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Sargos P, Bellera C, Bentahila R, Guerni M, Benziane-Ouaritini N, Teyssonneau D, Vuong NS, Ploussard G, Roupret M, Roubaud G. Short-term Darolutamide (ODM-201) Concomitant to Radiation Therapy for Patients with Unfavorable Intermediate-risk Prostate Cancer: The Darius (AFU-GETUG P15) Phase 2 Trial Protocol. Eur Urol Oncol 2024:S2588-9311(24)00116-0. [PMID: 38755095 DOI: 10.1016/j.euo.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Combination of androgen deprivation therapy (ADT) with external beam radiation therapy (EBRT) is a standard of care for patients with intermediate-risk prostate cancer (PCa). However, 6 months of ADT generates multiple side effects impacting quality of life (QoL). Darolutamide (an androgen receptor targeting agent [ARTA]) is associated with low blood-brain barrier penetrance and less drug-drug interaction. OBJECTIVE To assess the efficacy of a combination of 6 months of darolutamide with EBRT to treat patients with unfavorable intermediate-risk PCa. DESIGN, SETTING, AND PARTICIPANTS The DARIUS trial is a multicenter randomized non comparative phase 2 trial, randomizing the 6-months darolutamide + EBRT arm versus 6-months ADT + EBRT in patients with unfavorable intermediate-risk PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint is a biological response defined as prostate-specific antigen ≤0.1 ng/ml at month six of darolutamide or ADT. The key secondary endpoints are biochemical recurrence-free survival, disease-free survival, safety, and QoL. Ancillary studies using radiomics and genomic classifier are planned. Sixty-two patients will be included. RESULTS AND LIMITATIONS In this population of patients requiring ADT combined with EBRT, the use of an ARTA alone, such as darolutamide, may demonstrate antitumoral efficacy while minimizing toxicity and maintaining QoL. Limitations are mainly inherent to the open-label design of this study. CONCLUSIONS Six months of darolutamide + EBRT compared with 6 months of ADT + EBRT may be efficient in terms of a biological response, avoiding toxicity and altered QoL attributable to ADT in patients with unfavorable intermediate-risk PCa. PATIENT SUMMARY The ongoing DARIUS clinical trial assesses short-term (6 months) darolutamide treatment in association with external beam radiation therapy in men with localized prostate cancer. The trial investigates whether single-agent darolutamide can improve the biological response while maintaining a favorable tolerability profile.
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Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | - Carine Bellera
- Epicene Team, Bordeaux Population Health Research Center, UMR 1219, Inserm, University of Bordeaux, Bordeaux, France; Clinical and Epidemiological Research Unit, Comprehensive Cancer Center, Inserm CIC1401, Institut Bergonié, Bordeaux, France
| | - Rita Bentahila
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Marie Guerni
- Department of Radiotherapy, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France
| | | | | | - Nam-Son Vuong
- Urology Department, Clinique Saint-Augustin, Bordeaux, France
| | | | - Morgan Roupret
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
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Archer Goode E, Wang N, Munkley J. Prostate cancer bone metastases biology and clinical management (Review). Oncol Lett 2023; 25:163. [PMID: 36960185 PMCID: PMC10028493 DOI: 10.3892/ol.2023.13749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/09/2023] [Indexed: 03/25/2023] Open
Abstract
Prostate cancer (PCa) is one of the most prominent causes of cancer-related mortality in the male population. A highly impactful prognostic factor for patients diagnosed with PCa is the presence or absence of bone metastases. The formation of secondary tumours at the bone is the most commonly observed site for the establishment of PCa metastases and is associated with reduced survival of patients in addition to a cohort of life-debilitating symptoms, including mobility issues and chronic pain. Despite the prevalence of this disease presentation and the high medical relevance of bone metastases, the mechanisms underlying the formation of metastases to the bone and the understanding of what drives the osteotropism exhibited by prostate tumours remain to be fully elucidated. This lack of in-depth understanding manifests in limited effective treatment options for patients with advanced metastatic PCa and culminates in the low rate of survival observed for this sub-set of patients. The present review aims to summarise the most recent promising advances in the understanding of how and why prostate tumours metastasise to the bone, with the ultimate aim of highlighting novel treatment and prognostic targets, which may provide the opportunity to improve the diagnosis and treatment of patients with PCa with bone metastases.
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Affiliation(s)
- Emily Archer Goode
- Newcastle University Centre for Cancer, Newcastle University Institute of Biosciences, International Centre for Life, Newcastle NE1 3BZ, UK
| | - Ning Wang
- The Mellanby Centre for Musculoskeletal Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK
| | - Jennifer Munkley
- Newcastle University Centre for Cancer, Newcastle University Institute of Biosciences, International Centre for Life, Newcastle NE1 3BZ, UK
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3
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Persistent deficiencies in the measurement and reporting of tobacco use in contemporary genitourinary oncology clinical trials. Cancer Epidemiol 2021; 78:102022. [PMID: 34670728 DOI: 10.1016/j.canep.2021.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
Smoking is a causal or contributory factor for nearly all genitourinary cancers and exerts significant influence on treatment, quality of life, and survival outcomes. In order to understand the influence smoking has on the outcomes of contemporary therapies, pertinent smoking-related data must be systematically collected and report. We sought to determine how often and how rigorously smoking status is collected and reported in publications of clinical trials in genitourinary cancers by conducting a systematic review. Our initial search yielded 622 articles, 354 of which met criteria. The vast majority of included studies (91.8%) did not report any details about trial participants' smoking status. When included, 96.3% of studies reported baseline status qualitatively. No studies used a validated measurement instrument or reported change in participants' smoking status over the study period. Absence of the collection and reporting of smoking-related data precludes further study of how smoking impacts outcomes and highlights an important deficiency in GU oncology clinical trial design.
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Van Hemelrijck M, Sparano F, Moris L, Beyer K, Cottone F, Sprangers M, Efficace F. Harnessing the patient voice in prostate cancer research: Systematic review on the use of patient-reported outcomes in randomized controlled trials to support clinical decision-making. Cancer Med 2020; 9:4039-4058. [PMID: 32333639 PMCID: PMC7300413 DOI: 10.1002/cam4.3018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/31/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Given the growing importance of patient‐reported outcomes (PROs) as part of “big data” in improving patient care, there is a need to provide a state‐of‐the‐art picture of the added value of using PROs in prostate cancer (PCa) randomized controlled trials (RCTs). We aimed to synthetize the most recent high‐quality PRO evidence‐based knowledge from PCa RCTs and to examine whether quality of PRO reporting in PCa research improved over time. Methods We conducted a systematic literature search using PubMed, from April 2012 until February 2019. For benchmarking purposes, we also included RCTs identified in our previously published review of RCTs (2004‐2012). Methodology for study identification and evaluation followed standardized criteria and a predefined data extraction form was used to abstract information. PRO quality of the studies was evaluated using the International Society of Quality of Life Research (ISOQOL) recommended criteria. Results A total of 55 new RCTs were published between April 2012 and February 2019. About 24 (43.6%) RCTs were found to be of high‐quality regarding PRO assessments. Of these, 13 (54.2%) have been reported in the most recent European Association of Urology (EAU) PCa Guidelines. Overall QoL and sexual, urinary, and bowel function were the most commonly reported PROs. FACT‐P, EPIC‐26, and EORTC QLQ‐C30 and/or its module PR25 were most frequently used as measurement tools. An overall improvement in the completeness of PRO reporting was noted over time. Conclusion Many PRO trials are currently not included in the EAU guidelines. Our findings suggest that there has to be a better consensus on the use of PRO data for PCa patients, which will then be reflected in the PCa Guidelines and future data collection. Homogeneity in PROs collection and measurement tools will in turn enable “big data” Consortia to increase the patients’ voice in clinical research.
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Affiliation(s)
- Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Francesco Sparano
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
| | - Lisa Moris
- University Hospitals Leuven, Leuven, Belgium
| | - Katharina Beyer
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
| | - Mirjam Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Disease (GIMEMA), Rome, Italy
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Caumont F, Conti G, Hurwitz LM, Kuo C, Levie KE, Badiozamani K, Frankel JK, Flores JP, Brand TC, Chaurasia A, Rosner IL, Stroup SP, Musser JE, Cullen J, Porter CR. A prospective analysis of health-related quality of life in intermediate and high-risk prostate cancer patients managed with intensity modulated radiation therapy, with vs. without hormonal therapy. Urol Oncol 2020; 38:794.e1-794.e9. [PMID: 32139288 DOI: 10.1016/j.urolonc.2020.02.007] [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: 11/04/2019] [Revised: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Combined radiotherapy and hormonal treatment are recommended for intermediate- and high-risk prostate cancer (CaP). This study compared the long-term effects on health-related quality of life (HRQoL) of intermediate- and high-risk CaP patients managed with radiation therapy (RT) with vs. without hormone therapy (HT). METHODS Patients with intermediate- and high-risk CaP enrolled in the Center for Prostate Disease Research diagnosed from 2007 to 2017 were included. EPIC and SF-36 questionnaires were completed and HRQoL scores were compared for patients receiving RT vs. RT + HT at baseline (pretreatment), 6, 12, 24, 36, 48, and 60 months after CaP diagnosis. Longitudinal patterns of change in HRQoL were modeled using linear regression models, adjusting for baseline HRQoL, age at CaP diagnosis, race, comorbidities, National Comprehensive Cancer Network (NCCN) risk stratum, time to treatment, and follow-up time. RESULTS Of 164 patients, 93 (56.7%) received RT alone and 71 (43.3%) received RT + HT. Both groups reported comparable baseline HRQoL. Patients receiving RT+HT were more likely to be NCCN high risk as compared to those receiving only RT. The RT + HT patients experienced worse sexual function, hormonal function, and hormonal bother than those who only received RT; however, HRQoL recovered over time for the RT + HT group. No significant differences were observed between groups in urinary and bowel domains or SF-36 mental and physical scores. CONCLUSION Combined RT + HT treatment was associated with temporary lower scores in sexual and hormonal HRQoL compared with RT only. Intermediate- and high-risk CaP patients should be counseled about the possible declines in HRQoL associated with HT.
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Affiliation(s)
| | - Galen Conti
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD
| | - Lauren M Hurwitz
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD
| | - Claire Kuo
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD
| | - Katherine E Levie
- Virginia Mason Medical Center, Seattle, WA; Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD
| | | | | | | | - Timothy C Brand
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Madigan Army Medical Center, Tacoma, WA
| | - Avinash Chaurasia
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Inger L Rosner
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sean P Stroup
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Naval Medical Center, San Diego, CA
| | - John E Musser
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Tripler Army Medical Center, Honolulu, HI
| | - Jennifer Cullen
- Department of Defense, Center for Prostate Disease Research, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation, Bethesda, MD.
| | - Christopher R Porter
- Virginia Mason Medical Center, Seattle, WA; Department of Defense, Center for Prostate Disease Research, Bethesda, MD
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Marandino L, De Luca E, Zichi C, Lombardi P, Reale ML, Pignataro D, Di Stefano RF, Ghisoni E, Mariniello A, Trevisi E, Leone G, Muratori L, La Salvia A, Sonetto C, Buttigliero C, Tucci M, Aglietta M, Novello S, Scagliotti GV, Perrone F, Di Maio M. Quality-of-Life Assessment and Reporting in Prostate Cancer: Systematic Review of Phase 3 Trials Testing Anticancer Drugs Published Between 2012 and 2018. Clin Genitourin Cancer 2019; 17:332-347.e2. [PMID: 31416754 DOI: 10.1016/j.clgc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
Quality of life (QoL) is not included among the end points in many studies, and QoL results are underreported in many phase 3 oncology trials. We performed a systematic review to describe QoL prevalence and heterogeneity in QoL reporting in recently published prostate cancer phase 3 trials. A PubMed search was performed to identify primary publications of randomized phase 3 trials testing anticancer drugs in prostate cancer, issued between 2012 and 2018. We analyzed QoL inclusion among end points, presence of QoL results, and methodology of QoL analysis. Seventy-two publications were identified (15 early-stage, 20 advanced hormone-sensitive, and 37 castration-resistant prostate cancer [CRPC]). QoL was not listed among study end points in 23 studies (31.9%) (40.0% early stage, 40.0% advanced hormone sensitive, and 24.3% CRPC). QoL results were absent in 15 (30.6%) of 49 primary publications of trials that included QoL among end points. Overall, as a result of absent end point or unpublished results, QoL data were lacking in 38 (52.8%) primary publications (53.3% early stage, 55.0% in advanced hormone sensitive, and 51.4% in CRPC). The most commonly used QoL tools were Functional Assessment of Cancer Therapy-Prostate (FACT-P) (21, 53.8%) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) (14, 35.9%); most common methods of analysis were mean changes or mean scores (28, 71.8%), time to deterioration (14, 35.9%), and proportion of patients with response (10, 25.6%). In conclusion, QoL data are lacking in a not negligible proportion of recently published phase 3 trials in prostate cancer, although the presence of QoL results is better in positive trials, especially in CRPC. The methodology of QoL analysis is heterogeneous for type of instruments, analysis, and presentation of results.
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Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marcello Tucci
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy.
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Bandara V, Capp A, Ahmed G, Arm J, Martin J. Assessment and predictors of fatigue in men with prostate cancer receiving radiotherapy and androgen deprivation therapy. J Med Imaging Radiat Oncol 2019; 63:683-690. [PMID: 31588674 DOI: 10.1111/1754-9485.12922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/26/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Fatigue is a commonly reported symptom in men receiving radiation therapy and androgen deprivation therapy (ADT) for prostate cancer. Despite this, the complex mechanisms remain unclear. This study aims to investigate factors which correlate with development of fatigue. METHODS Twenty-seven men with high-risk prostate cancer undergoing radiation therapy and 18 months of ADT were assessed for fatigue, haemoglobin (Hb), testosterone, magnetic resonance imaging (MRI) fat fraction (FF) and apparent diffusion coefficient (ADC), at baseline and at intervals after radiotherapy. Changes from baseline were analysed using paired t-tests. Linear time trends were assessed using linear mixed effect models. RESULTS Overall, mean fatigue score increased from baseline to the 18-month time interval (difference 4.5, P = 0.0114). The mean value for Hb significantly decreased (P < 0.001) from baseline to 18 months. The mean value for testosterone significantly decreased (P < 0.001) from baseline to 12 months, and remained low. Mean for MRI FF showed a significant increase (P < 0.001) from baseline to 6 months. MRI ADC showed a non-significant decrease from baseline to 6 months (P = 0.4416). CONCLUSION Radiotherapy and ADT resulted in a significant increase in fatigue scores. Statistically significant changes were noted in Hb, testosterone and MRI FF and ADC, however, none were shown to have a strong association with worsening fatigue. Further investigation in a larger cohort is required to assess the interaction between fatigue and possible biological factors.
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Affiliation(s)
- Vindya Bandara
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Anne Capp
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gias Ahmed
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jameen Arm
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): 10-year results from a randomised, phase 3, factorial trial. Lancet Oncol 2018; 20:267-281. [PMID: 30579763 DOI: 10.1016/s1470-2045(18)30757-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The optimal duration of androgen suppression for men with locally advanced prostate cancer receiving radiotherapy with curative intent is yet to be defined. Zoledronic acid is effective in preventing androgen suppression-induced bone loss, but its role in preventing castration-sensitive bone metastases in locally advanced prostate cancer is unclear. The RADAR trial assessed whether the addition of 12 months of adjuvant androgen suppression, 18 months of zoledronic acid, or both, can improve outcomes in men with locally advanced prostate cancer who receive 6 months of androgen suppression and prostatic radiotherapy. This report presents 10-year outcomes from this trial. METHODS For this randomised, phase 3, 2 × 2 factorial trial, eligible men were 18 years or older with locally advanced prostate cancer (either T2b-4, N0 M0 tumours or T2a, N0 M0 tumours provided Gleason score was ≥7 and baseline prostate-specific antigen [PSA] concentration was ≥10 μg/L). We randomly allocated participants in a 2 × 2 factorial design by computer-generated randomisation (using the minimisation technique, and stratified by centre, baseline PSA concentration, clinical tumour stage, Gleason score, and use of a brachytherapy boost) in a 1:1:1:1 ratio to four treatment groups. Patients in the control group received 6 months of neoadjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly) and radiotherapy alone (short-term androgen suppression [STAS]); this treatment was either followed by another 12 months of adjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly; intermediate-term androgen suppression [ITAS]), or accompanied by 18 months of zoledronic acid (4 mg every 3 months, intravenously) starting at randomisation (STAS plus zoledronic acid), or both (ITAS plus zoledronic acid). All patients received radiotherapy to the prostate and seminal vesicles, starting from the end of the fifth month of androgen suppression; dosing options were 66, 70, and 74 Gy in 2-Gy fractions per day, or 46 Gy in 2-Gy fractions followed by a high-dose-rate brachytherapy boost dose of 19·5 Gy in 6·5-Gy fractions. Treatment allocation was open label. The primary endpoint was prostate cancer-specific mortality and was analysed according to intention-to-treat using competing-risks methods. The trial is closed to follow-up and this is the final report of the main endpoints. This trial is registered with ClinicalTrials.gov, number NCT00193856. FINDINGS Between Oct 20, 2003, and Aug 15, 2007, 1071 men were enrolled and randomly assigned to STAS (n=268), ITAS (n=268), STAS plus zoledronic acid (n=268), and ITAS plus zoledronic acid (n=267). Median follow-up was 10·4 years (IQR 7·9-11·7). At this 10-year follow-up, no interactions were observed between androgen suppression and zoledronic acid so the treatment groups were collapsed to compare treatments according to duration of androgen suppression: 6 months of androgen suppression plus radiotherapy (6AS+RT) versus 18 months of androgen suppression plus radiotherapy (18AS+RT) and to compare treatments according to whether or not patients received zoledronic acid. The total number of deaths was 375 (200 men receiving 6AS+RT and 175 men receiving 18AS+RT), of which 143 (38%) were attributable to prostate cancer (81 men receiving 6AS+RT and 62 men receiving 18AS+RT). When analysed by duration of androgen suppression, the adjusted cumulative incidence of prostate cancer-specific mortality was 13·3% (95% CI 10·3-16·0) for 6AS+RT versus 9·7% (7·3-12·0) for 18AS+RT, representing an absolute difference of 3·7% (95% CI 0·3-7·1; sub-hazard ratio [sHR] 0·70 [95% CI 0·50-0·98], adjusted p=0·035). The addition of zoledronic acid did not affect prostate cancer-specific mortality; the adjusted cumulative incidence of prostate cancer-specific mortality was 11·2% (95% CI 8·7-13·7) with zoledronic acid vs 11·7% (9·2-14·1) without, representing an absolute difference of -0·5% (95% CI -3·8 to 2·9; sHR 0·95 [95% CI 0·69-1·32], adjusted p=0·78). Although safety analysis was not prespecified for this 10-year analysis, one new serious adverse event (osteonecrosis of the mandible, in a patient who received 18 months of androgen suppression plus zoledronic acid) occurred since our previous report, bringing the total number of cases of this serious adverse event to three (<1% out of 530 patients who received zoledronic acid evaluated for safety) and the total number of drug-related serious adverse events to 12 (1% out of all 1065 patients evaluable for safety). No treatment-related deaths occurred during the study. INTERPRETATION 18 months of androgen suppression plus radiotherapy is a more effective treatment option for locally advanced prostate cancer than 6 months of androgen suppression plus radiotherapy, but the addition of zoledronic acid to this treatment regimen is not beneficial. Evidence from the RADAR and French Canadian Prostate Cancer Study IV trials suggests that 18 months of androgen suppression with moderate radiation dose escalation is an effective but more tolerable option than longer durations of androgen suppression for men with locally advanced prostate cancer including intermediate and high risk elements. FUNDING National Health and Medical Research Council of Australia, Novartis Pharmaceuticals Australia, AbbVie Pharmaceuticals Australia, New Zealand Health Research Council, New Zealand Cancer Society, Cancer Standards Institute New Zealand, University of Newcastle (Australia), Hunter Medical Research Institute, Calvary Mater Newcastle Radiation Oncology Fund, and Maitland Cancer Appeal.
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Yeoh E(E, Botten R, Di Matteo A, Tippett M, Hutton J, Fraser R, Dinning PG, Wattchow D. Pudendal nerve injury impairs anorectal function and health related quality of life measures ≥2 years after 3D conformal radiotherapy for prostate cancer. Acta Oncol 2018; 57:456-464. [PMID: 29139310 DOI: 10.1080/0284186x.2017.1400690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To compare GI symptoms, measures of generic and disease specific health related quality of life (HRQoL), anorectal and pudendal nerve function and anal sphincter morphology between (i) patients ≥2 years after 3D conformal radiotherapy (3D-CRT)±high dose rate (HDR) brachytherapy for carcinoma of the prostate and aged matched patients before radiotherapy and (ii) symptomatic and asymptomatic patients ≥2 years after 3D-CRT ± HDR brachytherapy. MATERIAL AND METHODS Methodology included: (i) modified LENT-SOMA scales for GI symptoms, (ii) EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires for generic and disease specific HRQoL, (iii) anorectal manometry and terminal motor latency for anorectal and pudendal nerve function and (iv) endorectal ultrasound for anal sphincter morphology. GI symptoms, parameters of HRQoL, anorectal and pudendal nerve function and anal sphincter morphology were compared using Mann-Whitney's U, unpaired t and χ2 tests. RESULTS Impairment of HRQoL bowel symptoms in the patients ≥2 years after 3D-CRT ± HDR brachytherapy was associated with worse anorectal motor and sensory function, internal and external anal sphincter morphology and 5× greater prevalence of pudendal nerve dysfunction compared with age matched patients before radiotherapy. Symptomatic patients had worse (i) HRQoL measures including global quality of life and bowel and urinary symptom scores, (ii) rectal bleeding, fecal urgency and incontinence scores and (iii) a 2× higher prevalence of pudendal nerve dysfunction compared with asymptomatic patients. Rectal and anal (i) V 40 Gy >65%, (ii) Dmax >60 Gy, (iii) pudendal nerve Dmax >60 Gy and (iv) Anal V 60 Gy >40% were associated with a greater prevalence of pudendal nerve dysfunction. CONCLUSIONS 3D-CRT ± HDR brachytherapy for prostate carcinoma, impairs late functional measures including HRQoL, anorectal and pudendal nerve function. Rectal, anal and pudendal nerve radiation dose constraints are proposed for reducing the prevalence of pudendal nerve dysfunction.
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Affiliation(s)
- Eng (Eric) Yeoh
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Rochelle Botten
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Marcus Tippett
- Department of Gastroenterology, Gut Function Laboratory, Royal Adelaide Hospital, Adelaide, Australia
| | - Jonathon Hutton
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Robert Fraser
- Department of Gastroenterology, Flinders Medical Centre & School of Medicine, Flinders University, Adelaide, Australia
| | - Phillip G. Dinning
- Department of Gastroenterology, Flinders Medical Centre & School of Medicine, Flinders University, Adelaide, Australia
| | - David Wattchow
- Department of Surgery, Flinders Medical Centre & School of Surgery, Flinders University, Adelaide, Australia
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Osteoclast inhibitors to prevent bone metastases in men with high-risk, non-metastatic prostate cancer: A systematic review and meta-analysis. PLoS One 2018; 13:e0191455. [PMID: 29370211 PMCID: PMC5784941 DOI: 10.1371/journal.pone.0191455] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/07/2018] [Indexed: 01/24/2023] Open
Abstract
Background In advanced prostate cancer, osteoclast inhibitors prevent and palliate skeletal related events associated with bone metastases. However, it is uncertain whether they play a disease-modifying role earlier in the course of the disease. Methods Medline, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and ASCO conference proceedings were searched for randomized controlled trials that compared osteoclast inhibitors with placebo and/or standard of care (SOC) in patients with high-risk, non-metastatic prostate cancer. The primary outcome measure was incidence of new bone metastases; secondary outcomes included overall survival (OS), prostate cancer specific survival, mortality unrelated to prostate cancer, toxicity and health related quality of life outcomes. Results are presented as relative risk (RR) with 95% confidence intervals (CI). Results Six randomized controlled trials (5947 participants) were included, five evaluating bisphosphonates and one denosumab. Overall, there was no difference in incidence of bone metastases between participants treated with osteoclast inhibitors versus placebo/SOC (RR 1.09, 95%CI 0.84–1.41, p = 0.51) however significant heterogeneity was observed between studies. The denosumab trial was the largest and only positive trial amongst the included studies (RR 0.83, 95%CI 0.73–0.95, p = 0.007). No significant difference was observed in OS (RR 0.99 95% CI 0.89–1.10, p = 0.84) nor prostate cancer specific survival (RR 1.12 95%CI 0.93–1.36, p = 0.24). Most studies reported increased rates of osteonecrosis of the jaw (5% or less) and hypocalcemia (2% or less) with osteoclast inhibitors. Conclusions While there is limited evidence that bisphosphonates alter the natural history of high-risk, non-metastatic prostate cancer, denosumab delays onset of bone metastases in this patient population. Neither class of osteoclast inhibitor demonstrated an impact on survival outcomes. Future trials with better defined patient selection and a robust definition for high risk disease is critical.
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11
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Takei A, Sakamoto S, Wakai K, Tamura T, Imamura Y, Xu M, Maimaiti M, Kawamura K, Imamoto T, Komiya A, Akakura K, Ichikawa T. Duration of androgen deprivation therapy and nadir of testosterone at 20 ng/dL predict testosterone recovery to supracastrate level in prostate cancer patients who received external beam radiotherapy. Int J Urol 2018; 25:352-358. [DOI: 10.1111/iju.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Akinori Takei
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Shinichi Sakamoto
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Ken Wakai
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Takaaki Tamura
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Yusuke Imamura
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Minhui Xu
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Maihulan Maimaiti
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Koji Kawamura
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Takashi Imamoto
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Akira Komiya
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
| | - Koichiro Akakura
- Department of Urology; Japan Community Healthcare Organization Tokyo Shinjuku Medical Center; Tokyo Japan
| | - Tomohiko Ichikawa
- Department of Urology; Chiba University Graduate School of Medicine; Chiba Japan
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12
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Taaffe DR, Buffart LM, Newton RU, Spry N, Denham J, Joseph D, Lamb D, Chambers SK, Galvão DA. Time on androgen deprivation therapy and adaptations to exercise: secondary analysis from a 12‐month randomized controlled trial in men with prostate cancer. BJU Int 2017; 121:194-202. [DOI: 10.1111/bju.14008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dennis R. Taaffe
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
- School of Human Movement and Nutrition Sciences University of Queensland Brisbane Qld Australia
| | - Laurien M. Buffart
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Departments of Epidemiology and Biostatistics and Medical Oncology VU University Medical Centre Amsterdam The Netherlands
| | - Robert U. Newton
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
- Institute of Human Performance University of Hong Kong Hong Kong Hong Kong
- University of Queensland Centre for Clinical Research University of Queensland Brisbane Qld Australia
| | - Nigel Spry
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Genesis CancerCare Joondalup WA Australia
- Faculty of Medicine University of Western Australia Nedlands WA Australia
| | - James Denham
- School of Medicine and Public Health University of Newcastle Callaghan NSW Australia
- Newcastle Mater Hospital Newcastle NSW Australia
| | - David Joseph
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Faculty of Medicine University of Western Australia Nedlands WA Australia
- Department of Radiation Oncology Sir Charles Gairdner Hospital Nedlands WA Australia
| | - David Lamb
- University of Otago Wellington New Zealand
| | - Suzanne K. Chambers
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Qld Australia
- Centre for Research in Cancer Cancer Council Queensland Brisbane Qld Australia
- Prostate Cancer Foundation of Australia Sydney NSW Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
- School of Medical and Health Sciences Edith Cowan University Joondalup WA Australia
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13
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Duchesne GM, Woo HH, King M, Bowe SJ, Stockler MR, Ames A, D'Este C, Frydenberg M, Loblaw A, Malone S, Millar J, Tai KH, Turner S. Health-related quality of life for immediate versus delayed androgen-deprivation therapy in patients with asymptomatic, non-curable prostate cancer (TROG 03.06 and VCOG PR 01-03 [TOAD]): a randomised, multicentre, non-blinded, phase 3 trial. Lancet Oncol 2017; 18:1192-1201. [DOI: 10.1016/s1470-2045(17)30426-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/12/2022]
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14
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Sharpley CF, Bitsika V, Christie DRH, Bradford R, Steigler A, Denham JW. Psychological resilience aspects that mediate the depressive effects of urinary incontinence in prostate cancer survivors 10 years after treatment with radiation and hormone ablation. J Psychosoc Oncol 2017; 35:438-450. [PMID: 28318448 DOI: 10.1080/07347332.2017.1306733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Repeated surveys of prostate cancer (PCa) patients indicate that their prevalence of depression is well above that for their non-PCa peers. Although standard first-line treatments for depression are only about 35% effective, some recent comments have suggested that a focus upon the possible correlates (factors that aggravate or mediate depression) might help improve treatment efficacy. To investigate this issue, 144 10 year PCa survivors were asked about the frequency of urinary incontinence, a common side effect of some PCa treatments. The 53 patients who suffered urinary incontinence had significantly higher depression scores on the Zung Self-rating Depression Scale than those patients who did not report urinary incontinence. Using mediation analysis, patients' psychological resilience (PR) significantly mediated the depressive effects of urinary incontinence, but those effects were confined to just one of the five components of PR-a sense of control over the things that happen to oneself. Implications for treatment models of psychosocial oncology support for PCa survivors are discussed.
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Affiliation(s)
- Christopher F Sharpley
- a Brain-Behaviour Research Group , University of New England , Armidale , New South Wales , Australia
| | - Vicki Bitsika
- b Centre for Autism Spectrum Disorders , Bond University , Gold Coast , Queensland , Australia
| | - David R H Christie
- a Brain-Behaviour Research Group , University of New England , Armidale , New South Wales , Australia.,c Genesiscare , Tugun , Queensland , Australia
| | - Rosemary Bradford
- d School of Medicine and Public Health , University of Newcastle , Newcastle , New South Wales , Australia
| | - Allison Steigler
- d School of Medicine and Public Health , University of Newcastle , Newcastle , New South Wales , Australia
| | - James W Denham
- d School of Medicine and Public Health , University of Newcastle , Newcastle , New South Wales , Australia
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15
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Patient-reported quality of life during definitive and postprostatectomy image-guided radiation therapy for prostate cancer. Pract Radiat Oncol 2017; 7:e117-e124. [DOI: 10.1016/j.prro.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
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16
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Yahya N, Ebert MA, Bulsara M, House MJ, Kennedy A, Joseph DJ, Denham JW. Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods. Med Phys 2017; 43:2040. [PMID: 27147316 DOI: 10.1118/1.4944738] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. METHODS The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. RESULTS Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. CONCLUSIONS Logistic regression and MARS were most likely to be the best-performing strategy for the prediction of urinary symptoms with elastic-net and random forest producing competitive results. The predictive power of the models was modest and endpoint-dependent. New features, including spatial dose maps, may be necessary to achieve better models.
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Affiliation(s)
- Noorazrul Yahya
- School of Physics, University of Western Australia, Western Australia 6009, Australia and School of Health Sciences, National University of Malaysia, Bangi 43600, Malaysia
| | - Martin A Ebert
- School of Physics, University of Western Australia, Western Australia 6009, Australia and Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia 6959, Australia
| | - Michael J House
- School of Physics, University of Western Australia, Western Australia 6009, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia and School of Surgery, University of Western Australia, Western Australia 6009, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, New South Wales 2308, Australia
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17
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Chang K, Qin XJ, Zhang HL, Dai B, Zhu Y, Shi GH, Shen YJ, Zhu YY, Ye DW. Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy: primary results of study CU1005. Asian J Androl 2017; 18:452-5. [PMID: 26323560 PMCID: PMC4854103 DOI: 10.4103/1008-682x.160884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival (P = 0.004) compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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18
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Sharpley C, Bitsika V, Christie D, Bradford R, Steigler A, Denham J. Total depression and subtypes in prostate cancer survivors 10 years after treatment. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 12/28/2022]
Affiliation(s)
- C.F. Sharpley
- Brain-Behaviour Research Group; University of New England; Armidale NSW Australia
| | - V. Bitsika
- Centre for Autism Spectrum Disorders; Bond University; Robina Qld Australia
| | - D.R.H. Christie
- Brain-Behaviour Research Group; University of New England; Armidale NSW Australia
- Genesiscare; Tugun Qld Australia
| | - R. Bradford
- School of Medicine & Public Health; University of Newcastle; Callaghan NSW Australia
| | - A. Steigler
- School of Medicine & Public Health; University of Newcastle; Callaghan NSW Australia
| | - J.W. Denham
- School of Medicine & Public Health; University of Newcastle; Callaghan NSW Australia
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19
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Ghose S, Denham JW, Ebert MA, Kennedy A, Mitra J, Dowling JA. Multi-atlas and unsupervised learning approach to perirectal space segmentation in CT images. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:933-941. [PMID: 27844331 DOI: 10.1007/s13246-016-0496-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/31/2016] [Indexed: 11/27/2022]
Abstract
Perirectal space segmentation in computed tomography images aids in quantifying radiation dose received by healthy tissues and toxicity during the course of radiation therapy treatment of the prostate. Radiation dose normalised by tissue volume facilitates predicting outcomes or possible harmful side effects of radiation therapy treatment. Manual segmentation of the perirectal space is time consuming and challenging in the presence of inter-patient anatomical variability and may suffer from inter- and intra-observer variabilities. However automatic or semi-automatic segmentation of the perirectal space in CT images is a challenging task due to inter patient anatomical variability, contrast variability and imaging artifacts. In the model presented here, a volume of interest is obtained in a multi-atlas based segmentation approach. Un-supervised learning in the volume of interest with a Gaussian-mixture-modeling based clustering approach is adopted to achieve a soft segmentation of the perirectal space. Probabilities from soft clustering are further refined by rigid registration of the multi-atlas mask in a probabilistic domain. A maximum a posteriori approach is adopted to achieve a binary segmentation from the refined probabilities. A mean volume similarity value of 97% and a mean surface difference of 3.06 ± 0.51 mm is achieved in a leave-one-patient-out validation framework with a subset of a clinical trial dataset. Qualitative results show a good approximation of the perirectal space volume compared to the ground truth.
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Affiliation(s)
- Soumya Ghose
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Martin A Ebert
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia. .,School of Physics, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Angel Kennedy
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
| | - Jhimli Mitra
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jason A Dowling
- Australian e-Health Research Centre, CSIRO, Brisbane, QLD, 4029, Australia
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20
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Yahya N, Ebert MA, House MJ, Kennedy A, Matthews J, Joseph DJ, Denham JW. Modeling Urinary Dysfunction After External Beam Radiation Therapy of the Prostate Using Bladder Dose-Surface Maps: Evidence of Spatially Variable Response of the Bladder Surface. Int J Radiat Oncol Biol Phys 2016; 97:420-426. [PMID: 28068247 DOI: 10.1016/j.ijrobp.2016.10.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/27/2016] [Accepted: 10/14/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE We assessed the association of the spatial distribution of dose to the bladder surface, described using dose-surface maps, with the risk of urinary dysfunction. METHODS AND MATERIALS The bladder dose-surface maps of 754 participants from the TROG 03.04-RADAR trial were generated from the volumetric data by virtually cutting the bladder at the sagittal slice, intersecting the bladder center-of-mass through to the bladder posterior and projecting the dose information on a 2-dimensional plane. Pixelwise dose comparisons were performed between patients with and without symptoms (dysuria, hematuria, incontinence, and an International Prostate Symptom Score increase of ≥10 [ΔIPSS10]). The results with and without permutation-based multiple-comparison adjustments are reported. The pixelwise multivariate analysis findings (peak-event model for dysuria, hematuria, and ΔIPSS10; event-count model for incontinence), with adjustments for clinical factors, are also reported. RESULTS The associations of the spatially specific dose measures to urinary dysfunction were dependent on the presence of specific symptoms. The doses received by the anteroinferior and, to lesser extent, posterosuperior surface of the bladder had the strongest relationship with the incidence of dysuria, hematuria, and ΔIPSS10, both with and without adjustment for clinical factors. For the doses to the posteroinferior region corresponding to the area of the trigone, the only symptom with significance was incontinence. CONCLUSIONS A spatially variable response of the bladder surface to the dose was found for symptoms of urinary dysfunction. Limiting the dose extending anteriorly might help reduce the risk of urinary dysfunction.
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Affiliation(s)
- Noorazrul Yahya
- School of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia; School of Physics, University of Western Australia, Perth, Western Australia, Australia.
| | - Martin A Ebert
- School of Physics, University of Western Australia, Perth, Western Australia, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael J House
- School of Physics, University of Western Australia, Perth, Western Australia, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John Matthews
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Assessment of quality of life in advanced, metastatic prostate cancer: an overview of randomized phase III trials. Qual Life Res 2016; 26:813-822. [DOI: 10.1007/s11136-016-1429-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/12/2022]
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22
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Sridharan S, Steigler A, Spry NA, Joseph D, Lamb DS, Matthews JH, Atkinson C, Tai KH, Duchesne G, Christie D, Attia J, Holliday EG, Denham JW. Oligometastatic bone disease in prostate cancer patients treated on the TROG 03.04 RADAR trial. Radiother Oncol 2016; 121:98-102. [PMID: 27528117 DOI: 10.1016/j.radonc.2016.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND It remains unclear whether eradication of oligometastases by stereotactic body radiation therapy or other means will result in cure or prolongation of survival in some cases, or merely provide palliation. We address this issue with prospectively collected progression and treatment data from the TROG 03.04 RADAR randomised controlled trial for men with locally advanced prostate cancer (PC). METHODS Three Fine and Gray competing risk survival models with time-dependent covariates were used to determine whether metastatic progression status at first diagnosis of bony metastases, i.e. number of bony sites involved and presence of prior or simultaneous other sites of progression, impacts on prostate cancer-specific mortality (PCSM) when adjusted for baseline prognostic factors and allocated primary treatment. RESULTS Between 2003 and 2014, 176 of the 1071 subjects developed bone metastases, 152 developed other sites of progression and 91 died of PC. All subjects received secondary treatment using androgen suppression but none received extirpative treatments. The three models found evidence: 1 - of a clear prognostic gradient according to number of bony metastatic sites; 2 - that other sites of progression contributed to PCSM to a lesser extent than bone progression; and 3 - that further bony metastatic progression in men with up to 3 bony metastases had a major impact on PCSM. CONCLUSION Randomised trials are essential to determine the value of extirpative treatment for oligometastatic bony metastases due to PC.
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Affiliation(s)
| | - Allison Steigler
- School of Medicine and Public Health, University of Newcastle, Australia
| | | | | | | | | | - Chris Atkinson
- St Georges Cancer Care Centre, Christchurch, New Zealand
| | - Keen-Hun Tai
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth G Holliday
- School of Medicine and Public Health, University of Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Australia.
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Karunasinghe N, Zhu Y, Han DY, Lange K, Zhu S, Wang A, Ellett S, Masters J, Goudie M, Keogh J, Benjamin B, Holmes M, Ferguson LR. Quality of life effects of androgen deprivation therapy in a prostate cancer cohort in New Zealand: can we minimize effects using a stratification based on the aldo-keto reductase family 1, member C3 rs12529 gene polymorphism? BMC Urol 2016; 16:48. [PMID: 27485119 PMCID: PMC4971639 DOI: 10.1186/s12894-016-0164-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/22/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is an effective palliation treatment in men with advanced prostate cancer (PC). However, ADT has well documented side effects that could alter the patient's health-related quality of life (HRQoL). The current study aims to test whether a genetic stratification could provide better knowledge for optimising ADT options to minimize HRQoL effects. METHODS A cohort of 206 PC survivors (75 treated with and 131 without ADT) was recruited with written consent to collect patient characteristics, clinical data and HRQoL data related to PC management. The primary outcomes were the percentage scores under each HRQoL subscale assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (QLQ-C30 and PR25) and the Depression Anxiety Stress Scales developed by the University of Melbourne, Australia. Genotyping of these men was carried out for the aldo-keto reductase family 1, member C3 (AKR1C3) rs12529 single nucleotide polymorphism (SNP). Analysis of HRQoL scores were carried out against ADT duration and in association with the AKR1C3 rs12529 SNP using the generalised linear model. P-values <0 · 05 were considered significant, and were further tested for restriction with Bonferroni correction. RESULTS Increase in hormone treatment-related effects were recorded with long-term ADT compared to no ADT. The C and G allele frequencies of the AKR1C3rs12529 SNP were 53·4 % and 46·6 % respectively. Hormone treatment-related symptoms showed an increase with ADT when associated with the AKR1C3 rs12529 G allele. Meanwhile, decreasing trends on cancer-specific symptoms and increased sexual interest were recorded with no ADT when associated with the AKR1C3 rs12529 G allele and reverse trends with the C allele. As higher incidence of cancer-specific symptoms relate to cancer retention it is possible that associated with the C allele there could be higher incidence of unresolved cancers under no ADT options. CONCLUSIONS If these findings can be reproduced in larger homogeneous cohorts, a genetic stratification based on the AKR1C3 rs12529 SNP, can minimize ADT-related HRQoL effects in PC patients. Our data additionally show that with this stratification it could also be possible to identify men needing ADT for better oncological advantage.
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Affiliation(s)
- Nishi Karunasinghe
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand.
| | - Yifei Zhu
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Dug Yeo Han
- Discipline of Nutrition and Dietetics, FM&HS, The University of Auckland, Auckland, New Zealand
| | - Katja Lange
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Shuotun Zhu
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Alice Wang
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Stephanie Ellett
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | | | - Megan Goudie
- Urology Department, Auckland Hospital, Auckland, New Zealand
| | - Justin Keogh
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Human Potential Centre, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
| | - Benji Benjamin
- Radiation Oncology Department, Auckland Hospital, Auckland, New Zealand
| | - Michael Holmes
- Urology Department, Waikato Hospital, Hamilton, New Zealand
| | - Lynnette R Ferguson
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand.,Discipline of Nutrition and Dietetics, FM&HS, The University of Auckland, Auckland, New Zealand
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24
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Abstract
Since prostate cancer becomes more common with age, at least one-third of men have sexual problems at diagnosis. All localized treatments for prostate cancer greatly increase the prevalence of sexual dysfunction, which include loss of desire, erectile dysfunction, and changes in orgasm. Even men on active surveillance have a higher rate of problems than matched peers without prostate cancer. However, men given androgen deprivation therapy (ADT) have the worst rates of sexual dysfunction. Even after 3 to 4 months of ADT, men's desire for sex is decreased and irreversible damage may occur to the erectile tissue in the penis. Erections do not recover in about one-half of men, even if ADT is discontinued. Although intermittent ADT allows some recovery of sexual function, serum testosterone requires 9 to 12 months off ADT to recover. Again, one-half of men have permanent erectile dysfunction. If ADT causes atrophy of the erectile tissue, blood leaks out of the venous system during erection. This syndrome is difficult to treat except with surgery to implant a penile prosthesis. Despite the high rate of sexual problems in men on ADT, a small group stays sexually active and is able to have reliable erections. To improve men's sexual satisfaction on ADT, it may be important to educate them about getting extra mental and physical sexual stimulation, as well as using penile rehabilitation during hormone therapy. Information on reaching orgasm and coping with problems such as dry orgasm, pain with orgasm, and urinary incontinence during sex also should be provided.
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Affiliation(s)
- Leslie R Schover
- From the Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Jackson WC, Schipper MJ, Johnson SB, Foster C, Li D, Sandler HM, Palapattu GS, Hamstra DA, Feng FY. Duration of Androgen Deprivation Therapy Influences Outcomes for Patients Receiving Radiation Therapy Following Radical Prostatectomy. Eur Urol 2016; 69:50-7. [DOI: 10.1016/j.eururo.2015.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 05/05/2015] [Indexed: 11/28/2022]
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26
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Van Acker HH, Anguille S, Willemen Y, Smits EL, Van Tendeloo VF. Bisphosphonates for cancer treatment: Mechanisms of action and lessons from clinical trials. Pharmacol Ther 2015; 158:24-40. [PMID: 26617219 DOI: 10.1016/j.pharmthera.2015.11.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing body of evidence points toward an important anti-cancer effect of bisphosphonates, a group of inexpensive, safe, potent, and long-term stable pharmacologicals that are widely used as osteoporosis drugs. To date, they are already used in the prevention of complications of bone metastases. Because the bisphosphonates can also reduce mortality in among other multiple myeloma, breast, and prostate cancer patients, they are now thoroughly studied in oncology. In particular, the more potent nitrogen-containing bisphosphonates have the potential to improve prognosis. The first part of this review will elaborate on the direct and indirect anti-tumoral effects of bisphosphonates, including induction of tumor cell apoptosis, inhibition of tumor cell adhesion and invasion, anti-angiogenesis, synergism with anti-neoplastic drugs, and enhancement of immune surveillance (e.g., through activation of γδ T cells and targeting macrophages). In the second part, we shed light on the current clinical position of bisphosphonates in the treatment of hematological and solid malignancies, as well as on ongoing and completed clinical trials investigating the therapeutic effect of bisphosphonates in cancer. Based on these recent data, the role of bisphosphonates is expected to further expand in the near future outside the field of osteoporosis and to open up new avenues in the treatment of malignancies.
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Affiliation(s)
- Heleen H Van Acker
- Laboratory of Experimental Hematology, Tumor Immunology Group (TIGR), Faculty of Medicine and Health Sciences, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
| | - Sébastien Anguille
- Laboratory of Experimental Hematology, Tumor Immunology Group (TIGR), Faculty of Medicine and Health Sciences, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Yannick Willemen
- Laboratory of Experimental Hematology, Tumor Immunology Group (TIGR), Faculty of Medicine and Health Sciences, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Evelien L Smits
- Laboratory of Experimental Hematology, Tumor Immunology Group (TIGR), Faculty of Medicine and Health Sciences, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research (CORE), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Viggo F Van Tendeloo
- Laboratory of Experimental Hematology, Tumor Immunology Group (TIGR), Faculty of Medicine and Health Sciences, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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27
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Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporosis and Low Bone Mineral Density in Men with Testosterone Deficiency Syndrome. Sex Med Rev 2015; 3:298-315. [PMID: 27784602 DOI: 10.1002/smrj.63] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Testosterone deficiency syndrome (TDS) is a risk factor for low bone mineral density (BMD) and osteoporosis. Knowledge of the relationship between TDS and bone health, as well as the practical aspects of how to diagnose and treat low BMD, is therefore of practical importance to sexual medicine practitioners. AIM The aim of this study was to review the physiologic basis and clinical evidence of the relationship between TDS and bone health; and to provide a practical, evidence-based algorithm for the diagnosis and management of low BMD in men with TDS. METHODS Method used was a review of relevant publications in PubMed. MAIN OUTCOME MEASURES Pathophysiology of low BMD in TDS, morbidity, and mortality of osteoporosis in men, association between TDS and osteoporosis, indications for dual X-ray absorptiometry (DXA) scanning in TDS, evidence for testosterone replacement therapy (TRT) in men with osteoporosis, treatment for osteoporosis in the setting of TDS. RESULTS Sex hormones play a pleomorphic role in maintenance of BMD. TDS is associated with increased risk of osteoporosis and osteopenia, both of which contribute to morbidity and mortality in men. DXA scanning is indicated in men older than 50 years with TDS, and in younger men with longstanding TDS. Men with TDS and osteoporosis should be treated with anti-osteoporotic agents and TRT should be highly considered. Men with osteopenia should be stratified by fracture risk. Those at high risk should be treated with anti-osteoporotic agents with strong consideration of TRT; while those at low risk should be strongly considered for TRT, which has a beneficial effect on BMD. CONCLUSION Low BMD is a prevalent and treatable cause of morbidity and mortality in men with TDS. Utilization of a practical, evidence-based approach to diagnosis and treatment of low BMD in men with TDS enables sexual medicine practitioners to make a meaningful impact on patient quality of life and longevity. Gaffney CD, Pagano MJ, Kuker AP, Stember DS, and Stahl PJ. Osteoporosis and low bone mineral density in men with testosterone deficiency syndrome.
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Affiliation(s)
| | - Matthew J Pagano
- Department of UrologyColumbia University Medical CenterNew YorkNYUSA
| | - Adriana P Kuker
- Division of EndocrinologyDepartment of MedicineColumbia University Medical CenterNew YorkNYUSA
| | - Doron S Stember
- Department of UrologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Peter J Stahl
- Department of UrologyColumbia University Medical CenterNew YorkNYUSA.
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28
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Yahya N, Ebert MA, Bulsara M, Haworth A, Kennedy A, Joseph DJ, Denham JW. Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial. Radiother Oncol 2015; 116:112-8. [PMID: 26163088 DOI: 10.1016/j.radonc.2015.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/31/2015] [Accepted: 06/08/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE/OBJECTIVE To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. MATERIAL AND METHODS Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. RESULTS Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. CONCLUSIONS The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact.
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Affiliation(s)
- Noorazrul Yahya
- School of Physics, University of Western Australia, Australia; Faculty of Health Sciences, National University of Malaysia, Bangi, Malaysia.
| | - Martin A Ebert
- School of Physics, University of Western Australia, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | - Annette Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia; School of Surgery, University of Western Australia, Australia
| | - Jim W Denham
- School of Medicine and Public Health, University of Newcastle, Australia
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29
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Denham JW, Steigler A, Joseph D, Lamb DS, Spry NA, Duchesne G, Atkinson C, Matthews J, Turner S, Kenny L, Tai KH, Gogna NK, Gill S, Tan H, Kearvell R, Murray J, Ebert M, Haworth A, Kennedy A, Delahunt B, Oldmeadow C, Holliday EG, Attia J. Radiation dose escalation or longer androgen suppression for locally advanced prostate cancer? Data from the TROG 03.04 RADAR trial. Radiother Oncol 2015; 115:301-7. [DOI: 10.1016/j.radonc.2015.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
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30
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Buffart LM, Newton RU, Chinapaw MJ, Taaffe DR, Spry NA, Denham JW, Joseph DJ, Lamb DS, Brug J, Galvão DA. The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer. Cancer 2015; 121:2821-30. [PMID: 25891302 DOI: 10.1002/cncr.29406] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The current study examined effects, moderators (for whom), and mediators (working mechanisms) of 12 months of exercise on health-related quality of life (HRQoL) in older long-term survivors of prostate cancer. METHODS In total, 100 men aged 71.7 years (standard deviation, 6.4 years) were randomly assigned to 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance program (EX group) or printed education material regarding physical activity for 12 months (PA group). Assessments took place at baseline and after 6 and 12 months. Generalized estimating equations were used to study the effects of EX versus PA on HRQoL at 6 and 12 months, adjusting for baseline HRQoL. The authors examined potential sociodemographic and clinical moderators by adding interaction terms, and potential physical and psychological mediators using the product-of-coefficients test. RESULTS At 6 months, significant beneficial effects were found for global QoL, physical function, and social function in the EX group compared with the PA group. For physical function, beneficial effects were sustained at 12 months. Moderation analyses demonstrated larger effects of EX versus PA for patients who were married, started exercising sooner after their diagnosis, and previously used bisphosphonates. Changes in lower body functional performance significantly mediated the effect of EX on global QoL, physical function, and social function. No mediating effects on HRQoL were found for aerobic fitness, physical activity, fatigue, distress, or falls self-efficacy. CONCLUSIONS Aerobic and resistance exercise appears to have beneficial effects on HRQoL among older, long-term survivors of prostate cancer. Effects were moderated by marital status, time since diagnosis, and use of bisphosphonates, and were mediated by lower body functional performance.
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Affiliation(s)
- Laurien M Buffart
- Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Robert U Newton
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mai J Chinapaw
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Dennis R Taaffe
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nigel A Spry
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Newcastle Mater Hospital, Newcastle, New South Wales, Australia
| | - David J Joseph
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - David S Lamb
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Daniel A Galvão
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
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31
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Yahya N, Ebert MA, Bulsara M, Haworth A, Kearvell R, Foo K, Kennedy A, Richardson S, Krawiec M, Joseph DJ, Denham JW. Impact of treatment planning and delivery factors on gastrointestinal toxicity: an analysis of data from the RADAR prostate radiotherapy trial. Radiat Oncol 2014; 9:282. [PMID: 25498565 PMCID: PMC4271488 DOI: 10.1186/s13014-014-0282-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the impact of incremental modifications of treatment planning and delivery technique, as well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate radiotherapy trial. METHODS The RADAR trial accrued 813 external beam radiotherapy participants during 2003-2008 from 23 centres. Following review and archive to a query-able database, digital treatment plans and data describing treatment technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features, were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and 54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and anal canal. RESULTS A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242-0.783, corrected p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency compared to patients with no dietary intervention (OR: 3.639, CI: 1.502-8.818, corrected p = 0.04). Despite higher risks of toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH values between EQD23 = 15 Gy and EQD23 = 35 Gy. Planning target volume (PTV), conformity index, rectal width and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy, treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional area did not affect the risk of toxicities. CONCLUSIONS The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal toxicity. A number of interesting associations were subsequently found and some factors, previously hypothesised to influence toxicity, did not demonstrate any significant impact. We recommend trial registries be encouraged to record technical modifications introduced during the trial in order for more powerful evidence to be gathered regarding the impact of the interventions.
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Affiliation(s)
- Noorazrul Yahya
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia. .,School of Health Sciences, National University of Malaysia, Bangi, Malaysia.
| | - Martin A Ebert
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia. .,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
| | - Annette Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.
| | - Rachel Kearvell
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Kerwyn Foo
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Sharon Richardson
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Michele Krawiec
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. .,School of Surgery, University of Western Australia, Crawley, Western Australia, Australia.
| | - Jim W Denham
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
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32
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Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3 factorial trial. Lancet Oncol 2014; 15:1076-89. [PMID: 25130995 DOI: 10.1016/s1470-2045(14)70328-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND We investigated whether 18 months of androgen suppression plus radiotherapy, with or without 18 months of zoledronic acid, is more effective than 6 months of neoadjuvant androgen suppression plus radiotherapy with or without zoledronic acid. METHODS We did an open-label, randomised, 2 × 2 factorial trial in men with locally advanced prostate cancer (either T2a N0 M0 prostatic adenocarcinomas with prostate-specific antigen [PSA] ≥10 μg/L and a Gleason score of ≥7, or T2b-4 N0 M0 tumours regardless of PSA and Gleason score). We randomly allocated patients by computer-generated minimisation--stratified by centre, baseline PSA, tumour stage, Gleason score, and use of a brachytherapy boost--to one of four groups in a 1:1:1:1 ratio. Patients in the control group were treated with neoadjuvant androgen suppression with leuprorelin (22·5 mg every 3 months, intramuscularly) for 6 months (short-term) and radiotherapy alone (designated STAS); this procedure was either followed by another 12 months of androgen suppression with leuprorelin (intermediate-term; ITAS) or accompanied by 18 months of zoledronic acid (4 mg every 3 months for 18 months, intravenously; STAS plus zoledronic acid) or by both (ITAS plus zoledronic acid). The primary endpoint was prostate cancer-specific mortality. This analysis represents the first, preplanned assessment of oncological endpoints, 5 years after treatment. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00193856. FINDINGS Between Oct 20, 2003, and Aug 15, 2007, 1071 men were randomly assigned to STAS (n=268), STAS plus zoledronic acid (n=268), ITAS (n=268), and ITAS plus zoledronic acid (n=267). Median follow-up was 7·4 years (IQR 6·5-8·4). Cumulative incidences of prostate cancer-specific mortality were 4·1% (95% CI 2·2-7·0) in the STAS group, 7·8% (4·9-11·5) in the STAS plus zoledronic acid group, 7·4% (4·6-11·0) in the ITAS group, and 4·3% (2·3-7·3) in the ITAS plus zoledronic acid group. Cumulative incidence of all-cause mortality was 17·0% (13·0-22·1), 18·9% (14·6-24·2), 19·4% (15·0-24·7), and 13·9% (10·3-18·8), respectively. Neither prostate cancer-specific mortality nor all-cause mortality differed between control and experimental groups. Cumulative incidence of PSA progression was 34·2% (28·6-39·9) in the STAS group, 39·6% (33·6-45·5) in the STAS plus zoledronic acid group, 29·2% (23·8-34·8) in the ITAS group, and 26·0% (20·8-31·4) in the ITAS plus zoledronic acid group. Compared with STAS, no difference was noted in PSA progression with ITAS or STAS plus zoledronic acid; however, ITAS plus zoledronic acid reduced PSA progression (sub-hazard ratio [SHR] 0·71, 95% CI 0·53-0·95; p=0·021). Cumulative incidence of local progression was 4·1% (2·2-7·0) in the STAS group, 6·1% (3·7-9·5) in the STAS plus zoledronic acid group, 1·5% (0·5-3·7) in the ITAS group, and 3·4% (1·7-6·1) in the ITAS plus zoledronic acid group; no differences were noted between groups. Cumulative incidences of bone progression were 7·5% (4·8-11·1), 14·6% (10·6-19·2), 8·4% (5·5-12·2), and 7·6% (4·8-11·2), respectively. Compared with STAS, STAS plus zoledronic acid increased the risk of bone progression (SHR 1·90, 95% CI 1·14-3·17; p=0·012), but no differences were noted with the other two groups. Cumulative incidence of distant progression was 14·7% (10·7-19·2) in the STAS group, 17·3% (13·0-22·1) in the STAS plus zoledronic acid group, 14·2% (10·3-18·7) in the ITAS group, and 11·1% (7·6-15·2) in the ITAS plus zoledronic acid group; no differences were recorded between groups. Cumulative incidence of secondary therapeutic intervention was 25·6% (20·5-30·9), 28·9% (23·5-34·5), 20·7% (16·1-25·9), and 15·3% (11·3-20·0), respectively. Compared with STAS, ITAS plus zoledronic acid reduced the need for secondary therapeutic intervention (SHR 0·67, 95% CI 0·48-0·95; p=0·024); no differences were noted with the other two groups. An interaction between trial factors was recorded for Gleason score; therefore, we did pairwise comparisons between all groups. Post-hoc analyses suggested that the reductions in PSA progression and decreased need for secondary therapeutic intervention with ITAS plus zoledronic acid were restricted to tumours with a Gleason score of 8-10, and that ITAS was better than STAS in tumours with a Gleason score of 7 or lower. Long-term morbidity and quality-of-life scores were not affected adversely by 18 months of androgen suppression or zoledronic acid. INTERPRETATION Compared with STAS, ITAS plus zoledronic acid was more effective for treatment of prostate cancers with a Gleason score of 8-10, and ITAS alone was effective for tumours with a Gleason score of 7 or lower. Nevertheless, these findings are based on secondary endpoint data and post-hoc analyses and must be regarded cautiously. Long- term follow-up is necessary, as is external validation of the interaction between zoledronic acid and Gleason score. STAS plus zoledronic acid can be ruled out as a potential therapeutic option. FUNDING National Health and Medical Research Council of Australia, Novartis Pharmaceuticals Australia, Abbott Pharmaceuticals Australia, New Zealand Health Research Council, New Zealand Cancer Society, University of Newcastle (Australia), Calvary Health Care (Calvary Mater Newcastle Radiation Oncology Fund), Hunter Medical Research Institute, Maitland Cancer Appeal, Cancer Standards Institute New Zealand.
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Nguyen PL, Alibhai SMH, Basaria S, D'Amico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2014; 67:825-36. [PMID: 25097095 DOI: 10.1016/j.eururo.2014.07.010] [Citation(s) in RCA: 510] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 07/11/2014] [Indexed: 01/11/2023]
Abstract
CONTEXT Androgen-deprivation therapy (ADT) is a key component of treatment for aggressive and advanced prostate cancer, but it has also been associated with adverse effects on bone, metabolic, cardiovascular, sexual, and cognitive health as well as body composition. OBJECTIVE To review the current literature on the adverse effects of ADT and strategies for ameliorating harm from ADT. EVIDENCE ACQUISITION The Medline database (through PubMed) was searched from inception to August 1, 2013, for studies documenting the side effects of ADT and for randomized and prospective trials of interventions to mitigate those side effects. EVIDENCE SYNTHESIS Adverse effects of ADT include decreases in bone mineral density; metabolic changes such as weight gain, decreased muscle mass, and increased insulin resistance; decreased libido and sexual dysfunction; hot flashes; gynecomastia; reduced testicle size; anemia; and fatigue. Several observational studies suggest an increased risk of diabetes and cardiovascular events, although most published studies report that ADT is not linked to greater cardiovascular mortality. Randomized trials have found value in treatments for some adverse effects including bone loss (bisphosphonates, denosumab, selective estrogen receptor modulators), markers of metabolic syndrome (exercise, diet, metformin), gynecomastia (tamoxifen, prophylactic radiation), muscle loss (resistance and aerobic exercise), and hot flashes (venlafaxine, medroxyprogesterone, cyproterone acetate, gabapentin). CONCLUSIONS ADT is often a necessary component of the treatment of aggressive prostate cancer, yet it has known harms that can impair health and quality of life. Clinicians should be aware of interventions that can help mitigate these adverse effects. PATIENT SUMMARY Androgen deprivation therapy is a critical component of the management of aggressive and advanced prostate cancer, but it causes adverse effects including bone loss, metabolic changes, gynecomastia, muscle loss, hot flashes, and possibly increased cardiovascular events. Clinicians should be aware of interventions that can help mitigate these adverse effects.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
| | | | - Shehzad Basaria
- Section on Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Philip W Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy L Keating
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - David F Penson
- Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN, USA
| | - Derek J Rosario
- Academic Urology Unit, Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Bertrand Tombal
- Division of Urology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Matthew R Smith
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Lamb DS, Greig L, Russell GL, Nacey JN, Broome K, Studd R, Delahunt B, Iupati D, Jain M, Rooney C, Murray J, Lamb PJ, Bethwaite PB. Patterns of failure after iodine-125 seed implantation for prostate cancer. Radiother Oncol 2014; 112:68-71. [PMID: 25082097 DOI: 10.1016/j.radonc.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. MATERIALS AND METHODS From 2001-2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. RESULTS Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. CONCLUSIONS If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA 'bounce' and have PSA dynamics initially mimicking those of BF.
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Affiliation(s)
- David S Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand.
| | - Lynne Greig
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | | | - John N Nacey
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand; Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Kim Broome
- Omahu Urology Clinic, Hawkes Bay, New Zealand
| | - Rod Studd
- Urology, Southern Cross Hospital, Wellington, New Zealand
| | - Brett Delahunt
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Douglas Iupati
- Radiation Oncology, Southern Cross Hospital, Wellington, New Zealand
| | - Mohua Jain
- Anesthetics, Southern Cross Hospital, Wellington, New Zealand
| | - Colin Rooney
- Medical Physics, Southern Cross Hospital, Wellington, New Zealand
| | - Judy Murray
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter J Lamb
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter B Bethwaite
- Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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Gacci M, Baldi E, Tamburrino L, Detti B, Livi L, De Nunzio C, Tubaro A, Gravas S, Carini M, Serni S. Quality of Life and Sexual Health in the Aging of PCa Survivors. Int J Endocrinol 2014; 2014:470592. [PMID: 24744780 PMCID: PMC3976934 DOI: 10.1155/2014/470592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Beatrice Detti
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Lorenzo Livi
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
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Sharpley CF, Bitsika V, Denham JW. Factors associated with feelings of loss of masculinity in men with prostate cancer in the RADAR trial. Psychooncology 2013; 23:524-30. [DOI: 10.1002/pon.3448] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Vicki Bitsika
- Brain-Behaviour Research Group; Bond University; Gold Coast Australia
| | - James W. Denham
- Department of Radiation Oncology; Calvary Mater Newcastle Hospital; Newcastle Australia
- School of Medicine & Public Health; University of Newcastle; Newcastle Australia
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Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, Lamb DS, Chambers SK, Newton RU. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 RADAR. Eur Urol 2013; 65:856-64. [PMID: 24113319 DOI: 10.1016/j.eururo.2013.09.041] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term prostate cancer (PCa) survivors are at increased risk for comorbidities and physical deconditioning. OBJECTIVE To determine the effectiveness of a year-long randomised controlled trial of exercise training in PCa survivors >5 yr postdiagnosis on physical functioning. DESIGN, SETTING, AND PARTICIPANTS Between 2010 and 2011, 100 long-term PCa survivors from Trans-Tasman Radiation Oncology Group 03.04 Randomised Androgen Deprivation and Radiotherapy previously treated with androgen-deprivation therapy and radiation therapy were randomly assigned to 6 mo of supervised exercise followed by 6 mo of a home-based maintenance programme (n=50) or printed educational material about physical activity (n=50) for 12 mo across 13 university-affiliated exercise clinics in Australia and New Zealand. INTERVENTION Supervised resistance and aerobic exercise or printed educational material about physical activity. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was a 400-m walk as a measure of cardiovascular fitness. Secondary end points were physical function, patient-reported outcomes, muscle strength, body composition, and biomarkers. Analysis of covariance was used to compare outcomes for groups at 6 and 12 mo adjusted for baseline values. RESULTS AND LIMITATIONS Participants undergoing supervised exercise showed improvement in cardiorespiratory fitness performance at 6 mo (-19 s [p=0.029]) and 12 mo (-13 s [p=0.028]) and better lower-body physical function across the 12-mo period (p<0.01). Supervised exercise also improved self-reported physical functioning at 6 (p=.006) and 12 mo (p=0.002), appendicular skeletal muscle at 6 mo (p=0.019), and objective measures of muscle strength at 6 and 12 mo (p<0.050). Limitations included the restricted number of participants undertaking body composition assessment, no blinding to group assignment for physical functioning measures, and inclusion of well-functioning individuals. CONCLUSIONS Supervised exercise training in long-term PCa survivors is more effective than physical activity educational material for increasing cardiorespiratory fitness, physical function, muscle strength, and self-reported physical functioning at 6 mo. Importantly, these benefits were maintained in the long term with a home-based programme with follow-up at 12 mo. CLINICAL TRIAL REGISTRY The effect of an exercise intervention on cardiovascular and metabolic risk factors in prostate cancer patients from the RADAR study, ACTRN: ACTRN12609000729224.
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Affiliation(s)
- Daniel A Galvão
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia.
| | - Nigel Spry
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - James Denham
- School of Medicine and Public Health, University of Newcastle, NSW, Australia; Newcastle Mater Hospital, Newcastle, NSW, Australia
| | - Dennis R Taaffe
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia; School of Environmental and Life Sciences, University of Newcastle, NSW, Australia
| | - Prue Cormie
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia
| | - David Joseph
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Suzanne K Chambers
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia; Griffith Health Institute, Griffith University, Gold Coast, Australia; Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - Robert U Newton
- Edith Cowan University Health and Wellness Institute, Joondalup, WA, Australia
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Grossmann M, Cheung AS, Zajac JD. Androgens and prostate cancer; pathogenesis and deprivation therapy. Best Pract Res Clin Endocrinol Metab 2013; 27:603-16. [PMID: 24054933 DOI: 10.1016/j.beem.2013.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although androgen receptor signaling is critical for prostate cancer growth and survival, evidence supporting a favorable risk-benefit ratio of androgen deprivation therapy (ADT) is currently limited to men with high-risk or metastatic disease. This is in part because ADT has been associated with a number of constitutional and somatic side effects, consistent with the widespread tissue expression of sex steroid receptors. ADT is the most common contemporary cause of severe hypogonadism, and men receiving this therapy represent a unique model of severe sex steroid deficiency with a defined time of onset. This review will present an update on the role of ADT in the treatment of prostate cancer, will summarize recent evidence regarding ADT-associated adverse effects with particular emphasis on cardiometabolic and musculoskeletal health, and will provide recommendations for further research.
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Affiliation(s)
- Mathis Grossmann
- Dept. of Medicine, Austin Health, University of Melbourne, Victoria, Australia; Dept. of Endocrinology, Austin Health, Victoria, Australia.
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Denham JW, Steigler A. Picking the Optimal Duration of Hormonal Therapy in Men With High-Risk and Locally Advanced Prostate Cancer Treated With Radiotherapy. Semin Radiat Oncol 2013; 23:206-14. [DOI: 10.1016/j.semradonc.2013.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Do hormone treatments for prostate cancer cause anxiety and depression? Int J Clin Oncol 2013; 19:523-30. [DOI: 10.1007/s10147-013-0569-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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Gray PJ, Efstathiou JA, Shipley WU. The opportunity cost of androgen suppression in locally advanced prostate cancer. Asian J Androl 2013; 15:356-7. [DOI: 10.1038/aja.2012.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Goineau A, Marchand V, Rigaud J, Bourdin S, Rio E, Campion L, Bonnaud-Antignac A, Mahé MA, Supiot S. Prospective evaluation of quality of life 54 months after high-dose intensity-modulated radiotherapy for localized prostate cancer. Radiat Oncol 2013; 8:53. [PMID: 23510499 PMCID: PMC3605179 DOI: 10.1186/1748-717x-8-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/25/2013] [Indexed: 12/02/2022] Open
Abstract
Objective To determine late toxicity and quality of life (QoL) in patients with localized prostate cancer after high-dose intensity-modulated radiotherapy (IMRT). Patient and methods This was a prospective study in patients with localized prostate adenocarcinoma who had been treated by IMRT (76 Gy) between February and November 2006. Physicians scored acute and late toxicity using the Common Terminology Criteria for Adverse Events (version 3.0). Patients completed cancer and prostate-specific QoL questionnaires (EORTC QLQ-C30 and QLQ-PR25) before IMRT (baseline) and at 2, 6, 18 and 54 months. Result Data were available for 38 patients (median age, 73 years) (18% low risk; 60% intermediate risk; 32% high risk). The incidence of urinary and gastrointestinal toxicity was respectively: immediately post IMRT: 36.8% and 23.7% (grade 1), 5.3% and 5.3% (grade 2), 2.6% and 0% (grade 3); at 18 months: 23.7% and 10.3% (grade 1), 26.3% and 13.2% (grade 2), 0% and 2.6% (grade 3); at 54 months: 34.2% and 23.7% (grade 1), 5.3% and 15.8% (grade 2), 5.3% and 0% (grade 3). At 54 months, significant worsening was reported by patients for 11/19 QoL items but the worsening was clinically relevant (>10 points) for 7 items only: physical, role as well as social functioning, fatigue, pain, dyspnoea and constipation. There was no significant difference between 54-month and baseline QoL scores for global health, gastrointestinal symptoms, treatment-related symptoms and sexual function. However, there was significant - but clinically non-relevant (<10 points) - worsening of urinary symptom. Conclusion High-dose IMRT to the prostate with accurate patient positioning did not induce any clinically relevant worsening in late urinary and gastrointestinal QoL at 54 months. Impaired physical and role functioning may be related to age and comorbidities.
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Affiliation(s)
- Aurore Goineau
- Integrated Center of Oncology René Gauducheau, Nantes-St Herblain, France
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Short-term versus long-term hormone therapy plus radiotherapy or prostatectomy for prostate cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2013; 139:783-96. [PMID: 23380891 DOI: 10.1007/s00432-013-1383-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the efficacy and safety of short-term versus long-term hormonotherapy (HT) plus radiotherapy (RT) or prostatectomy (RP) for prostate cancer. METHODS Literatures were searched from Embase, PubMed, Web of science and Cochrane Library up to October, 2012. Quality of the study was evaluated according to the Cochrane's risk of bias of randomized controlled trial (RCT); the Grading of Recommendations Assessment, Development and Evaluation System was used to rate the level of evidence. RevMan 5.1 was used for statistical analysis. Two comparisons were of interest: RT plus short-term HT versus RT plus long-term HT and RP plus short-term HT versus RP plus long-term HT. Pooled risk ratio or standardized mean differences were calculated; HT adverse reactions were descriptively evaluated. RESULTS Nine RCTs (total 4,743 patients) were included, 7 RCTs compared RT plus short-term HT with RT plus long-term HT, 2 RCTs compared RP plus short-term HT with RP plus long-term HT. Meta-analysis showed there was no significant difference in overall survival, disease-free survival and PSA level before RP; long-term was superior to short-term hormonotherapy in biochemical failure rate, clinical progression rate, prostate cancer-specific mortality, positive surgical margin rate and prostate volume before RP. Systematic review demonstrated adverse events caused by the increased length of HT were more common. CONCLUSIONS Long-term HT plus RT showed a trend toward improved overall survival; long-term HT plus RP declined positive surgical margin rate and prostate volume before RP. So, long-term HT may benefit more, but it did not significantly improve the patients' overall survival, and the adverse reactions are inevitable.
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Chi KN, Nguyen PL, Higano CS. Androgen deprivation for prostate cancer: when and how, the good and the bad. Am Soc Clin Oncol Educ Book 2013:0011300176. [PMID: 23714494 DOI: 10.14694/edbook_am.2013.33.e176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Androgen deprivation therapy (ADT) is the mainstay systemic treatment of prostate cancer because of the androgen dependence of the disease. Although ADT has long been used to manage prostate cancer, its use continues to evolve as data from clinical trials mature and long-term effects are recognized. For patients with localized disease and high-risk features, short and long courses of ADT as neoadjuvant/adjuvant therapy have been shown to improve survival when used with radiation therapy, but this has not been demonstrated with radical prostatectomy. The role of ADT with salvage radiotherapy after radical prostatectomy continues to be defined. Lifelong ADT in patients with node-positive disease after surgery or with radiation is also associated with increased survival. Increasingly though, the adverse effects of ADT that go beyond those on libido and hot flashes are being acknowledged. The metabolic effects on lipids, glycemic control, and bone loss from ADT can lead to an increased risk of cardiovascular events and osteoporosis, which needs to be considered when deciding to initiate and treat patients with ADT. Large, randomized trials comparing intermittent to continuous ADT have now been reported. Although the hope for improved cancer outcomes with intermittent therapy has not come to realization, an interrupted approach to therapy may help mitigate some of the negative effects of ADT in selected patients by allowing for off-treatment intervals.
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Affiliation(s)
- Kim N Chi
- From the BC Cancer Agency - Vancouver Cancer Centre, Vancouver, British Columbia, Canada; Dana-Farber Cancer Institute, Boston, MA; Univeristy of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
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