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Definition of Castrate Resistant Prostate Cancer: New Insights. Biomedicines 2022; 10:biomedicines10030689. [PMID: 35327491 PMCID: PMC8945091 DOI: 10.3390/biomedicines10030689] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/05/2022] [Accepted: 03/15/2022] [Indexed: 12/10/2022] Open
Abstract
The term castrate resistant prostate cancer (CRPC) was initially proposed by the Prostate Cancer Working Group 2 in 2008 to define the state of clinical and/or biochemical progression of prostate cancer (PCa) in an environment with very low serum testosterone concentration. Clinical progression is based on the radiological imaging proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) adapted to PCa. Biochemical progression is defined as an over 25% increase in serum prostate-specific antigen within two consecutive measurements separated by at least one week, and an absolute value above 2.0 ng/mL. Finally, the castrate environment is usually defined as a serum testosterone concentration maintained below 50 ng/dL or 1.7 nmol/dL. This definition does not incorporate the new and more accurate imaging modalities to assess clinical progression and the capability of the new biochemical measurements to assess the true castration environment. Ga-68-PSMA-11 PET CT/MRI and whole-body MRI are the new imaging modalities that should replace the classic thoracic CT scan, abdomino-pelvic CT scan, and technetium 99-m bone scintigraphy. In addition, Ga-68-PSMA-11 PET is the current basis for the new therapies targeting metastatic sites. Moreover, the current methods for measuring the very low serum testosterone concentrations in clinical laboratories are the widespread chemiluminescent assays, which are inappropriate, while LC-MSMS is the only method recommended to assess the castrate environment. In addition, recent research shows that serum luteinising hormone concentration associates better than serum testosterone with the castration environment, even when it is measured with LC-MSMS. In summary, the current definition of CRPC seems outdated. An extensive update to diagnose true CRPC is also needed to differentiate CRPC men with M0 (non-metastatic) from those with M1 (metastatic) CRPC. WC: 277.
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Tan YG, Quek SZH, Huang HH, Ho HSS, Yuen JSP, Tay KJ, Tuan JKL, Chen K. Serum testosterone levels and testosterone 'bounce' phenomenon predict response to novel anti-androgen therapies in castration-resistant prostate cancer. Urol Oncol 2021; 39:829.e9-829.e17. [PMID: 34023195 DOI: 10.1016/j.urolonc.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The relevance of continuous testosterone (TT) monitoring in castration-resistant prostate cancer (CRPC) remains in question. OBJECTIVE To determine if TT levels before and during novel anti-androgen therapies (NAAT), and the TT 'bounce' phenomenon may predict treatment response in CRPC. MATERIALS AND METHODS From 2014 through 2018, we identified 92 CRPC patients treated with either Abiraterone or Enzalutamide from a prospectively maintained cancer registry. The TT levels measured before and during NAAT were correlated with the oncological outcomes, determined by PSA response (% change), PSA progression-free survival (PFS) and overall survival (OS). RESULTS AND LIMITATIONS At CRPC, 58 (63.0%) and 34 (37.0%) patients opted for Abiraterone and Enzalutamide respectively. Median TT levels at CRPC status before and during NAAT were 10.37 ng/dl and 20.46 ng/dl respectively. PSA response was superior in patients with a higher TT before NAAT (P:0.048, median difference: 18.22%, 95% CI 0.70 - 40.37) and longer time to CRPC (P: 0.041, median difference: 15.31%, 95% CI 1.84 -34.84), with a trend towards lower TT during NAAT (P: 0.062). Over a follow up of 33.0 months, 65 patients (70.7%) developed PSA progression. PSA PFS was longer in patients with higher TT before NAAT (16.3 vs. 10.8 months; P: 0.023), lower TT during NAAT (17.0 vs. 9.1 months; P: 0.001), and longer time to CRPC (13.4 vs. 8.0 months; P: 0.032). Importantly, better OS was observed in lower TT during NAAT (45.0 vs. 33.0 months; P:0.029) and longer time to CRPC (43.0 vs. 31.0 months; P: 0.025). The TT 'bounce' phenomenon was observed in 28 patients (33.3%), and was associated with a poorer PSA response (P: 0.029, median difference: 18.90%, 95% CI 3.83 - 41.45), shorter PSA PFS (8.6 vs 15.2 months, P: 0.002) and shorter OS (29.0 vs. 45.0 months, P: 0.012). CONCLUSION In CRPC patients, TT behaviors before and during NAAT, and the 'bounce' phenomenon continue to predict treatment response and could guide clinical decisions.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore.
| | - Sheriff Z H Quek
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Henry S S Ho
- Department of Urology, Singapore General Hospital, Singapore
| | - John S P Yuen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Jeffrey K L Tuan
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
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DeJongh J, Ahsman M, Snelder N. A population K-PD model analysis of long-term testosterone inhibition in prostate cancer patients undergoing intermittent androgen deprivation therapy. J Pharmacokinet Pharmacodyn 2021; 48:465-477. [PMID: 33538922 DOI: 10.1007/s10928-020-09736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
Intermittent androgen deprivation therapy with gonadotropin-releasing-hormone (GnRH) agonists can prevent or delay disease progression and development of castration resistant prostate cancer for subpopulations of prostate cancer patients. It may also reduce risk and severity of side effects associated with chemical castration in prostate cancer (PCa) patients. One of the earliest comprehensively documented clinical trials on this was reported in a Canadian patient population treated with leuprorelin preceded by a lead-in with cyproterone acetate. A systems-based mixed effect analysis of testosterone response in active and recovery phases allows inference of new information from this patient population. Efficacy of androgen deprivation therapy is presumed to depend on a treshold value for testosterone at the nadir, below which no additional beneficial effects on PSA reponse can be expected, and occurance of testosterone breakthroughs during active therapy. The present analysis results in a mixed effect model, incorporating GnRH receptor activation, testosterone turnover and feedback mechanisms, describing and predicting testosterone inhibition under intermittent androgen deprivation therapy on the individual and population level, during multiple years of therapy. Testosterone levels in these patients decline over time with an estimated first order rate constant of 0.083 year-1(T1/2 = 8.4 y), with a substantial distribution among this patient population, compared to the general population. PCa patients leaving the trial due to unmanageble PSA relapse appear to have slightly higher testosterone levels at the nadir than sustained responders. These findings are expected to contribute to an increased understanding of the role of testosterone in long term disease progression of prostate cancer.
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Affiliation(s)
- Joost DeJongh
- LAP&P Consultants BV, Archimedesweg 31, 2333 CM, Leiden, The Netherlands.
| | - Maurice Ahsman
- LAP&P Consultants BV, Archimedesweg 31, 2333 CM, Leiden, The Netherlands
| | - Nelleke Snelder
- LAP&P Consultants BV, Archimedesweg 31, 2333 CM, Leiden, The Netherlands
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Pourahadi A, Nojavan S, Hosseiny Davarani SS. Gel-electromembrane extraction of peptides: Determination of five hypothalamic agents in human plasma samples. Talanta 2020; 217:121025. [DOI: 10.1016/j.talanta.2020.121025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/02/2020] [Accepted: 04/08/2020] [Indexed: 01/06/2023]
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Abstract
Androgen deprivation therapy (ADT) is the mainstay for the treatment of advanced prostate cancer. Since the clinical evolution from surgical orchiectomy, we have typically used ADT and orchiectomy to be synonymous terms for castration. The goal of this study is to determine if, in contemporary medical practice, surgical and chemical castration provide for similar levels of diminishment of total and free testosterone. Further, what approaches should be used to most accurately measure testosterone levels in men with advanced prostate cancer and what cutoff values, for example for total testosterone 50 ng dl-1 or 20 ng dl-1, should be utilized. Studies available in the literature have been analyzed and compiled to address these questions. Finally, evidence is provided that free testosterone, the biologically active component, should be utilized to provide clinically relevant state of castration.
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Affiliation(s)
- Sarin Itty
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL33328, USA
| | - Robert H Getzenberg
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL33328, USA
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Hosseiny Davarani SS, Pourahadi A, Ghasemzadeh P. Quantification of controlled release leuprolide and triptorelin in rabbit plasma using electromembrane extraction coupled with HPLC–UV. Electrophoresis 2019; 40:1074-1081. [DOI: 10.1002/elps.201800481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
Affiliation(s)
| | - Ahmad Pourahadi
- Faculty of ChemistryShahid Beheshti University Evin Tehran Iran
| | - Peivand Ghasemzadeh
- Faculty of PharmacyTehran Medical SciencesIslamic Azad University Tehran Iran
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Höti N, Yang S, Hu Y, Shah P, Haffner MC, Zhang H. Overexpression of α (1,6) fucosyltransferase in the development of castration-resistant prostate cancer cells. Prostate Cancer Prostatic Dis 2018; 21:137-146. [PMID: 29339807 PMCID: PMC5895601 DOI: 10.1038/s41391-017-0016-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/14/2017] [Indexed: 01/07/2023]
Abstract
Glycosylation is recognized as one of the most common modifications on proteins. Recent studies have shown that aberrant expression of α (1,6) fucosyltransferase (FUT8), which catalyzes the transfer of fucose from GDP-fucose to core-GlcNAc of the N-linked glycoproteins, modulates cellular behavior that could lead to the development of aggressive prostate cancer. While the relationship between the abnormal expression of FUT8 and glycoprotein fucosylation in different prostate cancer cells has been demonstrated, there is no evidence that shows dysregulated fucosylation might be involved in prostate cancer progression from androgen-dependent to castration-resistant prostate cancer. In this study, using a proteomics approach, we analyzed androgen-dependent and androgen-resistant LAPC4 cells and identified FUT8 to be significantly overexpressed in the androgen-resistant LAPC4 cells. These findings were independently confirmed in LAPC4 cells that were treated with non-steroidal anti-androgen (bicalutamide) and in the in vivo castrated tumor xenograft models. Similarly, we also demonstrated that overexpression of FUT8 might be responsible for the decreased PSA expression in prostate cancer specimens. To our knowledge, this is the first study reporting the functional role of fucosylated enzyme in the development of castration-resistant prostate cancer.
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Affiliation(s)
- Naseruddin Höti
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Shuang Yang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Yingwei Hu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Punit Shah
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Michael C Haffner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Hui Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.
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Irurzun-Arana I, Janda A, Ardanza-Trevijano S, Trocóniz IF. Optimal dynamic control approach in a multi-objective therapeutic scenario: Application to drug delivery in the treatment of prostate cancer. PLoS Comput Biol 2018; 14:e1006087. [PMID: 29672523 PMCID: PMC5929575 DOI: 10.1371/journal.pcbi.1006087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/01/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022] Open
Abstract
Numerous problems encountered in computational biology can be formulated as optimization problems. In this context, optimization of drug release characteristics or dosing schedules for anticancer agents has become a prominent area not only for the development of new drugs, but also for established drugs. However, in complex systems, optimization of drug exposure is not a trivial task and cannot be efficiently addressed through trial-error simulation exercises. Finding a solution to those problems is a challenging task which requires more advanced strategies like optimal control theory. In this work, we perform an optimal control analysis on a previously developed computational model for the testosterone effects of triptorelin in prostate cancer patients with the goal of finding optimal drug-release characteristics. We demonstrate how numerical control optimization of non-linear models can be used to find better therapeutic approaches in order to improve the final outcome of the patients.
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Affiliation(s)
- Itziar Irurzun-Arana
- Pharmacometrics & Systems Pharmacology group, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Alvaro Janda
- Department of Physics and Applied Mathematics, University of Navarra, Pamplona, Navarra, Spain
| | | | - Iñaki F. Trocóniz
- Pharmacometrics & Systems Pharmacology group, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
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Shen YC, Kang CH, Chiang PH. Efficacy of switching therapy of luteinizing hormone-releasing hormone analogue for advanced prostate cancer. Kaohsiung J Med Sci 2016; 32:567-571. [PMID: 27847099 DOI: 10.1016/j.kjms.2016.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/03/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022] Open
Abstract
This study was conducted to determine the efficacy of switching therapy with a second-line luteinizing hormone-releasing hormone (LHRH) analogue after prostate-specific antigen (PSA) progression for advanced prostate cancer. We enrolled 200 patients, from December 2005 to September 2013, with nodal positive, metastatic prostate cancer or disease progression after definite treatment receiving continuous LHRH analogue therapy with monthly depot leuprorelin(sc) acetate 3.75 mg/vial (LA) or goserelin acetate(sc) 3.6 mg/vial (GA). If the patients had castration-resistant prostate cancer, the treatment choice of switching therapy (from LA to GA or from GA to LA) prior to starting chemotherapy was given. The LH, testosterone level, and PSA change were recorded. The records showed that there were 127 patients receiving LA as initial ADT therapy, whereas the other 73 patients were in GA therapy. A total of 92 patients received LHRH analogue switching therapy (54 patients switched from LA to GA and 38 switched from GA to LA). The effect of LH and testosterone reduction prior to and after switching therapy was comparable between the two groups, and increased PSA level after 3 months of treatment was seen in both groups (median PSA: 15.7-67.7 ng/mL in the LA to GA group; 15.2-71.4 ng/mL in the GA to LA group). This study concluded that switching therapy for patients with PSA progression after ADT has no efficacy of further PSA response.
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Affiliation(s)
- Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Cheng Shiu University, Kaohsiung, Taiwan
| | - Chih-Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Moul JW. Hormone naïve prostate cancer: predicting and maximizing response intervals. Asian J Androl 2016; 17:929-35; discussion 933. [PMID: 26112479 PMCID: PMC4814946 DOI: 10.4103/1008-682x.152821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hormone naïve advanced prostate cancer is subdivided into two disease states: biochemical recurrence and traditional M1 (metastatic) prostate cancer and characterized by no prior hormonal therapy or androgen deprivation therapy (ADT). In biochemical recurrence/prostate-specific antigen (PSA) recurrence, men should be risk-stratified based on their PSA doubling time, the Gleason score and the timing of the recurrence. In general, only men who are at high risk should be considered for early/immediate ADT although this is best done using shared decision with the patient. The type of ADT to be used in biochemical recurrence ranging from oral-only peripheral blockade (peripheral androgen deprivation) to complete hormonal therapy (combined androgen blockade [CAB]) remains in debate owing to lack of randomized controlled trials (RCT). However, there is good RCT support for use of intermittent hormonal therapy (IHT). There is also limited research on biomarker response (PSA and testosterone decline) to predict prognosis. On the other hand, in the setting of M1 hormone naïve prostate cancer, there are many more RCT's to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps provide a slight efficacy advantage while IHT may be slightly inferior with minimal M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic tool for M1 patients. There is growing recognition that serum testosterone (T) control while on ADT is linked to the development of castrate-resistant prostate cancer. Especially for a M1 patient, maintaining a serum T below 20–30 ng dl−1 prolongs the response to ADT. Novel oral agents (abiraterone and enzalutamide) may soon find use in hormone naïve disease and may alter the treatment landscape. Despite over 75 years of experience with ADT, many questions remain, and the field continues to evolve.
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Affiliation(s)
- Judd W Moul
- Division of Urology, Department of Urology, Duke Cancer Institute, Duke South, Duke University Medical Center, Durham, NC 27710, USA
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Re: Lower testosterone levels with luteinizing hormone-releasing hormone agonist therapy than with surgical castration: new insights attained by mass spectrometry: T. M. van der Sluis, H. N. Bui, E. J. Meuleman, A. C. Heijboer, J. F. Hartman, N. van Adrichem, E. Boevé, W. de Ronde, R. J. van Moorselaar and A. N. Vis. J Urol 2012; 187: 1601-1606. J Urol 2012; 188:2020; author reply 2020-1. [PMID: 22999544 DOI: 10.1016/j.juro.2012.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Indexed: 11/20/2022]
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12
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Hayashi T, Sentani K, Oue N, Ohara S, Teishima J, Anami K, Sakamoto N, Matsubara A, Yasui W. The Search for Secreted Proteins in Prostate Cancer by the Escherichia coli Ampicillin Secretion Trap: Expression of NBL1 Is Highly Restricted to the Prostate and Is Related to Cancer Progression. Pathobiology 2012; 80:60-9. [DOI: 10.1159/000341396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/18/2012] [Indexed: 01/08/2023] Open
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Pickles T, Hamm J, Morris WJ, Schreiber WE, Tyldesley S. Incomplete testosterone suppression with luteinizing hormone-releasing hormone agonists: does it happen and does it matter? BJU Int 2012; 110:E500-7. [PMID: 22564197 DOI: 10.1111/j.1464-410x.2012.11190.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Previous reports, with small numbers of patients, have described the problem of incomplete testosterone suppression (>1.1 or 1.7 nmol/L) with LHRH agonists. Various predisposing factors have been suggested: different drug agents and patient factors such as age, pretreatment testosterone levels and weight. Such incomplete testosterone suppression has been shown in one small report to be associated with increased PSA failure rates and in another report in those with metastases, with worse survival. This study used testosterone assays that are more accurate at low levels than those used in most previous reports in a large dataset of 2196 men, and confirmed incomplete testosterone suppression (breakthrough) rates >1.7 nmol/L of 3.4% and >1.1 nmol/L of 6.6%. We showed that younger age was strongly associated with the risk of breakthrough, with a minor effect of increasing body mass index. Repeated breakthroughs were more common (16%) in those who had already had one breakthrough. Interim measures of cancer control (PSA kinetics during LHRH therapy) were inferior in those with a breakthrough, and those with breakthroughs between 1.1 and 1.7 nmol/L had worse long-term biochemical control rates. OBJECTIVES • To describe breakthrough rates above castrate levels of testosterone, in a population-based series of men undergoing adjuvant luteinizing hormone-releasing hormone (LHRH) agonist therapy with curative radiation therapy. • To explore the predisposing factors for such breakthroughs and their impact on subsequent outcomes. PATIENTS AND METHODS • All men treated for prostate cancer between 1998 and 2007 with curative radiation in the province of British Columbia, Canada were potentially eligible (n= 11752). Of these, 2196 fulfilled the eligibility criteria. • Serial testosterone measurements were obtained during continuous LHRH therapy. • Breakthrough rates >1.1 nmol/L and >1.7 nmol/L were calculated for each LHRH injection and for each patient course. • Predisposing factors were identified, and early surrogates of oncological outcome (neoadjuvant nadir and post-treatment nadir) were determined. RESULTS • The risk of a breakthrough >1.1 nmol/L was 6.6%, and >1.7 nmol/L was 3.4% per patient course and 5.4% and 2.2% per LHRH injection (inclusive ranges). • Repeated breakthroughs occurred in 16% of patients. • Younger men were more liable to breakthroughs (P < 0.001). • Early PSA kinetic surrogates of cancer control were inferior in those with breakthroughs. • Neither overall biochemical non-evidence of disease (bNED) nor survival were compromised, although subgroup analysis showed inferior 5-year bNED in those with breakthroughs of 1.1-1.7 nmol/L vs those without (58% vs 73%, respectively; P= 0.048). CONCLUSIONS • Breakthroughs with LHRH agonists occur occasionally per injection, but occur commonly per patient course of treatment, and adversely affect early surrogate measures of outcome. • The monitoring of testosterone levels during therapy is therefore advised.
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Affiliation(s)
- Tom Pickles
- Radiation Programme, BC Cancer Agency, and Department of Radiotherapy and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada.
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Wiechno PJ, Sadowska M, Kalinowski T, Michalski W, Demkow T. Does pharmacological castration as adjuvant therapy for prostate cancer after radiotherapy affect anxiety and depression levels, cognitive functions and quality of life? Psychooncology 2011; 22:346-51. [DOI: 10.1002/pon.2095] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 10/04/2011] [Accepted: 10/05/2011] [Indexed: 12/12/2022]
Affiliation(s)
- Paweł J. Wiechno
- Maria Skłodowska-Curie Memorial Cancer Center; Department of Urooncology; Warsaw Poland
| | - Małgorzata Sadowska
- Maria Skłodowska-Curie Memorial Cancer Center; Department of Urooncology; Warsaw Poland
| | - Tomasz Kalinowski
- Maria Skłodowska-Curie Memorial Cancer Center; Department of Urooncology; Warsaw Poland
| | - Wojciech Michalski
- Maria Skłodowska-Curie Memorial Cancer Center; Clinical Trials and Biostatistics Unit; Warsaw Poland
| | - Tomasz Demkow
- Maria Skłodowska-Curie Memorial Cancer Center; Department of Urooncology; Warsaw Poland
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Alcaraz A, Burgos FJ, Cózar JM, Gómez-Veiga F, Morote J, Solsona E, Unda M, Carballido J. Prostate cancer in Spain: from guidelines to clinical practice. BJU Int 2011; 108:61-6. [PMID: 21223474 DOI: 10.1111/j.1464-410x.2010.09832.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE • To determine how closely practice in prostate cancer (PCa) follows European Association of Urology (EAU) guidelines. MATERIALS AND METHODS • This project involving 242 experts comprised four phases: (1) selection of controversial topics by a panel of experts; (2) preparation of case descriptions and associated questionnaires; (3) determination of their face validity; and (4) completion (November 2007 to January 2008). • The primary endpoint was percentage agreement with the recommendations given by the EAU guidelines. Topics not specifically addressed in these guidelines were also analysed. RESULTS • For the selected controversial topics, the overall mean adherence to the guidelines was 52.1%. Topics with a mean adherence <40% are detailed below. • For localized/locally advanced PCa the lowest adherence was found for the type of anaesthesia used during biopsy (30.3%, sd= 14.4), local staging (17.3%, sd= 10.4), new criteria for biochemical relapse after radiotherapy (32.9%, sd= 27.6), and the interpretation of raised PSA after prostatectomy (34.4%, sd= 20.1). • For metastatic PCa, the lowest adherence referred to androgen blockade (34.5%, sd= 24.94) and the reintroduction of hormone therapy (21.8%, sd= 13.5). • Regarding the monitoring of patients, 83.9% of the urologists stated that they measure testosterone levels at some point, and the conventional threshold level of 50 ng/dL testosterone was only used by 17.4%. • Differences in opinion were also observed for the recommendation for a digital rectal examination at each visit (agreed by only 22.3%). CONCLUSION • The PROSEO project represents an opportunity to consolidate and improve EAU guidelines by identifying issues that, on the basis of clinical practice in PCa and topics of current concern to urologists, have not been fully addressed or might need specific recommendations.
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Hwang TIS, Lin YC, Lee MCC, Juang GD, Yeh CH, Cheng YH, Chou KY, Chen HE, Tsai TF. The Effects of Medical Castration on Testes in Patients With Advanced Prostate Cancer. UROLOGICAL SCIENCE 2010. [DOI: 10.1016/s1879-5226(10)60038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Schulman CC, Irani J, Morote J, Schalken JA, Montorsi F, Chlosta PL, Heidenreich A. Androgen-Deprivation Therapy in Prostate Cancer: A European Expert Panel Review. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chung E, Watt H, Glasgow A, Skyring T. Patient rationale in selecting androgen deprivation (PRISAD): do we give patients what they want? Med Oncol 2008; 26:420-3. [PMID: 19052927 DOI: 10.1007/s12032-008-9139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
Abstract
To assess patient rationale in selecting androgen deprivation, structured telephone interviews were conducted on consecutive patients on androgen deprivation over a 17-year period. The majority of these patients have stable disease that require long-term follow-up with 6-monthly PSA estimations. Synchronous PSA check with depot injections are preferred by majority of patients and longer intervals between the depot administrations are preferable due to perceived less needle pain. This study highlights for the first time patients' preferences for synchronous PSA check with their depot injections and a longer interval between the depot administrations due to perceived less needle pain.
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Affiliation(s)
- Eric Chung
- Department of Urology and Oncology, Wollongong Hospital, Wollongong, NSW, Australia.
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Optimal Control of Testosterone: A Clinical Case-Based Approach of Modern Androgen-Deprivation Therapy. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2007.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Beuzeboc P, Cornud F, Eschwege P, Gaschignard N, Grosclaude P, Hennequin C, Maingon P, Molinié V, Mongiat-Artus P, Moreau JL, Paparel P, Péneau M, Peyromaure M, Revery V, Rébillard X, Richaud P, Salomon L, Staerman F, Villers A. Cancer de la prostate. Prog Urol 2007; 17:1159-230. [DOI: 10.1016/s1166-7087(07)74785-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Heidenreich A. Guidelines and counselling for treatment options in the management of prostate cancer. Recent Results Cancer Res 2007; 175:131-62. [PMID: 17432558 DOI: 10.1007/978-3-540-40901-4_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Prostate cancer is often a complex disease and one in which many aspects of the disease and the affected patient must be taken into consideration before decisions about diagnostic work-up, treatments, follow-up, etc. can be made. The current chapter reflects the current recommendations of the European Prostate Cancer Guideline Group made on the basis of criteria of evidence-based medicine after extensive review of the literature available up to December 2005.
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Mottet N, Prayer-Galetti T, Hammerer P, Kattan MW, Tunn U. Optimizing outcomes and quality of life in the hormonal treatment of prostate cancer. BJU Int 2006; 98:20-7. [PMID: 16566812 DOI: 10.1111/j.1464-410x.2006.06176.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We review the effectiveness of androgen-deprivation therapy (ADT) in the management of prostate cancer, and the effect that this treatment has on a patient's quality of life (QoL), based on discussions held at a European symposium on the management of prostate cancer. The overall QoL is reduced in asymptomatic men, and there are known decreases in cognitive function, self-esteem, libido and sexual function. Hot flashes are also a frequent problem. Prolonged ADT can lead to osteoporosis and subsequently fractures. Various effective methods exist to manage and minimize these side-effects; some are specific to the side-effect, whereas other more general methods include lifestyle changes, specific drugs and added hormonal manipulations. Intermittent ADT for patients taking luteinizing hormone-releasing hormone agonists offers a promising method to reduce adverse effects, and possibly increases the time to androgen independence. Initial studies indicate that prostate-specific antigen-based progression with intermittent ADT is similar to that seen with continuous ADT, but there is a reduction in side-effects, leading to an improvement in QoL.
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Affiliation(s)
- Nicolas Mottet
- Department of Urology, Clinique Mutualiste, St Etienne, France.
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Hammerer PG, Kattan MW, Mottet N, Prayer-Galetti T. Using prostate-specific antigen screening and nomograms to assess risk and predict outcomes in the management of prostate cancer. BJU Int 2006; 98:11-9. [PMID: 16566811 DOI: 10.1111/j.1464-410x.2006.06177.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We review the role of prostate-specific antigen (PSA) and the importance of patient education in the management of prostate cancer, based on discussions held at a European symposium on managing prostate cancer. Although PSA is the most widely used serum marker for detecting prostate cancer and for monitoring treatment responses, its use as a diagnostic marker is controversial due to concerns of over-diagnosis and low specificity. PSA isoforms, as well as PSA doubling time, might improve the specificity for earlier prostate cancer detection and can be used as surrogate markers for treatment efficacy. Patients can differ considerably in the importance they place on health-related quality of life aspects and fear of cancer progression. Consequently, there needs to be active, educated discussion of risk and outcomes between physicians and patients. Risk assessment tools, e.g. validated nomograms, enable clinicians to improve their decision analysis and form the basis for subsequent discussion of treatment options between the physician and patient, thereby enabling informed consent and appropriate decision-making.
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Affiliation(s)
- Peter G Hammerer
- Department of Urology, Academic Hospital, Braunschweig, Germany.
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Berges R, Bello U. Effect of a new leuprorelin formulation on testosterone levels in patients with advanced prostate cancer. Curr Med Res Opin 2006; 22:649-55. [PMID: 16684425 DOI: 10.1185/030079906x96425] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND SCOPE Leuprorelin is a well known luteinising hormone releasing hormone (LHRH) agonist. The drug is effective in the treatment of advanced prostate cancer and is well tolerated. This article reviews published literature (based on a search of PubMed, EMBASE and Biosis databases to the end of 2005) and other sources of data on a new formulation of leuprorelin acetate (Eligard) for use in the treatment of hormone-dependent advanced prostate cancer. This product takes advantage of a novel delivery system (Atrigel) which forms an implant in situ that is capable of delivering double doses of leuprorelin consistently to provide better, more sustained testosterone suppression compared with a microsphere leuprolide acetate formulation. Two formulations, 7.5 mg and 22.5 mg, are currently available with duration of action of 1 and 3 months, respectively. The 2-week stability at room temperature prior to mixing facilitates its use and reduces the potential for waste. FINDINGS In clinical studies of the new leuprorelin acetate formulation reviewed here, all patients achieved testosterone levels < or = 50 ng/dL and up to 98% of patients showed levels comparable to those resulting from surgical bilateral orchidectomy (< or = 20 ng/dL). Both formulations showed minimal breakthroughs, defined as a rise in testosterone levels after reaching levels of 50 ng/dL. The safety profile is typical of LHRH agonists, with mild to moderately severe 'hot flushes' being the most common adverse event. The higher dose of 22.5 mg, with a volume of 0.375 mL is administered subcutaneously via a small 20G needle, causing little local discomfort. CONCLUSION Prostate cancer remains a major cause of morbidity and mortality in older men. In the majority of cases, suppression of serum testosterone levels is very effective. The level of testosterone suppression is currently under debate, with ideal suppression levels ranging from 20 to 50 ng/dL. Not all LHRH agonist therapy achieves the same degree of testosterone suppression as bilateral orchidectomy. The new leuprorelin acetate (Eligard) appears to achieve a testosterone suppression of 20 ng/dL in 98% of patients, while maintaining a side effect profile comparable to other products in its class.
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Affiliation(s)
- R Berges
- PAN-Klinik am Neumarkt, Cologne, Germany.
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How Good do Current LHRH Agonists Control Testosterone? Can this be Improved with Eligard®? ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.eursup.2005.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zlotta A, Debruyne FM. Expert Opinion on Optimal Testosterone Control in Prostate Cancer. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.eursup.2005.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Appropriate Castration with Luteinising Hormone Releasing Hormone (LHRH) Agonists: What is the Optimal Level of Testosterone? ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.eursup.2005.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berges R. Eligard®: Pharmacokinetics, Effect on Testosterone and PSA Levels and Tolerability. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.eursup.2005.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Perez-Marrero R, Tyler RC. A subcutaneous delivery system for the extended release of leuprolide acetate for the treatment of prostate cancer. Expert Opin Pharmacother 2005; 5:447-57. [PMID: 14996640 DOI: 10.1517/14656566.5.2.447] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following Huggins' original observation of the dependence of the prostate on androgens, testosterone suppression by either orchiectomy or oestrogen compounds (e.g., diethylstilbesterol [DES]) became the standard palliative treatment for advanced prostate cancer. Early studies showed testosterone suppression improved symptoms and patient survival by several months but was not curative. In addition, DES treatment resulted in significant cardiovascular morbidity and mortality from increased thrombotic events. Thus, both orchiectomy and DES were indicated for palliation in late stage disease, but were considered too extreme for earlier stage disease. The discovery of the hypothalamic peptide, luteinising hormone releasing hormone (LHRH), and its stimulatory release of luteinising hormone (LH) from the pituitary gland led to the synthesis of LHRH analogues (i.e., hormone therapy). LHRH analogues (e.g., leuprolide acetate) desensitise and downregulate pituitary LHRH receptors, thus reducing LH synthesis and release. The reduced release, in turn, decreases testosterone levels to those observed in DES-treated and orchiectomised patients. In contrast, LHRH analogues do not increase cardiovascular events. Therefore, leuprolide acetate therapy has been adopted as a safer alternative to DES and is considered to be generally reversible. This increased safety has allowed LHRH therapy to be applied in earlier stage prostate cancer. Recent studies have shown decreased rates of biochemical failure and a potential for increased patient survival with hormone therapy in conjunction with radical prostatectomy or radiation therapy. This article will focus on the literature supporting early, adjuvant LHRH therapy and Eligard 7.5 mg, a new depot formulation of leuprolide acetate that uses the Atrigel drug delivery system, causing an increase in bioavailability and optimising testosterone suppression - two key features of depot hormone suppression.
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Issa MM, Krishnan A, Bouet R, Young MR, Hood N, Petros JA. THE FATE OF THE MEDICALLY CASTRATED TESTIS: EXPECTATION VERSUS REALITY. J Urol 2004; 172:1042-4. [PMID: 15311033 DOI: 10.1097/01.ju.0000135831.19857.5c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, and yet to our knowledge the fate of the medically castrated testis has never been accurately tested and documented in the literature. We determined the weight of testes in patients receiving medical castration and compared it to that in a control group receiving primary surgical castration. MATERIALS AND METHODS We performed a retrospective analysis of 88 patients with prostate cancer who underwent bilateral simple orchiectomy with epididymal sparing. The study was done at Veterans Administration Medical Center, Atlanta, Georgia. All procedures were performed using local anesthesia in an outpatient clinical setting. Patients were divided into 2 groups, namely 52 receiving luteinizing hormone releasing hormone (LH-RH) agonist therapy prior to the procedure and 36 controls who were not. The weight of the testes was compared between the 2 groups. RESULTS Median testicular weight significantly decreased following treatment with LH-RH agonist compared to the control group. Median weight of the testis was 7.0 gm (range 0.5 to 22.0) in the LH-RH agonist group compared to 15 gm (range 4.0 to 44.0) in the control group (p = 0.0049 x 10). CONCLUSIONS Medical castration with LH-RH agonist therapy significantly decreases the weight of testes and compromises the cosmetic outcome. Since cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, patients should be fully informed about the significant testicular atrophy associated with medical castration before making their decision.
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Affiliation(s)
- Muta M Issa
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
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