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Rathbun JT, Schroeder TM, Eberhardt SC. High postprostatectomy prostate-specific antigen level prior to salvage radiation therapy is not always a bad sign. Rev Urol 2018; 19:190-194. [PMID: 29302244 DOI: 10.3909/riu0754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although radical prostatectomy is a popular treatment modality for clinically localized prostate cancer, 10-year biochemical recurrence can reach 28%. Before salvage radiation therapy (SRT), prostate-specific antigen (PSA) values alone should be used cautiously in predicting SRT eligibility. A long, slow PSA rise may suggest locally confined disease still amenable to SRT; corresponding imaging to identify potential gross recurrence is useful. Patients with local disease may safely benefit from higher doses of radiation.
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Affiliation(s)
- John T Rathbun
- Department of Radiation Oncology, University of New MexicoAlbuquerque, NM
| | - Thomas M Schroeder
- Department of Radiation Oncology, University of New MexicoAlbuquerque, NM
| | - Steven C Eberhardt
- Departmant of Diagnostic Radiology, University of New MexicoAlbuquerque, NM
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Mukherjee A, Dang T, Morrell H, Yerramilli R, Bishop JJ. Expanding the Utility of High-Sensitivity Dried Blood Spot Immunoassay Testing with Single Molecule Counting. ACTA ACUST UNITED AC 2017; 2:674-686. [DOI: 10.1373/jalm.2017.023911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
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Negishi T, Kuroiwa K, Hori Y, Tomoda T, Uchino H, Tokuda N, Furubayashi N, Nagase K, Iwai H, Nakamura M. Predictive factors of late biochemical recurrence after radical prostatectomy. Jpn J Clin Oncol 2017; 47:233-238. [PMID: 27940489 DOI: 10.1093/jjco/hyw181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/23/2016] [Indexed: 12/29/2022] Open
Abstract
Objective To assess the characteristics of biochemical recurrence in the late period (>5 years after radical prostatectomy) and the differences in the predictors of biochemical recurrence in different periods, we conducted a multicenter retrospective study. Methods We reviewed 478 men who underwent radical prostatectomy for clinically localized prostate cancer. All of the patients were followed up for at least 5 years. The cohort was then divided into three groups; no recurrence group, recurrence <5 years after surgery group and recurrence ≥5 years after surgery group. The background characteristics of each group were compared using the χ2 test. A Cox multivariate regression analysis was performed to determine the predictors of biochemical recurrence in each period. Results Biochemical recurrence occurred in 135 men. In 113 (84%) of the patients, biochemical recurrence occurred at <5 years after surgery; in 22 (16%), it occurred at ≥5 years after surgery. The proportion of men with a low preoperative prostate-specific antigen level was significantly larger in the latter group (P = 0.0023). A preoperative prostate-specific antigen level and a positive surgical margin were significant predictors of biochemical recurrence at <5 years after surgery (hazard ratio: 1.03 and 3.20). A positive surgical margin was also a significant predictor of biochemical recurrence at ≥5 years after surgery (hazard ratio: 3.03); however, a high preoperative prostate-specific antigen level was not. Conclusions Biochemical recurrence occurred at ≥5 years after surgery in 16% of the patients. A positive surgical margin predicted biochemical recurrence in both the early and late periods.
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Affiliation(s)
- Takahito Negishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Kentarou Kuroiwa
- Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki
| | - Yoshifumi Hori
- Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki
| | | | - Hiroshi Uchino
- Department of Urology, Saga-Ken Medical Center Koseikan, Saga, Japan
| | - Noriaki Tokuda
- Department of Urology, Saga-Ken Medical Center Koseikan, Saga, Japan
| | - Nobuki Furubayashi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Kei Nagase
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Hidenori Iwai
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - Motonobu Nakamura
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka
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Cozzarini C, Briganti A, Fossati N, Montorsi F, Di Muzio N, Fiorino C. Dose Escalation in Salvage Radiation Therapy and Urinary Toxicity: A Small Price to Pay for a Significant Prospective Benefit. J Clin Oncol 2016; 34:1704-5. [PMID: 26951317 DOI: 10.1200/jco.2016.66.7139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alberto Briganti
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
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Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy. Case Rep Urol 2015; 2015:839738. [PMID: 26171272 PMCID: PMC4480240 DOI: 10.1155/2015/839738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/07/2015] [Indexed: 11/17/2022] Open
Abstract
A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period.
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Tilki D, Kim SI, Hu B, Dall’Era MA, Evans CP. Ultrasensitive Prostate Specific Antigen and its Role after Radical Prostatectomy: A Systematic Review. J Urol 2015; 193:1525-31. [DOI: 10.1016/j.juro.2014.10.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Derya Tilki
- Martini-Clinic Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, School of Medicine, University of California-Davis, Sacramento, California
| | - Sun Il Kim
- Department of Urology, School of Medicine, University of California-Davis, Sacramento, California
- Department of Urology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Brian Hu
- Department of Urology, School of Medicine, University of California-Davis, Sacramento, California
| | - Marc A. Dall’Era
- Department of Urology, School of Medicine, University of California-Davis, Sacramento, California
| | - Christopher P. Evans
- Department of Urology, School of Medicine, University of California-Davis, Sacramento, California
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Horwich A, Hugosson J, de Reijke T, Wiegel T, Fizazi K, Kataja V, Parker C, Bellmunt J, Berthold D, Bill-Axelson A, Carlsson S, Daugaard G, De Meerleer G, de Reijke T, Dearnaley D, Fizazi K, Fonteyne V, Gillessen S, Heinrich D, Horwich A, Hugosson J, Kataja V, Kwiatkowski M, Nilsson S, Padhani A, Papandreou C, Parker C, Roobol M, Sella A, Valdagni R, Van der Kwast T, Verhagen P, Wiegel T. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013; 24:1141-62. [DOI: 10.1093/annonc/mds624] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Schiavina R, Borghesi M, Fiorentino M, Brunocilla E, Manferrari F, Vagnoni V, Martorana G. Identification of prostate cancer risk categories according to surgical margins status, pathological stage and Gleason score. Int J Urol 2013; 20:1097-103. [DOI: 10.1111/iju.12124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Marco Borghesi
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Michelangelo Fiorentino
- Department of Pathology and Molecular Oncology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Harvard University; Dana-Farber Cancer Institute; Boston Massachusetts USA
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Fabio Manferrari
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Valerio Vagnoni
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Giuseppe Martorana
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
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CORTÉS-GONZÁLEZ JEFFR, CASTELLANOS ENRIQUE, SANDBERG KATINKA, ERIKSSON MARIEHJELM, WIKLUND PETER, CARLSSON STEFAN, COHN-CEDERMARK GABRIELLA, HARMENBERG ULRIKA, GUSTAFSSON OVE, LEVITT SEYMOURH, LENNERNÄS BO, BRANDBERG YVONNE, MÁRQUEZ MARCELA, KÄLKNER KARLMIKAEL, NILSSON STEN. Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy. Int J Oncol 2012; 42:109-17. [DOI: 10.3892/ijo.2012.1694] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/21/2012] [Indexed: 11/12/2022] Open
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Stephenson AJ, Bolla M, Briganti A, Cozzarini C, Moul JW, Roach III M, van Poppel H, Zietman A. Postoperative Radiation Therapy for Pathologically Advanced Prostate Cancer After Radical Prostatectomy. Eur Urol 2012; 61:443-51. [DOI: 10.1016/j.eururo.2011.10.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/12/2011] [Indexed: 01/09/2023]
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Postoperative radiotherapy after radical prostatectomy: indications and open questions. Prostate Cancer 2012; 2012:963417. [PMID: 22530131 PMCID: PMC3316943 DOI: 10.1155/2012/963417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 11/18/2022] Open
Abstract
Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64 Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72 Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial.
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Can early implementation of salvage radiotherapy for prostate cancer improve the therapeutic ratio? A systematic review and regression meta-analysis with radiobiological modelling. Eur J Cancer 2011; 48:837-44. [PMID: 21945099 DOI: 10.1016/j.ejca.2011.08.013] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/17/2011] [Accepted: 08/17/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE For prostate cancer that is thought to be locally recurrent after prostatectomy, the optimal timing, dose and techniques for salvage radiotherapy (SRT) have not been established. Here we perform a systematic review of published reports including regression meta-analysis and radiobiologic modelling to identify predictors of biochemical disease control and late toxicity. METHODS We performed a review of published series reporting treatment outcomes following SRT. Studies with at least 30 patients, median PSA before SRT of less than 2.0 ng/mL, and median follow-up of greater than 36 months were identified. Univariate and multivariate analyses were performed to test Gleason Score, SRT dose, SRT timing, pre-SRT PSA, whole pelvic irradiation and androgen deprivation therapy as predictors of 5-year biochemical progression-free survival (bPFS) and severe (grade≥3) late GI and GU toxicity. bPFS and toxicity data were fit to tumour control probability and normal tissue complication probability models, respectively. RESULTS Twenty-five articles met the inclusion criteria for this analysis. Five-year bPFS ranged from 25% to 70%. Severe late GI toxicity rates were 0% to 9%, and severe late GU toxicity rates were 1-11%. On multivariate analysis, bPFS increased with SRT dose by 2.5% per Gy and decreased with pre-SRT PSA by 18.3% per ng/mL (p<0.001). Late GI and GU toxicity increased with SRT dose by 1.2% per Gy (p=0.012) and 0.7% per Gy (p=0.010), respectively. Radiobiological models demonstrate the interaction between pre-SRT PSA, SRT dose and bPFS. For example, an increase in pre-SRT PSA from 0.4 to 1.0 ng/mL increases the SRT dose required to achieve a 50% bPFS rate from 60 to 70Gy. This could increase the rate of severe late toxicity by approximately 10%. CONCLUSION Biochemical control rates following SRT increase with SRT dose and decrease with pre-SRT PSA. Severe late GI and GU toxicity rates also increase with SRT dose. Radiobiological models suggest that the therapeutic ratio of SRT may be improved by initiating treatment at low PSA levels.
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Abstract
Approximately 15-25% of men who undergo radical prostatectomy for localized prostate cancer will experience a PSA-defined biochemical recurrence (BCR) of their cancer--men with poorly differentiated cancer, non-organ-confined disease, and positive surgical margins are at the highest risk. Accumulating evidence indicates that postoperative radiation therapy to the prostate bed favorably influences the course of disease in men with pathological features of poor prognosis. Three phase III randomized trials of adjuvant radiotherapy versus observation have reported improved freedom from BCR, and one study has reported improved metastasis-free survival and overall survival. Similar evidence from randomized trials for salvage radiotherapy is lacking; however, several observational studies have reported durable responses to salvage radiotherapy and reduced cancer-specific mortality in a substantial proportion of high-risk patients, provided that it is administered at the earliest evidence of BCR. The appeal of salvage radiotherapy is that a substantial proportion of patients with non-organ-confined cancer or positive surgical margins are cured after radical prostatectomy alone, thereby limiting the adverse effects of postoperative radiotherapy--which include urinary and bowel dysfunction, sexual dysfunction and secondary pelvic malignancies--to only those whose cancer was not cured by surgery. In the absence of data from randomized trials demonstrating the superiority of adjuvant radiotherapy over a surveillance strategy (with planned salvage radiotherapy at the earliest evidence of BCR), we advocate shared decision making between physicians and patients, based on the relative advantages and disadvantages of each approach.
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Asimakopoulos AD, Miano R, Virgili G, Vespasiani G, Finazzi Agrò E. HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: a pilot study. Urol Oncol 2011; 30:577-83. [PMID: 21292508 DOI: 10.1016/j.urolonc.2010.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/29/2010] [Accepted: 08/19/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test high-intensity focused ultrasound (HIFU) as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer (CaP) after radical prostatectomy (RP). MATERIALS AND METHODS Nineteen patients with palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP after RP, unwilling to undergo salvage radiotherapy (SRT), underwent HIFU as a single-session procedure. Pre-, intra-, and postoperative data including early and late complications, and oncologic outcomes (PSA nadir, biochemical recurrence (BCR)-free survival, and need of secondary adjuvant treatment) were prospectively evaluated. Success was defined as PSA nadir ≤0.1 ng/ml obtained within 3 months from HIFU. In case of PSA nadir >0.1 ng/ml or PSA increase ≥1 ng/ml above the PSA nadir, a biopsy of the treated lesion was performed, and if negative, maximum androgen blockade (MAB) was adopted. In case of positive biopsy, RT was performed. Failure was defined as use of secondary adjuvant treatment (MAB or RT). RESULTS Median follow-up was 48 months. All cases were performed as overnight procedure. No case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed; 2 (mild incontinence) were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatment;17/19 patients (89,5%) were classified as success. Two patients failed to show a PSA nadir <0.1 ng/ml. During follow-up, 8/17 patients (47%) were classified as failure, with consequent total rate of failures 10/19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs. 5.45 ng/ml, respectively, P = 0.013) and Gleason score of the RP specimen (P = 0.01) between the success and failure group. CONCLUSIONS Salvage first-line HIFU for palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP is a feasible, minimally invasive day-case procedure, with an acceptable morbidity profile. It seems to have a good cancer control in the short- and mid-term. Patients with lower pre-HIFU PSA level and favorable pathologic Gleason score presented better oncologic outcomes. A prospective randomized trial with an adequate recruitment and follow-up is necessary to confirm our preliminary oncologic results.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Division of Urology, Department of Surgery, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy.
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate Cancer. Am J Clin Oncol 2011; 34:92-8. [DOI: 10.1097/coc.0b013e3182005319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brodak M, Kosina J, Holub L, Louda M, Odrazka K, Dolezel M, Sefrová J, Jansa J, Pacovsky J. Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy. Urol Int 2011; 86:146-51. [DOI: 10.1159/000320494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022]
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The role of radiation therapy in prostate cancer after radical prostatectomy: when and why? Curr Opin Support Palliat Care 2010; 4:135-40. [DOI: 10.1097/spc.0b013e32833c6cd5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE In patients with clinically suspected local recurrence of prostate cancer, a lobulated hyperintense mass in the radical prostatectomy fossa can be readily visualized with T2-weighted MRI, but this imaging technique is less successful after treatments such as radiation therapy, high-intensity focused ultrasound, and cryosurgery. We describe the additional value of functional techniques in the assessment of local recurrence. CONCLUSION The use of functional MRI techniques such as MR spectroscopy, diffusion-weighted imaging, and dynamic contrast-enhanced MRI has shown promise in increasing overall imaging performance in the detection of local recurrence.
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Bastide C, Savage C, Cronin A, Zelefsky MJ, Eastham JA, Touijer K, Scardino PT, Guillonneau BD. Location and number of positive surgical margins as prognostic factors of biochemical recurrence after salvage radiation therapy after radical prostatectomy. BJU Int 2010; 106:1454-7. [DOI: 10.1111/j.1464-410x.2010.09406.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Choo R. Salvage radiotherapy for patients with PSA relapse following radical prostatectomy: issues and challenges. Cancer Res Treat 2010; 42:1-11. [PMID: 20369045 DOI: 10.4143/crt.2010.42.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A progressively rising level of serum prostate specific antigen (PSA) after radical prostatectomy (RP) invariably indicates the recurrence of prostate cancer. The optimal management of patients with post-RP PSA relapse has remained uncertain due to a wide variability in the natural course of post-RP PSA relapse and the inability to separate a recurrent disease confined to the prostate bed from that with occult distant metastasis. Management uncertainty is further compounded by the lack of phase III clinical studies demonstrating which therapeutic approach, if any, would prolong life with no significant morbidity. Radiotherapy has been the main therapeutic modality with a curative potential for patients with post-RP PSA relapse. This review article depicts issues and challenges in the management of patients with post-RP PSA relapse, presents the literature data for the efficacy of salvage radiotherapy, either alone or in combination of androgen ablation therapy, and discusses future directions that can optimize treatment strategies.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
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Bottke D, de Reijke TM, Bartkowiak D, Wiegel T. Salvage radiotherapy in patients with persisting/rising PSA after radical prostatectomy for prostate cancer. Eur J Cancer 2009; 45 Suppl 1:148-57. [DOI: 10.1016/s0959-8049(09)70027-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Radiothérapie de rattrapage pour récidive biochimique après prostatectomie : comparaison entre les définitions de récidive biochimique de l’Astro et de Phoenix. Cancer Radiother 2009; 13:267-75. [DOI: 10.1016/j.canrad.2009.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 02/15/2009] [Accepted: 02/22/2009] [Indexed: 11/19/2022]
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Bottke D, Wiegel T. [pT3R1 prostate cancer : Immediate or delayed radiotherapy after radical prostatectomy?]. Urologe A 2008; 47:1431-5. [PMID: 18810383 DOI: 10.1007/s00120-008-1724-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Approximately 50-60% of patients with tumor stage pT3R1 after radical prostatectomy (RP) who do not receive adjuvant therapy develop biochemical progression. At present it is unclear whether these patients should undergo immediate adjuvant irradiation or whether a wait and see approach should be adopted while monitoring PSA until the PSA level rises from zero and then initiate salvage radiotherapy (SRT).Three randomized trials showed that an absolute improvement of 20% in the 5-year biochemical no evidence of disease (bNED) could be achieved by administering adjuvant radiotherapy with 60 Gy in patients with tumor stage pT3R1, even with a PSA level around zero after RP. The rate of serious late effects is low. On the other hand, there are numerous, albeit retrospective studies, which provide evidence that SRT after an increase in PSA above zero is an effective treatment, but with higher total doses of 66-70 Gy and a higher rate of late effects. Prognostic factors such as the PSA level before radiotherapy is started, PSA doubling time, R1 resection, PSA velocity, and the Gleason score have a significant impact on both the return of the PSA level to zero and the bNED. Depending on the risk factor, between 20 and 70% of patients again achieve PSA levels around zero after SRT. Retrospective comparative studies suggest a benefit of adjuvant radiotherapy; prospective randomized trials do not exist.Adjuvant radiotherapy after RP in stage pT3R1 tumor and SRT in cases of PSA rising above zero or persistent PSA levels are valid options for the management of high-risk patients after RP. SRT requires higher total doses and thus carries a higher risk of late complications. A benefit has been demonstrated for bNED, but not for survival. The approach should be discussed with the individual patient.
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Affiliation(s)
- D Bottke
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Robert-Koch-Strasse 6, 89081, Ulm, Deutschland.
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Chalasani V, Iansavichene AE, Lock M, Izawa JI. Salvage radiotherapy following radical prostatectomy. Int J Urol 2008; 16:31-6. [DOI: 10.1111/j.1442-2042.2008.02144.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salvage Radiotherapy After Postprostatectomy Biochemical Failure: Does Pretreatment Radioimmunoscintigraphy Help Select Patients with Locally Confined Disease? Int J Radiat Oncol Biol Phys 2008; 71:1316-21. [DOI: 10.1016/j.ijrobp.2007.11.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 11/02/2007] [Accepted: 11/24/2007] [Indexed: 11/17/2022]
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Post-prostatectomy radiation therapy: Consensus guidelines of the Australian and New Zealand Radiation Oncology Genito-Urinary Group. Radiother Oncol 2008; 88:10-9. [DOI: 10.1016/j.radonc.2008.05.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 04/08/2008] [Accepted: 05/01/2008] [Indexed: 11/23/2022]
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Quero L, Mongiat-Artus P, Ravery V, Maylin C, Desgrandchamps F, Hennequin C. Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: a single institution experience. BMC Cancer 2008; 8:26. [PMID: 18230130 PMCID: PMC2257956 DOI: 10.1186/1471-2407-8-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 01/29/2008] [Indexed: 11/28/2022] Open
Abstract
Background To assess the efficacy of salvage radiotherapy (RT) for persistent or rising PSA after radical prostatectomy and to determine prognostic factors identifying patients who may benefit from salvage RT. Methods Between 1990 and 2003, 59 patients underwent RT for PSA recurrence after radical prostatectomy. Patients received a median of 66 Gy to the prostate bed with 3D or 2D RT. The main end point was biochemical failure after salvage RT, defined as an increase of the serum PSA value >0.2 ng/ml confirmed by a second elevation. Results Median follow-up was 38 months. The 3-year and 5-year bDFS rates were 56.1% and 41.2% respectively. According to multivariate analysis, only preRT PSA ≥1 ng/ml was associated with biochemical relapse. Conclusion When delivered early, RT is an effective treatment after radical prostatectomy. Only preRT PSA ≥1 ng/ml predicted relapse.
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Affiliation(s)
- Laurent Quero
- Department of Radiation Oncology, Saint Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
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Mohile SG, Petrylak DP. Management of asymptomatic rise in prostatic-specific antigen in patients with prostate cancer. Curr Oncol Rep 2007; 8:213-20. [PMID: 16618386 DOI: 10.1007/s11912-006-0022-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Biochemical failure after curative-intent therapies is an increasingly common dilemma confronting patients and physicians. No definition of biochemical failure exists that can be applied to all forms of treatment and that is not to some degree affected by the follow-up interval, pretreatment prognostic factors, or the frequency of prostatic-specific antigen (PSA) testing. Available imaging techniques lack sensitivity in detection of occult micrometastases. Prognostic factors such as tumor characteristics and PSA kinetics should be considered when recommending second-line therapies. For those patients with suspected localized recurrence, second-line treatment with salvage therapies may provide long-term disease control. Hormonal therapy, although most commonly employed for PSA recurrence, is of palliative benefit only. Currently, the most appropriate therapeutic intervention for asymptomatic patients with evidence of biochemical failure remains undefined.
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Affiliation(s)
- Supriya G Mohile
- Departments of Medicine and Epidemiology, Columbia Presbyterian Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
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Speight JL, Roach M. Radiotherapy in the management of common genitourinary malignancies. Hematol Oncol Clin North Am 2006; 20:321-46. [PMID: 16730297 DOI: 10.1016/j.hoc.2006.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A continued role for radiation therapy in the multidisciplinary management of genitourinary malignancies seems certain. Treatment outcomes continue to improve, accompanied by diminishing rates of toxicity. With continued technologic advances in the delivery of radiation, including the use of adaptive radiotherapy, the discovery and application of novel treatment agents, and the combined efforts of urologists, medical oncologists, and radiation oncologists, patients who have genitourinary malignancies have an excellent chance of cure.
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Affiliation(s)
- Joycelyn L Speight
- Department of Radiation Oncology, University of California San Francisco Comprehensive Cancer Center, H1031, 1600 Divisadero Street, San Francisco, CA 94143, USA.
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Fujita T, Teh BS, Timme TL, Mai WY, Satoh T, Kusaka N, Naruishi K, Fattah EA, Aguilar-Cordova E, Butler EB, Thompson TC. Sustained long-term immune responses after in situ gene therapy combined with radiotherapy and hormonal therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2006; 65:84-90. [PMID: 16472937 DOI: 10.1016/j.ijrobp.2005.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 10/12/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore long-term immune responses after combined radio-gene-hormonal therapy. METHODS AND MATERIALS Thirty-three patients with prostate specific antigen 10 or higher or Gleason score of 7 or higher or clinical stage T2b to T3 were treated with gene therapy that consisted of 3 separate intraprostatic injections of AdHSV-tk on Days 0, 56, and 70. Each injection was followed by 2 weeks of valacyclovir. Intensity-modulated radiation therapy was delivered 2 days after the second AdHSV-tk injection for 7 weeks. Hormonal therapy was initiated on Day 0 and continued for 4 months or 2.3 years. Blood samples were taken before, during, and after treatment. Lymphocytes were analyzed by fluorescent antibody cell sorting (FACS). RESULTS Median follow-up was 26 months (range, 4-48 months). The mean percentages of DR+CD8+ T cells were increased at all timepoints up to 8 months. The mean percentages of DR+CD4+ T cells were increased later and sustained longer until 12 months. Long-term (2.3 years) use of hormonal therapy did not affect the percentage of any lymphocyte population. CONCLUSIONS Sustained long-term (up to 8 to 12 months) systemic T-cell responses were noted after combined radio-gene-hormonal therapy for prostate cancer. Prolonged use of hormonal therapy does not suppress this response. These results suggest the potential for sustained activation of cell-mediated immune responses against cancer.
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Affiliation(s)
- Tetsuo Fujita
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Abstract
Radical prostatectomy (RP) is the most common primary treatment for prostate cancer. About 40% of those with high-risk pathologic features, such as a positive margin or seminal vesicle involvement, will develop biochemical failure at some point in the future. Radiotherapy (RT), with or without concurrent androgen deprivation, has been used liberally in the management of men with a rising prostate-specific antigen (PSA) after RP, based mostly on relatively small retrospective series. Factors such as the prostatectomy Gleason score, seminal vesicle invasion, absolute pre-RT PSA level, and pre-RT PSA doubling time are emerging as important determinants of outcome after RT. These factors should be used as a guide to the options of local therapy alone (RT), local therapy plus systemic therapy (typically androgen deprivation therapy), and systemic therapy alone.
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Affiliation(s)
- Shelly Bowers Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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