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Jang TL, Patel N, Faiena I, Radadia K, Moore DF, Elsamra SE, Singer EA, Stein MN, Lin Y, Kim IY, Eastham JA, Scardino PT, Lu-Yao GL. Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer. Cancer 2018; 124:4010-4022. [PMID: 30252932 PMCID: PMC6234085 DOI: 10.1002/cncr.31726] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Men with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) are at high risk for death from their disease. Clinical guidelines support multimodal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) and XRT plus androgen deprivation therapy (ADT). However, there are limited data comparing these substantially different treatment approaches. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study compared survival outcomes and adverse effects associated with RP plus XRT versus XRT plus ADT in these men. METHODS SEER-Medicare data were queried for men with cT3-T4N0M0 (LAPCa) or cT3-T4N1M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between the treatment arms. Survival analyses were analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS From 1992 to 2009, 13,856 men (≥65 years old) were diagnosed with LAPCa or RAPCa: 6.1% received RP plus XRT, and 23.6% received XRT plus ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Regardless of the tumor stage or the Gleason score, the adjusted 10-year prostate cancer-specific survival and 10-year overall survival favored men who underwent RP plus XRT over men who underwent XRT plus ADT. However, RP plus XRT versus XRT plus ADT was associated with higher rates of erectile dysfunction (28% vs 20%; P = .0212) and urinary incontinence (49% vs 19%; P < .001). CONCLUSIONS Men with LAPCa or RAPCa treated initially with RP plus XRT had a lower risk of prostate cancer-specific death and improved overall survival in comparison with those men treated with XRT plus ADT, but they experienced higher rates of erectile dysfunction and urinary incontinence.
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Affiliation(s)
- Thomas L. Jang
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Neal Patel
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Izak Faiena
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kushan Radadia
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dirk F. Moore
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E. Elsamra
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A. Singer
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Mark N. Stein
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y. Kim
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - James A. Eastham
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, Weill Cornell Medical College, New York, NY
| | - Peter T. Scardino
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, Weill Cornell Medical College, New York, NY
| | - Grace L. Lu-Yao
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Department of Medical Oncology, Sidney Kimmel Medical College, Jefferson College of Population Health, Philadelphia, PA (GLY)
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Kang YJ, Kim HS, Jang WS, Kwon JK, Yoon CY, Lee JY, Cho KS, Ham WS, Choi YD. Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin. BMC Cancer 2017; 17:321. [PMID: 28482884 PMCID: PMC5422954 DOI: 10.1186/s12885-017-3307-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between lymphovascular invasion and lymphatic or hematogenous metastasis has been suspected, with conflicting evidence. We have investigated the association between the risk of biochemical recurrence and lymphovascular invasion in resection margin negative patients, as well as its association with lymph node metastasis. METHODS One thousand six hundred thirty four patients who underwent radical prostatectomy from 2005 to 2014 were selected. Patients with bone or distant organ metastasis at the time of operation were excluded. Survival analysis was performed to assess biochemical recurrence, metastasis and mortality risks by Kaplan-Meier analysis and multivariate Cox proportional hazard regression. Odds of lymph node metastasis were evaluated by Logistic regression. RESULTS LVI was detected in 118 (7.4%) patients. The median follow-up duration was 33.1 months. In the Kaplan-Meier analysis, lymphovascular invasion was associated with significantly increased 5-year and 10-year BCR rate (60.2% vs. 39.1%, 60.2% vs. 40.1%, respectively; p < 0.001), 10-year bone metastasis rate and cancer specific mortality (16.9% vs. 5.1%, p = 0.001; 6.8% vs. 2.7%, p = 0.034, respectively) compared to patients without LVI. When stratified by T stage and resection margin status, lymphovascular invasion resulted in significantly increased 10-year biochemical recurrence rate in T3 patients both with and without positive surgical margin (p = 0.008, 0.005, respectively). In the multivariate Cox regression model lymphovascular invasion resulted in 1.4-fold BCR risk and 1.7-fold metastasis risk increase (95% CI 1.045-1.749, 1.024-2.950; p = 0.022, 0.040, respectively). Lymphovascular invasion was revealed to be strongly associated with lymph node metastasis in the multivariate Logistic regression (OR 4.317, 95% CI 2.092-8.910, p < 0.001). CONCLUSION Lymphovascular invasion increases the risk of recurrence in T3 patients regardless of margin status, by accelerating lymph node metastasis and distant organ metastasis.
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Affiliation(s)
- Yong Jin Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jong Kyou Kwon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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3
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Kilcoyne A, Price MC, McDermott S, Harisinghani MG. Imaging on nodal staging of prostate cancer. Future Oncol 2016; 13:551-565. [PMID: 27785926 DOI: 10.2217/fon-2016-0216] [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] [Indexed: 01/05/2023] Open
Abstract
Prostate cancer is the second most common cancer in men and is the second highest cause of cancer death in men of all races. Accurate lymph node staging is essential to ensure adequate treatment of prostate cancer. Historically, conventional imaging methods have demonstrated limited sensitivity and specificity in the detection of lymph node metastases. There are many emerging PET tracers that have recently proven to be effective. In addition, the use of ultrasmall iron oxide nanoparticle-enhanced MRI has demonstrated promising results. This review outlines the strengths and limitations of each of the different imaging modalities as well as individual tracers used, including preclinical and clinical agents.
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Affiliation(s)
- Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Melissa C Price
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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4
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Hager B, Kraywinkel K, Keck B, Katalinic A, Meyer M, Zeissig SR, Scheufele R, Wirth MP, Huber J. Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study. Prostate Cancer Prostatic Dis 2016; 20:61-66. [DOI: 10.1038/pcan.2016.43] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/17/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022]
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Megas G, Chrisofos M, Anastasiou I, Tsitlidou A, Choreftaki T, Deliveliotis C. Estrogen receptor (α and β) but not androgen receptor expression is correlated with recurrence, progression and survival in post prostatectomy T3N0M0 locally advanced prostate cancer in an urban Greek population. Asian J Androl 2016; 17:98-105. [PMID: 25219910 PMCID: PMC4291886 DOI: 10.4103/1008-682x.136445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the expression of estrogen receptors (ER(α) and ER(β)) and androgen receptors (ARs) as prognostic factors for biochemical recurrence, disease progression and survival in patients with pT3N0M0 prostate cancer (PCa) in an urban Greek population. A total of 100 consecutive patients with pT3N0M0 PCa treated with radical prostatectomy participated in the study. The mean age and follow-up were 64.2 and 6 years, respectively. The HSCORE was used for semi-quantitative analysis of the immunoreactivity of the receptors. The prognostic value of the ER(α) and ER(β) and AR was assessed in terms of recurrence, progression, and survival. AR expression was not associated with any of the above parameters; however, both ERs correlated with the prognosis. A univariate Cox regression analysis showed that ER(α) positive staining was significantly associated with a greater hazard for all outcomes. Increased ER(β) staining was significantly associated with a lower hazard for all outcomes in the univariate analysis. When both ER HSCORES were used for the analysis, it was found that patients with high ER(α) or low ER(β) HSCORES compared with patients with negatively stained ER(α) and >1.7 hSCORE ER(β) had 6.03, 10.93, and 10.53 times greater hazard for biochemical disease recurrence, progression of disease and death, respectively. Multiple Cox proportional hazard analyses showed that the age, preoperative prostate specific antigen, Gleason score and ERs were independent predictors of all outcomes. ER expression is an important prognosticator after radical prostatectomy in patients with pT3N0M0 PCa. By contrast, AR expression has limited prognostic value.
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Affiliation(s)
- Georgios Megas
- Department of Urology, General Hospital of Athens "G. Gennimatas", Greece
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6
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Abdollah F, Sood A, Sammon JD, Hsu L, Beyer B, Moschini M, Gandaglia G, Rogers CG, Haese A, Montorsi F, Graefen M, Briganti A, Menon M. Long-term Cancer Control Outcomes in Patients with Clinically High-risk Prostate Cancer Treated with Robot-assisted Radical Prostatectomy: Results from a Multi-institutional Study of 1100 Patients. Eur Urol 2015; 68:497-505. [DOI: 10.1016/j.eururo.2015.06.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/14/2015] [Indexed: 01/28/2023]
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7
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Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M, Guazzoni G, Sjoberg DD, Vickers AJ, Montorsi F, Briganti A. Impact of stage migration and practice changes on high-risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades. BJU Int 2015; 117:740-7. [PMID: 25787671 DOI: 10.1111/bju.13125] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the impact of year of surgery on clinical, pathological and oncological outcomes of patients with high-risk prostate cancer. PATIENTS AND METHODS We evaluated 1 033 patients with clinically high-risk prostate cancer, defined as the presence of at least one of the following risk factors: preoperative prostate-specific antigen (PSA) level >20 ng/mL, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single institution. The year-by-year trends in clinical and pathological characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncological outcomes. RESULTS We observed a decrease over time in the proportion of patients with high-risk disease (preoperative PSA >20 ng/mL or clinical stage cT3). A trend in the opposite direction was seen for biopsy Gleason score ≥8 tumours. We observed a considerable increase in the median number of lymph nodes removed, which was associated with an increased rate of lymph node invasion (LNI). On multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (hazard ratio [HR] per 5-year interval 0.90, 95% confidence interval [CI] 0.84-0.96; P = 0.01) and distant metastasis (HR per 5-year interval 0.91, 95% CI 0.83-0.99; P = 0.039), after adjusting for age, preoperative PSA, pathological stage, LNI, surgical margin status, and pathological Gleason score. CONCLUSIONS In this single-centre study, an increased diagnosis of localized and less extensive high-grade prostate cancer was observed over the last two decades. Patients with high-risk disease who were selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high-risk prostate cancer among contemporary patients are needed.
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Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Niccolò M Passoni
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Freschi
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Centre, Humanitas University, Milan, Italy
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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8
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[Radiotherapy in case of locally advanced prostate cancer: long-term follow-up in 223 patients]. Urologia 2012; 79 Suppl 19:53-7. [PMID: 23371274 DOI: 10.5301/ru.2012.9740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2012] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY To evaluate the long-term follow-up in patients undergoing external beam radiotherapy for locally advanced prostate cancer. PATIENTS AND METHODS From November 1999 to January 2007, 223 patients with a histologic diagnosis (204 transperineal needle biopsies; 19 trans-urethral prostatic resections) of locally advanced prostate cancer underwent external beam radiotherapy; of these patients, 151 were T3a (extracapsular extension) and 72 were T3b (involvement of seminal vesicles); the extracapsular extension was demonstrated using pelvic RMN or transrectal ultrasound, while the presence of distant and lymph node metastases was excluded using TC total body or bone scan. PSA value at diagnosis was 29.1 ng/mL (0.4-379 ng/mL). Radiotherapy was used on prostate and seminal vesicles in 201 patients (141 T3a; 60 T3b) while in 22 patients (10 T3a; 12 T3b) it was extended to the pelvis. Biochemical recurrence was defined using ASTRO definition (three consecutive PSA rises after PSA nadir); no patients underwent control prostate needle biopsy for problems of interpretation related to postactinic tissue changes. All complications were recorded and analyzed using Radiation Morbidity Scoring Criteria (RTOG). RESULTS At a mean 55-month follow-up, of the 223 patients treated, 26 have escaped controls, 168 are alive (141 disease-free; 27 with recurrent disease) and 29 died; of this group, 11 patients died from clinical progression, while in the others the cause was not related to the prostatic problem; only one patient died from iatrogenic problems. Hormone treatment was conducted in different ways (neoadjuvant, adjuvant, concurrent to radiotherapy or in association) considering patients' characteristics. Most common complications involved rectum and bladder.
CONCLUSIONS Radiotherapy is a viable and safe method in the treatment of locally advanced prostate cancer; however, it is essential the role of hormone therapy.
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Pal RP, Wild B, Mayer NJ, Khan MA. Is there a role for routine pelvic magnetic resonance imaging in intermediate risk prostate cancer? JOURNAL OF CLINICAL UROLOGY 2012. [DOI: 10.1016/j.bjmsu.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectivesTo determine the role of staging pelvic magnetic resonance imaging (MRI) in men with intermediate risk prostate cancer.Patients and methodsWe identified all patients diagnosed with intermediate risk (NICE definition: PSA 10-20 ng/ml, or Gleason score 7, or clinical stage T2b/T2c) prostate cancer between 1st January 2007 and 31st December 2008. Through retrospective case note review, we determined the number of patients who had undergone a pelvic MRI and whether such an investigation had altered the patient's management by increasing tumour stage.ResultsA total of 222 men (mean age 66 years; range: 48-88) were diagnosed with intermediate risk prostate cancer during our study period. The mean PSA was 11.8 ng/ml (range: 3-20 ng/ml). Of these, 112 (50.5%) underwent an MRI. Overall, in 25/112 (22.3%) patients, pelvic MRI findings impacted significantly upon patient treatment by demonstrating either extra-prostatic extension of cancer, lymph node involvement or bone metastases.ConclusionsOur retrospective study has demonstrated that a pelvic MRI in men diagnosed with intermediate risk prostate cancer may influence treatment decision in approximately a quarter of patients. Routine pelvic MRI is indicated in men with intermediate risk prostate cancer where radical treatment is contemplated.
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Affiliation(s)
- Raj P Pal
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK
| | - Benn Wild
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK
| | - Nick J Mayer
- Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK
| | - Masood A Khan
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK
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10
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Schmitges J, Trinh QD, Walz J, Graefen M. Surgery for high-risk localized prostate cancer. Ther Adv Urol 2011; 3:173-82. [PMID: 21969847 DOI: 10.1177/1756287211418722] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Treatment of men with high-risk prostate cancer (PCa) remains challenging for urologists. The complex natural history of high-risk PCa and the lack of specific and accurate definitions for high-risk disease impede treatment decision making. Historically, surgery in this patient group has been avoided based on the perception of ostensibly higher complication rates associated with inferior functional and oncological outcomes. To date, no randomized data comparing different therapy approaches have been made available. Several investigators have reported that continence rates in patients after radical prostatectomy (RP) for high-risk disease seem to be unaffected. Similarly, in a large proportion of these men, a nerve-sparing procedure can be performed without a significant negative impact on surgical margin rates and with comparable potency results. Moreover, extended pelvic lymph node dissection (EPLND) contributes to accurate pathological staging with a marginal effect on perioperative morbidity. With regards to the benefits of RP on local recurrence and cure rates, realistic expectations regarding the success of RP alone or in the context of a multimodal approach should be provided during patient counseling.
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Affiliation(s)
- Jan Schmitges
- Martiniklinik am Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
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11
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Akdemir AO, Ozden C, Oztekin CV, Aktas BK, Cetinkaya M, Memis A, Doluoglu OG. Stage-by-stage effects of surgical margin status on biochemical failure after radical prostatectomy in patients with clinically localized prostate cancer. Urol Int 2011; 86:156-60. [PMID: 21311164 DOI: 10.1159/000322840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/28/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the effects of pathological stage and surgical margin status on biochemical failure rates after radical prostatectomy (RP). MATERIALS AND METHODS The records of 205 patients who underwent RP for clinically localized prostate cancer (CaP) were evaluated. Known risk factors for biochemical failure (BF) were analyzed using univariate and multivariate logistic regression analysis. The effects of surgical margin status together with pathological stage on BF were evaluated. p values lower than 0.05 were accepted to be statistically significant. RESULTS Pathological stage, positive surgical margin (PSM), seminal vesicle invasion, lymph node involvement, biopsy Gleason score and postoperative Gleason score were the factors associated with BF in univariate analysis. Logistic regression analysis revealed that pT3a patients with PSM had a significant BF rate when compared to pT2 patients with a negative surgical margin (NSM) (OR 7.46, p = 0.002). pT3a patients with a NSM had a similar BF rate to that of pT2 patients with PSM. CONCLUSIONS pT2 patients with PSM had a similar biochemical prognosis to that of pT3a patients without PSM, implicating that a PSM may have a negative effect on prognosis similar to that of extracapsular invasion.
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Affiliation(s)
- Alp Ozgur Akdemir
- Clinic of Urology II, Ankara Numune Education and Research Hospital, Ankara, Turkey
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12
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Walz J, Joniau S, Chun FK, Isbarn H, Jeldres C, Yossepowitch O, Chao-Yu H, Klein EA, Scardino PT, Reuther A, Poppel HV, Graefen M, Huland H, Karakiewicz PI. Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy. BJU Int 2010; 107:765-770. [PMID: 20875089 DOI: 10.1111/j.1464-410x.2010.09594.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jochen Walz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Joniau
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Felix K Chun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hendrik Isbarn
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Claudio Jeldres
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ofer Yossepowitch
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hsu Chao-Yu
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Klein
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peter T Scardino
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alwyn Reuther
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hein Van Poppel
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Markus Graefen
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hartwig Huland
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Should we affraid of induced cancer in group of patients after radical radiotherapy of prostate cancer? Rep Pract Oncol Radiother 2009. [DOI: 10.1016/s1507-1367(10)60034-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sato M, Mori T, Shirai S, Kishi K, Inagaki T, Hara I. High-Dose-Rate Brachytherapy of a Single Implant With Two Fractions Combined With External Beam Radiotherapy for Hormone-Naive Prostate Cancer. Int J Radiat Oncol Biol Phys 2008; 72:1002-9. [DOI: 10.1016/j.ijrobp.2008.02.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/19/2008] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
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Van Poppel H, Vekemans K, Da Pozzo L, Bono A, Kliment J, Montironi R, Debois M, Collette L. Radical prostatectomy for locally advanced prostate cancer: Results of a feasibility study (EORTC 30001). Eur J Cancer 2006; 42:1062-7. [PMID: 16624554 DOI: 10.1016/j.ejca.2005.11.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 11/19/2005] [Indexed: 11/16/2022]
Abstract
The aim of this open, non-randomised, 2-stage feasibility study was to determine whether radical prostatectomy (RP) was safe and could provide cure for good prognosis patients with clinical T3 prostate cancer, in a multicentre setting. Cure was defined as a 3 months post-operative of undetectable serum PSA in combination with the presence of pathologically negative margins in the surgical specimen. Forty patients were enrolled of whom 38 were eligible. Six patients (5 pN+ and 1 pNx) did not meet the inclusion criteria and were excluded leaving 32 evaluable pN0 patients of whom 19 (59.4%, SE=4.26) achieved a complete response (CR) and in whom only two serious toxic events (STEs) were observed. The results of the first phase of the study passed the toxicity criteria (<3 STE's) but failed on the cure rate (>20 CRs). This resulted in discontinuation of the study after the first stage. The main reason for failure was the incidence of positive margins in the resected specimen. Although the study was stopped after the first phase, 28 of the 32 pN0 patients (87.5%) had undetectable serum PSA at 3 months. We continue to believe that RP with extensive resection can be beneficial as monotherapy for T3aN0M0 prostate cancer.
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Affiliation(s)
- H Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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Abstract
The dramatic increase in the number of patients diagnosed with localized prostate cancer in the last decade presents a difficult challenge for physicians. Because the window of opportunity for cure is short it is vital to begin treatment before the cancer cells invade neighbouring tissues and organs or metastasise to other sites. This pressure of increased patient numbers provided clinicians with the opportunity to investigate other treatment options. New surgical techniques including laparoscopic radical prostatectomy, improving therapeutic radiation by the introduction of conformal radiotherapy, neutron radiation, cryosurgery, high intensity focussed ultrasound (HIF) and the revival of brachytherapy with or without external beam radiation are currently being investigated. The goal of these techniques is to treat localized prostate cancer based on the endpoints of disease specific mortality, no evidence of disease, absent or low levels of prostate-specific antigen (PSA), reduced side-effects, improved quality of life and importantly increased cost-efficacy. It is important to remember however, that watchful waiting and endocrine therapy are still valid therapy options in certain patient groups. The lack of randomized, prospective trials on local treatment of prostate cancer, makes it difficult to compare the efficacy of the different treatments, especially in terms of disease-specific survival. Trials are now in progress but it will be several years before results are available. In the meantime, we need to focus on surrogate endpoints, side effects, quality of life and the cost-efficacy of each treatment. It is also important to ensure that patients are kept informed and up-to-date with any new therapeutic developments.
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Affiliation(s)
- L J Denis
- Oncology Centre Antwerp, Lange Gasthuisstraat 35-37, 2000, Antwerp, Belgium
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