymph node metastases (yes vs no: OR = 18.56, 95% CI: 7.82-44.06, P <.001), higher pathological stage (≥ T3 vs < T2: OR = 6.75, 95% CI: 5.46-8.36, P <.001), positive surgical margin (positive vs negative: OR = 2.42, 95% CI: 1.57-3.72, P <.001) and seminal vesicle invasion (yes vs no: OR = 5.72, 95% CI: 2.45-13.36, P <.001). CONCLUSIONS This study suggests that LVI in histopathology is associated with a higher risk of BCR and advanced clinicopathological features in PCa patients and could serve as a poor prognostic factor in patients who underwent RP.
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Affiliation(s)
- Wei Jiang
- Department of Urology, Taizhou People's Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou
| | - Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
| | - Yuan Jun
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
| | - Yuefang Jiang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, Jiangsu Province, China
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Bottke D, Bartkowiak D, Siegmann A, Thamm R, Böhmer D, Budach V, Wiegel T. Effect of early salvage radiotherapy at PSA < 0.5 ng/ml and impact of post-SRT PSA nadir in post-prostatectomy recurrent prostate cancer. Prostate Cancer Prostatic Dis 2018; 22:344-349. [PMID: 30487644 DOI: 10.1038/s41391-018-0112-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/27/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND For patients with recurrent prostate cancer after radical prostatectomy (RP), salvage radiotherapy (SRT) offers a second chance of cure. European guidelines (EAU) recommend SRT at a PSA < 0.5 ng/ml. We analyze the efficacy of SRT given according to this recommendation and investigate the predictive power of the post-SRT PSA nadir. METHODS Between 1998 and 2013, 301 patients of two university hospitals received SRT at a PSA < 0.5 ng/ml (median 0.192 ng/ml, IQR 0.110-0.300). Patients, who previously received androgen deprivation therapy, were excluded. All patients had 3D-conformal RT or intensity-modulated radiotherapy (IMRT, n = 59) (median 66.6 Gy). The median follow-up was 5.9 years. Progression and overall survival were the endpoints. RESULTS After SRT, 252 patients re-achieved an undetectable PSA. In univariate analysis, pre-RP PSA ≥ 10 ng/ml, pT3-4, Gleason score (GS) 7-10 or 8-10, negative surgical margins, post-RP PSA ≥ 0.1 ng/ml, pre-SRT PSA ≥ 0.2 ng/ml and post-SRT PSA nadir ≥ 0.1 ng/ml correlated unfavorably with post-SRT progression. In a multivariable Cox model, pT3-4, GS 7-10, negative margins and a pre-SRT PSA ≥ 0.2 ng/ml were significant risk factors. If the post-SRT PSA was added to the analysis, it dominated the outcome (HR = 9.00). Of the patients with a pre-SRT PSA < 0.2 ng/ml, only 9% failed re-achieving an undetectable PSA. Overall survival in these patients was 98% after 5.9 years compared to 91% in patients with higher pre-SRT PSA (Logrank p = 0.004). CONCLUSIONS SRT at a PSA < 0.2 ng/ml correlates significantly with achieving a post-SRT undetectable PSA (<0.1 ng/ml) and subsequently with improved freedom from progression. Given these overall favorable outcomes, whether additional androgen deprivation therapy is required for these men requires further study.
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Affiliation(s)
- Dirk Bottke
- MVZ Klinikum Esslingen GmbH, Fachbereich Strahlentherapie, Esslingen, Germany.
| | - Detlef Bartkowiak
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - Alessandra Siegmann
- Department of Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Reinhard Thamm
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany
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Berg S, Nabi J, Trinh QD. Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy. JAMA Oncol 2018; 4:1619-1620. [PMID: 30422246 DOI: 10.1001/jamaoncol.2018.3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sebastian Berg
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Junaid Nabi
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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38
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McGrane J, Mark F, Troup J, Parker C, Payne H. RADICAL(S) Radiotherapy Post-prostatectomy, Current and Future Practice. Clin Oncol (R Coll Radiol) 2018; 30:793-797. [PMID: 30213705 DOI: 10.1016/j.clon.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022]
Affiliation(s)
- J McGrane
- Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK.
| | - F Mark
- Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK
| | - J Troup
- British Uro-Oncology Group, UK
| | - C Parker
- Royal Marsden Hospital, Sutton, Surrey, UK
| | - H Payne
- Oncology Department, University College Hospital, London, UK
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Vogel MME, Kessel KA, Gschwend JE, Weichert W, Wilkens JJ, Combs SE. Early and late toxicity profiles of patients receiving immediate postoperative radiotherapy versus salvage radiotherapy for prostate cancer after prostatectomy. Strahlenther Onkol 2018; 195:131-144. [PMID: 30182246 DOI: 10.1007/s00066-018-1359-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study aims to evaluate both early and late toxicity profiles of patients receiving immediate postoperative radiotherapy (RT; adjuvant RT or additive RT) compared to salvage RT. METHODS We evaluated 253 patients with prostate cancer treated with either immediate postoperative (adjuvant RT, n = 42; additive RT, n = 39) or salvage RT (n = 137). Thirty-five patients received salvage treatment but did not achieve a postoperative prostate specific antigen (PSA) level <0.1 ng/ml and thus were excluded from analysis. RESULTS A significantly higher rate of early grade 1/2 proctitis in the immediate postoperative RT group without additional pelvic RT was observed (p = 0.02). Patients in the immediate postoperative RT group without additional pelvic RT showed significantly more early urinary tract obstructions (p = 0.003). Toxicity rates of early (<3 months) and late (3-6 months) postoperative RT were similar (p > 0.05). Baseline recovery rate of erectile dysfunction was better in patients with immediate postoperative RT without additional pelvic RT (p = 0.02; hazard ratio (HR) = 2.22, 95%-confidence interval, 95%-CI: 1.12-4.37). Recovery rate of urinary incontinence showed no significant difference in all groups (p > 0.05). CONCLUSION Patients receiving immediate postoperative RT (adjuvant or additive RT) without additional pelvic RT experience early gastrointestinal (GI) side effect proctitis and, as well as early genitourinary (GU) toxicity urinary tract obstruction more frequently than patients treated with salvage RT. Therefore, complete recovery after surgery is essential. However, we suggest basing the treatment decision on the patient's postoperative clinical condition and evaluation of any adverse risk factors, since many studies demonstrate a clear benefit for immediate postoperative RT (adjuvant or additive RT) in terms of oncological outcome.
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Affiliation(s)
- Marco M E Vogel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
- Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
- Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Wilko Weichert
- Department of Pathology, Technical University of Munich (TUM), Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany.
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Casas F, Valduvieco I, Oses G, Izquierdo L, Archila I, Costa M, Cortes KS, Barreto T, Ferrer F. Postoperative adjuvant and very early salvage radiotherapy after prostatectomy in high-risk prostate cancer patients can improve specific and overall survival. Clin Transl Oncol 2018; 21:355-362. [PMID: 30128953 DOI: 10.1007/s12094-018-1931-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Adjuvant radiotherapy (ART) for biochemical relapse (BR) after radical prostatectomy (RP) showed increased disease-free survival (DFS) in three previous randomized trials. Retrospective phase II trials evaluated if early salvage RT (ESRT) is equivalent to ART. Our study aims to compare ART and ESRT to salvage RT. MATERIALS AND METHODS We compared RP plus ART and ESRT versus SRT. Indication for RT was made by PSA determination after RP: ART when PSA ≤ 0.2 ng/ml, ESRT when PSA ≤ 0.3 after PSA rise from 0.0 to SRT PSA ≥ 0.3. The cause of death of each patients was analyzed, DFS, cause-specific survival (CSS) overall survival (OS) and metastasis-free survival (MFS) in relation to RT intention. RESULTS Between 1993 and 2008, 204 patients with a median age of 65 years (44-75) were treated. The median follow-up was 160 months (28.1-273.3). At diagnosis, 89.7% had localized clinical stages and 90.2% had Gleason (G) ≤ 7. The median PSA was 10 (range 4-101). The postoperative G was ≥ 7 in 66.2%; 56.4% had ≥ 2 positive margins; 29.4% received ART, 20% ESRT and 59.3% SRT. The DFS for ART, ESRT and SRT was 74, 56 and 39% with significant differences between the three groups (p < 0.001). ART + ESRT were combined versus SRT; for the DFS, the significant differences (p < 0.001) remained 67% versus 39%. Positive margins, pT3 and pre-RT PSA were significant factors on multivariate analysis. The CSS in the ART + ESRT group was 92 vs. 78% in the SRT group (p < 0.05). OS was 69% in ART + ESRT vs. 57% in SRT (p < 0.05). MFS was 82.7% in ART + ESRT vs. 67.4% in SRT. CONCLUSIONS In this study the ART + ESRT presented benefits versus SRT in DFS, CSS, OS and MFS.
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Affiliation(s)
- F Casas
- Radiation Oncology Department, Hospital Clínic, Barcelona, Spain.
| | - I Valduvieco
- Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - G Oses
- Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - L Izquierdo
- Urology Department, Hospital Clínic, Barcelona, Spain
| | - I Archila
- Pathology Department, Hospital Clínic, Barcelona, Spain
| | - M Costa
- Urology Department, Hospital Clínic, Barcelona, Spain
| | - K S Cortes
- Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - T Barreto
- Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - F Ferrer
- Radiation Oncology Department, Institut Català d'Oncologia, IDIBELL, Universitat de Barcelona, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
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Dal Pra A, Abramowitz MC, Stoyanova R, Pollack A. Contemporary role of postoperative radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:399-413. [PMID: 30050800 PMCID: PMC6043752 DOI: 10.21037/tau.2018.06.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
While radical prostatectomy (RP) has provided long-term disease control for the majority of patients with localized prostate cancer (CaP), nearly 30% of all surgical patients have disease progression. For high-risk patients, more than half of men experience disease recurrence within 10 years. Postoperative radiotherapy is the only known potentially curative treatment for a large number of patients following prostatectomy. Lately, there have been several advances with the potential to improve outcomes for patients undergoing postoperative radiotherapy. This article will give an overview of the existing literature and current controversies on: (I) timing of postoperative radiation; (II) use of concomitant androgen deprivation therapy; (III) optimal dose to the prostate bed; (IV) use of hypofractionation; (V) elective treatment of the pelvic lymph nodes; (VI) novel imaging modalities, and (VII) genomic biomarkers.
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Affiliation(s)
- Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
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Kanwal R, Shukla S, Walker E, Gupta S. Acquisition of tumorigenic potential and therapeutic resistance in CD133+ subpopulation of prostate cancer cells exhibiting stem-cell like characteristics. Cancer Lett 2018; 430:25-33. [PMID: 29775627 DOI: 10.1016/j.canlet.2018.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 12/12/2022]
Abstract
The role of CD133 (Prominin-1) as a cancer stem cell marker may be useful for therapeutic approaches and prognostication in prostate cancer patients. We investigated the stem-cell-related function and biological features of a subpopulation of CD133+ cells isolated from established primary human prostate cancer cell lines. The CD133+ cells sorted from human prostate cancer 22Rv1 exhibited high clonogenic and tumorigenic capabilities, sphere forming capacity and serially reinitiated transplantable tumors in NOD-SCID mice. Gene profiling analysis of CD133+ cells showed upregulation of markers of stem cell differentiation (CD44, Oct4, SOX9 and Nanog), epithelial-to-mesenchymal transition (c-myc and BMI1), osteoblastic differentiation (Runx2), and skeletal morphogenesis (BMP2), compared to side population of CD133- cells. These cells are highly malignant and resistant to γ-radiation and chemotherapeutic drug, docetaxel. Importantly, a docetaxel-resistant subclone was more enriched in CD133+ cells with significant increase in Runx2 expression, compared to CD133- cells. Furthermore, knockdown of Runx2 in these cells resulted in differential response to chemotherapy, sensitizing them to increased cell death. These results demonstrate therapy-resistant population with stem-like features are distinct subpopulation of malignant cells that resides within parental cell lines. The molecular signature of CD133+ cells may lead to identification of novel therapeutic targets and prognostic markers in the treatment of prostate cancer.
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Affiliation(s)
- Rajnee Kanwal
- Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, OH, 44106, USA; The Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA; Department of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA
| | - Sanjeev Shukla
- Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, OH, 44106, USA; The Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Ethan Walker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Sanjay Gupta
- Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, OH, 44106, USA; The Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA; Department of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA; Department of Nutrition, Case Western Reserve University, Cleveland, OH, 44106, USA; Division of General Medical Sciences, Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA.
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Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, Hearn JW, Koontz BF, Lee WR, Michalski JM, Pisansky TM, Liauw SL, Abramowitz MC, Pollack A, Moghanaki D, Anscher MS, Den RB, Zietman AL, Stephenson AJ, Efstathiou JA. Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer With Adverse Pathological Features. JAMA Oncol 2018; 4:e175230. [PMID: 29372236 PMCID: PMC5885162 DOI: 10.1001/jamaoncol.2017.5230] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/16/2017] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer with adverse pathological features (ie, pT3 and/or positive margins) after prostatectomy may be managed with adjuvant radiotherapy (ART) or surveillance followed by early-salvage radiotherapy (ESRT) for biochemical recurrence. The optimal timing of postoperative radiotherapy is unclear. Objective To compare the clinical outcomes of postoperative ART and ESRT administered to patients with prostate cancer with adverse pathological features. Design, Setting, and Participants This multi-institutional, propensity score-matched cohort study involved 1566 consecutive patients who underwent postprostatectomy ART or ESRT at 10 US academic medical centers between January 1, 1987, and December 31, 2013. Propensity score 1-to-1 matching was used to account for covariates potentially associated with treatment selection. Data were collected from January 1 to September 30, 2016. Data analysis was conducted from October 1, 2016, to October 21, 2017. Main Outcomes and Measures Freedom from postirradiation biochemical failure, freedom from distant metastases, and overall survival. All outcomes were measured from date of surgery to address lead-time bias. Results Of 1566 patients, 1195 with prostate-specific antigen levels of 0.1 to 0.5 ng/mL received ESRT and 371 patients with prostate-specific antigen levels lower than 0.1 ng/mL received ART. The median age (interquartile range) was 60 (55-65) years. After propensity score matching, the median (interquartile range) follow-up after surgery was similar between the ESRT and ART groups (73.3 [44.9-106.6] months vs 65.8 [40-107] months; P = .22). Adjuvant RT, compared with ESRT, was associated with higher freedom from biochemical failure (12-year actuarial rates: 69% [95% CI, 60%-76%] vs 43% [95% CI, 35%-51%]; effect size, 26%), freedom from distant metastases (95% [95% CI, 90%-97%] vs 85% [95% CI, 76%-90%]; effect size, 10%), and overall survival (91% [95% CI, 84%-95%] vs 79% [95% CI, 69%-86%]; effect size, 12%). Adjuvant RT, lower Gleason score and T stage, nodal irradiation, and postoperative androgen deprivation therapy were favorable prognostic features on multivariate analysis for biochemical failure. Sensitivity analysis demonstrated that the decreased risk of biochemical failure associated with ART remained significant unless more than 56% of patients in the ART group were cured by surgery alone. This threshold is greater than the estimated 12-year freedom from biochemical failure rate of 33% to 52% after radical prostatectomy alone, as determined by a contemporary dynamic nomogram. Conclusions and Relevance Adjuvant RT, compared with ESRT, was associated with reduced biochemical recurrence, distant metastases, and death for high-risk patients, pending prospective validation. These findings suggest that a greater proportion of patients with prostate cancer who have adverse pathological features may benefit from postprostatectomy ART rather than surveillance followed by ESRT.
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Affiliation(s)
- William L. Hwang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rahul D. Tendulkar
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shree Agrawal
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kevin L. Stephans
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Jason W. Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Bridget F. Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - W. Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | | | - Stanley L. Liauw
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | | | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Drew Moghanaki
- Department of Radiation Oncology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Mitchell S. Anscher
- Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond
| | - Robert B. Den
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J. Stephenson
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Matsuoka D, Watanabe H, Shimizu Y, Kimura H, Yagi Y, Kawai R, Ono M, Saji H. Structure–activity relationships of succinimidyl-Cys-C(O)-Glu derivatives with different near-infrared fluorophores as optical imaging probes for prostate-specific membrane antigen. Bioorg Med Chem 2018; 26:2291-2301. [DOI: 10.1016/j.bmc.2018.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 12/18/2022]
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45
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Okubo T, Mitsuzuka K, Koie T, Hoshi S, Matsuo S, Saito S, Tsuchiya N, Habuchi T, Ohyama C, Arai Y. Two years of bicalutamide monotherapy in patients with biochemical relapse after radical prostatectomy. Jpn J Clin Oncol 2018; 48:570-575. [DOI: 10.1093/jjco/hyy060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Teppei Okubo
- Department of Urology, Graduate School of Medicine, Tohoku University, Miyagi
| | - Koji Mitsuzuka
- Department of Urology, Graduate School of Medicine, Tohoku University, Miyagi
| | - Takuya Koie
- Department of Urology, Graduate School of Medicine, Hirosaki University, Aomori
| | - Senji Hoshi
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata
| | | | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, Tohoku University, Miyagi
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa
| | - Norihiko Tsuchiya
- Department of Urology, Graduate School of Medicine, Akita University, Akita
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomonori Habuchi
- Department of Urology, Graduate School of Medicine, Akita University, Akita
| | - Chikara Ohyama
- Department of Urology, Graduate School of Medicine, Hirosaki University, Aomori
| | - Yoichi Arai
- Department of Urology, Graduate School of Medicine, Tohoku University, Miyagi
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46
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van Leeuwen PJ, van der Poel HG. Re: Karim A. Touijer, Robert Jeffery Karnes, Niccolo Passoni, et al. Survival Outcomes of Men with Lymph Node-positive Prostate Cancer After Radical Prostatectomy: A Comparative Analysis of Different Postoperative Management Strategies. Eur Urol 2018;73:890-6. Eur Urol 2018; 74:e15-e17. [PMID: 29661485 DOI: 10.1016/j.eururo.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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47
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Use of Concomitant Androgen Deprivation Therapy in Patients Treated with Early Salvage Radiotherapy for Biochemical Recurrence After Radical Prostatectomy: Long-term Results from a Large, Multi-institutional Series. Eur Urol 2018; 73:512-518. [DOI: 10.1016/j.eururo.2017.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/21/2017] [Indexed: 01/18/2023]
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48
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Dess RT, Morgan TM, Nguyen PL, Mehra R, Sandler HM, Feng FY, Spratt DE. Adjuvant Versus Early Salvage Radiation Therapy Following Radical Prostatectomy for Men with Localized Prostate Cancer. Curr Urol Rep 2018; 18:55. [PMID: 28589403 DOI: 10.1007/s11934-017-0700-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radical prostatectomy (RP) is now the most common definitive treatment for high-risk prostate cancer. Unfortunately, many men will have residual microscopic disease after surgery alone. Despite level 1 evidence supporting the use of adjuvant radiation therapy (ART), <10% of men with adverse pathology (positive margins or T3 disease) receive ART in the USA. Early salvage radiation therapy (eSRT) at the time of biochemical recurrence has been proposed as an alternative strategy despite the lack of published randomized trials to support this approach. Multiple randomized trials are ongoing or recently completed to compare ART to eSRT, but given the long natural history of prostate cancer, long-term oncologic outcomes from these trials will not be reported for several years. In this review, we discuss the shifting trends in the diagnosis of high-risk prostate cancer given a decline in PSA screening, use of RP for high-risk disease, and compare and contrast the retrospective and randomized evidence regarding ART and SRT.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars Sinai, Los Angeles, CA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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49
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Kim YJ, Song C, Eom KY, Kim IA, Kim JS. Lymph node ratio determines the benefit of adjuvant radiotherapy in pathologically 3 or less lymph node-positive prostate cancer after radical prostatectomy: a population-based analysis with propensity-score matching. Oncotarget 2017; 8:110625-110634. [PMID: 29299174 PMCID: PMC5746409 DOI: 10.18632/oncotarget.22610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background The survival benefit of adjuvant radiotherapy (ART) in prostate adenocarcinoma, with limited numbers of pathologically involved lymph nodes (LNs) after radical prostatectomy (RP), is controversial. Materials and Methods From 2004 to 2014, data for prostate cancer patients categorized as N1M0 after RP were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. After propensity-score matching, the 10-year cancer-specific survival (CSS) rates between patients who received ART (ART group) or did not/unknown (no-ART group) were compared for each stratum of lymph node ratio (LNR) (%) according to the number of involved LNs. Results Optimal matching formed pairs of no-ART (n = 905) and ART (n = 905) groups. ART increased the CSS rate, even in patients with up to 3 positive LNs when the LNR is 7% or higher. Conclusions ART after RP showed a CSS benefit in prostate adenocarcinoma with 4 or more involved LNs irrespective of LNR. In prostate adenocarcinoma with up to 3 involved LNs after RP, ART may provide CSS benefits when the LNR is 7% or higher. The number of LN dissections required to achieve an LNR below 7% is 15, 29, and 43 or more for 1, 2, and 3 involved LNs, respectively.
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Affiliation(s)
- Yi-Jun Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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50
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Rodriguez JF, Liauw SL, Eggener SE. Managing Cancer Relapse After Radical Prostatectomy: Adjuvant Versus Salvage Radiation Therapy. Urol Clin North Am 2017; 44:597-609. [PMID: 29107276 DOI: 10.1016/j.ucl.2017.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasing proportion of men are undergoing radical prostatectomy for locally advanced prostate cancer. More than half of men with adverse pathologic features are expected to experience disease recurrence within 10 years. This article discusses the use of postoperative radiation therapy to decrease this risk. Evidence from 3 randomized trials and multiple retrospective studies indicates that either adjuvant or salvage radiation improve biochemical progression-free survival and may improve overall survival. Novel imaging and genomic analysis can improve patient selection for either modality, however current tests are unable to identify all patients who may benefit from additional local therapy.
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Affiliation(s)
- Joseph F Rodriguez
- Section of Urology, University of Chicago, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, The University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, University of Chicago, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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