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Aoyama S, Izumi K, Makino T, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Kawaguchi S, Shigehara K, Nohara T, Mizokami A. A seed link connector protruding into the bladder formed a bladder stone. IJU Case Rep 2024; 7:188-191. [PMID: 38440715 PMCID: PMC10909139 DOI: 10.1002/iju5.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Low-dose-rate brachytherapy is performed for localized prostate cancer. We report the first case of a bladder stone encompassing the seed migrated into the bladder in a patient treated with low-dose-rate brachytherapy. Case presentation A man was diagnosed with prostate cancer and underwent low-dose-rate brachytherapy. After 2 months, dysuria occurred, and ultrasonography revealed a needle-shaped high-intensity protruding from the prostate into the bladder. Cystoscopy examination found a seed link connector. With the possibility of natural dissolution of the seed link, careful observation was chosen. However, 16 months later, hematuria occurred, and an X-ray revealed a bladder stone encompassing the seed. Compared with the X-ray right after seeding, the seed located near the right bladder neck had fallen. The seed was removed by transurethral bladder lithotripsy. Conclusion Seeds should be carefully located within the prostate, otherwise a bladder stone may be formed encompassing the seed.
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Affiliation(s)
- Shuhei Aoyama
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Kouji Izumi
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Tomoyuki Makino
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Renato Naito
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Suguru Kadomoto
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Hiroaki Iwamoto
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Hiroshi Yaegashi
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Shohei Kawaguchi
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Kazuyoshi Shigehara
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Takahiro Nohara
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
| | - Atsushi Mizokami
- Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical SciencesKanazawa CityIshikawa PrefectureJapan
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Sanmamed N, Locke G, Crook J, Liu A, Raman S, Glicksman R, Chung P, Berlin A, Fleshner N, Helou J. Long-Term Biochemical Control of a Prospective Cohort of Prostate Cancer Patients Treated With Interstitial Brachytherapy Versus Radical Prostatectomy. Clin Oncol (R Coll Radiol) 2023; 35:262-268. [PMID: 36737311 DOI: 10.1016/j.clon.2023.01.006] [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: 08/24/2022] [Revised: 12/05/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
AIMS To report long-term oncological outcomes of men treated prospectively as part of the American College of Surgeons Oncology Group phase III Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial (SPIRIT) at our institution. MATERIALS AND METHODS In 2003-2004, patients eligible for SPRIT attended a multidisciplinary educational session, following which they could choose radical prostatectomy, low dose rate brachytherapy (LDR-BT) or randomisation to SPIRIT. Biochemical failure was determined by the accepted definitions of a prostate-specific antigen (PSA) level ≥0.2 ng/ml after radical prostatectomy and the Phoenix definition of PSA ≥2 ng/ml above the nadir after LDR-BT. A sensitivity analysis, using a PSA >0.5 ng/ml to define biochemical failure after LDR-BT and a threshold PSA ≥0.2 ng/ml, was carried out to test the robustness of the results. To account for the competing risk of death, Gray's test was used to test the equality of the cumulative incidence function of biochemical failure between treatment groups. The Kaplan-Meier method was used to estimate overall survival and prostate cancer-specific survival. A P-value ≤0.05 was considered statistically significant. RESULTS Of 156 patients, 100 received LDR-BT (15 after randomisation) and 56 underwent radical prostatectomy (15 after randomisation). The median follow-up was 12.6 and 14.7 years for LDR-BT and radical prostatectomy, respectively. The median age was 60 years; the median pre-treatment PSA was 5.5 (interquartile range 4.3-7.1). No significant differences in patient characteristics were found between groups. Two patients received adjuvant radiotherapy after radical prostatectomy. The cumulative incidence function of biochemical failure was 0%, 1.1% and 2.4% at 5, 10 and 15 years, respectively, in the LDR-BT arm versus 8.5%, 15.8% and 15.8% in the radical prostatectomy arm (P < 0.001). These results were consistent when varying the definition of biochemical failure defined as PSA ≥0.5 ng/ml (P = 0.01). At 15 years, overall survival was higher in patients treated with radical prostatectomy compared with those treated with LDR-BT; however, no statistical difference was found in prostate cancer-specific survival. CONCLUSION In low-risk prostate cancer patients, LDR-BT offers excellent long-term oncological outcomes comparable with radical prostatectomy, in addition to the previously reported advantage for LDR-BT in urinary and sexual quality of life domains and patient satisfaction.
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Affiliation(s)
- N Sanmamed
- Department of Radiation Oncology, Hospital Clinico San Carlos, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - G Locke
- Department of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Crook
- BC Cancer and University of British Columbia, Kelowna, British Columbia, Canada
| | - A Liu
- Department of Statistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - R Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - P Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - A Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; TECHNA Institute, University of Toronto, Toronto, Ontario, Canada
| | - N Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - J Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Wu SY, Huy LD, Liao CJ, Huang CC. Acute, Subchronic, and Chronic Complications of Radical Prostatectomy Versus Radiotherapy With Hormone Therapy in Older Adults With High-Risk Prostate Adenocarcinoma. Front Oncol 2022; 12:875036. [PMID: 35586485 PMCID: PMC9108927 DOI: 10.3389/fonc.2022.875036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare acute, subchronic, and chronic complications between older patients with high-risk localized prostate cancer (HR-LPC) receiving radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT). Patients and Methods We recruited older patients (≥80 years) with HR-LPC from the Taiwan Cancer Registry database. After propensity score matching, logistic regression analysis was used to compare the acute, subchronic, and chronic complication rates between patients who underwent RP (the RP group) and high-dose IMRT combined with long-term HT (the IMRT+HT group). Results Benign prostatic hyperplasia (BPH) symptoms and urinary incontinence (UI) were the most common complications over 5 years (BPH symptoms: RP, 17.69%; IMRT+HT, 29.58%; UI: RP, 10.47%; IMRT+HT, 5.50%). Compared with the RP group, the IMRT+HT group had higher odds of BPH symptoms and lower odds of UI and hernia after the 5-year follow-up period. The impotence rates were significantly higher in the IMRT+HT group than in the RP group at 3 months and 1 year after treatment and became nonsignificant after 2 years. At 5 years after treatment, the IMRT+HT group had lower risks of UI (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.28–0.88) and hernia (aOR, 0.21; 95% CI, 0.11–0.82) and a higher risk of BPH symptoms (aOR, 4.15; 95% CI, 2.82–7.37) than the RP group. Conclusion IMRT+HT was associated with lower UI and hernia risks than RP. By contrast, RP was associated with fewer complications of BPH over the follow-up period and less impotence during the first year after treatment. Our findings provide important and valuable references for shared decision-making for optimal therapy selection among older men with HR-LPC.
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Affiliation(s)
- Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Le Duc Huy
- Master Program in School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Chih Jung Liao
- Department of Medical Imaging, Taipei Medical University-Shuang-ho Hospital, New Taipei City, Taiwan
| | - Chung-Chien Huang
- International PhD Program in Biotech and Healthcare Management, School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Department of Medical Quality, Taipei Municipal Wan Fang Hospital - Managed by Taipei Medical University, Taipei, Taiwan
- Department of Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department and School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Chung-Chien Huang,
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4
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Li C, Zhang M, Wang J, Zhang X. The 45-month therapy outcomes of permanent seed implantation and radical prostatectomy for prostate cancer patients. Invest New Drugs 2022; 40:660-667. [PMID: 35150357 PMCID: PMC9098556 DOI: 10.1007/s10637-021-01189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
Objective To compare the efficacy and safety-related outcomes after radical prostatectomy (RP) and permanent seed implantation (PI) using iodine-125 seeds in patients with prostate cancer. Method A retrospective analysis of 196 patients with biopsy-confirmed prostate cancer (T2-T3) was performed in this study. Forty-five patients who underwent PI using iodine-125 seeds combined with endocrine therapy or androgen deprivation therapy (ADT) were compared with 151 patients who underwent RP combined with endocrine therapy or adjuvant ADT. The efficacy and safety outcomes were compared using Kaplan–Meier curves and t-tests. Results Between the RP and PI treatment modalities, no significant difference (P > 0.05) in biochemical recurrence-free survival (BRFS) was observed using Kaplan–Meier curves, regardless of the combination of adjuvant treatment modalities. Furthermore, no significant differences were observed (P > 0.05) with respect to PSA fluctuations, albumin, leukocyte count, urinary and rectal symptoms, erectile function or quality of life (QoL) between the two therapy methods. However, significant differences in the maximum flow rate, average length of hospital stay and indwelling catheter time were observed between the two groups (P < 0.001). Conclusion Iodine-125 seed implantation significantly shortened the average length of hospital stay and indwelling catheter time compared with RP, and the haemoglobin level was significantly higher in the PI group than in the RP group; however, the maximum urine flow rate was lower after of PI than after RP. These two methods showed similar BRFS rates among prostate cancer patients.
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Affiliation(s)
- Chao Li
- Department of Urology Surgery, Shijiazhuang People´s Hospital, 36 Fanxi Road, 050011, Shijiazhuang, China
| | - Mengdong Zhang
- Urology Institute of Capital Medical University, Department of Urology, Beijing ChaoYang Hospital, Capital Medical University, No. 8 Gong Ti Nan Lu, 100020, Beijing, China
| | - Jianwen Wang
- Urology Institute of Capital Medical University, Department of Urology, Beijing ChaoYang Hospital, Capital Medical University, No. 8 Gong Ti Nan Lu, 100020, Beijing, China
| | - Xiaodong Zhang
- Urology Institute of Capital Medical University, Department of Urology, Beijing ChaoYang Hospital, Capital Medical University, No. 8 Gong Ti Nan Lu, 100020, Beijing, China.
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Uematsu T, Torimoto K, Tanaka N, Asakawa I, Hori S, Yamaki K, Nakai Y, Miyake M, Anai S, Hasegawa M, Fujimoto K. Factors affecting urinary frequency after low-dose-rate brachytherapy for prostate cancer. Low Urin Tract Symptoms 2021; 14:4-9. [PMID: 34288506 DOI: 10.1111/luts.12402] [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: 05/07/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms are transiently exacerbated by low-dose-rate brachytherapy (LDR-BT) for prostate cancer and recover to pretreatment levels 1 year thereafter. Generally, these symptoms are influenced by temperature. We aimed to search for factors affecting the lower urinary tract symptoms after seed implant including seasons. METHODS We retrospectively enrolled 812 patients who underwent LDR-BT at Nara Medical University Hospital from January 2010 to December 2018 and for whom the International Prostate Symptom Score, Overactive Bladder Symptom Score, and frequency volume charts were available. We investigated the relationships between lower urinary tract symptoms, 24-hours urinary frequency, 24-hours urinary volume before and after seed implant, radiation dose, and season of seed implant. RESULTS The mean age was 69.5 years. The mean prostate volume was 24.2 mL. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and 24-hours urinary frequency increased until 3 months and gradually decreased over 6 months after seed implant. Multiple linear regression analysis revealed that 24-hours urinary frequency at 3 months after seed implant was significantly influenced by external beam radiotherapy, larger prostate volume before implant, higher 24-hours urinary frequency at baseline, larger 24-hours urinary volume at 3 months after implant, and performance of implant in summer. CONCLUSIONS Lower urinary tract symptoms worsened 3 months after seed implant of LDR-BT regardless of the season of implant. The urinary frequency 3 months after seed implant was slightly lower when seed implant was performed in the summer.
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Affiliation(s)
| | | | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan.,Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Isao Asakawa
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan.,Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
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Wu SY, Chang SC, Chen CI, Huang CC. Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13071517. [PMID: 33806181 PMCID: PMC8036838 DOI: 10.3390/cancers13071517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Scarce reports have evaluated oncologic outcomes in relatively young men with unfavorable intermediate-risk prostate cancer (UIR-PC) receiving radical prostatectomy (RP) or high-dose intensity-modulated radiotherapy (IMRT). After a literature review, we present the leading and largest head-to-head propensity score-matched study to examine all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM) in relatively young men with UIR-PC undergoing RP or high-dose IMRT. After adjustment for confounders, RP was found to be superior to high-dose IMRT in terms of the patients’ overall survival, BF, LRR, and DM. Abstract Purpose: To estimate the oncologic outcomes of radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) with short-term androgen-deprivation therapy (ADT) in relatively young men with unfavorable intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network (NCCN-UIR-PC). Patients and Methods: We enrolled relatively young men (≤65 years) from the Taiwan Cancer Registry who had been diagnosed as having NCCN-UIR-PC and who had received RP or high-dose IMRT (at least ≥72 Gy) with short-term ADT (4–6 months). After propensity score matching of the confounders, Cox proportional regression was used to model the time from the index date (i.e., date of diagnosis) to all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM). Results: The corresponding adjusted hazard ratios (95% confidence intervals) of the risk of all-cause death, BF, LRR, and DM were 2.76 (1.36–5.60, p = 0.0050), 2.74 (1.72–4.84, p < 0.0001), 1.28 (1.09–1.90, p = 0.0324), and 2.11 (1.40–4.88, p = 0.0052), respectively. Conclusions: RP is superior to high-dose IMRT with short-term ADT in terms of oncologic outcomes for relatively young men with UIR-PC.
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Affiliation(s)
- Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242062, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Shyh-Chyi Chang
- Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan;
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
| | - Chang-I Chen
- International Ph.D. Program in Biotech and Healthcare Management, Taipei Medical University, Taipei 110, Taiwan;
- Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
| | - Chung-Chien Huang
- Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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Donath E, Alcaidinho A, Delouya G, Taussky D. The one hundred most cited publications in prostate brachytherapy. Brachytherapy 2021; 20:611-623. [PMID: 33674184 DOI: 10.1016/j.brachy.2021.01.008] [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: 08/13/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study is to identify the leaders in research on prostate brachytherapy through a bibliometric analysis of the top 100 most cited publications in the field. METHODS AND MATERIALS A broad search was performed with the term "prostate brachytherapy" using the Web of Science database to generate wide-ranging results that were reviewed by reading the abstracts and, if necessary, the articles to select the top 100 most cited publications. RESULTS The median of the total citation count was 187 (range 132-1464). The median citation per year index (citations/year since publication) was 13.5 (range 6.3-379.0). In all publications, the first author was also the corresponding author. The top publishing countries of the first author included the United States (n = 78), Canada (n = 6), the UK (n = 5), and Germany (n = 4). The journal with the most publications was the International Journal of Radiation Oncology Biology Physics (n = 38). There were 27 more publications on low-dose-rate (LDR) than on high-dose-rate (HDR) (43 vs 16) among the top 100. HDR publications had only one first author that had three articles in comparison to LDR publications, which had four first authors, each with three articles on LDR. The United States was the leading country in 43.8% of HDR publications (n = 7) and 88.4% of LDR publications (n = 38). CONCLUSIONS Our bibliometric analysis of the top 100 most cited publications clearly demonstrates the North American dominance in the publications of prostate brachytherapy, especially in LDR. However, European first authors were more frequent in HDR publications.
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Affiliation(s)
- Elisheva Donath
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Alcaidinho
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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Gogineni E, Rana Z, Soberman D, Sidiqi B, D'Andrea V, Lee L, Potters L, Parashar B. Biochemical Control and Toxicity Outcomes of Stereotactic Body Radiation Therapy Versus Low-Dose-Rate Brachytherapy in the Treatment of Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 109:1232-1242. [PMID: 33171199 DOI: 10.1016/j.ijrobp.2020.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Low-dose-rate (LDR) brachytherapy and stereotactic body radiation therapy (SBRT) have both shown acceptable outcomes in the treatment of low- and intermediate-risk prostate cancer. Minimal data have been published directly comparing rates of biochemical control and toxicity with these 2 modalities. We hypothesize that LDR and SBRT will provide similar rates of biochemical control. METHODS AND MATERIALS All low- and intermediate-risk patients with prostate cancer treated definitively with SBRT or LDR between 2010 and 2018 were captured. Phoenix definition was used for biochemical failure. Independent t tests were used to compare baseline characteristics, and repeated measure analysis of variance test was used to compare American Urologic Association (AUA) and the Expanded Prostate Cancer Index Composite (EPIC) scores between treatment arms over time. Biochemical control was estimated using the Kaplan-Meier method. Differences in acute and late toxicity were assessed via Pearson χ2. RESULTS In the study, 219 and 118 patients were treated with LDR and SBRT. Median follow-up was 4.3 years (interquartile range, 3.1-6.1). All patients treated with LDR received 125.0 Gy in a single fraction. SBRT consisted of 42.5 Gy in 5 fractions. Five-year biochemical control for LDR versus SBRT was 91.6% versus 97.6% (P = .108). LDR patients had a larger increase in mean AUA scores at 1 month (17.2 vs 10.3, P < .001) and 3 months posttreatment (14.0 vs 9.7, P < .001), and in mean EPIC scores at 1 month (15.7 vs 13.8, P < .001). There was no significant difference between LDR and SBRT in late grade 3 genitourinary toxicity (0.9% vs 2.5%, P = .238); however, LDR had lower rates of late grade 3 gastrointestinal toxicity (0.0% vs 2.5%, P = .018). CONCLUSIONS Our data show similar biochemical control and genitourinary toxicity rates at 5 years for both SBRT and LDR, with slightly higher gastrointestinal toxicity with SBRT and higher AUA and EPIC scores with LDR.
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Affiliation(s)
- Emile Gogineni
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Zaker Rana
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Danielle Soberman
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Baho Sidiqi
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Vincent D'Andrea
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Lucille Lee
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Louis Potters
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Bhupesh Parashar
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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9
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Zhang P, Qian B, Shi J, Xiao Y. Radical prostatectomy versus brachytherapy for clinically localized prostate cancer on oncological and functional outcomes: a meta-analysis. Transl Androl Urol 2020; 9:332-343. [PMID: 32420139 PMCID: PMC7215023 DOI: 10.21037/tau.2020.02.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Prostate cancer (PCa) is a form of malignancy that harms the health status of elderly men worldwide. It is unclear which of radical prostatectomy (RP) or brachytherapy (BT) is the more effective treatment for PCa. This study presents the first highly comprehensive and up-to-date comparative analysis of the overall outcomes of RP versus BT. Methods We conducted a systematic literature search for studies published on PubMed, EMBASE, and the Cochrane Library on the outcomes of RP versus BT in clinically localized PCa. The cumulative analysis was performed using Review Manager Version 5.3 software, and the Chi-square test was employed to test the statistical heterogeneity. The summary odds ratio (OR) and standard mean difference (SMD) was estimated using random effects models at 95% confidence intervals (CIs). Results In total, 2 randomized, 2 prospective, and 21 retrospective comparative studies were included. No significant differences in biochemical recurrence rate (BCR) (OR: 1.24; 95% CI: 0.91, 1.68) and prostate cancer-specific mortality (PCSM) (OR: 1.62; 95% CI: 0.86, 3.04) between RP and BT were noted. With erectile dysfunction and urinary incontinence, BT was more protective than RP in both short-term post-operative reports (OR: 2.06; 95% CI: 1.15, 3.70 and OR: 4.62; 95% CI: 2.33, 9.16) and long-term patient outcome reports (SMD: -5.62; 95% CI: -13.81, 2.57 and SMD: -11.52; 95% CI: -18.32, -4.72). Conclusions BT and RP for PCa therapy pose comparable risks of PCSM and BCR, while BT is associated with a lower incidence of erectile dysfunction and urinary incontinence. This study tentatively confirms that BT is an alternative to RP for patients seeking a curative treatment with minimal risks of urinary incontinence and sexual dysfunction.
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Affiliation(s)
- Pu Zhang
- Department of Urology Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bei Qian
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiawei Shi
- Department of Urology Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yajun Xiao
- Department of Urology Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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10
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Tanaka N, Asakawa I, Hasegawa M, Fujimoto K. Low-dose-rate brachytherapy for prostate cancer: A 15-year experience in Japan. Int J Urol 2019; 27:17-23. [PMID: 31549770 DOI: 10.1111/iju.14098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022]
Abstract
The history of prostate brachytherapy has passed one century. In 1983, modern low-dose-rate prostate brachytherapy using a transrectal ultrasound-guided procedure was introduced. In the early 1990s, low-dose-rate brachytherapy was introduced and rapidly spread across the USA due to its excellent oncological control, cost-effectiveness and technically easy procedure. Since low-dose-rate brachytherapy was introduced in Japan (2003), over 15 years have passed. More than 43 000 patients have undergone low-dose-rate brachytherapy. Japanese urologists and radiation oncologists are on course with leading brachytherapists in the USA. A nationwide prospective cohort study, J-POPS, was initiated in 2005. The J-POPS group also provides educational programs including an annual novel training course in low-dose-rate brachytherapy to familiarize urologists, radiation oncologists and pathologists with the procedure. Important information on Japanese patients has accumulated, especially by the J-POPS study group. The Japanese investigators reported excellent oncological outcomes of low-dose-rate brachytherapy, showing equivalent or superior efficacy to surgery in low- to intermediate-risk patients, and superior efficacy in high-risk patients using the surgery biochemical recurrence definition (prostate-specific antigen cut-off value of 0.2 ng/mL). Two randomized controlled studies (SHIP study: intermediate risk, and TRIP study: high risk) carried out by the J-POPS group are ongoing, and an additional follow-up study (J-POPS 2 study) has been started to evaluate survival outcomes over longer follow-up periods. Low-dose-rate brachytherapy is expected to provide a survival benefit, which must be confirmed by further studies with longer follow-up periods in the future.
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Affiliation(s)
- Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Onishi K, Tanaka N, Miyake M, Nakai Y, Anai S, Torimoto K, Yamaki K, Asakawa I, Hasegawa M, Fujii T, Konishi N, Fujimoto K. Changes in lower urinary tract symptoms after iodine-125 brachytherapy for prostate cancer. Clin Transl Radiat Oncol 2018; 14:51-58. [PMID: 30547097 PMCID: PMC6282112 DOI: 10.1016/j.ctro.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who received BT experienced acute urinary morbidity 3 months after BT of the prostate. Acute urinary symptoms gradually improved with time and returned to BL at 36 months. Storage symptoms take longer to return to BL compared with voiding symptoms.
Purpose To investigate chronological changes in lower urinary tract symptoms (LUTS) in patients who received iodine-125 brachytherapy (BT) for prostate cancer. Methods We enrolled 706 patients who received BT. Of these, 265 (38%) received BT combined with external beam radiation therapy (EBRT). An International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL) score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL), and 1, 3, 6, 12, 24, 36, 48, and 60 months after BT. The sum of frequency (2), urgency (4) and nocturia (7) of the IPSS questionnaire was defined as the storage symptoms score, whereas the sum of emptying (1), intermittency (3), weak stream (5), and hesitancy (6) was defined as the voiding symptom score. Results Total IPSS significantly increased at 3 months following BT compared with BL (mean score: 17.1 vs. 7.99, P < 0.001) and returned to BL by 36 months. The storage symptom score did not return to BL 36 months after BT. Total OABSS significantly increased 3 months after BT compared with BL (mean score: 6.52 vs. 3.45, P < 0.001), and returned to BL 48 months after BT. The IPSS-QOL score was the highest score (mean score: 2.46 vs. 3.9, P < 0.001) 3 months after BT and returned to BL 48 months after BT, however the IPSS-QOL score was lower than BL (mean score: 2.01 vs 2.46, P < 0.001) at 60 months. The risk factors for LUTS within 1 year after BT were BL IPSS (P < 0.001) and PV (P < 0.001). Patients who received combined EBRT experienced transient storage symptoms 24 and 36 months after BT, whereas those who received BT alone did not. However, the storage symptom score of the patients who received combined EBRT was improving 48 months after BT and eventually showed no significant difference compared with those treated with BT alone. Conclusion Three months after BT, LUTS, including storage symptoms, deteriorated the most but improved with time. The urinary symptom in patients who received combined EBRT can potentially flare again in 24 and 36 months after BT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.
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Key Words
- BL, baseline
- BT, brachytherapy
- Brachytherapy
- EBRT, external beam radiation therapy
- GS, Gleason score
- IMRT, intensity modulated radiation therapy
- IQR, interquartile
- LUTS, lower urinary tract symptoms
- Lower urinary tract symptom
- NADT, neoadjuvant androgen deprivation therapy
- PV, prostate volume
- Prostate cancer
- QOL, quality of life
- Quality of life
- Urinary symptom flare
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Affiliation(s)
- Kenta Onishi
- Department of Urology, Nara Medical University, Japan
| | | | - Makito Miyake
- Department of Urology, Nara Medical University, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Japan
| | | | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Japan
| | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Japan
| | - Noboru Konishi
- Department of Diagnostic Pathology, Kouseikai Takai Hospital, Japan
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12
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Cozzi G, Musi G, Bianchi R, Bottero D, Brescia A, Cioffi A, Cordima G, Delor M, Di Trapani E, Ferro M, Matei DV, Russo A, Mistretta FA, De Cobelli O. Meta-analysis of studies comparing oncologic outcomes of radical prostatectomy and brachytherapy for localized prostate cancer. Ther Adv Urol 2018; 9:241-250. [PMID: 29662542 DOI: 10.1177/1756287217731449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/23/2017] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to compare oncologic outcomes of radical prostatectomy (RP) with brachytherapy (BT). Methods A literature review was conducted according to the 'Preferred reporting items for systematic reviews and meta-analyses' (PRISMA) statement. We included studies reporting comparative oncologic outcomes of RP versus BT for localized prostate cancer (PCa). From each comparative study, we extracted the study design, the number and features of the included patients, and the oncologic outcomes expressed as all-cause mortality (ACM), PCa-specific mortality (PCSM) or, when the former were unavailable, as biochemical recurrence (BCR). All of the data retrieved from the selected studies were recorded in an electronic database. Cumulative analysis was conducted using the Review Manager version 5.3 software, designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was tested using the Chi-square test. Results Our cumulative analysis did not show any significant difference in terms of BCR, ACM or PCSM rates between the RP and BT cohorts. Only three studies reported risk-stratified outcomes of intermediate- and high-risk patients, which are the most prone to treatment failure. Conclusions our analysis suggested that RP and BT may have similar oncologic outcomes. However, the analysis included a limited number of studies, and most of them were retrospective, making it impossible to derive any definitive conclusion, especially for intermediate- and high-risk patients. In this scenario, appropriate urologic counseling remains of utmost importance.
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Affiliation(s)
- Gabriele Cozzi
- Division of Urology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Danilo Bottero
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Antonio Brescia
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Antonio Cioffi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giovanni Cordima
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Maurizio Delor
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Andrea Russo
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy Università Degli Studi Di Milano, Milan, Italy
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De Bari B, Fiorentino A, Greto D, Ciammella P, Arcangeli S, Avuzzi B, D'Angelillo RM, Desideri I, Kirienko M, Marchiori D, Massari F, Fundoni C, Franco P, Filippi AR, Alongi F. Prostate cancer as a paradigm of multidisciplinary approach? Highlights from the Italian young radiation oncologist meeting. TUMORI JOURNAL 2018; 99:637-49. [DOI: 10.1177/030089161309900601] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims and background The diagnostic and therapeutic approach to prostate cancer has evolved rapidly in last decades. Young professionals need an update about these recent developments in order to improve the care of patients treated in their daily clinical practice. Methods On May 18, 2013, AIRO Giovani (the young section of the Italian Association of Radiation Oncology) organized a multidisciplinary meeting involving, as speakers, several young physicians from many parts of Italy actively involved in the diagnostic and therapeutic approach to prostate cancer. The meeting was specifically addressed to young physicians (radio-oncologists, urologists, medical oncologists) and presented the state-of-the-art of the diagnostic/therapeutic approach based on the latest evidence on the issue. Highlights of the congress are summarized and presented in this report. Results The large participation in the meeting (more than 120 participants were present) confirmed the interest of young radiation oncologists in improving their skills in prostate cancer management. The contributions of the speakers confirmed the need for regular updates, considering the promising results of recently published studies and the many new ongoing trials, on the diagnostic and therapeutic approaches to prostate cancer. Conclusions Multidisciplinary meetings are helpful to improve the skills of young professionals.
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Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, AO Spedali Civili and University of Brescia, Brescia
| | - Alba Fiorentino
- Radiation Oncology Department, IRCCS/CROB, Rionero in Vulture (PZ)
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia
| | | | - Barbara Avuzzi
- Radiation Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | | | | | - Francesco Massari
- Medical Oncology, ‘GB Rossi’ Academic Hospital, University of Verona, Verona
| | | | - Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale U Parini, AUSL Valle d'Aosta, Aosta
| | - Andrea R Filippi
- Department of Oncology, Radiation Oncology, University of Torino, Turin
| | - Filippo Alongi
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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14
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Chiumento C, Montagna A, Clemente S, Cozzolino M, Fusco V. A retrospective analysis after low-dose-rate prostate brachytherapy with permanent 125I seed implant: clinical and dosimetric results in 70 patients. TUMORI JOURNAL 2018; 97:335-40. [DOI: 10.1177/030089161109700313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate the biochemical disease-free survival (bDFS) rate after 125I permanent-implant prostate brachytherapy. Methods Patients with a diagnosis of prostate adenocarcinoma and adequate PSA follow-up were selected for this retrospective study. Brachytherapy with permanent 125I seeds was performed as monotherapy, with a prescribed dose of 145 Gy to the prostate. Patients were stratified into recurrence risk groups according to the National Comprehensive Cancer Network (NCCN) guidelines. Biochemical failure was defined using the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. The post-implant D90 (defined as the minimum dose covering 90% of the prostate) was obtained for each patient. Two cutoff points were used to test the correlation between D90 and bDFS results: 130 Gy and 140 Gy. bDFS was calculated from the implant date to the date of biochemical recurrence. Univariate and multivariate analysis were performed using the SPSS software and included clinical stage, pretreatment PSA, Gleason score (GS), androgen deprivation therapy, D90, and risk groups. In the univariate analysis we used a cutoff point of 5.89 ng/mL for PSA and 5 for GS. Results From June 2003 to April 2007, 70 patients were analyzed. The patients' distribution into recurrence risk groups was as follows: 39 patients (56%) in the low-risk group, 23 patients (33%) in the intermediate-risk group, and 8 patients (11%) in the high-risk group. At a median follow-up of 47 months (range, 19–70 months) bDFS was 88.4%, with a global actuarial 5-year bDFS of 86%. Disease-related factors including initial PSA level, GS and risk group were significant predictors of biochemical failure (P = 0.01, P = 0.01, P = 0.006, respectively). In multivariate analysis, risk group (P = 0.005) and GS (P = 0.03) were statistically significant. Conclusion Our data are in agreement with those in the literature and, despite the short follow-up, confirm the advantage of brachytherapy for patients at low and intermediate risk of recurrence.
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Affiliation(s)
- Costanza Chiumento
- Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy
| | - Antonietta Montagna
- Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy
| | - Stefania Clemente
- Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy
| | - Mariella Cozzolino
- Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy
| | - Vincenzo Fusco
- Department of Radiation Oncology, IRCCS-CROB, Rionero in Vulture (PZ), Italy
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15
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Correlation between Chromosome 9p21 Locus Deletion and Prognosis in Clinically Localized Prostate Cancer. Int J Biol Markers 2017; 32:e248-e254. [DOI: 10.5301/jbm.5000242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 01/16/2023]
Abstract
Background Some studies have reported that deletions at chromosome arm 9p occur frequently and represent a critical step in carcinogenesis of some neoplasms. Our aim was to evaluate the deletion of locus 9p21 and chromosomes 3, 7 and 17 in localized prostate cancer (PC) and correlate these alterations with prognostic factors and biochemical recurrence after surgery. Methods We retrospectively evaluated surgical specimens from 111 patients with localized PC who underwent radical prostatectomy. Biochemical recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/mL and the mean postoperative follow-up was 123 months. The deletions were evaluated using fluorescence in situ hybridization with centromeric and locus-specific probes in a tissue microarray containing 2 samples from each patient. We correlated the occurrence of any deletion with pathological stage, Gleason score, ISUP grade group, PSA and biochemical recurrence. Results We observed a loss of any probe in only 8 patients (7.2%). The most common deletion was the loss of locus 9p21, which occurred in 6.4% of cases. Deletions of chromosomes 3, 7 and 17 were observed in 2.3%, 1.2% and 1.8% patients, respectively. There was no correlation between chromosome loss and Gleason score, ISUP, PSA or stage. Biochemical recurrence occurred in 83% cases involving 9p21 deletions. Loss of 9p21 locus was significantly associated with time to recurrence (p = 0.038). Conclusions We found low rates of deletion in chromosomes 3, 7 and 17 and 9p21 locus. We observed that 9p21 locus deletion was associated with worse prognosis in localized PC treated by radical prostatectomy.
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Makino T, Miwa S, Koshida K. Impact of Gleason Pattern 5 on outcomes of patients with prostate cancer and iodine-125 prostate brachytherapy. Prostate Int 2016; 4:152-155. [PMID: 27995115 PMCID: PMC5153429 DOI: 10.1016/j.prnil.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022] Open
Abstract
Background The Gleason grading system is a powerful predictor of prostate cancer (PCa) prognosis. Gleason scores (GS) of 8–10 are considered as a single high-risk grade category, and Gleason Pattern 5 (GP5) predicts biochemical recurrence. We report the clinical outcomes of patients treated with 125I prostate brachytherapy for clinically localized PCa and prognosis in the presence or absence of GP5. Methods We enrolled 316 patients with T1c–T2N0M0 PCa and undergoing prostate brachytherapy treatment. All patients were followed up for ≥ 1 year. The primary endpoint was biochemical recurrence-free survival. Biochemical recurrence was defined by the Phoenix criteria. Survival curves were calculated by the Kaplan–Meier method, and the prognostic impact of biochemical recurrence was analyzed using a Cox proportional hazards model. Results The 5-year biochemical recurrence-free survival rate for all patients was 95.2%, and according to the D’Amico risk classification criteria, the rates were 98.7% for patients in low-risk, 96.9% in intermediate-risk, and 81.1% in high-risk groups (P < 0.0001). The 5-year biochemical recurrence-free survival rates for patients with GS8 or GS9–10 were 87.7% and 61.5%, respectively (P = 0.0057). Multivariate analysis found that GS and clinical T stage were independent predictors of biochemical recurrence. Conclusions The presence of GP5 in GS9–10 prostate cancer has a worse prognosis than GS8 prostate cancer in the absence of GP5 for patients undergoing prostate brachytherapy.
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Affiliation(s)
- Tomoyuki Makino
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Sotaro Miwa
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Kiyoshi Koshida
- Department of Urology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
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17
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Injectable polypeptide micelles that form radiation crosslinked hydrogels in situ for intratumoral radiotherapy. J Control Release 2016; 228:58-66. [PMID: 26928529 DOI: 10.1016/j.jconrel.2016.02.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/22/2016] [Accepted: 02/24/2016] [Indexed: 01/03/2023]
Abstract
Intratumoral radiation therapy - 'brachytherapy' - is a highly effective treatment for solid tumors, particularly prostate cancer. Current titanium seed implants, however, are permanent and are limited in clinical application to indolent malignancies of low- to intermediate-risk. Attempts to develop polymeric alternatives, however, have been plagued by poor retention and off-target toxicity due to degradation. Herein, we report on a new approach whereby thermally sensitive micelles composed of an elastin-like polypeptide (ELP) are labeled with the radionuclide (131)I to form an in situ hydrogel that is stabilized by two independent mechanisms: first, body heat triggers the radioactive ELP micelles to rapidly phase transition into an insoluble, viscous coacervate in under 2 min; second, the high energy β-emissions of (131)I further stabilize the depot by introducing crosslinks within the ELP depot over 24h. These injectable brachytherapy hydrogels were used to treat two aggressive orthotopic tumor models in athymic nude mice: a human PC-3 M-luc-C6 prostate tumor and a human BxPc3-luc2 pancreatic tumor model. The ELP depots retained greater than 52% and 70% of their radioactivity through 60 days in the prostate and pancreatic tumors with no appreciable radioactive accumulation (≤ 0.1% ID) in off-target tissues after 72h. The (131)I-ELP depots achieved >95% tumor regression in the prostate tumors (n=8); with a median survival of more than 60 days compared to 12 days for control mice. For the pancreatic tumors, ELP brachytherapy (n=6) induced significant growth inhibition (p=0.001, ANOVA) and enhanced median survival to 27 days over controls.
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18
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Klaff R, Rosell J, Varenhorst E, Sandblom G. The Long-term Disease-specific Mortality of Low-risk Localized Prostate Cancer: A Prospective Population-based Register Study Over Two Decades. Urology 2016; 91:77-82. [PMID: 26879734 DOI: 10.1016/j.urology.2016.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/19/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify prognostic factors, and to estimate the long-term disease-specific and annual disease-specific mortality rates of low-risk prostate cancer patients from the early prostate-specific antigen (PSA) era. PATIENTS AND METHODS We studied data extracted from the Southeast Region Prostate Cancer Register in Sweden, on1300 patients with clinically localized low-risk tumors, T1-2, PSA level ≤10 µg/L and Gleason scores 2-6 or World Health Organization Grade 1, diagnosed 1992-2003. The Cox multivariate regression model was used to evaluate factors predicting survival. Prostate cancer death rates per 1000 person-years were estimated for 4 consecutive follow-up time periods: 0-5, 5-10, 10-15, and 15+ years after diagnosis. RESULTS During the follow-up of overall survivors (mean 10.6 years; maximum 21.8 years), 93 patients (7%) died of prostate cancer. Cancer-specific survival was 0.98 (95% confidence interval [CI] 0.97-0.99), 0.95 (95% CI 0.93-0.96), 0.89 (95% CI 0.86-0.91), and 0.84 (95% CI 0.80-0.88), 5, 10, 15, and 20 years after diagnosis. The 5-year increases in cancer-specific mortality were statistically significant (P < .001). Patients with PSA ≥ 4 µg/L managed initially with watchful waiting and those aged 70 years or older had a significantly higher risk of dying from their prostate cancer. CONCLUSION The long-term disease-specific mortality of low-risk localized prostate cancer is low, but the annual mortality rate from prostate cancer gradually increases. This indicates that some tumors slowly develop into lethal cancer, particularly in patients 70 years or older with a PSA level ≥ 4 µg/L.
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Affiliation(s)
- Rami Klaff
- Department of Urology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Johan Rosell
- Regional Cancer Centre, Southeast, Region, Linköping, Sweden
| | - Eberhard Varenhorst
- Department of Urology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gabriel Sandblom
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Hospital, Huddinge, Sweden
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Clinical efficacy of combination therapy with an alpha blocker and low-dose sildenafil on post-therapy lower urinary tract symptoms after low-dose-rate brachytherapy for prostate cancer. World J Urol 2016; 34:1269-74. [DOI: 10.1007/s00345-016-1777-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022] Open
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20
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Kim DS, Jeon SH, Chang SG, Lee SH. Comparison of biochemical recurrence in prostate cancer patients treated with radical prostatectomy or radiotherapy. Korean J Urol 2015; 56:703-9. [PMID: 26495071 PMCID: PMC4610897 DOI: 10.4111/kju.2015.56.10.703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/25/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose We evaluated the biochemical recurrence (BCR) of prostate cancer patients treated by radical prostatectomy (RP) or radiotherapy (RT). Materials and Methods Patients who underwent RP or RT as primary definitive treatment from 2007 were enrolled for this study. They were divided into two groups; the low-intermediate risk group and the high risk group according to the National Comprehensive Cancer Network guidelines. We compared differences such as age, prostate specific antigen, Gleason score, follow-up duration, clinical T staging, and BCR. Their BCR-free survival rates were analyzed. Results A total of 165 patients were enrolled. There were 115 patients in the low-intermediate risk. Among them, 88 received RP and 27 underwent RT. BCR occurred in 9 of the RP patients (10.2%) and 3 of the RT patients (11.1%). For the high risk group, 50 patients were included. RP was performed in 25 patients and RT in 25 patients. BCR was observed in 4 of the RP patients (16%) and 12 of the RT patients (48%). There were no differences in BCR-free survival for the low-intermediate group (p=0.765). For the high risk group, the RP group had a higher BCR free survival rate (p=0.032). Conclusions No difference of BCR and BCR-free survival was seen in the low-intermediate risk group but lower BCR and better BCR-free survival were observed for patients that received RP in the high risk group. RP should be a more strongly considered option when deciding the treatment method for selected high risk patients.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Goo Chang
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
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Schreiber D, Rineer J, Weiss JP, Safdieh J, Weiner J, Rotman M, Schwartz D. Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer. Radiat Oncol J 2015; 33:21-8. [PMID: 25874174 PMCID: PMC4394065 DOI: 10.3857/roj.2015.33.1.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 11/06/2022] Open
Abstract
Purpose We analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation. Materials and Methods From 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (≥7,560 cGy) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups. Results The median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS. Conclusion Treatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.
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Affiliation(s)
- David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin Rineer
- University of Florida Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Jeffrey P Weiss
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Safdieh
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Weiner
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marvin Rotman
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
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Axiak-Bechtel SM, Upendran A, Lattimer JC, Kelsey J, Cutler CS, Selting KA, Bryan JN, Henry CJ, Boote E, Tate DJ, Bryan ME, Katti KV, Kannan R. Gum arabic-coated radioactive gold nanoparticles cause no short-term local or systemic toxicity in the clinically relevant canine model of prostate cancer. Int J Nanomedicine 2014; 9:5001-11. [PMID: 25378926 PMCID: PMC4218919 DOI: 10.2147/ijn.s67333] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Gum arabic-coated radioactive gold nanoparticles (GA-198AuNPs) offer several advantages over traditional brachytherapy in the treatment of prostate cancer, including homogenous dose distribution and higher dose-rate irradiation. Our objective was to determine the short-term safety profile of GA-198AuNPs injected intralesionally. We proposed that a single treatment of GA-198AuNPs would be safe with minimal-to-no evidence of systemic or local toxicity. Methods Nine dogs with spontaneously occurring prostatic cancer were treated. Injections were performed with ultrasound or computerized tomography guidance. Complete blood counts, chemistry panels, and urinalyses were performed at weekly intervals for 1 month and imaging was repeated 4 weeks postinjection. Planar scintigraphic images were obtained within 30 minutes of injection. Results No statistically significant difference was found in any hematologic or biochemical parameter studied, nor was any evidence of tumor swelling or abscessation found in eight dogs with repeat imaging; one dog died secondary to urethral obstruction 12 days following injection. At 30 minutes postinjection, an average of 53% of injected dose in seven dogs was retained in the prostate, with loss of remaining activity in the bladder and urethra; no systemic uptake was detected. Conclusion GA-198AuNP therapy had no short-term toxicity in the treatment of prostatic cancer. While therapeutic agent was found in the prostate immediately following injection, some loss of agent was detected in the bladder and urethra. Localization of radioactivity within the prostate was lower than anticipated and likely due to normal vestigial prostatic ducts. Therefore, further study of retention, dosimetry, long-term toxicity, and efficacy of this treatment is warranted prior to Phase I trials in men.
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Affiliation(s)
- Sandra M Axiak-Bechtel
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Anandhi Upendran
- Department of Physics, University of Missouri, Columbia, MO, USA ; Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA
| | - Jimmy C Lattimer
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - James Kelsey
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Missouri University Research Reactor, Columbia, MO, USA
| | | | - Kim A Selting
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Carolyn J Henry
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA ; Department of Internal Medicine, University of Missouri, Columbia, MO, USA
| | | | - Deborah J Tate
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Margaret E Bryan
- Department of Statistics, University of Missouri, Columbia, MO, USA
| | - Kattesh V Katti
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Raghuraman Kannan
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Department of Radiology, University of Missouri, Columbia, MO, USA
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Ingrosso G, Carosi A, Ponti E, Murgia A, di Cristino D, Barbarino R, Benassi M, Di Murro L, Giudice E, Bove P, Santoni R. Acute and Late Toxicity after Three-Dimensional Conformal Image-Guided Radiotherapy for Localized Prostate Cancer. Cancer Invest 2014; 32:526-32. [DOI: 10.3109/07357907.2014.970193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhang YY, Zhang ZG, Yu YL, Chen YC, Ni KX, Wang MC, Zhao WP, Rehman F, Wan SP, Li GH. Early channel transurethral resection of the prostate for patients with urinary retention after brachytherapy. J Zhejiang Univ Sci B 2014; 15:756-60. [PMID: 25091995 DOI: 10.1631/jzus.b1400100] [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: 01/29/2023]
Abstract
OBJECTIVE It is recommended that transurethral resection of the prostate (TURP) after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP (cTURP) within six months post-implant for patients with refractory urinary retention. METHODS One hundred and ninety patients with localized prostate cancer of clinical stages T1c to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. RESULTS The median interval between prostate brachytherapy and cTURP was three months (range 1.5 to 5.0 months). There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months (range 6 to 26 months) after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen (PSA) of the patients who underwent cTURP was 0.42 ng/ml (range 0.08 to 0.83 ng/ml) at the end of their follow-up. CONCLUSIONS Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.
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Affiliation(s)
- You-yun Zhang
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; Department of Urology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China
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Lamb DS, Greig L, Russell GL, Nacey JN, Broome K, Studd R, Delahunt B, Iupati D, Jain M, Rooney C, Murray J, Lamb PJ, Bethwaite PB. Patterns of failure after iodine-125 seed implantation for prostate cancer. Radiother Oncol 2014; 112:68-71. [PMID: 25082097 DOI: 10.1016/j.radonc.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. MATERIALS AND METHODS From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. RESULTS Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. CONCLUSIONS If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.
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Affiliation(s)
- David S Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand.
| | - Lynne Greig
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | | | - John N Nacey
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Kim Broome
- Omahu Urology Clinic, Hawkes Bay, New Zealand
| | - Rod Studd
- Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Brett Delahunt
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Douglas Iupati
- Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand
| | - Mohua Jain
- Anesthetics, Southern Cross Hospital, Wellington, New Zealand
| | - Colin Rooney
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | - Judy Murray
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter J Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter B Bethwaite
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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Rodrigues G, Yao X, Loblaw DA, Brundage M, Chin JL. Low-dose rate brachytherapy for patients with low- or intermediate-risk prostate cancer: A systematic review. Can Urol Assoc J 2014; 7:463-70. [PMID: 24381672 DOI: 10.5489/cuaj.1482] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We review the current evidence for the role of low-dose rate brachytherapy (PB) in patients with low- or intermediate-risk prostate cancer using a systematic review of the literature. METHODS We searched MEDLINE and EMBASE (from January 1996 to October 2011), the Cochrane Library, relevant guideline web-sites, and websites for meetings specific for genitourinary diseases. RESULTS Ten systematic reviews and 55 single-study papers met the pre-planned study selection criteria. In the end, 36 articles were abstracted and analyzed for this systematic review. There is no evidence for a difference in efficacy between PB and external beam radiation therapy (EBRT), or between PB and radical prostatectomy (RP). During the 6 months to 3 years after treatment, PB was associated with less urinary incontinence and sexual impotency than RP, and RP was associated with less urinary irritation and rectal morbidity than PB. However, these differences diminished over time. PB conferred less risk of impotency and rectal morbidity in the three years after treatment than EBRT. Iodine-125 and alladium-103 did not differ with respect to biochemical relapse-free survival and patient-reported outcomes. CONCLUSIONS PB alone is a treatment option with equal efficacy to EBRT or RP alone in patients with newly diagnosed low- or intermediate-risk prostate cancer who require or choose active treatment.
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Affiliation(s)
- George Rodrigues
- London Health Sciences Centre, Department of Oncology, Western University, London, ON
| | - Xiaomei Yao
- Program in Evidence-based Care, McMaster University, Hamilton, ON
| | - D Andrew Loblaw
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University
| | - Joseph L Chin
- Division of Urology, London Health Sciences Centre, Division of Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
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Pontes-Júnior J, Reis ST, Bernardes FS, Oliveira LCN, Barros ÉAFD, Dall'Oglio MF, Timosczuk LMS, Ribeiro-Filho LA, Srougi M, Leite KRM. Correlation between beta1 integrin expression and prognosis in clinically localized prostate cancer. Int Braz J Urol 2014; 39:335-42; discussion 343. [PMID: 23849566 DOI: 10.1590/s1677-5538.ibju.2013.03.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Integrins are transmembrane glycoprotein receptors that regulate cell-matrix interactions, thus functioning as sensors from the environment. They also act as cell adhesion molecules that are responsible for the maintenance of the normal epithelial phenotype. Some studies have reported a correlation between carcinogenesis and changes in integrin expression, especially β1 integrin, however its role in prostate cancer (PC) is unclear. The aim of our study was to evaluate the expression of β1 integrin in localized PC and to correlate the pattern of expression with recurrence after surgical treatment. Methods For this case-control study, we retrospectively selected surgical specimens from 111 patients with localized PC who underwent radical prostatectomy. Recurrence was defined as a PSA level exceeding 0.2 ng/mL after surgery, and the median follow-up was 123 months. Integrin expression was evaluated by immunohistochemistry in a tissue microarray containing two samples from each tumor. We employed a semiquantitative analysis and considered a case as positive when the expression was strong and diffusely present. RESULTS There was a loss of 11 cases during the tissue micro array assembling. β1 expression was positive in 79 of the 100 evaluated cases (79%). The univariate and multivariate analyses showed that the negative expression of β1 integrin was associated with biochemical recurrence (p = 0.047) and time to recurrence after radical prostatectomy (p = 0.023). When β1 was negative, the odds ratio for recurrence was 2.78 times higher than that observed in the positive cases [OR = 2.78, p = 0.047, IC 95% (1.01-7.66)]. CONCLUSIONS The loss of β1 integrin immune expression was correlated with biochemical recurrence in patients treated with radical prostatectomy for localized PC.
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Affiliation(s)
- José Pontes-Júnior
- Laboratory of Medical Investigation - LIM 55, Urology Department, University of Sao Paulo Medical, School and Universidade Nove de Julho, Sao Paulo, Brazil
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Illing R, Emberton M. Sonablate®-500: transrectal high-intensity focused ultrasound for the treatment of prostate cancer. Expert Rev Med Devices 2014; 3:717-29. [PMID: 17280536 DOI: 10.1586/17434440.3.6.717] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostate cancer (PCa) is the most common cancer in men and the second leading cause of death from malignancy in the UK. The number of men diagnosed with PCa is increasing, due in part to an increased willingness of men to visit their family doctors with lower urinary tract symptoms, and also a willingness of physicians to test for it. As the demographic of men diagnosed with PCa becomes younger and better informed, so the demand for a less-invasive alternative to standard therapies becomes greater. The Sonablate-500 is one of only two high-intensity focused ultrasound (HIFU) devices commercially available to treat PCa. HIFU is an attractive treatment option as it is the only form of therapy that neither involves direct instrumentation of the prostate nor ionizing radiation. This article describes the unique features of both the Sonablate-500 system hardware and software, and the outcome data from this device in the context of current standard therapies. Finally, a view into the future attempts to outline where this technology is heading and how a paradigm shift in the way that PCa is considered may make HIFU even more relevant.
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Affiliation(s)
- Rowland Illing
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35/43 Lincolns Inn Fields, London, UK.
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Rutten TP, Lawson JM, Marcu LG. Treatment technique evolution and dosimetry trends over seven years of low dose rate prostate brachytherapy at an Australian institution. Phys Med 2013; 29:662-9. [DOI: 10.1016/j.ejmp.2012.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/03/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022] Open
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Ohashi T, Yorozu A, Saito S, Momma T, Toya K, Nishiyama T, Yamashita S, Shiraishi Y, Shigematsu N. Outcomes following iodine-125 prostate brachytherapy with or without neoadjuvant androgen deprivation. Radiother Oncol 2013; 109:241-5. [PMID: 24183866 DOI: 10.1016/j.radonc.2013.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/27/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the biochemical failure-free survival (BFFS), cause-specific survival (CSS), and overall survival (OS) outcomes of patients treated with iodine-125 (I-125) brachytherapy for clinically localized prostate cancer. METHODS AND MATERIALS Between 2003 and 2009, I-125 permanent prostate brachytherapy without supplemental external-beam radiotherapy was performed for 663 patients with low-risk and low-tier intermediate-risk (defined as organ-confined disease, PSA <10ng/mL, and Gleason score 3+4 with biopsy positive core rate <33%) prostate cancer. Early in the study period, the preplanning method was used in the first 104 patients, and later the real-time planning method was used. Biochemical failure was determined using the American Society for Therapeutic Radiology Oncology (ASTRO) and Phoenix definitions. RESULTS The 7-year BFFS rates for the ASTRO and Phoenix definitions were 96.1% and 95.9%, respectively. The corresponding BFFS rates by risk group were 97.6% and 96.7% for low-risk, and 91.8% and 93.6% for low-tier intermediate-risk disease (p=0.007 and 0.08, respectively). The median times to biochemical failure in those who failed were 29.5 and 43.9months according to the ASTRO and Phoenix definitions, respectively. The 7-year CSS and OS were 99.1% and 96.4%. There was no significant difference in CSS or OS between the low-risk and low-tier intermediate-risk groups. In multivariate Cox regression analysis, risk group and prostate D90 were independent predictors of BFFS for the ASTRO definition, while only the prostate D90 was significant for the Phoenix definition. CONCLUSION I-125 prostate brachytherapy results in excellent 7-year BFFS, CSS, and OS for low-risk and low-tier intermediate-risk prostate cancer.
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Affiliation(s)
- Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan; Department of Radiology, National Hospital Organization Saitama Hospital, Japan.
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Long-term follow-up of International Prostate Symptom Score (IPSS) in men following prostate brachytherapy. World J Urol 2013; 32:1061-6. [DOI: 10.1007/s00345-013-1188-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022] Open
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Miwa S, Mizokami A, Konaka H, Ueno S, Kitagawa Y, Koh E, Namiki M. Prospective longitudinal comparative study of health-related quality of life and treatment satisfaction in patients treated with hormone therapy, radical retropubic prostatectomy, and high or low dose rate brachytherapy for prostate cancer. Prostate Int 2013; 1:117-24. [PMID: 24223413 PMCID: PMC3814119 DOI: 10.12954/pi.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/27/2013] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To evaluate the effects of four different prostate cancer treatments on quality of life (QoL) and patient satisfaction. METHODS Ninety-six prostate cancer patients were treated with hormone therapy, radical retropubic prostatectomy, high dose rate brachytherapy, or low dose rate brachytherapy. We assessed general, cancer-specific, and prostate disease-specific QoL. More than one year since commencement of treatment, the patients were asked the following questions: 1) How do you feel about your treatment? 2) Would you undergo the same treatment again? RESULTS The comparison of baseline and 12-month results showed that general and cancer-specific QoL had changed little in all groups. At baseline, the general and cancer-specific QoL tended to be lower in the hormone therapy patients. In the radical the retropubic prostatectomy patients, all scores on the Medical Outcomes Study 36-Item Short Form were worse than the baseline scores at three months. Scores for the International Index of Erectile Function-5 had also worsened, with no recovery. In the low-dose rate brachytherapy patients, the prostate disease-specific QoL at baseline tended to improve. However, the satisfaction levels for each treatment were reasonably good, and most patients would choose the same treatment again. CONCLUSIONS The results of each of the four treatments differed in assessments of QoL. In the radical retropubic prostatectomy patients, the decrease in the International Index of Erectile Function-5 scores was especially remarkable and did not show recovery. In contrast, both brachy therapy groups had attained superior sexual function. However, regardless of the quality of life evaluations, most patients surveyed were satisfied with their treatments and would choose the same treatment again.
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Affiliation(s)
- Sotaro Miwa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Cao Z, Wang Y, Liu ZY, Zhang ZS, Ren SC, Yu YW, Qiao M, Zhai BB, Sun YH. Overexpression of transglutaminase 4 and prostate cancer progression: a potential predictor of less favourable outcomes. Asian J Androl 2013; 15:742-6. [PMID: 23974364 DOI: 10.1038/aja.2013.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/16/2013] [Accepted: 05/30/2013] [Indexed: 01/13/2023] Open
Abstract
Transglutaminase 4 has been shown to enhance various biological properties of prostate cancer cells, e.g., cell-matrix adhesion, invasiveness and the epithelial-mesenchymal transition. The objectives of this study were to investigate the associations between transglutaminase 4 expression and the established features and biochemical recurrence of prostate cancer. Transglutaminase 4 immunostaining was performed on a tissue microarray. The expression of transglutaminase 4 was evaluated by a scoring method based on the intensity and extent of staining. The clinical and pathological information was obtained through a review of medical records. Follow-up data were obtained by consulting the hospital medical records and the prostate cancer database of our department and by contacting patients or family members. We then compared the transglutaminase 4 expression levels between the prostate cancer tissues and the paracarcinoma tissues and evaluated the correlation of transglutaminase 4 expression with the clinical parameters and biochemical recurrence of prostate cancer. Our results indicated that the transglutaminase 4 staining was significantly higher in tumour tissue than in paracarcinoma tissue (P<0.001) and was positively associated with higher Gleason score (P<0.001) and higher prostate-specific antigen level (P=0.005). Patients with transglutaminase 4 overexpression experienced shorter biochemical recurrence-free survival after surgery (P=0.042) in the univariate analysis but not in the multivariate analysis (P=0.139), which indicated that transglutaminase 4 may serve as a potential predictor of biochemical recurrence of prostate cancer.
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Affiliation(s)
- Zhi Cao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Kristiansen G, Stöckle M, Albers P, Schmidberger H, Martus P, Wellek S, Härter M, Bussar-Maatz R, Wiegel T. Die Bedeutung der Pathologie in der deutschen Prostatakrebsstudie PREFERE. DER PATHOLOGE 2013; 34:449-62. [DOI: 10.1007/s00292-013-1788-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ferrer M, Guedea F, Suárez JF, de Paula B, Macías V, Mariño A, Hervás A, Herruzo I, Ortiz MJ, Ponce de León J, Sancho G, Boladeras A, Ayala A, Craven-Bratle J, Ávila M, Cunillera O, Pardo Y, Alonso J, Aguiló F. Quality of life impact of treatments for localized prostate cancer: Cohort study with a 5year follow-up. Radiother Oncol 2013; 108:306-13. [DOI: 10.1016/j.radonc.2013.05.038] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 01/24/2023]
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Rodrigues G, Yao X, Loblaw DA, Brundage M, Chin JL. Evidence-based guideline recommendations on low-dose rate brachytherapy in patients with low- or intermediate-risk prostate cancer. Can Urol Assoc J 2013; 7:E411-6. [PMID: 23826053 DOI: 10.5489/cuaj.478] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Genitourinary Cancer Disease Site Group (GU DSG) and Cancer Care Ontario's Program in Evidence-Based Care (PEBC) in Ontario, Canada developed a guideline on low-dose rate brachytherapy (LDR-BT) in patients with early-stage low-grade prostate cancer in 2001. The current updated guideline focuses on the research questions regarding the effect of LDR-BT alone, the effect of LDR-BT with external beam radiation therapy (EBRT) and the selection of an isotope. METHODS This guideline was developed by using the methods of the Practice Guidelines Development Cycle and the core methodology was a systematic review. MEDLINE and EMBASE (from January 1996 to October 2011), the Cochrane Library, main guideline websites, and main annual meeting abstract websites specific for genitourinary diseases were searched. Internal and external reviews of the draft guideline were conducted. RESULTS The draft guideline was developed according to a total of 10 systematic reviews and 55 full text articles that met the pre-planned study selection criteria. The quality of evidence was low to moderate. The final report reflects integration of the feedback obtained through the internal review (two oncologists and a methodologist) and external review (five target reviewers and 48 professional consultation reviewers) process, with final approval given by the GU DSG and the PEBC. CONCLUSION THE MAIN RECOMMENDATIONS ARE: (1) For patients with newly diagnosed low-risk or intermediate-risk prostate cancer who require or choose active treatment, LDR-BT alone is a treatment option as an alternative to EBRT alone or RP alone; and (2) I-125 and Pd-103 are each reasonable isotope options.
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Affiliation(s)
- George Rodrigues
- London Health Sciences Centre, Department of Oncology, Western University, London, ON
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Le Fur E, Malhaire JP, Nowak E, Rousseau B, Erauso A, Pene-Baverez D, Papin G, Delage F, Perrouin-Verbe MA, Fournier G, Pradier O, Valeri A. Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation. Brachytherapy 2013; 12:589-95. [PMID: 23669150 DOI: 10.1016/j.brachy.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/05/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.
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Affiliation(s)
- Emmanuelle Le Fur
- Radiation Therapy Department, Centre Hospitalier Universitaire Morvan, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; Inserm U650, Laboratoire de Traitement de l'Information Médicale, Brest, France.
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DeGroot JM, Brundage MD, Lam M, Rohland SL, Heaton J, Mackillop WJ, Siemens DR, Groome PA. Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy. Can Urol Assoc J 2013; 7:E299-305. [PMID: 23766831 PMCID: PMC3668411 DOI: 10.5489/cuaj.11294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We compared the cause-specific survival of patients who received radiotherapy to those who received surgery for cure of their prostate cancer using a number of design and analytic steps to mitigate confounding by indication. METHODS This was a case-cohort study of 2213 patients in the Ontario Cancer Registry diagnosed between 1990 and 1998 who were either treatment candidates or received curative radiotherapy or surgery. Cases included patients who died of prostate cancer within 10 years. The study population was restricted to those who were candidates for either treatment (radiotherapy or surgery) based on disease severity (low and intermediate risk using the Genitourinary Radiation Oncologists of Canada risk groups). The median follow-up was 51 months. Cause-specific survival was analyzed using Cox-proportional hazards regression with case-cohort variance adjustment. Results from intent-to-treat analyses were compared to results by treatment received. RESULTS Adjusted hazard ratios for risk of prostate cancer death for radiotherapy compared to surgery for the entire study population were 1.62 (95%CI 1.00-2.61) and 2.02 (1.19-3.43) analyzing by intent-to-treat and treatment received, respectively. Intent-to-treat hazard ratios for the low- and intermediate-risk groups were 0.87 (0.28-2.76) and 1.57 (0.95-2.61), respectively. CONCLUSION Overall results were driven by the finding in the intermediate-risk group, which indicated that radiotherapy was not as effective as surgery in this group. Confirmation was needed with special attention paid to risk stratification and the impact of more contemporary delivery of these treatment options.
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Affiliation(s)
- Julie M. DeGroot
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Michael D. Brundage
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Miu Lam
- Department of Community Health and Epidemiology, Queen’s University, Kingston, ON
| | - Susan L. Rohland
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | - Jeremy Heaton
- Department of Urology, Queen’s University, Kingston, ON
| | - William J. Mackillop
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
| | | | - Patti A. Groome
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON
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Yoshida K, Ohashi T, Yorozu A, Toya K, Nishiyama T, Saito S, Hanada T, Shiraishi Y, Shigematsu N. Comparison of preplanning and intraoperative planning for I-125 prostate brachytherapy. Jpn J Clin Oncol 2013; 43:383-9. [PMID: 23315386 DOI: 10.1093/jjco/hys240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare two widely used permanent prostate brachytherapy techniques, preplanning and intraoperative planning, based on postimplant dosimetry, toxicity and biochemical outcomes. METHODS Between 2003 and 2006, 665 men with localized prostate cancer were treated with permanent interstitial implantation. The first 227 consecutive men were treated with the preplanning technique, followed by 438 men treated with the intraoperative technique. Late toxicity was scored by the Common Terminology Criteria for Adverse Events v.4.0. Biochemical failure was defined as a prostate-specific antigen increase of more than 2 ng/ml above the nadir value excluding a benign bounce. Univariate and multivariate analyses were performed to identify the variables associated with biochemical failure-free survival. RESULTS Postimplant target coverage was similar in the two groups, with a small difference in risk organ doses. Mean V100 was 96.3 vs. 96.7% (P = 0.205), D90 was 119.6 vs. 119.4% (P = 0.884), urethral D10 was 157.5 vs. 146.1% (P = 0.010), rectal V100 was 0.57 vs. 0.43 cc (P = 0.002) in the preplanning and intraoperative planning groups, respectively. Acute and late Grade 3 genitourinary and gastrointestinal toxicities were <1% for both methods. The 5-year biochemical failure-free survival rate was 95.4% for the preplanning and 94.0% for the intraoperative planning group (P = 0.776). Multivariate analysis revealed Gleason score, biopsy positive rate and V100 to be predictors of biochemical failure-free survival, while the planning technique was not significant. CONCLUSION This large-scale analysis of high-quality implants revealed similar postimplant dosimetry, toxicity profiles and biochemical failure-free survival for the preplanning and intraoperative planning methods.
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Affiliation(s)
- Kayo Yoshida
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Meyer A, Wassermann J, Warszawski-Baumann A, Baumann R, Machtens S, Karstens JH, Christiansen H, Merseburger A, Kuczyk MA, von Klot C. Segmental dosimetry, toxicity and long-term outcome in patients with prostate cancer treated with permanent seed implants. BJU Int 2013; 111:897-904. [PMID: 23305079 DOI: 10.1111/j.1464-410x.2012.11558.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The development of side effects characteristic for the different treatment methods with impact on the patients' quality of life plays a growing role for individual patients with early stage prostate cancer. Using permanent brachytherapy a high dose to the prostate can be applied with a steep dose gradient to the normal tissue. However, small partial volumes of normal tissue may be exposed to high doses inducing special side effects including lower urinary tract symptoms and/or erectile dysfunction. In the literature there are only few publications so far regarding segmental dosimetry and its influence on side effects and the results are conflicting. We could not identify any dosimetric parameter in segmental dosimetry that may have an influence at certain time intervals on the development of side effects such as lower urinary tract symptoms or erectile dysfunction. However, we could state clearly that the preoperative situation is the most important factor for postoperative outcome. OBJECTIVE To report on the side effects of patients with low to low-intermediate risk prostate cancer treated with permanent interstitial brachytherapy with special emphasis on segmental dosimetry. PATIENTS AND METHODS A series of 186 consecutive patients treated for early stage prostate cancer receiving definitive I-125 brachytherapy (permanent seed implantation) between November 2001 and April 2005 at our institution were examined for the development of side effects. Morbidity was assessed prospectively using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) in a mean follow-up interval of 30 months. The scores were correlated with segmental dosimetry performed 6 weeks after the implantation. RESULTS The mean postoperative dose to 90% of the prostate volume (D90) was 180.2 Gy, the mean preoperative IPSS 7.2 and the mean IIEF-5 14.35, with all scores showing a maximum deterioration after 6 weeks with normalization after 24 months. After correlating the segmental dosimetry and the scores at different time intervals, only the baseline scores remained statistically significant in multivariate regression analysis at all time intervals (P < 0.00). CONCLUSIONS We could not demonstrate a correlation of segmental dosimetry with induction of side effects. There is no relationship between dose exposure of partial volumes and the development of radiation-induced toxicities. The preoperative situation regarding lower urinary tract symptoms and erectile function are the most important factors for postoperative outcome.
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Affiliation(s)
- Andreas Meyer
- Clinic of Radiation Oncology, Hannover Medical School, Hannover, Germany.
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Le Fur E, Malhaire J, Baverez D, Delage F, Perrouin-Verbe M, Schlurmann F, Guerif S, Fournier G, Pradier O, Valeri A. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer. Strahlenther Onkol 2012; 188:1091-5. [DOI: 10.1007/s00066-012-0242-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
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[Sexual function after permanent seed implant prostate brachytherapy]. Nihon Hinyokika Gakkai Zasshi 2012; 103:599-603. [PMID: 23120993 DOI: 10.5980/jpnjurol.103.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effects of permanent seed implant prostate brachytherapy (BT) on sexual function (SF). MATERIALS AND METHODS From September 2003 to July 2005, 56 patients underwent radical retropubic prostatectomy (RRP) without any hormone therapy, while 353 patients had undergone BT without any adjuvant hormone therapy in a single institute. Out of these 353 patients in the BT group, 305 patients received neoadjuvant hormone therapy (BT NHT + group), while 48 did not (BT NHT - group). SF was prospectively evaluated using the UCLA Prostate Cancer Index (UCLA-PCI). Potency was defined as the UCLA-PCI Q26 point of > or = 3. RESULT The preimplant UCLA-PCI scores of SF for BT NHT - and BT NHT + groups were 50.9 and 13.4, respectively. The SF score of the NHT - group post operatively decreased to 38.9 within 6 months, but was maintained at the same level after that. With the recovery of the androgen, SF score of the NHT + group improved after BT: however, it did not reach up to that of the NHT - group. In the univariate analysis, patient's age was the only predictive factor for SF after BT. Thirty-four out of 48 patients in the BT NHT - group and 23 out of 56 patients in the RRP group showed adequate potency before surgery. Their 5-year potency preservation rate was 73.6% in the BT NHT - group and 4.3% in the RRP group. CONCLUSION SF slightly decreased immediately after BT but was usually maintained during the course observation for 5 years. The 5-year SF preservation rate after BT was 73.6%.
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Miyake H, Fujisawa M. Prognostic prediction following radical prostatectomy for prostate cancer using conventional as well as molecular biological approaches. Int J Urol 2012; 20:301-11. [DOI: 10.1111/j.1442-2042.2012.03175.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Hideaki Miyake
- Division of Urology; Kobe University Graduate School of Medicine; Kobe; Japan
| | - Masato Fujisawa
- Division of Urology; Kobe University Graduate School of Medicine; Kobe; Japan
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Low-dose rate brachytherapy of the prostate in elderly patients. LA RADIOLOGIA MEDICA 2012; 118:1412-21. [DOI: 10.1007/s11547-012-0872-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/03/2012] [Indexed: 10/27/2022]
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Pinkawa M, Piroth MD, Holy R, Escobar-Corral N, Caffaro M, Djukic V, Klotz J, Eble MJ. Quality of life after intensity-modulated radiotherapy for prostate cancer with a hydrogel spacer. Matched-pair analysis. Strahlenther Onkol 2012; 188:917-25. [PMID: 22933033 DOI: 10.1007/s00066-012-0172-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hydrogel spacer is an innovative method to protect the rectal wall during prostate cancer radiotherapy. Clinical effects are not well known. METHODS Patients have been surveyed before, at the last day, and 2-3 months after radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite). Median dose to the prostate in the spacer subgroup (SP) was 78 Gy in 2 Gy fractions. The results were independently compared with two matched-pair subgroups (treated conventionally without spacer): 3D conformal 70.2 Gy in 1.8 Gy fractions (3DCRT) and intensity-modulated radiotherapy (IMRT) 76 Gy in 2 Gy fractions. There were 28 patients in each of the three groups. RESULTS Baseline mean bowel bother scores were 96 points in all subgroups. Similar mean changes (SP 16, 3DCRT 14, IMRT 17 points) were observed at the end of radiotherapy. The smallest difference resulted in the spacer subgroup 2-3 months after radiotherapy (SP 2, 3DCRT 8, IMRT 6 points). Bowel bother scores were only significantly different in comparison to baseline levels in the spacer subgroup. The percentage of patients reporting moderate/big bother with specific symptoms did not increase for any item (urgency, frequency, diarrhoea, incontinence, bloody stools, pain). CONCLUSION Moderate bowel quality-of-life changes can be expected during radiotherapy irrespective of spacer application or total dose. Advantages with a spacer can be expected a few weeks after treatment.
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Affiliation(s)
- M Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Pauwelsstr. 30, 52072 Aachen, Germany.
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Marcu LG, Lawson JM, Rutten T, Gowda R. Quality indicators and technique for analyzing permanent I-125 prostate seed implants: seven years postimplant dosimetry evaluation. Med Phys 2012; 39:4123-31. [PMID: 22830745 DOI: 10.1118/1.4725173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The roles of postimplant dosimetry (PID) after permanent I-125 implant are to identify and rectify inadequate implants, assess the dosimetric quality indicators, and evaluate dose to the organs at risk. The aim of the current work was to assess the progress of prostate implant quality via postimplant dosimetry over seven years. METHODS The following factors were investigated to assess the PID results obtained over seven years: the improvement in implant technique, the computed tomography (CT) delineation-based PID versus ultrasound-CT (US-CT) fusion-based PID, and the evolution of parameters such as D90 and NDR (natural dose ratio). The correlation between dosimetric parameters and clinical outcomes were also evaluated. RESULTS The seven years PID learning curve shows clear changes in dosimetric trend for the 265 patients studied. Manual target contouring on CT was shown to overestimate the prostate volume when compared to ultrasound data, translating to CT-based D90 values being lower than US-CT D90. It was found that NDR does not contribute with additional dosimetric information to postimplant dosimetry evaluation. Patient follow-up data show that 4.7% patients have relapsed, and urinary retention was reported in 2.7% of the patients. CONCLUSIONS CT-based PID was found less reliable than US-CT fusion-based PID due to target volume overestimation. This result shows the biased interpretation of low D90 values based on CT-based targeting, providing unreliable correlations between D90 and relapse probability. The low urinary retention statistics are in accordance with the PID data for the organ, as only 5.2% of patients had their PID D10 > 218 Gy, i.e., above the recommended GEC-ESTRO guidelines. Besides the "learning" component, the PID D90 curve is influenced by the PID technique.
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Affiliation(s)
- Loredana G Marcu
- Department of Medical Physics, Royal Adelaide Hospital, SA 5000, Australia. loredana@
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Ottley E, Gold E. Insensitivity to the growth inhibitory effects of activin A: An acquired capability in prostate cancer progression. Cytokine Growth Factor Rev 2012; 23:119-25. [DOI: 10.1016/j.cytogfr.2012.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
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Kudchadker RJ, Pugh TJ, Swanson DA, Bruno TL, Bolukbasi Y, Frank SJ. Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy. Med Dosim 2012; 37:387-90. [PMID: 22560295 DOI: 10.1016/j.meddos.2012.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/09/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022]
Abstract
Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R(2) = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.
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Affiliation(s)
- Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Mitsui Y, Shiina H, Hiraki M, Arichi N, Hiraoka T, Sumura M, Honda S, Yasumoto H, Igawa M. Tumor Suppressor Function of PGP9.5 Is Associated with Epigenetic Regulation in Prostate Cancer—Novel Predictor of Biochemical Recurrence after Radical Surgery. Cancer Epidemiol Biomarkers Prev 2012; 21:487-96. [DOI: 10.1158/1055-9965.epi-11-0970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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ACR Appropriateness Criteria® definitive external beam irradiation in stage T1 and T2 prostate cancer. Am J Clin Oncol 2012; 34:636-47. [PMID: 22101389 DOI: 10.1097/coc.0b013e3182354a65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE : External beam radiation therapy is a standard of care treatment for men who present with clinically localized (T1-T2) prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with external beam radiation therapy. METHODS : A panel consisting of physicians with expertise on prostate cancer was assembled and provided with a number of clinical scenarios for consensus treatment and management guidelines. Prostate cancer patient vignettes were presented along with specific management recommendations based on an extensive review of the modern external beam radiotherapy literature. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances, where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. RESULTS : Modern external beam radiation therapy series demonstrate favorable biochemical control rates for patients with localized prostate cancer. Morbidity profiles are also favorable and it is clear that this is enhanced by modern techniques like 3-dimensional conformal radiation therapy and intensity-modulated radiation therapy. An active area of investigation is evaluating the use of hypofractionated dosing. CONCLUSIONS : Continued investigation to refine patient selection, external beam radiation technology application, and alternative dosing schedules should result in further improvements in biochemical outcome and decreased morbidity with external beam radiation treatment for localized prostate cancer.
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