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Kwak L, Ravi P, Armstrong JG, Beckendorf V, Chin JL, D'Amico AV, Dearnaley DP, Di Stasi SM, Gillessen S, Lukka H, Mottet N, Pommier P, Seiferheld W, Sydes MR, Tombal B, Zapatero A, Regan MM, Xie W, Sweeney CJ. Prognostic Impact of Prostate-Specific Antigen at 6 Months After Radiotherapy in Localized Prostate Cancer: An Individual Patient Data Analysis of Randomized Trials. J Clin Oncol 2024; 42:2132-2138. [PMID: 38471051 DOI: 10.1200/jco.23.00762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE We sought to evaluate the prognostic impact of prostate-specific antigen (PSA) at 6 months after completion of radiotherapy (RT) in patients treated with RT alone, RT plus short-term (st; 3-6 months), and RT plus long-term (lt; 24-36 months) androgen-deprivation therapy (ADT). PATIENTS AND METHODS Individual patient data were obtained from 16 randomized trials evaluating RT ± ADT for localized prostate cancer (PCa) between 1987 and 2011. The lowest PSA recorded within 6 months after RT completion was identified and categorized as < or ≥0.1 ng/mL. The primary outcomes were metastasis-free survival (MFS), PCa-specific mortality (PCSM), and overall survival (OS), from 12 months after random assignment. RESULTS Ninety-eight percent (n = 2,339/2,376) of patients allocated to RT alone, 84% (n = 4,756/5,658) allocated to RT + stADT, and 77% (n = 1,258/1,626) allocated to RT + ltADT had PSA ≥0.1 ng/mL within 6 months after completing RT. PSA ≥0.1 ng/mL was associated with lower MFS and OS and higher PCSM among patients allocated to RT ± ADT (RT - MFS: hazard ratio [HR], 2.24 [95% CI, 1.21 to 4.16]; PCSM: subdistribution hazard ratio [sHR], 1.82 [0.51 to 6.49]; OS: HR, 1.72 [0.97 to 3.05]; RT + stADT - MFS: HR, 1.27 [1.12 to 1.44]; PCSM: sHR, 2.10 [1.52 to 2.92]; OS: HR, 1.26 [1.11 to 1.44]; RT + ltADT - MFS: HR, 1.58 [1.27 to 1.96]; PCSM: sHR, 1.97 [1.11 to 3.49]; OS: HR, 1.59 [1.27 to 1.99]). Five-year MFS rates among patients allocated to RT, RT + stADT, and RT + ltADT were 91% versus 79%, 83% versus 76%, and 87% versus 74%, respectively, based on PSA < or ≥0.1 ng/mL. CONCLUSION PSA ≥0.1 ng/mL within 6 months after RT completion was prognostic for lt outcomes in patients treated with RT ± ADT for localized PCa. This can be used to counsel patients treated with RT ± ADT and in guiding clinical trial design evaluating novel systemic therapies with RT + ADT as well as (de)intensification strategies.
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Affiliation(s)
- Lucia Kwak
- Dana-Farber Cancer Institute, Boston, MA
| | | | - John G Armstrong
- Radiation Oncology Department, Cancer Trials Ireland, St Luke's Hospital, Dublin, Ireland
| | | | | | | | - David P Dearnaley
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Himanshu Lukka
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | | | | | | | | | - Almudena Zapatero
- Department of Radiation Oncology, La Princesa University Hospital, Health Research Institute, Madrid, Spain
| | | | | | - Christopher J Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
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Sargos P, Bellera C, Bentahila R, Guerni M, Benziane-Ouaritini N, Teyssonneau D, Vuong NS, Ploussard G, Roupret M, Roubaud G. Short-term Darolutamide (ODM-201) Concomitant to Radiation Therapy for Patients with Unfavorable Intermediate-risk Prostate Cancer: The Darius (AFU-GETUG P15) Phase 2 Trial Protocol. Eur Urol Oncol 2024:S2588-9311(24)00116-0. [PMID: 38755095 DOI: 10.1016/j.euo.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Combination of androgen deprivation therapy (ADT) with external beam radiation therapy (EBRT) is a standard of care for patients with intermediate-risk prostate cancer (PCa). However, 6 months of ADT generates multiple side effects impacting quality of life (QoL). Darolutamide (an androgen receptor targeting agent [ARTA]) is associated with low blood-brain barrier penetrance and less drug-drug interaction. OBJECTIVE To assess the efficacy of a combination of 6 months of darolutamide with EBRT to treat patients with unfavorable intermediate-risk PCa. DESIGN, SETTING, AND PARTICIPANTS The DARIUS trial is a multicenter randomized non comparative phase 2 trial, randomizing the 6-months darolutamide + EBRT arm versus 6-months ADT + EBRT in patients with unfavorable intermediate-risk PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint is a biological response defined as prostate-specific antigen ≤0.1 ng/ml at month six of darolutamide or ADT. The key secondary endpoints are biochemical recurrence-free survival, disease-free survival, safety, and QoL. Ancillary studies using radiomics and genomic classifier are planned. Sixty-two patients will be included. RESULTS AND LIMITATIONS In this population of patients requiring ADT combined with EBRT, the use of an ARTA alone, such as darolutamide, may demonstrate antitumoral efficacy while minimizing toxicity and maintaining QoL. Limitations are mainly inherent to the open-label design of this study. CONCLUSIONS Six months of darolutamide + EBRT compared with 6 months of ADT + EBRT may be efficient in terms of a biological response, avoiding toxicity and altered QoL attributable to ADT in patients with unfavorable intermediate-risk PCa. PATIENT SUMMARY The ongoing DARIUS clinical trial assesses short-term (6 months) darolutamide treatment in association with external beam radiation therapy in men with localized prostate cancer. The trial investigates whether single-agent darolutamide can improve the biological response while maintaining a favorable tolerability profile.
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Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | - Carine Bellera
- Epicene Team, Bordeaux Population Health Research Center, UMR 1219, Inserm, University of Bordeaux, Bordeaux, France; Clinical and Epidemiological Research Unit, Comprehensive Cancer Center, Inserm CIC1401, Institut Bergonié, Bordeaux, France
| | - Rita Bentahila
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Marie Guerni
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France
| | | | | | - Nam-Son Vuong
- Urology Department, Clinique Saint-Augustin, Bordeaux, France
| | | | - Morgan Roupret
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
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3
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von Eyben FE, Kairemo K, Kapp DS. Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low Shall We Go? A Systematic Review. Biomedicines 2024; 12:822. [PMID: 38672176 PMCID: PMC11048591 DOI: 10.3390/biomedicines12040822] [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: 09/15/2023] [Revised: 12/25/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
Serum prostate-specific antigen (PSA) needs to be monitored with ultrasensitive PSA assays (uPSAs) for oncologists to be able to start salvage radiotherapy (SRT) while PSA is <0.5 µg/L for patients with prostate cancer (PCa) relapsing after a radical prostatectomy (RP). Our systematic review (SR) aimed to summarize uPSAs for patients with localized PCa. The SR was registered as InPLASY2023110084. We searched for studies on Google Scholar, PUBMED and reference lists of reviews and studies. We only included studies on uPSAs published in English and excluded studies of women, animals, sarcoidosis and reviews. Of the 115 included studies, 39 reported PSA assay methods and 76 reported clinical findings. Of 67,479 patients, 14,965 developed PSA recurrence (PSAR) and 2663 died. Extremely low PSA nadir and early developments of PSA separated PSAR-prone from non-PSAR-prone patients (cumulative p value 3.7 × 1012). RP patients with the lowest post-surgery PSA nadir and patients who had the lowest PSA at SRT had the fewest deaths. In conclusion, PSA for patients with localized PCa in the pre-PSAR phase of PCa is strongly associated with later PSAR and survival. A rising but still exceedingly low PSA at SRT predicts a good 5-year overall survival.
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Affiliation(s)
| | - Kalevi Kairemo
- Department of Molecular Radiotherapy & Nuclear Medicine, Docrates Cancer Center, FI-00185 Helsinki, Finland;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Franco FB, Leeman JE, Fedorov A, Vangel M, Fennessy FM. Early change in apparent diffusion coefficient as a predictor of response to neoadjuvant androgen deprivation and external beam radiation therapy for intermediate- to high-risk prostate cancer. Clin Radiol 2024; 79:e607-e615. [PMID: 38302377 DOI: 10.1016/j.crad.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/15/2023] [Accepted: 12/31/2023] [Indexed: 02/03/2024]
Abstract
AIM To determine the role of serial apparent diffusion coefficient (ADC) as a biomarker for response to neoadjuvant androgen deprivation therapy (nADT) followed by external beam radiation therapy (EBRT) in intermediate- to high-risk prostate cancer (PCa) patients. METHODS This Health Insurance Portability and Accountability Act (HIPAA)-compliant, institutional review board (IRB)-approved prospective study included 12 patients with intermediate- to high-risk PCa patients prior to nADT and EBRT, who underwent serial serum prostate-specific antigen (PSA) and multiparametric prostate magnetic resonance imaging (mpMRI) at baseline (BL), 8-weeks after nADT initiation (time point [TP]1), 6-weeks into EBRT delivery (TP2), and 6-months after nADT initiation (TP3). Tumour volume (tVOL) and tumour and normal tissue ADC (tADC and nlADC) were determined at all TPs. tADC and nlADC dynamics were correlated with post-treatment PSA using Pearson's correlation coefficient. Paired t-tests compared pre/post-treatment ADC. RESULTS There was a sequential decrease in PSA at all TPs, reaching their lowest values at TP3 post-treatment completion. Mean tADC increased significantly from baseline to TP1 (917.8 ± 107.7 × 10-6 versus 1033.8 ± 139.3 × 10-6 mm2/s; p<0.01), with no subsequent change at TP2 or TP3. Both percentage and absolute change in tADC from BL to TP1 correlated with post-treatment PSA (r=-0.666, r=-0.674; p=0.02). Post-treatment PSA in good responders (<0.1 ng/ml) versus poor responders (≥ 0.1 ng/ml) was associated with a greater increase in tADC from BL to TP1 (169.2 ± 122.4 × 10-6 versus 22.9 ± 75.5 × 10-6 mm2/s, p=0.03). CONCLUSION This pilot study demonstrates the potential for early ADC metrics as a biomarker of response to nADT and EBRT in intermediate to high-risk PCA.
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Affiliation(s)
- F B Franco
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - J E Leeman
- Department of Radiation Oncology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - A Fedorov
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - M Vangel
- Statistician, General Clinical Research Center, Massachusetts Institute of Technology and Massachusetts General Hospital, 55 Fruit St, Boston, MA 02214, USA
| | - F M Fennessy
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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5
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Kim DY, Lee WW, Song YS, Hong SK, Byun SS, Kim JS. Detection of Recurrence Sites using 18F-fluorocholine PET/CT in Prostate Cancer Patients with PSA failure. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bryant AK, Nelson TJ, McKay RR, Kader AK, Parsons JK, Einck JP, Kane CJ, Sandhu AP, Mundt AJ, Murphy JD, Rose BS. Impact of age on treatment response in men with prostate cancer treated with radiotherapy. BJUI COMPASS 2021; 3:243-250. [PMID: 35492227 PMCID: PMC9045578 DOI: 10.1002/bco2.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To analyse the effect of age at diagnosis on clinical outcomes of localized prostate cancer (PCa) treated with radiation therapy. Subjects and methods We identified 12 784 patients with intermediate‐ or high‐risk localized PCa treated with radiation therapy (RT) and neoadjuvant androgen deprivation therapy (ADT) between 2000 and 2015 from nationwide Veterans Affairs data. Patients were grouped into three age categories (≤59, 60–69, and ≥70 years old). Outcomes included immediate PSA response (3‐month post‐RT PSA and 2‐year PSA nadir, grouped into <0.10 ng/ml, 0.10–0.49 ng/ml, and ≥0.50 ng/ml), biochemical recurrence, and PCa‐specific mortality. Multivariable regression models included ordinal logistic regression for short‐term PSA outcomes, Cox regression for biochemical recurrence, and Fine‐Gray competing risks regression for PCa‐specific mortality. Results A total of 2136 patients (17%) were ≤59 years old at diagnosis, 6107 (48%) were 60–69 years old, and 4541 (36%) were ≥70 years old. Median follow‐up was 6.3 years. Younger age was associated with greater odds of higher 3‐month PSA group (≤59 vs. ≥70: adjusted odds ratio [aOR] 1.90, 95% CI 1.64–2.20; p < 0.001) and higher 2‐year PSA nadir group (≤59 vs. ≥70: aOR 1.89, 95% CI 1.62–2.19, p < 0.001). Younger age was associated with greater risk of biochemical recurrence (≤59 vs. ≥70: adjusted hazard ratio 1.45, 95% CI 1.26–1.67, p < 0.001) but not PCa‐specific mortality (p = 0.16). Conclusion In a large nationwide sample of US veterans treated with ADT and RT for localized PCa, younger age was associated with inferior short‐term PSA response and higher risk of biochemical recurrence.
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Affiliation(s)
- Alex K. Bryant
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Radiation OncologyVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Tyler J. Nelson
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Rana R. McKay
- Division of Hematology‐Oncology, Department of Internal MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - A. Karim Kader
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - J. Kellogg Parsons
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - John P. Einck
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Christopher J. Kane
- Department of UrologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Ajay P. Sandhu
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
| | - James D. Murphy
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
| | - Brent S. Rose
- Department of Radiation Medicine and Applied SciencesUniversity of California San DiegoLa JollaCaliforniaUSA
- Clinical and Translational Research InstituteUniversity of California San DiegoLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemLa JollaCaliforniaUSA
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7
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Li P, Liu C, Wu S, Deng L, Zhang G, Cai X, Hu S, Cheng J, Xu X, Wu B, Guo X, Zhang Y, Fu S, Zhang Q. Combination of 99mTc-Labeled PSMA-SPECT/CT and Diffusion-Weighted MRI in the Prediction of Early Response After Carbon Ion Therapy in Prostate Cancer: A Non-Randomized Prospective Pilot Study. Cancer Manag Res 2021; 13:2191-2199. [PMID: 33688262 PMCID: PMC7937376 DOI: 10.2147/cmar.s285167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to assess the potential of 99mTc-labeled PSMA-SPECT/CT and diffusion-weighted image (DWI) for predicting treatment response after carbon ion radiotherapy (CIRT) in prostate cancer. Patients and Methods We prospectively registered 26 patients with localized prostate cancer treated with CIRT. All patients underwent 99mTc-labeled PSMA-SPECT/CT and multiparametric magnetic resonance imaging (MRI) before and after CIRT. The tumor/background ratio (TBR) and mean apparent diffusion coefficient (ADCmean) were measured on the tumor and the percentage changes before and after therapy (ΔTBR and ΔADCmean) were calculated. Patients were divided into two groups: good response and poor response according to clinical follow-up. Results The median follow up time was 38.3months. The TBR was significantly decreased (p=0.001), while the ADCmean was significantly increased compared with the pretreatment value (p<0.001). The ΔTBR and ΔADCmean were negatively correlated with each other (p = 0.002). On ROC curve analysis for predicting treatment response, the area under the ROC curve (AUC) of ΔTBR (0.867) for predicting good response was higher than that of ΔADCmean (0.819). The AUC of combined with ΔTBR and ΔADCmean (0.895) was higher than that of either ΔADCmean or ΔTBR alone. The combined use of ΔTBR and ΔADCmean showed 91.4% sensitivity and 95.2% specificity. Conclusion Our preliminary data indicate that the changes of TBR and ADCmean maybe an early bio-marker for predicting prognosis after CIRT in localized prostate cancer patients. In addition, the ΔTBR seems to be a more powerful prognostic factor than ΔADCmean in prostate cancer treated with CIRT.
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Affiliation(s)
- Ping Li
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China
| | - Chang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, People's Republic of China
| | - Shuang Wu
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People's Republic of China
| | - Lin Deng
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China
| | - Guangyuan Zhang
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China
| | - Xin Cai
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, People's Republic of China
| | - Jingyi Cheng
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, People's Republic of China.,Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People's Republic of China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, People's Republic of China
| | - Bin Wu
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Department of Radiology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People's Republic of China
| | - Xiaomao Guo
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, People's Republic of China
| | - Yingjian Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, People's Republic of China
| | - Shen Fu
- Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, People's Republic of China.,Department of Radiation Oncology, Shanghai Concord Cancer Hospital, Shanghai, People's Republic of China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Proton and Heavy ion Radiation Therapy, Shanghai, People's Republic of China
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8
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Dror CM, Chi KN. Apalutamide for the treatment of metastatic castration-sensitive prostate cancer. Future Oncol 2020; 16:2905-2916. [DOI: 10.2217/fon-2020-0557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer is the fifth leading cause of cancer-related death among men with the majority of deaths linked to metastatic disease. Accumulating clinical data have confirmed the substantial survival benefit of the addition of docetaxel or androgen signaling inhibitors to androgen deprivation therapy for the treatment of metastatic castration-sensitive prostate cancer (mCSPC). Apalutamide, a next-generation androgen receptor inhibitor, has recently been shown to provide an added survival benefit in the treatment of mCSPC and consequently approved for this indication. This review summarizes the body of evidence with regards to the preclinical activity and clinical efficacy of apalutamide with a specific focus on its efficacy in the treatment of mCSPC.
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Affiliation(s)
| | - Kim Nguyen Chi
- BC Cancer & Vancouver Prostate Centre, Vancouver, Canada
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9
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Hallemeier CL, Zhang P, Pisansky TM, Hanks GE, McGowan DG, Roach M, Zeitzer KL, Firat SY, Husain SM, D'Souza DP, Souhami L, Parliament MB, Rosenthal SA, Lukka HR, Rotman M, Horwitz EM, Miles EF, Paulus R, Sandler HM. Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2019; 104:1057-1065. [PMID: 30959123 DOI: 10.1016/j.ijrobp.2019.03.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE To validate whether prostate-specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external beam radiation therapy (RT) with concurrent short-term androgen suppression (AS) in patients with prostate cancer. METHODS AND MATERIALS This study included 2404 patients. The patients were treated with neoAS before RT and concurrent AS (without post-RT AS) and were pooled from NRG Oncology/RTOG trials 9202, 9408, 9413, and 9910. Multivariable models were used to test associations between the prespecified dichotomized post-neoAS, pre-RT PSA level (≤0.1 vs >0.1 ng/mL) groupings, and clinical outcomes. RESULTS The median follow-up for surviving patients was 9.4 years. The median post-neoAS, pre-RT PSA level was 0.3 ng/mL, with 32% of patients having levels ≤0.1 ng/mL. Race, Gleason score, tumor stage, node stage, pretreatment PSA level, and duration of neoAS were associated with the groups of patients with PSA levels ≤0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA level >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR], 2.04; P < .0001); local failure (HR, 2.51; P < .0001); distant metastases (HR, 1.73; P = .0006); cause-specific mortality (HR, 2.36; P < .0001); and all-cause mortality (HR, 1.24; P = .005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA level >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR, 2.00; P < .0001); local failure (HR, 2.33; P < .0001); and cause-specific mortality (HR, 1.75; P = .03). CONCLUSIONS Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. The role of post-neoAS, pre-RT PSA level relative to PSA levels obtained along the continuum of medical care is not presently defined but could be tested in future clinical trials.
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Affiliation(s)
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | - Mack Roach
- University of California, San Francisco, San Francisco, California
| | | | - Selim Y Firat
- Medical College of Wisconsin-Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Luis Souhami
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Himanshu R Lukka
- McMaster University, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Edward F Miles
- Naval Medical Center Accruals Dartmouth Hitchcock Medical Center, Portsmouth, Virginia
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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10
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Bryant AK, McKay RR, Kader AK, Parsons JK, Einck JP, Kane CJ, Mundt AJ, Murphy JD, Rose BS. Subcastrate Testosterone Nadir and Clinical Outcomes in Intermediate- or High-Risk Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 103:1068-1076. [PMID: 30543857 DOI: 10.1016/j.ijrobp.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE It is unclear if additional serum testosterone suppression below the castrate threshold of 50 ng/dL improves clinical outcomes in patients with localized prostate cancer undergoing definitive therapy. METHODS AND MATERIALS We examined the association of subcastrate testosterone nadir with prostate-specific antigen (PSA) response and long-term clinical outcomes in 764 U.S. veterans with intermediate- or high-risk localized prostate cancer treated with androgen deprivation therapy and definitive radiation therapy from 2000 to 2015. Patients were categorized into testosterone nadir groups based on the minimum testosterone measurement during continuous gonadotropic-releasing hormone agonist therapy (<20 ng/dL vs 20-49 ng/dL). Outcomes included PSA response (3-month post-radiation therapy PSA and 2-year PSA nadir; multivariable linear regression) and long-term clinical outcomes (biochemical recurrence, metastasis, and prostate cancer-specific mortality; Fine-Gray competing risk regression). RESULTS A testosterone nadir of 20 to 49 ng/dL was associated with higher 3-month post-radiation therapy PSA compared to <20 ng/dL (ß = 0.16, 95% confidence interval [CI], 0.06-0.26, P = .001) and higher 2-year PSA nadir (ß = 0.12, 95% CI, 0.04-0.21, P = .005). Compared to the <20-ng/dL group, the 20 to 49-ng/dL group showed higher 10-year biochemical recurrence rates (28.1% vs 18.3%) and metastasis rates (12.9% vs 7.8%) persisting on multivariable analyses (biochemical recurrence: sub-distribution hazard ratio [SDHR], 1.62 for 20-49 ng/dL, 95% CI, 1.07-2.45, P = .02; metastasis: SDHR, 2.19, 95% CI, 1.21-3.94, P = .009). There was a trend toward inferior prostate cancer-specific mortality for the 20 to 49-ng/dL group (SDHR, 1.95, 95% CI, 0.90-4.22, P = .09). CONCLUSIONS Additional serum testosterone suppression below 50 ng/dL was associated with improved PSA responses and lower rates of biochemical recurrence and metastasis in this cohort of patients with localized prostate cancer.
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Affiliation(s)
- Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Rana R McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, San Diego, California
| | - A Karim Kader
- Department of Urology, University of California San Diego, San Diego, California
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, San Diego, California
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Christopher J Kane
- Department of Urology, University of California San Diego, San Diego, California
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California; Clinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California; Clinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California; Clinical and Translational Research Institute, University of California San Diego, San Diego, California.
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Bryant AK, D'Amico AV, Nguyen PL, Einck JP, Kane CJ, McKay RR, Simpson DR, Mundt AJ, Murphy JD, Rose BS. Three-month posttreatment prostate-specific antigen level as a biomarker of treatment response in patients with intermediate-risk or high-risk prostate cancer treated with androgen deprivation therapy and radiotherapy. Cancer 2018; 124:2939-2947. [PMID: 29727915 DOI: 10.1002/cncr.31400] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/31/2018] [Accepted: 03/25/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) measurement after definitive radiotherapy (RT) and androgen deprivation therapy for localized prostate cancer has been proposed as an early prognostic biomarker. In the current study, the authors investigated the association between 3-month post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS). METHODS A total of 5783 patients with intermediate-risk or high-risk localized prostate cancer who were diagnosed between 2000 and 2015 and treated with RT and androgen deprivation therapy were identified from Veterans Affairs data. Patients were divided into groups based on 3-month post-RT PSA values: <0.10 ng/mL, 0.10 to 0.49 ng/mL, and ≥0.50 ng/mL. The effect of the 3-month PSA group on bPFS, PCSS, and OS was evaluated in multivariable Cox models adjusting for potential confounders. RESULTS There were 2651 patients with intermediate-risk and 3132 with high-risk disease; approximately 11% had a 3-month PSA level of ≥0.50 ng/mL. A higher 3-month PSA level was found to be strongly associated with each outcome; compared with patients in the group with a 3-month PSA value <0.10 ng/mL, the authors noted greater hazards for the patients with a 3-month PSA value ≥0.50 ng/mL (hazard ratio for bPFS: 5.23; PCSS: 3.97; and OS: 1.50 [P<.001 for all]) and the patients with a 3-month PSA value of 0.10 to 0.49 ng/mL (hazard ratio for bPFS: 2.41 [P<.001]; PCSS: 2.29 [P<.001]; and OS: 1.21 [P = .003]). When analyzed separately, the 3-month PSA level was found to be predictive of OS in the high-risk group (P<.001) but not the intermediate-risk group (P = .21). CONCLUSIONS The 3-month post-RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate-risk and high-risk prostate cancer, particularly those with high-risk disease. The 3-month PSA measurement may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials. Cancer 2018;124:2939-47. © 2018 American Cancer Society.
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Affiliation(s)
- Alex K Bryant
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - Christopher J Kane
- Department of Urology, University of California at San Diego, San Diego, California
| | - Rana R McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California at San Diego, San Diego, California
| | - Daniel R Simpson
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California.,Clinical and Translational Research Institute, University of California at San Diego, San Diego, California
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Fenner A. 6-monthly PSA test predicts survival. Nat Rev Urol 2016; 13:495. [DOI: 10.1038/nrurol.2016.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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