1
|
Benziane-Ouaritini N, Zilli T, Giraud A, Ingrosso G, Di Staso M, Trippa F, Pommier P, Meyer E, Francolini G, Schick U, Pasquier D, Marc Cosset J, Magne N, Martin E, Gnep K, Renard-Penna R, Anger E, Achard V, Giraud N, Aristei C, Ferrari V, Pasquier C, Zaine H, Osman O, Detti B, Perennec T, Mihoci I, Supiot S, Latorzeff I, Sargos P. Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study. Eur Urol Oncol 2023:S2588-9311(23)00067-6. [PMID: 37059627 DOI: 10.1016/j.euo.2023.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Management of macroscopic local recurrence (MLR) after radical prostatectomy is a challenging situation with no standardized approach. OBJECTIVE The objective of our study was to assess the efficacy and safety of functional image-guided salvage radiotherapy (SRT) in patients with MLR in the prostate bed. DESIGN, SETTING, AND PARTICIPANTS In this international multicenter retrospective study across 16 European centers, eligible patients were initially treated by radical prostatectomy (RP) with or without pelvic lymph node dissection for localized or locally advanced adenocarcinoma of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prostate-specific antigen (PSA) measured 4 wk after RP was <0.1 ng/ml. All patients presented a biochemical relapse after RP defined by an increase in PSA level of ≥0.2 ng/ml on two successive measures. Only patients with an MLR lesion in the prostatectomy bed visualized on functional imaging (multiparametric magnetic resonance imaging, positron emission tomography/computed tomography [PET/CT] choline, or PET/CT prostate-specific membrane antigen) were eligible. Patients with lymph node, bone, or visceral dissemination at restaging imaging (CT and/or bone scintigraphy and/or magnetic resonance imaging and/or PET) were excluded. Dose escalation was defined as a dose of >66 Gy prescribed to the prostate bed or to MLR. Toxicities were classified using the Common Terminology Criteria for Adverse Events scale, version 4.03. The primary endpoint was progression-free survival (PFS). Secondary outcomes were metastasis-free survival (MPFS), biochemical progression-free survival, and overall survival. Genitourinary (GU) and gastrointestinal (GI) toxicities were analyzed. RESULTS AND LIMITATIONS Between January 2000 and December 2019, 310 patients received at least one dose escalation on MLR and 25 patients did not receive any dose escalation. The median PSA level before SRT was 0.63 ng/ml (interquartile range [IQR], 0.27-1.7). The median follow-up was 54 mo (IQR, 50-56). Five-year PFS and MPFS were 70% (95% confidence interval [CI]: [64; 75]) and 84% (95% CI: [78; 88]), respectively. Grade ≥2 GU and GI late toxicities were observed in 43 (12%) and 11 (3%) patients, respectively. When the prescribed dose on the MLR lesion was ≥72 Gy, an improvement in 5-yr PFS was found for patients received at least one dose escalation (73% [95% CI: 65-79]) vs 60% [95% CI: 48; 70]; p = 0.03). CONCLUSIONS In this contemporary study integrating functional imaging data, we found potential efficacy of SRT with dose escalation ≥72 Gy for patients with MLR in the prostate bed and with an acceptable toxicity profile. Prospective data exploring this MLR dose escalation strategy are awaited. PATIENT SUMMARY In this report, we looked at the outcomes from salvage radiotherapy for prostate cancer and macroscopic relapse in a large European population. We found that outcomes varied with prostate-specific antigen at relapse, Gleason score, and dose escalation. We found potential efficacy of salvage radiotherapy with dose escalation for macroscopic relapse in the prostate bed, with an acceptable toxicity profile.
Collapse
Affiliation(s)
| | - Thomas Zilli
- Department of Radiotherapy, University of Geneva, Geneva, Switzerland
| | - Antoine Giraud
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | - Gianluca Ingrosso
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Mario Di Staso
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabio Trippa
- Department of Radiotherapy, Saint Maria Hospital, Terni, Italy
| | - Pascal Pommier
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | - Emmanuel Meyer
- Department of Radiotherapy, Centre Francois Baclesse, Caen, France
| | | | - Ulrike Schick
- Department of Radiotherapy, Morvan Hospital Brest, France
| | - David Pasquier
- Department of Radiotherapy, Oscar Lambret Cancer Centre, Lille, France
| | | | - Nicolas Magne
- Department of Radiotherapy, St Etienne University, St Etienne, France
| | - Etienne Martin
- Department of Radiotherapy, Georges-François Leclerc Centre, Dijon, France
| | - Kémara Gnep
- Department of Radiotherapy, Eugene Marquis Cancer Institute, Rennes, France
| | - Raphaelle Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Hopital Pitié-Salpétrière Hospital, Paris, France
| | - Ewen Anger
- Department of Radiotherapy, Eugene Marquis Cancer Institute, Rennes, France
| | - Vérane Achard
- Department of Radiotherapy, University of Geneva, Geneva, Switzerland
| | - Nicolas Giraud
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | | | - Victoria Ferrari
- Department of Medical Oncology, Antoine-Lacassagne Centre, Nice, France
| | - Corentin Pasquier
- Department of Radiotherapy, University Hospital Centre Toulouse, Toulouse, France
| | - Hind Zaine
- Department of Radiotherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Osman Osman
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - Tanguy Perennec
- Department of Radiotherapy, Institute of Cancer Research Western France, St Herblain, France
| | - Inga Mihoci
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stéphane Supiot
- Department of Radiotherapy, Institute of Cancer Research Western France, St Herblain, France
| | - Igor Latorzeff
- Department of Radiotherapy, Pasteur Clinic, Toulouse, France
| | - Paul Sargos
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France.
| |
Collapse
|
2
|
Staal FHE, Janssen J, Brouwer CL, Langendijk JA, Ng Wei Siang K, Schuit E, de Jong IJ, Verzijlbergen JF, Smeenk RJ, Aluwini S. Phase III randomised controlled trial on PSMA PET/CT guided hypofractionated salvage prostate bed radiotherapy of biochemical failure after radical prostatectomy for prostate cancer (PERYTON-trial): study protocol. BMC Cancer 2022; 22:416. [PMID: 35428210 PMCID: PMC9013125 DOI: 10.1186/s12885-022-09493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases. Methods The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of < 1.0 ng/mL and a recent negative PSMA PET/CT scan. Participants will be randomised in a 1:1 ratio between the conventional fractionated treatment arm (35 × 2 Gy) and the experimental hypofractionated treatment arm (20 × 3 Gy). The primary endpoint is the 5-year progression-free survival after treatment. The secondary endpoints include toxicity, quality of life and disease specific survival. Discussion Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed. Trial registration This study is registered at ClinicalTrials.gov (Identifier: NCT04642027). Registered on 24 November 2020 – Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants. • This is the first PSMA PET/CT based study addressing the role of hypofractionation in salvage external beam radiation therapy (sEBRT); • Participants will be randomised 1:1 to conventional fractionated sEBRT (35 × 2 Gy) or hypofractionated sEBRT (20 × 3 Gy); • The PSMA PET/CT-scan will be used for staging of all participants at baseline; • The primary endpoint is 5-year progression-free survival after treatment; • All participants will receive early sEBRT (PSA < 1.0 ng/mL) without the use of androgen deprivation therapy; • A quality assurance program was undertaken, to ensure protocol compliance within the PERYTON-trial; • An interim analysis will be performed after the inclusion of 25% (n = 135) of the total number of required participants, to identify any early signs of excessive (unexpected) acute toxicity.
Collapse
|
3
|
Adherence to contouring and treatment planning requirements within a multicentric trial -results of the quality assurance of the SAKK 09/10 trial. Int J Radiat Oncol Biol Phys 2022; 113:80-91. [PMID: 34990777 DOI: 10.1016/j.ijrobp.2021.12.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the results of the radiation therapy (RT) quality assurance (QA) program of the phase III randomized "XXXX-Anonymized for Review" trial in biochemically recurrent prostate cancer (PC) patients after prostatectomy. METHODS AND MATERIALS Within the "XXXX-Anonymized for Review" trial testing 64Gy versus 70Gy salvage RT, a central collection of treatment plans were performed, which were thoroughly reviewed by a dedicated medical physicist and radiation oncologist. Adherence to the treatment protocol and specifically to the European Organization for the Research and Treatment of Cancer (EORTC) guidelines for target volume definition (classified as deviation observed yes vs. no) and its potential correlation with acute and late toxicity (Common Terminology Criteria for Adverse Events (CTCAE) v4.0) and freedom from biochemical progression (FFBP) were investigated. RESULTS The treatment plans of 344 patients treated between February 2011 and April 2014 depicted important deviations to the EORTC guidelines and to the recommendations per trial protocol. For example, in up to half of the cases, the delineated structures deviated from the protocol (e.g., prostate bed (PB) in 48.8%, rectal wall (RW) in 41%). In addition, variations in clinical (CTV) - and planning target volume (PTV) occurred frequently (e.g., CTV and PTV deviations in up to 42.4% and 25.9%, respectively). The detected deviations showed a significant association with a lower risk of grade ≥ 2 gastrointestinal (GI) acute toxicity when CTV not overlapped RW vs. CTV overlapping RW, (OR 0.43; CI [0.22, 0.85]; p= 0.014), and a higher rate of grade ≥ 2 late genitourinary (GU) toxicity in case of the CTV overlapped with RW, (OR 2.58; CI [1.17, 5.72]; p= 0.019). A marginally significant lower risk of grade ≥ 2 late GU toxicity in patients when PB not overlapping RW versus overlapping RW was observed (OR 0.51; CI [0.25, 1.03]; p= 0.06). In addition, a marginally significant decrease of FFBP in patients with PTV not including surgical clips as potential markers of the limits of the prostate bed, (HR 1.44; CI [0.96, 2.17]; p= 0.07) was observed. CONCLUSIONS Despite a thorough QA program, the central review of a phase-III trial showed limited adherence to treatment protocol recommendations which was associated with a higher risk of toxicity by means of acute or late GI or GU toxicity and showed a trend towards worse FFBP. Data from this QA review may help refine future QA programs and prostate bed delineation guidelines.
Collapse
|
4
|
Ghadjar P, Hayoz S, Bernhard J, Zwahlen DR, Hölscher T, Gut P, Polat B, Hildebrandt G, Müller AC, Plasswilm L, Papachristofilou A, Schär C, Sumila M, Zaugg K, Guckenberger M, Ost P, Reuter C, Bosetti DG, Khanfir K, Gomez S, Wust P, Thalmann GN, Aebersold DM. Dose-intensified Versus Conventional-dose Salvage Radiotherapy for Biochemically Recurrent Prostate Cancer After Prostatectomy: The SAKK 09/10 Randomized Phase 3 Trial. Eur Urol 2021; 80:306-315. [PMID: 34140144 DOI: 10.1016/j.eururo.2021.05.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Salvage radiotherapy (SRT) is utilized for biochemical progression of prostate cancer after radical prostatectomy (RP). OBJECTIVE To report the outcomes of the SAKK 09/10 trial comparing conventional and dose-intensified SRT. DESIGN, SETTING, AND PARTICIPANTS SAKK 09/10 was a randomized, multicenter, phase 3 trial that recruited men with biochemical progression after RP. INTERVENTION Patients were randomly assigned to conventional-dose (64 Gy) or dose-intensified SRT (70 Gy) to the prostate bed without hormonal therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was freedom from biochemical progression (FFBP). Secondary endpoints included clinical progression-free survival (PFS), time to hormonal treatment, overall survival (OS), acute and late toxicity (Common Terminology Criteria for Adverse Events v4.0), and quality of life (QoL). RESULTS AND LIMITATIONS Between February 2011 and April 2014, 350 patients were randomly assigned to 64 Gy (n = 175) or 70 Gy (n = 175). Median prostate-specific antigen at randomization was 0.3 ng/ml. After median follow-up of 6.2 yr, the median FFBP was 8.2 yr in the 64 Gy arm and 7.6 in the 70 Gy arm (log-rank p = 0.4), with a hazard ratio of 1.14 (95% confidence interval 0.82-1.60). The 6-year FFBP rates were 62% and 61%, respectively. No significant differences in clinical PFS, time to hormonal treatment, or OS were observed. Late grade 2 and 3 genitourinary toxicity was observed in 35 (21%) and 13 (7.9%) patients in the 64 Gy arm, and 46 (26%) and seven (4%) in the 70 Gy arm, respectively (p = 0.8). Late grade 2 and 3 gastrointestinal toxicity was observed in 12 (7.3%) and seven patients (4.2%) in the 64 Gy arm, and 35 (20%) and four (2.3%) in the 70 Gy arm, respectively (p = 0.009). There were no significant differences in QoL. CONCLUSIONS Conventional-dose SRT to the prostate bed is sufficient in patients with early biochemical progression of prostate cancer after RP. PATIENT SUMMARY The optimal radiation therapy dose for patients who have increased tumor markers after surgery for prostate cancer is unclear. We found that administering a higher dose only increased the gastrointestinal side effects without providing any benefits to the patient. This clinical trial is registered on ClinicalTrials.gov as NCT01272050.
Collapse
Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
| | | | - Jürg Bernhard
- IBCSG Coordinating Center, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Tobias Hölscher
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Gut
- Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | | | - Ludwig Plasswilm
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | | | - Marcin Sumila
- Department of Radiation Oncology, Hirslanden Hospital Group, Zürich, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Department of Radiation Oncology, Stadtspital Triemli, Zürich, Switzerland
| | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Christiane Reuter
- Department of Radiation Oncology, Kantonsspital Münsterlingen, Switzerland
| | - Davide G Bosetti
- Department of Radiation Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Hôpital Valais, Sion, Switzerland
| | - Silvia Gomez
- Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - George N Thalmann
- Department of Urology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | | |
Collapse
|
5
|
Beck M, Ghadjar P, Mehrhof F, Zips D, Paulsen F, Wegener D, Burock S, Kaul D, Stromberger C, Nadobny J, Ott OJ, Fietkau R, Budach V, Wust P, Müller AC, Zschaeck S. Salvage-Radiation Therapy and Regional Hyperthermia for Biochemically Recurrent Prostate Cancer after Radical Prostatectomy (Results of the Planned Interim Analysis). Cancers (Basel) 2021; 13:cancers13051133. [PMID: 33800872 PMCID: PMC7961934 DOI: 10.3390/cancers13051133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Several efforts like dose-escalated salvage radiation therapy and the use of androgen deprivation therapy aimed to improve the postoperative treatment in patients with biochemical recurrence of prostate cancer after prostatectomy. However, the oncological outcome is still not satisfactory. Hyperthermia is well-known to improve the efficacy of radiation therapy, whereas only limited data for postoperative therapy in prostate cancer are available. Thus, we conducted a prospective multicenter non-randomized Phase-II-Trial (HTProstate) investigating the implementation of combined salvage radiation therapy and regional hyperthermia in case of biochemical recurrence after prostatectomy with the aim to evaluate the safety, feasibility, and oncological outcome of this approach. The results of our planned interim analysis (n = 50) met the criteria of safety (only one patient with acute grade 3 hyperthermia-specific toxicity), showed feasibility of planned radiation and hyperthermia therapy, no significant changes in quality of life and promising short-term prostate-specific antigen response. Late toxicity and robust oncological outcome data will be reported after completion of the trial. Abstract Efforts to improve the outcome of prostate cancer (PC) patients after radical prostatectomy (RP) include adjuvant or salvage radiation therapy (SRT), but still up to 50% of patients develop a disease progression after radiotherapy (RT). Regional hyperthermia (HT) is well-known to improve tumor sensitivity to RT in several entities. Here we report on a planned interim analysis of tolerability and feasibility after recruitment of the first 50 patients of a trial combining SRT and HT. We conducted a prospective multicenter non-randomized Phase-II-Trial (HTProstate-NCT04159051) investigating the implementation of combined moderate-dose escalated SRT (70 Gy in 35 fractions) and locoregional deep HT (7–10 HT sessions). The primary endpoints were the rate of acute genitourinary (GU), gastrointestinal (GI), and HT-related toxicities, completed HT sessions (≥7), and SRT applications per protocol (≥95% of patients). The two-step design included a planned interim analysis for acute GU-, GI- and HT-specific toxicities to ensure patients’ safety. Between November 2016 and December 2019, 52 patients entered into the trial. After 50 patients completed therapy and three months of follow-up, we performed the planned interim analysis. 10% of patients developed acute grade 2 GU and 4% grade 2 GI toxicities. No grade ≥3 GU or GI toxicities occurred. HT-specific symptoms grade 2 and 3 were observed in 4% and 2% of all patients. Thus, the pre-specified criteria for safety and continuation of recruitment were met. Moreover, ≥7 HT treatments were applicable, indicating the combination of SRT + HT to be feasible. Evaluation of early QoL showed no significant changes. With its observed low rate of GU and GI toxicities, moderate and manageable rates of HT-specific symptoms, and good feasibility, the combined SRT + HT seems to be a promising treatment approach for biochemical recurrence after RP in PC patients.
Collapse
Affiliation(s)
- Marcus Beck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
- Correspondence: ; Tel.: +49-30-450-627-343; Fax: +49-30-450-7527343
| | - Pirus Ghadjar
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Felix Mehrhof
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Susen Burock
- Charité Comprehensive Cancer Center, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - David Kaul
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Carmen Stromberger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Jacek Nadobny
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Oliver J. Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (O.J.O.); (R.F.)
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (O.J.O.); (R.F.)
| | - Volker Budach
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Peter Wust
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
| | - Arndt-Christian Müller
- Department of Radiation Oncology, University Hospital Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (D.Z.); (F.P.); (D.W.); (A.-C.M.)
| | - Sebastian Zschaeck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany; (P.G.); (F.M.); (D.K.); (C.S.); (J.N.); (V.B.); (P.W.); (S.Z.)
- Berlin Institute of Health, 10117 Berlin, Germany
| |
Collapse
|
6
|
Diagnostic Performance of [ 18F]Fluorocholine and [ 68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study. J Clin Med 2020; 9:jcm9072308. [PMID: 32708097 PMCID: PMC7408886 DOI: 10.3390/jcm9072308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022] Open
Abstract
The current study endeavored to closely compare the detection rate of 68-Gallium labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA) versus [18F]Fluorocholine in men with prostate cancer (PC), to investigate the benefits and pitfalls of each modality in the setting of various patient characteristics. We retrospectively analyzed 29 biopsy-proven PC patients in two categories, staging and restaging, who underwent both scans within a maximum of 30 days of each other. Variables including patient demographics, prostate specific antigen (PSA) level, Gleason score, clinical course, and following treatments were recorded. The number and location of suspicious lesions as well as uptake values were noted. A total of 148 suspicious lesions were detected, of which 70.9% (105/148) were concordantly visualized in both imaging modalities. [68Ga]Ga-PSMA positron emission tomography/computed tomography (PET/CT) revealed a higher number of metastatic lesions per patients (91% vs 78%). The mean of maximum standardized uptake value (SUV max) in concordant lesions was significantly higher in [68Ga]Ga-PSMA compared to [18F]Fluorocholine PET/CT (14.6 ± 8.44 vs. 6.9 ± 3.4, p = 0.001). Discordant lesions were detected by both modalities, but more frequently by [68Ga]Ga-PSMA PET/CT (20.3% in [68Ga]Ga-PSMA versus 8.8% by [18F]Fluorocholine PET/CT). In patients with PSA levels below 1.0 ng/mL and <2.0 ng/mL, [18F]Fluorocholine PET/CT detection rate was half (57% and 55%, respectively) that of [68Ga]Ga-PSMA PET/CT. Tumor, nodes and metastases (TNM) staging, and subsequently patient management, was only influenced in 4/29 patients (14%), particularly by [68Ga]Ga-PSMA PET/CT with PSA values under 0.5 ng/mL. [68Ga]Ga-PSMA PET/CT revealed superior diagnostic performance to [18F]Fluorocholine PET/CT in staging and restaging of PC patients, especially in cases with low PSA levels. However, in a few hormone resistant high-risk PC patients, [18F]Fluorocholine PET/CT may improve overall diagnostic accuracy.
Collapse
|
7
|
Li X, Huang H, Zhang J, Jiang F, Guo Y, Shi Y, Guo Z, Ao L. A qualitative transcriptional signature for predicting the biochemical recurrence risk of prostate cancer patients after radical prostatectomy. Prostate 2020; 80:376-387. [PMID: 31961962 PMCID: PMC7065139 DOI: 10.1002/pros.23952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The qualitative transcriptional characteristics, the within-sample relative expression orderings (REOs) of genes, are highly robust against batch effects and sample quality variations. Hence, we develop a qualitative transcriptional signature based on REOs to predict the biochemical recurrence risk of prostate cancer (PCa) patients after radical prostatectomy. METHODS Gene pairs with REOs significantly correlated with the biochemical recurrence-free survival (BFS) were identified from 131 PCa samples in the training data set. From these gene pairs, we selected a qualitative transcriptional signature based on the within-sample REOs of gene pairs which could predict the recurrence risk of PCa patients after radical prostatectomy. RESULTS A signature consisting of 74 gene pairs, named 74-GPS, was developed for predicting the recurrence risk of PCa patients after radical prostatectomy based on the majority voting rule that a sample was assigned as high risk when at least 37 gene pairs of the 74-GPS voted for high risk; otherwise, low risk. The signature was validated in six independent datasets produced by different platforms. In each of the validation datasets, the Kaplan-Meier survival analysis showed that the average BFS of the low-risk group was significantly better than that of the high-risk group. Analyses of multiomics data of PCa samples from TCGA suggested that both the epigenomic and genomic alternations could cause the reproducible transcriptional differences between the two different prognostic groups. CONCLUSIONS The proposed qualitative transcriptional signature can robustly stratify PCa patients after radical prostatectomy into two groups with different recurrence risk and distinct multiomics characteristics. Hence, 74-GPS may serve as a helpful tool for guiding the management of PCa patients with radical prostatectomy at the individual level.
Collapse
Affiliation(s)
- Xiang Li
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
- Key Laboratory of Medical BioinformaticsFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Haiyan Huang
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Jiahui Zhang
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Fengle Jiang
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Yating Guo
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Yidan Shi
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Zheng Guo
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
- Key Laboratory of Medical BioinformaticsFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Lu Ao
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical SciencesFujian Medical UniversityFuzhouChina
- Key Laboratory of Medical BioinformaticsFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| |
Collapse
|
8
|
Pizzuto DA, Annunziata S, Ieria FP, Caldarella C, Isgrò MA, Lanni V, Bencivenga G, Rufini V, Giordano A. Lung uptake of fluorine-18 fluoroethyl-choline PET-CT in patients with prostate cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 63:387-393. [PMID: 29345442 DOI: 10.23736/s1824-4785.18.02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Metastatic spreading to the lungs is a negative prognostic factor in patients with prostate cancer (PC). Aim of our study was to assess the prevalence of lung PC metastases in patients with fluorine-18 fluoroethyl-choline (F-18-FECh) PET-CT positive lung lesions and the role of Gleason Score (GS) and common biochemical markers in predicting metastatic spreading to the lungs. METHODS We retrospectively evaluated the scans of 1283 patients ongoing (F-18-FECh) PET-CT for PC between May 2010 and July 2014. Patients with lung lesion with F-18-FECh uptake were included. Data concerning GS at diagnosis, "trigger" prostate-specific antigen (PSAtr), PSA doubling time (PSAdt), PSA velocity (PSAvel) and ongoing androgen deprivation therapy were collected. PET-CT findings were confirmed by histology or follow-up (FU) and classified as follows: inflammation, primary lung cancer or metastases from tumor other than PC, and lung metastases from PC. RESULTS Twenty-two patients with F-18-FECh positive lung lesion and available histology or FU were identified. PSAdt was significantly (P=0.029) shorter in patients with lung metastases from PC (median PSAdt 1.7 months, interquartile range [IQR] 1.5-4.1 months) than in patients without lung PC relapse (median PSAdt 6.7 months, IQR 3.9-7.8); PSAvel was significantly (P=0.019) higher in patients with lung metastases from PC (median PSAvel 3.2 ng/mL/month, IQR 0.65-6.65 ng/mL/month) than in patients without lung PC relapse (median PSAvel 0.3 ng/mL/month, IQR 0.2-0.5 ng/mL/month). Patients with lung metastases from PC had significantly (P=0.006) higher GS at diagnosis (median GS 8) than the other ones (median GS 7). CONCLUSIONS Our analysis shows that the prevalence of F-18-FECh positive lung metastases in patients with PC, especially with higher GS at diagnosis, is higher in presence of a steady increase in PSA values, confirmed by higher PSAvel and shorter PSAdt.
Collapse
Affiliation(s)
- Daniele A Pizzuto
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Salvatore Annunziata
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco P Ieria
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Caldarella
- Unit of Nuclear Medicine, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Maria A Isgrò
- Chemical-Clinical and Hematologic Analysis Laboratory, Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Valerio Lanni
- Unit of Nuclear Medicine, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Gaia Bencivenga
- PET-CT Center, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Vittoria Rufini
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
9
|
Kim R, Kim CK, Park JJ, Kim JH, Seo SI, Jeon SS, Lee HM. Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2. Korean J Radiol 2019; 20:256-264. [PMID: 30672165 PMCID: PMC6342765 DOI: 10.3348/kjr.2018.0613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To retrospectively determine whether the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) helps predict long-term outcomes for prostate cancer (PCa) patients following radical prostatectomy (RP). Materials and Methods A total of 166 patients with localized PCa evaluated with multiparametric magnetic resonance imaging (mpMRI) at 3T before RP were enrolled. Three groups were created based on PI-RADS v2 score used to predict clinical outcomes: group A, ≥ 3; group B, ≥ 4; group C, 5. We calculated biochemical recurrence-free survival (RFS) and progression-free survival (PFS). Cox proportion hazards models were used to identify variables predictive of biochemical recurrence and disease progression. Results During a median follow-up of 9.1 years, biochemical recurrence occurred in 67 patients (40.4%) and disease progression occurred in 55 patients (33.1%). In all groups, 10-year RFS and 10-year PFS were significantly lower for PI-RADS scores ≥ 3, ≥ 4 and 5 than for score < 3, < 4 and < 5 (p <0.05), respectively. In multivariate analysis, PI-RADS score ≥ 3 and score 5 were significant independent risk marker for biochemical recurrence (hazard ratio [HR] = 5.58, p = 0.018; HR = 1.75, p = 0.033) and disease progression (HR = 3.99, p = 0.047; HR = 2.31, p = 0.040). Moderate inter-observer agreement was seen for PI-RADS scoring. Conclusion PI-RADS v2 may be used to predict long-term outcomes following RP in PCa.
Collapse
Affiliation(s)
- Ran Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Jung Jae Park
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Hun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Rousseau C, Le Thiec M, Ferrer L, Rusu D, Rauscher A, Maucherat B, Frindel M, Baumgartner P, Fleury V, Denis A, Morel A, Varmenot N, Debeaupuis E, Campion L, Kraeber-Bodéré F. Preliminary results of a 68 Ga-PSMA PET/CT prospective study in prostate cancer patients with occult recurrence: Diagnostic performance and impact on therapeutic decision-making. Prostate 2019; 79:1514-1522. [PMID: 31421657 DOI: 10.1002/pros.23869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this prospective study (NCT03443609), we investigated the impact of 68Ga-PSMA-11 PET-CT on the treatment plan and therapeutic response obtained for patients with prostate cancer (PCa) presenting a recurrence with a low rising PSA. METHODS One hundred thirty hormone-naive (PSA < 1.5 ng/mL) patients were enrolled. All patients received radical treatment. PET images were recorded 1 and 2 hours after injection of tracer and interpreted by two independent nuclear physicians. Six months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. RESULTS Data analysis for the first 52 included patients has been completed. 68Ga-PSMA-11-positive lesions were detected in 38/52 (73.1%) patients. Ninety-four lesions were detected as follows, 53/94 in lymph nodes (56.4%), 25/94 in bone (26.6%), and 12/94 into the prostate bed (12.7%). Detection rates were 58%, 81%, and 82% for serum PSA levels lower than 0.25 ng/mL, between 0.25 to ≤ 0.69 ng/mL and 0.70 ng/mL, respectively. As a result of the PSMA PET-CT, therapeutic management changed in 38/52 patients (73.1%). Patients had undetectable serum PSA levels after treatment guided by 68Ga-PSMA-11 PET-CT results in 10/52 (19.2%) cases and with a PSA decrease of over 60% in 18/52 (34.6%) patients. CONCLUSION Whilst our patient population presented a very low PSA level, preliminary results of the 68Ga-PSMA PET-CT study showed recurrence localization in more than half of the patients and this had a major clinical impact, as it resulted in treatment change in more than half of the patients and a significant decrease in PSA levels in a third of patients.
Collapse
Affiliation(s)
- Caroline Rousseau
- Department of Nuclear Medicine, ICO Cancer Center
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
| | | | - Ludovic Ferrer
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Physics, ICO Cancer Center
| | - Daniela Rusu
- Department of Nuclear Medicine, ICO Cancer Center
| | | | | | | | | | | | | | - Agnes Morel
- Department of Nuclear Medicine, ICO Cancer Center
| | - Nicolas Varmenot
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Physics, ICO Cancer Center
| | | | - Loic Campion
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Biometrics, ICO Cancer Center, Nantes, France
| | - Francoise Kraeber-Bodéré
- Department of Nuclear Medicine, ICO Cancer Center
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
| |
Collapse
|
11
|
Wan S, Xi M, Zhao HB, Hua W, Liu YL, Zhou YL, Zhuo YJ, Liu ZZ, Cai ZD, Wan YP, Zhong WD. HMGCS2 functions as a tumor suppressor and has a prognostic impact in prostate cancer. Pathol Res Pract 2019; 215:152464. [DOI: 10.1016/j.prp.2019.152464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 12/28/2022]
|
12
|
Barbaud M, Frindel M, Ferrer L, Le Thiec M, Rusu D, Rauscher A, Maucherat B, Baumgartner P, Fleury V, Colombié M, Thierry-Morel A, Kraeber-Bodéré F, Campion L, Rousseau C. 68Ga-PSMA-11 PET-CT study in prostate cancer patients with biochemical recurrence and non-contributive 18F-Choline PET-CT: Impact on therapeutic decision-making and biomarker changes. Prostate 2019; 79:454-461. [PMID: 30549066 DOI: 10.1002/pros.23751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND In this retrospective study, we investigated the impact of 68 Ga-PSMA-11 PET-CT (PSMA PET-CT) upon the treatment plan and therapeutic response obtained for Prostate Cancer (PCa) patients presenting an occult biochemical recurrence. METHODS Forty-two patients with previously negative or doubtful 18F-Choline (FCH) were enrolled. PET images were recorded 1 h after injection of tracer. Only a few months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. RESULTS PSMA-positive lesions were detected in 34/42 (80.9%) patients. Detection rates were 85.7% and 89.3% for serum PSA levels lower than 2 ng/mL, and >2 ng/mL, respectively. One hundred seventy-three lesions were detected: 132/173 in lymph nodes (76.3%), 22/173 as metastatic sites (bone or lung) (12.7%), and 19/173 in the prostate bed (10.9%). As a result of the PSMA PET-CT, therapeutic management changed in 31/42 patients (73.8%). With a follow-up of 4.9 ± 2.27 months, 32/42 (76.2%) PSA assays after treatment guided by PSMA PET-CT were collected. For 37.5% (12/32) of patients, the serum PSA level was lower than 0.2 ng/mL and a PSA decrease of over 50% in 8 (25.0%) other patients were obtained. CONCLUSION Performing a PSMA PET-CT when FCH PET-CT was doubtful or negative allows the recurrence localization in more 80% of patients and this had a major clinical impact, as it resulted in treatment change in more than 70% of patients as well as a significant decrease in PSA levels in more than 60% of them.
Collapse
Affiliation(s)
- Matthieu Barbaud
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Mathieu Frindel
- Pharmacy Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Ludovic Ferrer
- Physics Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, Pays de la Loire, France
| | - Maelle Le Thiec
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Daniela Rusu
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Aurore Rauscher
- Pharmacy Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Bruno Maucherat
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Pierre Baumgartner
- Pharmacy Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Vincent Fleury
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Mathilde Colombié
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Agnes Thierry-Morel
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
| | - Françoise Kraeber-Bodéré
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, Pays de la Loire, France
| | - Loïc Campion
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, Pays de la Loire, France
- Biometrics Unit, ICO Cancer Center, Nantes, France
| | - Caroline Rousseau
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, Pays de la Loire, France
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, Pays de la Loire, France
| |
Collapse
|
13
|
Schwenck J, Olthof SC, Pfannenberg C, Reischl G, Wegener D, Marzec J, Bedke J, Stenzl A, Nikolaou K, la Fougère C, Zips D, Müller AC. Intention-to-Treat Analysis of 68Ga-PSMA and 11C-Choline PET/CT Versus CT for Prostate Cancer Recurrence After Surgery. J Nucl Med 2019; 60:1359-1365. [DOI: 10.2967/jnumed.118.224543] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
|
14
|
Shelan M, Odermatt S, Bojaxhiu B, Nguyen DP, Thalmann GN, Aebersold DM, Dal Pra A. Disease Control With Delayed Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy. Front Oncol 2019; 9:12. [PMID: 30873377 PMCID: PMC6403145 DOI: 10.3389/fonc.2019.00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose: To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP). Material and Methods: We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64-66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72-74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03. Results: Median time from RP to SRT was 66 months (IQR: 32-124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9-6.5). Median follow-up after SRT was 38 months (IQR: 24-66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5-165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%). Conclusions: Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention.
Collapse
Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seline Odermatt
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel P. Nguyen
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George N. Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
15
|
|
16
|
van Dessel LF, Reuvers SHM, Bangma CH, Aluwini S. Salvage radiotherapy after radical prostatectomy: Long-term results of urinary incontinence, toxicity and treatment outcomes. Clin Transl Radiat Oncol 2018; 11:26-32. [PMID: 30014044 PMCID: PMC6019864 DOI: 10.1016/j.ctro.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/08/2022] Open
Abstract
We report on long-term toxicity of salvage radiotherapy with a focus on incontinence. Salvage radiotherapy results in good long-term biochemical control. Toxicity and urinary incontinence rates are high after salvage radiotherapy.
Purpose For patients with local recurrent disease after radical prostatectomy (35–54%) salvage radiotherapy (SRT) is the treatment of choice. In the post prostatectomy setting, SRT may impose risk at increased toxicity. As data on long-term toxicity, especially on urinary incontinence, are scarce, we report on the long-term treatment outcomes, toxicity and urinary incontinence rates after SRT. Materials and methods Patients with biochemically recurrent prostate cancer after radical prostatectomy, who were treated with SRT (3D-CRT) at our institution between 1998 and 2012, were included in this retrospective cohort analysis. Primary endpoint was urinary incontinence rate. Secondary endpoints were acute and late grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicity rates, biochemical progression-free survival (bPFS), distant metastasis-free survival (DMFS), disease specific survival (DSS), and overall survival (OS). Results 244 patients were included. Median follow-up after SRT was 50 months (range: 4–187 months). Before start of SRT 69.7% of patients were continent for urine. After SRT de novo urinary incontinence complaints (grade ≥ 1) occurred in the respective acute and late phase in 6.1% and 17.6% of patients. Respective acute grade ≥2 GU and GI toxicity was 19.2% and 17.6%. Late grade ≥2 toxicity for GU was 29.9% and for GI was 21.3%, respectively. The respective 5-year bPFS, OS, DSS and DMFS rates were 47.6%, 91.8%, 98.8% and 80.5%. Conclusions Experience at our institution with SRT demonstrates that this results in good long-term biochemical control. However, toxicity and urinary incontinence rates were high.
Collapse
Key Words
- AMS, American medical systems
- CTCAE, common terminology criteria for adverse events
- DMFS, distant metastasis–free survival
- DSS, disease specific survival
- GI, gastrointestinal
- GU, genitourinary
- Gy, gray
- IMRT, intensity-modulated radiotherapy technique
- OS, overall survival
- PSA, prostate specific antigen
- Prostatic neoplasms
- RTOG, radiation therapy oncology group
- Radiotherapy
- SRT, salvage radiotherapy
- Salvage therapy
- Toxicity
- Urinary incontinence
- bPFS, biochemical progression-free survival
Collapse
Affiliation(s)
- Lisanne F van Dessel
- Department of Experimental Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sarah H M Reuvers
- Department of Urology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
17
|
Radiosensitization by the investigational NEDD8-activating enzyme inhibitor MLN4924 (pevonedistat) in hormone-resistant prostate cancer cells. Oncotarget 2018; 7:38380-38391. [PMID: 27224919 PMCID: PMC5122397 DOI: 10.18632/oncotarget.9526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/01/2016] [Indexed: 12/11/2022] Open
Abstract
Salvage radiotherapy (SRT) is the first-line treatment for prostate cancer patients with biochemical recurrence following radical prostatectomy, and new specific radiosensitizers are in urgent need to enhance SRT effect. MLN4924 (also known as Pevonedistat), a specific inhibitor of NEDD8-activating enzyme, has recently entered phase I/II clinical trials in several malignancies. By inhibiting cullin neddylation, MLN4924 inactivates Cullin-RING ligases (CRL), which have been validated as an attractive radiosensitizing target. In our study, we demonstrate that MLN4924 can be used as a potent radiosensitizer in hormone-resistant prostate cancer cells. We found that MLN4924 inhibited cullin neddylation and sensitized prostate cancer cells to irradiation (IR). Mechanistically, MLN4924 enhanced IR-induced G2 cell-cycle arrest, by inducing accumulation of WEE1/p21/p27, three well-known CRL substrates. Importantly, siRNA knockdown of WEE1/p21/p27 partially abrogated MLN4924-induced G2 cell-cycle arrest, indicating a causal role of WEE1/p21/p27 in MLN4924-induced radiosensitization. Further mechanistic studies revealed that induction of DNA damage and apoptosis also contributed to MLN4924 radiosensitization in hormone-resistant prostate cancer cells. Our findings lay the foundation for future application of MLN4924 as a potential radiosensitizer in hormone refractory prostate cancer (HRPC).
Collapse
|
18
|
Use of androgen deprivation and salvage radiation therapy for patients with prostate cancer and biochemical recurrence after prostatectomy. Strahlenther Onkol 2018; 194:619-626. [PMID: 29383406 DOI: 10.1007/s00066-018-1269-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/16/2018] [Indexed: 01/18/2023]
Abstract
AIM Overview on the use of androgen deprivation therapy (ADT) added to salvage radiation therapy (SRT) for prostate cancer patients with biochemical recurrence after prostatectomy. METHODS The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published between January 2009 and May 2017, and assessed the validity of the information on outcome parameters including overall survival (OS) and treatment-related toxicity. RESULTS Two randomized controlled trials and nine relevant retrospective analyses were identified. The RTOG 9601 trial showed an OS improvement for the combination of 2 years of bicalutamide and SRT compared to SRT alone after a median follow-up of 13 years. This improvement appeared to be restricted to those patients with a prostate specific antigen (PSA) level before SRT of ≥0.7 ng/mL. The GETUG AFU-16 trial showed that after a median follow-up of 5 years, the addition of 6 months of goserelin to SRT improved progression-free survival (PFS; based on biochemical recurrence) as compared to SRT alone. ADT in both trials was not associated with increased major late toxicities. Results of retrospective series were inconsistent with a suggestion that the addition of ADT improved biochemical PFS especially in patients with high-risk factors such as Gleason Score ≥8 and in the group with initially negative surgical margins. CONCLUSIONS ADT combined with SRT appears to improve OS in patients with a PSA level before SRT of ≥0.7 ng/mL. In patients without persistent PSA after prostatectomy and PSA levels of <0.7 ng/mL, ADT should not routinely be used, but may be considered in patients with additional risk factors such as Gleason Score ≥8 and negative surgical margins.
Collapse
|
19
|
Liang Y, Zhuo Y, Lin Z, Jiang F, Dai Q, Lu J, Dong W, Zhu X, Han Z, Zhong W. Decreased Expression of MYPT1 Contributes to Tumor Angiogenesis and Poor Patient Prognosis in Human Prostate Cancer. Curr Mol Med 2018; 18:100-108. [PMID: 29974831 PMCID: PMC6302349 DOI: 10.2174/1566524018666180705111342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Our previous study demonstrated that Myosin Phosphatase Targeting subunit 1 (MYPT1) may function as a direct target of microRNA-30d, which promotes tumor angiogenesis and tumor growth of prostate cancer (PCa). Here, we aimed to investigate the clinical significance of MYPT1 expression and its functions in PCa. METHODS Roles of MYPT1 deregulation in tumor angiogenesis of PCa was determined in vitro and in vivo experiments. Expression patterns of MYPT1 and CD31 proteins were examined by immunohistochemistry and immunofluorescence, respectively. Associations of MYPT1/CD31 combination with various clinicopathological features and patients' prognosis of PCa were also statistically evaluated. RESULTS Through gain- and loss-of-function experiments, MYPT1 inhibited capillary tube formation of endothelial cells and in vivo tumor angiogenesis in a mouse model with the downregulation of VEGF and CD31 expression. In addition, MYPT1 expression was significantly decreased, while CD31 expression was dramatically increased in PCa tissues compared to benign prostate tissues. Notably, MYPT1 expression levels in PCa tissues were negatively correlated with that of CD31. Statistically, MYPT1-low/CD31- high expression was distinctly associated with high Gleason score, positive biochemical recurrence, and reduced overall survival of PCa patients. Moreover, PCa patients with MYPT1-low/CD31-high expression more frequently had shorter overall, biochemical recurrence-free and metastasis-free survivals. MYPT1/CD31 combination was identified as an independent factor to predict biochemical recurrence-free and metastasis-free survivals of PCa patients. CONCLUSIONS Our findings indicate that MYPT1 may inhibit angiogenesis and contribute favorable prognosis in PCa patients, implying that MYPT1 might be a potential drug candidate in anticancer therapy.
Collapse
Affiliation(s)
- Y Liang
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Y Zhuo
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Z Lin
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - F Jiang
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Q Dai
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - J Lu
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - W Dong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - X Zhu
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Z Han
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - W Zhong
- Department of Urology, Guangzhou First People's Hospital, The Second Affliated Hospital of South China University of Technology, South China University of Technology, Guangzhou, Guangdong 510180, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, China
| |
Collapse
|
20
|
Docetaxel and mitoxantrone before radical prostatectomy in men with high-risk prostate cancer: 10-year follow-up and immune correlates. Anticancer Drugs 2017; 28:120-126. [PMID: 27669423 DOI: 10.1097/cad.0000000000000438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aims of this study were to report the clinical outcomes in a cohort of men with high-risk prostate cancer treated with neoadjuvant docetaxel and mitoxantrone 10 years after treatment, identify pretreatment clinical parameters that may be predictors of recurrence, and describe tumor-infiltrating leukocytes present in radical prostatectomy specimens. We conducted a phase I/II study of neoadjuvant docetaxel and mitoxantrone before radical prostatectomy in high-risk localized prostate cancer to determine the feasibility of this combination and predictors of prostate cancer recurrence after cytotoxic chemotherapy. After 10 years of follow-up, 34 (63%) of 54 participants experience a recurrence. In univariate analysis, prostate-specific antigen (PSA) density (P=0.01), pathological stage (P=0.03), lymph node status (P<0.0001), seminal vesicle invasion (P=0.003), and tissue vascular endothelial growth factor (VEGF) expression (P=0.016) were significantly associated with recurrence. In multivariate analysis, only lymph node status, PSA density, and VEGF expression were significant predictors of disease recurrence. We used a tissue microarray for the first 50 participants to characterize the tumor-infiltrating lymphocytes and evaluate them for association with recurrence. We measured CD3, CD4, CD8, FoxP3, CD20, CD15, CD68, and CD163 by immunohistochemistry in both tumor and normal prostate specimens, but did not find an association between immunophenotype and recurrence. There was a significantly different density of CD68 and CD163 cells between normal and tumor tissue. Lymph node status, PSA density, and tissue VEGF expression predict recurrence after chemotherapy for high-risk prostate cancer. Additional studies are needed to determine the potential benefit of chemotherapy in the neoadjuvant setting.
Collapse
|
21
|
Beck M, Wust P, Barelkowski T, Kaul D, Thieme AH, Wecker S, Wlodarczyk W, Budach V, Ghadjar P. Risk adapted dose-intensified postoperative radiation therapy in prostate cancer patients using a simultaneous integrated boost technique applied with helical Tomotherapy. Radiat Oncol 2017; 12:125. [PMID: 28793907 PMCID: PMC5551002 DOI: 10.1186/s13014-017-0862-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Postoperative adjuvant radiation therapy (ART) in T3 and R1 prostate cancer as well as salvage radiation therapy (SRT) in case of postoperative biochemical failure (BF) are established treatments. Dose-intensified postoperative radiation therapy (RT) schemes have shown superior biochemical control accompanied by increased toxicity rates. In our study we evaluate a novel risk adapted dose-intensified postoperative RT scheme. Methods A consecutive series of prostate cancer patients receiving postoperative RT after radical prostatectomy using helical Tomotherapy between 04/2012 and 04/2015 was analyzed retrospectively. RT was administered using a simultaneous integrated boost (SIB) to the area at risk (37 fractions of 1.9 Gy, total dose: 70.3 Gy) being defined based on histopathological findings (T3/R1 region) and in few cases according to additional diagnostic imaging. The whole prostate bed was treated with a dose of 66.6 Gy (37 fractions of 1.8 Gy). Primary endpoints were acute and late genitourinary (GU) and gastrointestinal (GI) toxicities. Secondary endpoints included patient reported outcome as assessed by the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence questionnaire (ICIQ) and prostate cancer specific Quality of Life questionnaire QLQ-PR25, as well as rates of BF. Results A total of 69 patients were analyzed. Sixteen patients underwent ART and 53 patients SRT, respectively. The median follow-up was 20 months (range, 8–41 months). Seven (10.1%) and four (5.8%) patients experienced acute grade 2 GU and GI toxicity. Two patients (2.9%) had late grade 2 GU toxicity, whereas no late grade 2 GI nor any grade 3 acute or late GU or GI events were observed. When compared to the baseline IPSS scores (p = 1.0) and ICIQ scores (p = 0.87) were not significantly different at the end of follow-up. Patient reported Quality of life (QoL) showed also no significant difference. A total of seven patients (10.1%) experienced a biochemical recurrence with the 2-year biochemical progression-free survival (bPFS) being 91%. Conclusions Postoperative RT for prostate cancer patients with a risk adapted dose-intensified SIB using helical tomotherapy is feasible and associated with favorable acute and late GU and GI toxicity rates, no significant change of IPSS-, ICIQ scores and patient reported QoL and results in promising bPFS rates.
Collapse
Affiliation(s)
- Marcus Beck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tomasz Barelkowski
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexander-Henry Thieme
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sascha Wecker
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Waldemar Wlodarczyk
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
22
|
Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy. Strahlenther Onkol 2017; 194:9-16. [DOI: 10.1007/s00066-017-1172-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
|
23
|
Khan M, Davidson AJ, McKinley M, Ischia J. Isolated prostate cancer soft tissue recurrence 10 years after radical prostatectomy. BMJ Case Rep 2017; 2017:bcr-2017-220140. [PMID: 28500118 DOI: 10.1136/bcr-2017-220140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In advanced disease, prostate cancer is well known to invade locally as well as metastasise to distant locations. Metastases occur commonly in lymph nodes and bone but have also been known to involve certain visceral organs, particularly the lungs. Involvement of soft tissue by metastases is far less common, particularly in the context of cancer recurrence. We present the case of a male aged 68 years who presented with a rising prostate-specific antigen (PSA) 10 years after radical prostatectomy (RP). The PSA increased despite salvage radiotherapy and was ultimately found to be caused by a PSA secreting prostate cancer soft tissue mass in the suprapubic region. Surgical resection of the mass caused a sharp decline in the PSA to negligible levels. This case highlights the need for ongoing surveillance post-RP and the potential for prostate cancer recurrence in the soft tissue that is refractory to routine salvage radiotherapy.
Collapse
Affiliation(s)
- Munad Khan
- Urology, Austin Health, Heidleberg, Victoria, Australia
| | | | | | - Joseph Ischia
- Urology, Austin Health, Heidleberg, Victoria, Australia
| |
Collapse
|
24
|
|
25
|
Abstract
18F-fluorocholine (FCH) PET/computed tomography (CT) is a valuable imaging modality in prostate cancer disease. Probably, its main role is restaging of patients with biochemical recurrence after radical prostatectomy or external beam radiotherapy. 18F-FCH PET/CT is strengthening its position in the initial staging, biopsy target definition, radiotherapy planning, and therapy monitoring. Gleason score and prostate-specific antigen value, doubling time, and velocity can influence positivity of 18F-FCH PET/CT. The influence of androgen deprivation therapy on choline uptake is not precisely clarified. Collaboration between nuclear medicine physicians, radiologists, urologists, oncologists, and radiotherapists is crucial to help patients with prostate cancer disease.
Collapse
Affiliation(s)
- Marina Hodolič
- Nuclear Medicine Research Department, Iason, Graz, Austria; Department of Nuclear Medicine, Palacký University Olomouc, Olomouc, Czech Republic.
| |
Collapse
|
26
|
Lin ZY, Chen G, Zhang YQ, He HC, Liang YX, Ye JH, Liang YK, Mo RJ, Lu JM, Zhuo YJ, Zheng Y, Jiang FN, Han ZD, Wu SL, Zhong WD, Wu CL. MicroRNA-30d promotes angiogenesis and tumor growth via MYPT1/c-JUN/VEGFA pathway and predicts aggressive outcome in prostate cancer. Mol Cancer 2017; 16:48. [PMID: 28241827 PMCID: PMC5327510 DOI: 10.1186/s12943-017-0615-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Even though aberrant expression of microRNA (miR)-30d has been reported in prostate cancer (PCa), its associations with cancer progression remain contradictory. The aim of this study was to investigate clinical significance, biological functions and underlying mechanisms of miR-30d deregulation in PCa. METHODS Involvement of miR-30d deregulation in malignant phenotypes of PCa was demonstrated by clinical sample evaluation, and in vitro and in vivo experiments. The mechanisms underlying its regulatory effect on tumor angiogenesis were determined. RESULTS miR-30d over-expression was observed in both PCa cells and clinical specimens. High-miR-30d was distinctly associated with high pre-operative PSA and Gleason score, advanced clinical and pathological stages, positive metastasis and biochemical recurrence (BCR), and reduced overall survival of PCa patients. Through gain- and loss-of-function experiments, we found that miR-30d promoted PCa cell proliferation, migration, invasion, and capillary tube formation of endothelial cells, as well as in vivo tumor growth and angiogenesis in a mouse model. Simulation of myosin phosphatase targeting subunit 1 (MYPT1), acting as a direct target of miR-30d, antagonized the effects induced by miR-30d up-regulation in PCa cells. Notably, miR-30d/MYPT1 combination was identified as an independent factor to predict BCR of PCa patients. Furthermore, miR-30d exerted its pro-angiogenesis function, at least in part, by inhibiting MYPT1, which in turn, increased phosphorylation levels of c-JUN and activated VEGFA-induced signaling cascade in endothelial cells. CONCLUSIONS miR-30d and/or its target gene MYPT1 may serve as novel prognostic markers of PCa. miR-30d promotes tumor angiogenesis of PCa through MYPT1/c-JUN/VEGFA pathway.
Collapse
Affiliation(s)
- Zhuo-Yuan Lin
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
| | - Guo Chen
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
| | - Yan-Qiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Hui-Chan He
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
| | - Yu-Xiang Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
| | - Jian-Heng Ye
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Ying-Ke Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ru-Jun Mo
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jian-Ming Lu
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yang-Jia Zhuo
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Fu-Neng Jiang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
| | - Zhao-Dong Han
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China
| | - Shu-Lin Wu
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Wei-de Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China.
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510230, China.
- Graduate school of Jinan University, Guangzhou, 510632, China.
| | - Chin-Lee Wu
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, 510180, China.
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
| |
Collapse
|
27
|
Koch MO, Cho JS, Kaimakliotis HZ, Cheng L, Sangale Z, Brawer M, Welbourn W, Reid J, Stone S. Use of the cell cycle progression (CCP) score for predicting systemic disease and response to radiation of biochemical recurrence. Cancer Biomark 2017; 17:83-8. [PMID: 27314296 DOI: 10.3233/cbm-160620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Determining the optimal treatment for biochemical recurrence (BCR) after radical prostatectomy (RP) is challenging. OBJECTIVE We evaluated the ability of CCP score (a prognostic RNA expression signature) to discriminate between systemic disease and local recurrence in patients with BCR after RP. METHODS Sixty patients with BCR after RP were selected for analysis based on: 1) metastatic disease, 2) non-response to salvage external beam radiotherapy (EBRT), and 3) durable response to salvage EBRT. CCP scores were generated from the RNA expression of 46 genes. Logistic regression assessed the association between CCP score and patient group. RESULTS Passing CCP scores were generated for 47 patients with complete clinical and pathologic data. CCP score predicted clinical status when comparing patients with metastatic disease or non-responders to salvage therapy to patients with durable response (p = 0.006). CCP score remained significantly predictive of clinical status after accounting for time to BCR, PSA level at BCR, and Gleason score (p = 0.0031). CONCLUSIONS Elevated CCP score was associated with increased risk of systemic disease, indicating that CCP score may be useful in identifying patients with BCR who are most likely to benefit from salvage radiation therapy.
Collapse
Affiliation(s)
- Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jane S Cho
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Julia Reid
- Myriad Genetics, Inc. Salt Lake City, UT, USA
| | | |
Collapse
|
28
|
Change in Salvage Radiotherapy Management Based on Guidance With FACBC (Fluciclovine) PET/CT in Postprostatectomy Recurrent Prostate Cancer. Clin Nucl Med 2017; 42:e22-e28. [PMID: 27749412 DOI: 10.1097/rlu.0000000000001379] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We explored the influence of FACBC (fluciclovine) PET/CT on the decision to offer radiotherapy and radiotherapy treatment field recommendations in postprostatectomy patients with recurrent prostate cancer. PATIENTS AND METHODS After obtaining institutional review board approval and informed consent, 87 patients with detectable prostate-specific antigen (PSA) levels were recruited into a prospective clinical trial. After an initial provider-determined radiotherapy plan based on conventional imaging, 44 of 87 patients were randomized to additionally undergo fluciclovine PET/CT. Pre- and post-fluciclovine radiotherapy decisions were compared and changes were noted. Statistical significance of these decision changes was determined. RESULTS Two of 44 patients in the experimental arm dropped out before fluciclovine scanning. Thirty-four (81.0%) of 42 had positive results on fluciclovine. Overall radiotherapy decision was changed in 17 (40.5%) of 42. Mean PSA, original Gleason score, and prostatectomy-PET interval did not differ significantly between patients with and without radiotherapy decision changes. Two (4.8%) of 42 had the decision for radiotherapy withdrawn due to positive extrapelvic findings. Radiotherapy field decision was changed in 15 (35.7%) of 42. Eleven (73.3%) of 15 had fields changed from prostate bed only to both prostate bed and pelvis, while 4 (26.7%) of 15 had fields changed from both prostate bed and pelvis to prostate bed only. Changes in overall radiotherapy decision and field were statistically significant (P < 0.0001). However, the change in the decision to offer radiotherapy or not was not statistically significant (P = 0.15). CONCLUSIONS Fluciclovine PET/CT significantly changed radiotherapy management decisions in postprostatectomy patients with recurrent prostate cancer. Further work in determining differences in PSA-free survival is ongoing.
Collapse
|
29
|
Gorin MA, Rowe SP, Denmeade SR. Clinical Applications of Molecular Imaging in the Management of Prostate Cancer. PET Clin 2017; 12:185-192. [PMID: 28267452 DOI: 10.1016/j.cpet.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
At the heart of selecting an optimal management strategy for men with prostate cancer is accurately determining a given patient's clinical stage and extent of disease. Molecular imaging with PET using properly selected radiotracers offers the opportunity for improved contrast resolution over conventional imaging and thus increased sensativity for detecting sites of disease. In addition, molecular imaging provides the prospect of obtaining functional or biological information regarding a patient's cancer. To date, several PET radiotracers have been developed for prostate cancer imaging. This review summarizes the potential clinical applications of molecular imaging in the management of men with prostate cancer.
Collapse
Affiliation(s)
- Michael A Gorin
- Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 118, Baltimore, MD 21287, USA.
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Samuel R Denmeade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
30
|
Beck M, Barelkowski T, Kaul D, Wecker S, Thieme AH, Zwahlen DR, Wust P, Aebersold DM, Budach V, Ghadjar P. Role of Dose Intensification for Salvage Radiation Therapy after Radical Prostatectomy. Front Oncol 2016; 6:48. [PMID: 26973815 PMCID: PMC4771737 DOI: 10.3389/fonc.2016.00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/17/2016] [Indexed: 11/13/2022] Open
Abstract
For primary radiation therapy (RT) of prostate cancer, dose intensification is established as standard of care. Less is known on the role of dose intensification in the postprostatectomy setting for salvage RT. Thus, we aimed to identify and summarize the existing literature. In retrospective analyses, dose-intensified salvage RT showed a superior biochemical control compared to standard dose salvage radiation with favorable acute and late gastrointestinal and genitourinary toxicity rates, especially when modern radiation techniques such as intensity modulated RT were applied. We identified one randomized phase III trial addressing the potential benefits of dose-intensified salvage RT (SAKK 09/10). Recently, acute gastrointestinal and genitourinary toxicities and early quality of life data of this trial were reported, and no significant difference in acute toxicities between both treatment arms were found; however, a significant worsening of genitourinary quality of life was noted in the dose-intensified treatment arm. Whereas dose-intensified salvage RT appears to be feasible and well tolerated, the improved biochemical control rates using dose intensified RT as suggested by retrospective analyses have yet to be validated by prospective trials.
Collapse
Affiliation(s)
- Marcus Beck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Tomasz Barelkowski
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Sascha Wecker
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Alexander H Thieme
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | | | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | | | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin , Berlin , Germany
| |
Collapse
|
31
|
Guzzo TJ. Preoperative Risk Assessment. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
32
|
Ghadjar P, Hayoz S, Bernhard J, Zwahlen DR, Hölscher T, Gut P, Guckenberger M, Hildebrandt G, Müller AC, Plasswilm L, Papachristofilou A, Stalder L, Biaggi-Rudolf C, Sumila M, Kranzbühler H, Najafi Y, Ost P, Azinwi NC, Reuter C, Bodis S, Kaouthar K, Wust P, Thalmann GN, Aebersold DM. Acute Toxicity and Quality of Life After Dose-Intensified Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer After Prostatectomy: First Results of the Randomized Trial SAKK 09/10. J Clin Oncol 2015; 33:4158-66. [DOI: 10.1200/jco.2015.63.3529] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with biochemical failure (BF) after radical prostatectomy may benefit from dose-intensified salvage radiation therapy (SRT) of the prostate bed. We performed a randomized phase III trial assessing dose intensification. Patients and Methods Patients with BF but without evidence of macroscopic disease were randomly assigned to either 64 or 70 Gy. Three-dimensional conformal radiation therapy or intensity-modulated radiation therapy/rotational techniques were used. The primary end point was freedom from BF. Secondary end points were acute toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) and quality of life (QoL) according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and PR25. Results Three hundred fifty patients were enrolled between February 2011 and April 2014. Three patients withdrew informed consent, and three patients were not eligible, resulting in 344 patients age 48 to 75 years in the safety population. Thirty patients (8.7%) had grade 2 and two patients (0.6%) had grade 3 genitourinary (GU) baseline symptoms. Acute grade 2 and 3 GU toxicity was observed in 22 patients (13.0%) and one patient (0.6%), respectively, with 64 Gy and in 29 patients (16.6%) and three patients (1.7%), respectively, with 70 Gy (P = .2). Baseline grade 2 GI toxicity was observed in one patient (0.6%). Acute grade 2 and 3 GI toxicity was observed in 27 patients (16.0%) and one patient (0.6%), respectively, with 64 Gy, and in 27 patients (15.4%) and four patients (2.3%), respectively, with 70 Gy (P = .8). Changes in early QoL were minor. Patients receiving 70 Gy reported a more pronounced and clinically relevant worsening in urinary symptoms (mean difference in change score between arms, 3.6; P = .02). Conclusion Dose-intensified SRT was associated with low rates of acute grade 2 and 3 GU and GI toxicity. The impact of dose-intensified SRT on QoL was minor, except for a significantly greater worsening in urinary symptoms.
Collapse
Affiliation(s)
- Pirus Ghadjar
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Stefanie Hayoz
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Jürg Bernhard
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Daniel R. Zwahlen
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Tobias Hölscher
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Philipp Gut
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Matthias Guckenberger
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Guido Hildebrandt
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Arndt-Christian Müller
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Ludwig Plasswilm
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Alexandros Papachristofilou
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Lukas Stalder
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Christine Biaggi-Rudolf
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Marcin Sumila
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Helmut Kranzbühler
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Yousef Najafi
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Piet Ost
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Ngwa C. Azinwi
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Christiane Reuter
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Stephan Bodis
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Khanfir Kaouthar
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Peter Wust
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - George N. Thalmann
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| | - Daniel M. Aebersold
- Pirus Ghadjar, Jürg Bernhard, George N. Thalmann, and Daniel M. Aebersold, Inselspital, Bern University Hospital, and University of Bern; Stefanie Hayoz, Lukas Stalder, and Christine Biaggi-Rudolf, Swiss Group for Clinical Cancer Research Coordinating Center; Jürg Bernhard, International Breast Cancer Study Group Coordinating Center, Bern; Daniel R. Zwahlen, Kantonsspital Graubünden, Chur; Philipp Gut, Kantonsspital Luzern, Luzern; Ludwig Plasswilm, Kantonsspital St Gallen, St Gallen; Alexandros
| |
Collapse
|
33
|
Müller AC, Zips D, Heinrich V, Lamprecht U, Voigt O, Burock S, Budach V, Wust P, Ghadjar P. Regional hyperthermia and moderately dose-escalated salvage radiotherapy for recurrent prostate cancer. Protocol of a phase II trial. Radiat Oncol 2015; 10:138. [PMID: 26152590 PMCID: PMC4493985 DOI: 10.1186/s13014-015-0442-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/20/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current studies on salvage radiotherapy (sRT) investigate timing, dose-escalation and anti-hormonal treatment (ADT) for recurrent prostate cancer. These approaches could either be limited by radiation-related susceptibility of the anastomosis or by suspected side-effects of long-term ADT. A phase II protocol was developed to investigate the benefit and tolerability of regional hyperthermia with moderately dose-escalated radiotherapy. METHODS The study hypothesis is that radio-thermotherapy is a safe and feasible salvage treatment modality. The primary endpoint is safety measured by frequency of grade 3+ genitourinary (GU) and gastrointestinal (GI) adverse events (AE) according to Common Toxicity Criteria (CTC) version 4. Feasibility is defined by number of hyperthermia treatments (n ≥ 7) and feasibility of radiotherapy according to protocol. Target volume delineation is performed according to the EORTC guidelines. Radiation treatment is administered with single doses of 2 Gy 5×/week to a total dose of 70 Gy. Regional hyperthermia is given 2×/week to a total of 10 treatments. RESULTS European centres participate in the phase II trial using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The initiating centres were participants of the SAKK 09/10 study, where the same patient criteria and target volume definition (mandatory successful performed dummy run) were applied insuring a high standardisation of the study procedures. CONCLUSIONS The introduced phase II study implements highly precise image-guided radiotherapy and regional hyperthermia. If the phase II study is found to be safe and feasible, a multicenter phase III study is planned to test whether the addition of regional hyperthermia to dose-intensified sRT improves biochemical control.
Collapse
Affiliation(s)
- Arndt-Christian Müller
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Ulf Lamprecht
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Otilia Voigt
- Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Susen Burock
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
34
|
Sawada Y, Omoto K, Kohei N, Sakaguchi K, Miura M, Tanabe K. Sulfoquinovosylacylpropanediol is a novel potent radiosensitizer in prostate cancer. Int J Urol 2015; 22:590-5. [DOI: 10.1111/iju.12753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/21/2015] [Accepted: 02/11/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Yugo Sawada
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kazuya Omoto
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Naoki Kohei
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kengo Sakaguchi
- Department of Applied Biology, Faculty of Science and Technology; Tokyo University of Science; Chiba Japan
| | - Masahiko Miura
- Oral Radiation Oncology, Department of Oral Restitution, Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| |
Collapse
|
35
|
Ball MW, Partin AW, Epstein JI. Extent of Extraprostatic Extension Independently Influences Biochemical Recurrence-free Survival: Evidence for Further pT3 Subclassification. Urology 2015; 85:161-4. [DOI: 10.1016/j.urology.2014.08.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/20/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
|
36
|
Cimitan M, Evangelista L, Hodolič M, Mariani G, Baseric T, Bodanza V, Saladini G, Volterrani D, Cervino AR, Gregianin M, Puccini G, Guidoccio F, Fettich J, Borsatti E. Gleason score at diagnosis predicts the rate of detection of 18F-choline PET/CT performed when biochemical evidence indicates recurrence of prostate cancer: experience with 1,000 patients. J Nucl Med 2014; 56:209-15. [PMID: 25552670 DOI: 10.2967/jnumed.114.141887] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The objective of this study was to explore the ability of the initial Gleason score (GS) to predict the rate of detection of recurrent prostate cancer (PCa) with (18)F-choline PET/CT in a large cohort of patients. METHODS Data from 1,000 patients who had undergone (18)F-choline PET/CT because of biochemical evidence of relapse of PCa between 2004 and 2013 were retrieved from databases at 4 centers. Continuous data were compared by the Student t test or ANOVA, and categoric variables were compared by the χ(2) test. Univariable and multivariable analyses were performed by logistic regression. RESULTS The GS at diagnosis was less than or equal to 6 in 257 patients, 7 in 347 patients, and greater than 7 in 396 patients. The results of 645 PET/CT scans were positive for PCa recurrence. Eighty-one percent of the positive PET/CT results were found in patients with a PSA level of greater than or equal to 2 ng/mL, 43% were found in patients with a PSA level of 1-2 ng/mL, and 31% were found in patients with a PSA level of less than or equal to 1 ng/mL; 78.8% of patients with positive PET/CT results had a GS of greater than 7. The results of (18)F-choline PET/CT scans were negative in 300 patients; 44% had a GS of less than or equal to 6, 35% had a GS of 7, and 17% had a GS of greater than 7. PET/CT results were rated as doubtful in only 5.5% of patients (median PSA, 1.8 ng/mL). When the GS was greater than 7, the rates of detection of (18)F-choline PET/CT were 51%, 65%, and 91% for a PSA level of less than 1 ng/mL, 1-2 ng/mL, and greater than 2 ng/mL, respectively. In univariable and multivariable analyses, both a GS of 7 and a GS of greater than 7 were independent predictors for positive (18)F-choline PET/CT results (odds ratios, 0.226 and 0.330, respectively; P values for both, <0.001). CONCLUSION A high GS at diagnosis is a strong predictive factor for positive (18)F-choline PET/CT scan results for recurrent PCa, even when the PSA level is low (i.e., ≤1 ng/mL).
Collapse
Affiliation(s)
- Marino Cimitan
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, Italy
| | - Laura Evangelista
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Marina Hodolič
- Nuclear Medicine Department, University Medical Center Ljubljana, Ljubljana, Slovenia; and
| | - Giuliano Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - Tanja Baseric
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, Italy
| | - Valentina Bodanza
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, Italy
| | - Giorgio Saladini
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - Anna Rita Cervino
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Michele Gregianin
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Giulia Puccini
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | | | - Jure Fettich
- Nuclear Medicine Department, University Medical Center Ljubljana, Ljubljana, Slovenia; and
| | - Eugenio Borsatti
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, Italy
| |
Collapse
|
37
|
Moul JW, Sarno MJ, McDermed JE, Triebell MT, Reynolds MA. NADiA ProsVue Prostate-specific Antigen Slope, CAPRA-S, and Prostate Cancer–specific Survival After Radical Prostatectomy. Urology 2014; 84:1427-32. [DOI: 10.1016/j.urology.2014.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
|
38
|
Safdieh JJ, Schwartz D, Weiner J, Weiss JP, Rineer J, Madeb I, Rotman M, Schreiber D. Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy. Radiat Oncol J 2014; 32:179-86. [PMID: 25324990 PMCID: PMC4194301 DOI: 10.3857/roj.2014.32.3.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. Materials and Methods The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. Results The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). Conclusion In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.
Collapse
Affiliation(s)
- Joseph J Safdieh
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schwartz
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Weiner
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin Rineer
- University of Florida Health Cancer Center, Orlando, FL, USA
| | - Isaac Madeb
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marvin Rotman
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schreiber
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
39
|
Kobayashi N, Uemura H, Nagahama K, Okudela K, Furuya M, Ino Y, Ito Y, Hirano H, Inayama Y, Aoki I, Nagashima Y, Kubota Y, Ishiguro H. Identification of miR-30d as a novel prognostic maker of prostate cancer. Oncotarget 2013; 3:1455-71. [PMID: 23231923 PMCID: PMC3717805 DOI: 10.18632/oncotarget.696] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignant carcinoma that develops in men in Western countries. MicroRNA (miRNA) have the potential to be used as biomarkers and therapeutic targets for the treatment of various cancers. We found significantly higher expression of miR-30d in 3 PCa cell lines (PC3, DU145 and LNCaP) compared with 2 normal prostate cell lines (RWPE-1 and PrSc) using miRNA microarrays and qPCR. Clinicopathological study revealed that miR-30d expression levels were significantly higher in cancer tissue samples than in the paired normal controls (P = 0.03). Furthermore, the miR-30d−high group had shorter time to biochemical recurrence (P = 0.026). MiR-30d overexpressed PCa cells promoted proliferation and invasion in vitro. Inoculation of miR-30d depleted PCa cells dramatically reduced tumor volumes in vivo. Using reporter gene assay, we identified miR-30d as a downregulator of SOCS1 expression by directly binding to 3'-UTR of SOCS1. MiR-30d regulated the expression of phospho-STAT3, MMP-2 and MMP-9 through the downregulation of SOCS1. The levels of SOCS1 mRNA and protein were significantly down-regulated in prostate cancer tissues. Consistently, miR-30d expression was inversely correlated with SOCS1 expression (P = 0.03). The miR-30d−high/SOCS1−low group was associated with an increased risk of early biochemical recurrence (P = 0.0057). Taken together, miR-30d appears to be a novel independent prognostic marker of PCa progression that allows clinicians to identify patients who need more intensive treatments.
Collapse
Affiliation(s)
- Naohito Kobayashi
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sassowsky M, Gut P, Hölscher T, Hildebrandt G, Müller AC, Najafi Y, Kohler G, Kranzbühler H, Guckenberger M, Zwahlen DR, Azinwi NC, Plasswilm L, Takacs I, Reuter C, Sumila M, Manser P, Ost P, Böhmer D, Pilop C, Aebersold DM, Ghadjar P. Use of EORTC target definition guidelines for dose-intensified salvage radiation therapy for recurrent prostate cancer: results of the quality assurance program of the randomized trial SAKK 09/10. Int J Radiat Oncol Biol Phys 2013; 87:534-41. [PMID: 23972722 DOI: 10.1016/j.ijrobp.2013.06.2053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. METHODS AND MATERIALS A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. RESULTS Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm(3)), and decrease in the union volume (79.3 vs 84.2 cm(3)). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. CONCLUSIONS The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol.
Collapse
Affiliation(s)
- Manfred Sassowsky
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Wuethrich PY, Thalmann GN, Studer UE, Burkhard FC. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer. PLoS One 2013; 8:e72873. [PMID: 23977366 PMCID: PMC3747085 DOI: 10.1371/journal.pone.0072873] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/14/2013] [Indexed: 12/20/2022] Open
Abstract
Background A beneficial effect of regional anesthesia on cancer related outcome in various solid tumors has been proposed. The data on prostate cancer is conflicting and reports on long-term cancer specific survival are lacking. Methods In a retrospective, single-center study, outcomes of 148 consecutive patients with locally advanced prostate cancer pT3/4 who underwent retropubic radical prostatectomy (RRP) with general anesthesia combined with intra- and postoperative epidural analgesia (n=67) or with postoperative ketorolac-morphine analgesia (n=81) were reviewed. The median observation time was 14.00 years (range 10.87-17.75 yrs). Biochemical recurrence (BCR)-free, local and distant recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier technique. Multivariate Cox proportional-hazards regression models were used to analyze clinicopathologic variables associated with disease progression and death. Results The survival estimates for BCR-free, local and distant recurrence-free, cancer-specific survival and overall survival did not differ between the two groups (P=0.64, P=0.75, P=0.18, P=0.32 and P=0.07). For both groups, higher preoperative PSA (hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.01-1.02, P<0.0001), increased specimen Gleason score (HR 1.24, 95% CI 1.06-1.46, P=0.007) and positive nodal status (HR 1.66, 95% CI 1.03-2.67, P=0.04) were associated with higher risk of BCR. Increased specimen Gleason score predicted death from prostate cancer (HR 2.46, 95% CI 1.65-3.68, P<0.0001). Conclusions General anaesthesia combined with epidural analgesia did not reduce the risk of cancer progression or improve survival after RRP for prostate cancer in this group of patients at high risk for disease progression with a median observation time of 14.00 yrs.
Collapse
Affiliation(s)
- Patrick Y Wuethrich
- University Department of Anaesthesiology and Pain Therapy, University Hospital, Berne, Berne, Switzerland.
| | | | | | | |
Collapse
|
42
|
Zhong L, Pon V, Srinivas S, Nguyen N, Frear M, Kwon S, Gong C, Malmstrom R, Wilson L. Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis. PLoS One 2013; 8:e64275. [PMID: 23717582 PMCID: PMC3661482 DOI: 10.1371/journal.pone.0064275] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Docetaxel is an established first-line therapy to treat metastatic castration-resistant prostate cancer (mCRPC). Recently, abiraterone and cabazitaxel were approved for use after docetaxel failure, with improved survival. National Institute for Health and Clinical Excellence (NICE) preliminary recommendations were negative for both abiraterone (now positive in final recommendation) and cabazitaxel (negative in final recommendation). OBJECTIVE To evaluate the cost-effectiveness of abiraterone, cabazitaxel, mitoxantrone and prednisone for mCRPC treatment in US. METHODS A decision-tree model was constructed to compare the two mCRPC treatments versus two placebos over 18 months from a societal perspective. Chance nodes include baseline pain as a severity indicator, grade III/IV side-effects, and survival at 18 months. Probabilities, survival and health utilities were from published studies. Model cost inputs included drug treatment, side-effect management and prevention, radiation for pain, and death associated costs in 2010 US dollars. RESULTS Abiraterone is a cost-effective choice at $94K/QALY (quality adjusted life years) compared to placebo in our base-case analysis. Cabazitaxel and abiraterone are the most effective, yet also most expensive agents. The incremental cost-effectiveness ratios (ICER) at base-case are $101K/QALY (extended dominated) for mitoxantrone vs. placebo, $91K/QALY for abiraterone vs. mitoxantrone, $956K/QALY for cabazitaxel vs. abiraterone. Abiraterone becomes less cost-effective as its AWP increases, or if the cost of mitoxantrone side-effect management decreases. Increases in the percentage of patients with baseline pain leads to an increased ICER for both mitoxantrone and abiraterone, but mitoxantrone does relatively better. Cabazitaxel remains not cost-effective. CONCLUSION Our base case model suggests that abiraterone is a cost-effective option in docetaxel-refractory mCRPC patients. Newer treatments will also need a CEA assessment compared to abiraterone.
Collapse
Affiliation(s)
- Lixian Zhong
- University of California San Francisco, San Francisco, California, United States of America
| | - Vickie Pon
- University of California San Francisco, San Francisco, California, United States of America
| | - Sandy Srinivas
- VA Northern California, Martinez, California, United States of America
- Stanford University Medical Center, Palo Alto, California, United States of America
| | - Nicole Nguyen
- University of California San Francisco, San Francisco, California, United States of America
| | - Meghan Frear
- University of California San Francisco, San Francisco, California, United States of America
| | - Sherry Kwon
- University of California San Francisco, San Francisco, California, United States of America
| | - Cynthia Gong
- VA Northern California, Martinez, California, United States of America
| | - Robert Malmstrom
- VA Northern California, Martinez, California, United States of America
| | - Leslie Wilson
- University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
43
|
The incremental value of contrast-enhanced MRI in the detection of biopsy-proven local recurrence of prostate cancer after radical prostatectomy: effect of reader experience. AJR Am J Roentgenol 2012; 199:360-6. [PMID: 22826397 DOI: 10.2214/ajr.11.6923] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The purpose of this study is to retrospectively assess the incremental value of contrast-enhanced MRI (CE-MRI) to T2-weighted MRI in the detection of postsurgical local recurrence of prostate cancer by readers of different experience levels, using biopsy as the reference standard. MATERIALS AND METHODS Fifty-two men with biochemical recurrence after prostatectomy underwent 1.5-T endorectal MRI with multiphase contrast-enhanced imaging and had biopsy within 3 months of MRI. Two radiologists (reader 1 had 1 year and reader 2 had 6 years of experience) independently reviewed each MRI study and classified the likelihood of recurrent cancer on a 5-point scale. Areas under receiver operating characteristic curves (A(z)) were calculated to assess readers' diagnostic performance with T2-weighted MRI alone and combined with CE-MRI. Interobserver agreement was assessed using Cohen kappa statistics. RESULTS Thirty-three patients (63%) had biopsy-proven local recurrence of prostate cancer. With the addition of CE-MRI to T2-weighted imaging, the A(z) for cancer detection increased significantly for reader 1 (0.77 vs 0.85; p = 0.0435) but not for reader 2 (0.86 vs 0.88; p = 0.7294). The use of CE-MRI improved interobserver agreement from fair (κ = 0.39) to moderate (κ = 0.58). CONCLUSION CE-MRI increased interobserver agreement and offered incremental value to T2-weighted MRI in the detection of locally recurrent prostate cancer for the relatively inexperienced reader.
Collapse
|
44
|
Friedrich M, Raum T, Lutterbuese R, Voelkel M, Deegen P, Rau D, Kischel R, Hoffmann P, Brandl C, Schuhmacher J, Mueller P, Finnern R, Fuergut M, Zopf D, Slootstra JW, Baeuerle PA, Rattel B, Kufer P. Regression of human prostate cancer xenografts in mice by AMG 212/BAY2010112, a novel PSMA/CD3-Bispecific BiTE antibody cross-reactive with non-human primate antigens. Mol Cancer Ther 2012; 11:2664-73. [PMID: 23041545 DOI: 10.1158/1535-7163.mct-12-0042] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For treatment of patients with prostate cancer (PCa), we developed a novel T cell-engaging (BiTE) antibody designated AMG 212 or BAY2010112 that is bispecific for prostate-specific membrane antigen (PSMA) and the CD3 epsilon subunit of the T cell receptor complex. AMG 212/BAY2010112 induced target cell-dependent activation and cytokine release of T cells, and efficiently redirected T cells for lysis of target cells. In addition to Chinese hamster ovary cells stably expressing human or cynomolgus monkey PSMA, T cells redirected by AMG 212/BAY2010112 also lysed human PCa cell lines VCaP, 22Rv1, MDA PCa 2b, C4-2, PC-3-huPSMA, and LnCaP at half maximal BiTE concentrations between 0.1 and 4 ng/mL (1.8-72 pmol/L). No lysis of PSMA-negative human PCa cell lines PC-3 and DU145 was observed. The subcutaneous (s.c.) formation of tumors from PC-3-huPSMA cells in NOD/SCID mice was significantly prevented by once daily intravenous (i.v.) injection of AMG 212/BAY2010112 at a dose level as low as 0.005 mg/kg/d. Rapid tumor shrinkage with complete remissions were observed in NOD/SCID mice bearing established s.c. 22Rv1 xenografts after repeated daily treatment with AMG 212/BAY2010112 by either the i.v. or s.c. route. Of note, 22Rv1 tumors were grown in the absence of human T cells followed by intraperitoneal injection of T cells 3 days before BiTE treatment. No effects on tumor growth were observed in the absence of human T cells or AMG 212/BAY2010112. On the basis of these preclinical results, AMG 212/BAY2010112 appears as a promising new BiTE antibody for the treatment of patients with PSMA-expressing PCa.
Collapse
|
45
|
Ripert T, Bayoud Y, Messaoudi R, Ménard J, Azémar MD, Duval F, Nguyen TD, Staerman F. Salvage radiotherapy after high-intensity focused ultrasound treatment for localized prostate cancer: feasibility, tolerance and efficacy. Can Urol Assoc J 2012; 6:E179-83. [PMID: 21539766 PMCID: PMC3478387 DOI: 10.5489/cuaj.10137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study is to evaluate the feasibility, tolerance and efficacy of salvage external beam radiotherapy (EBRT) in persistent or recurrent prostate cancer after failed high intensity focused ultrasound (HIFU) therapy. METHODS We reviewed data on tolerance and oncologic outcomes for all patients with biopsy-proven locally recurrent or persistent prostate cancer who underwent salvage EBRT in our department between April 2004 and June 2008. Minimum follow-up for inclusion was 2 years. Failure with EBRT was defined as biochemical relapse (Phoenix definition) or introduction of androgen deprivation therapy (ADT). Gastrointestinal and urinary toxicity and urinary stress incontinence were scored at 12 and 24 months (Radiation Therapy Oncology Group and Ingelman Sundberg rating, respectively). RESULTS The mean age of the patients was 68.8 years (range: 60-79). Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL (range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months (range: 24-54). No patient received adjunctive ADT. The EBRT course was well-tolerated and completed by all patients. The mean PSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after a median of 22 months (range: 12-36). One patient experienced biochemical failure and was prescribed ADT 30 months after EBRT. The disease-free survival rate was 83.3% at 36.5 months. There was no major EBRT-related toxicity at 12 or 24 months. CONCLUSIONS Our early clinical results confirm the feasibility and good tolerance of salvage radiotherapy after HIFU failure. Oncological outcomes were promising. A prospective study with longer follow-up is needed to identify factors predictive of success for salvage EBRT therapy after HIFU failure.
Collapse
Affiliation(s)
- Thomas Ripert
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| | - Younes Bayoud
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| | - Rabah Messaoudi
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| | - Johann Ménard
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| | | | - François Duval
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| | - Tan Dat Nguyen
- Department of Radiotherapy, Jean Godinot Institut, Reims, France
| | - Frédéric Staerman
- Department of Urology-Andrology, Reims Academic Hospital, Reims, France
| |
Collapse
|
46
|
Postoperative radiotherapy after radical prostatectomy: indications and open questions. Prostate Cancer 2012; 2012:963417. [PMID: 22530131 PMCID: PMC3316943 DOI: 10.1155/2012/963417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 11/18/2022] Open
Abstract
Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64 Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72 Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial.
Collapse
|
47
|
Szmulewitz RZ, Chung E, Al-Ahmadie H, Daniel S, Kocherginsky M, Razmaria A, Zagaja GP, Brendler CB, Stadler WM, Conzen SD. Serum/glucocorticoid-regulated kinase 1 expression in primary human prostate cancers. Prostate 2012; 72:157-64. [PMID: 21563193 PMCID: PMC6000822 DOI: 10.1002/pros.21416] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/06/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Serum/glucocorticoid-regulated kinase 1 (SGK1), a known target of the androgen receptor (AR) and glucocorticoid receptor (GR), is reported to enhance cell survival. This study sought to better define the role of SGK1 and GR in prostate cancer. METHODS Immunohistochemistry was performed for AR, GR, and SGK1 on primary prostate cancers (n = 138) and 18 prostate cancers from patients treated with androgen deprivation therapy. Relative staining intensity was compared utilizing a Fisher's exact test. Univariate analyses were performed using log-rank and chi-squared tests to evaluate prostate cancer recurrence with respect to SGK1 expression. RESULTS SGK1 expression was strong (3+) in 79% of untreated cancers versus 44% in androgen-deprived cancers (P = 0.003). Conversely, GR expression was present in a higher proportion of androgen-deprived versus untreated cancers (78% vs. 38%, P = 0.002). High-grade cancers were nearly twice as likely to have relatively low (0 to 2+) SGK1 staining compared to low-grade cancers (13.8% vs. 26.5%, P = 0.08). Low SGK1 expression in untreated tumors was associated with increased risk of cancer recurrence (adjusted log-rank test P = 0.077), 5-year progression-free survival 47.8% versus 72.6% (P = 0.034). CONCLUSIONS SGK1 expression is high in most untreated prostate cancers and declines with androgen deprivation. However, these data suggest that relatively low expression of SGK1 is associated with higher tumor grade and increased cancer recurrence, and is a potential indicator of aberrant AR signaling in these tumors. GR expression increased with androgen deprivation, potentially providing a mechanism for the maintenance of androgen pathway signaling in these tumors. Further study of the AR/GR/SGK1 network in castration resistance.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Humans
- Immediate-Early Proteins/biosynthesis
- Immediate-Early Proteins/genetics
- Immediate-Early Proteins/metabolism
- Immunohistochemistry
- Male
- Middle Aged
- Neoplasm Recurrence, Local/enzymology
- Neoplasm Recurrence, Local/pathology
- Neoplasms, Hormone-Dependent/enzymology
- Neoplasms, Hormone-Dependent/genetics
- Neoplasms, Hormone-Dependent/pathology
- Prostatic Neoplasms/enzymology
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
- Protein Serine-Threonine Kinases/biosynthesis
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Receptors, Androgen/biosynthesis
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Receptors, Glucocorticoid/biosynthesis
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- Tissue Array Analysis
Collapse
|
48
|
Croke J, Malone S, Roustan Delatour N, Belanger E, Avruch L, Morash C, Kayser C, Underhill K, Spaans J. Postoperative radiotherapy in prostate cancer: the case of the missing target. Int J Radiat Oncol Biol Phys 2012; 83:1160-8. [PMID: 22270169 DOI: 10.1016/j.ijrobp.2011.09.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 07/22/2011] [Accepted: 09/29/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Postoperative radiotherapy (XRT) increases survival in high-risk prostate cancer patients. Approximately 50% of patients on long-term follow-up relapse despite adjuvant XRT and the predominant site of failure remains local. Four consensus guidelines define postoperative clinical target volume (CTV) in prostate cancer. We explore the possibility that inadequate CTV coverage is an important cause of local failure. This study evaluates the utility of preoperative magnetic resonance imaging (MRI) in defining prostate bed CTV. METHODS AND MATERIALS Twenty prostate cancer patients treated with postoperative XRT who also had preoperative staging MRI were included. The four guidelines were applied and the CTVs were expanded to create planning target volumes (PTVs). Preoperative MRIs were fused with postoperative planning CT scans. MRI-based prostate and gross visible tumors were contoured. Three-dimensional (3D) conformal four- and six-field XRT plans were developed and dose-volume histograms analyzed. Subtraction analysis was conducted to assess the adequacy of prostate/gross tumor coverage. RESULTS Gross tumor was visible in 18 cases. In all 20 cases, the consensus CTVs did not fully cover the MRI-defined prostate. On average, 35% of the prostate volume and 32% of the gross tumor volume were missed using six-field 3D treatment plans. The entire MRI-defined gross tumor volume was completely covered in only two cases (six-field plans). The expanded PTVs did not cover the entire prostate bed in 50% of cases. Prostate base and mid-zones were the predominant site of inadequate coverage. CONCLUSIONS Current postoperative CTV guidelines do not adequately cover the prostate bed and/or gross tumor based on preoperative MRI imaging. Additionally, expanded PTVs do not fully cover the prostate bed in 50% of cases. Inadequate CTV definition is likely a major contributing factor for the high risk of relapse despite adjuvant XRT. Preoperative imaging may lead to more accurate CTV definition, which should result in further improvements in survival for patients with high-risk prostate cancer.
Collapse
Affiliation(s)
- Jennifer Croke
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Kuroda K, Horiguchi A, Asano T, Tasaki S, Yoshii H, Sato A, Asakuma J, Ito K, Seguchi K, Sumitomo M, Asano T. Prediction of biochemical recurrence after radical prostatectomy using peritumoral lymphatic vessel density in biopsy specimens in patients with localized prostate cancer. Urol Int 2012; 88:18-24. [PMID: 22222198 DOI: 10.1159/000335275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 11/20/2011] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Lymphatic invasion has been associated with biochemical recurrence (BCR), and many patients with postoperative elevation of prostate-specific antigen (PSA) develop distant metastases within several years. We previously found peritumoral lymphatic vessel density (PTLD) in biopsy cores to be an independent predictor of lymphatic invasion in radical prostatectomy specimens, so we speculate that PTLD parameters in biopsy specimens could also be independent predictors of BCR after surgery. PATIENTS AND METHODS We obtained positive biopsy cores from 110 patients who underwent radical prostatectomy at our institution. Biopsy cores were immunostained with the D2-40 monoclonal antibody, which specifically and selectively detects lymphatic endothelium. We evaluated differences between the BCR-free survival rates and used univariate and multivariate analyses to detect independent predictors of BCR. RESULTS The results of a Cox proportional hazards model showed that lymphatic invasion in prostatectomy specimens was one of the independent postoperative prognostic factors for BCR (p = 0.0338). An additional model showed that one PTLD parameter, maximal PTLD, was among the independent preoperative predictors of lower BCR-free survival rates (p = 0.0200). CONCLUSIONS Information about PTLD in prostate biopsy specimens could be helpful for selecting patients as radical prostatectomy candidates, and patients with high PTLD values should be carefully monitored after surgery.
Collapse
Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Japan. kksmy @ sa2.so-net.ne.jp
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Umezawa R, Ariga H, Ogawa Y, Jingu K, Matsushita H, Takeda K, Fujimoto K, Sakayauchi T, Sugawara T, Kubozono M, Narazaki K, Shimizu E, Takai Y, Yamada S. Impact of pathological tumor stage for salvage radiotherapy after radical prostatectomy in patients with prostate-specific antigen < 1.0 ng/ml. Radiat Oncol 2011; 6:150. [PMID: 22053922 PMCID: PMC3220651 DOI: 10.1186/1748-717x-6-150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate prognostic factors in salvage radiotherapy (RT) for patients with pre-RT prostate-specific antigen (PSA) < 1.0 ng/ml. METHODS Between January 2000 and December 2009, 102 patients underwent salvage RT for biochemical failure after radical prostatectomy (RP). Re-failure of PSA after salvage RT was defined as a serum PSA value of 0.2 ng/ml or more above the postradiotherapy nadir followed by another higher value, a continued rise in serum PSA despite salvage RT, or initiation of systemic therapy after completion of salvage RT. Biochemical relapse-free survival (bRFS) was estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model. RESULTS The median follow-up period was 44 months (range, 11-103 months). Forty-three patients experienced PSA re-failure after salvage RT. The 4-year bRFS was 50.9% (95% confidence interval [95% CI]: 39.4-62.5%). In the log-rank test, pT3-4 (p < 0.001) and preoperative PSA (p = 0.037) were selected as significant factors. In multivariate analysis, only pT3-4 was a prognostic factor (hazard ratio: 3.512 [95% CI: 1.535-8.037], p = 0.001). The 4-year bRFS rates for pT1-2 and pT3-4 were 79.2% (95% CI: 66.0-92.3%) and 31.7% (95% CI: 17.0-46.4%), respectively. CONCLUSIONS In patients who have received salvage RT after RP with PSA < 1.0 ng/ml, pT stage and preoperative PSA were prognostic factors of bRFS. In particular, pT3-4 had a high risk for biochemical recurrence after salvage RT.
Collapse
Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|