Ductal prostate cancer: Clinical features and outcomes from a multicenter retrospective analysis and overview of the current literature

Construction and validation of a prognostic nomogram for ductal adenocarcinoma of the prostate: A population-based study

This study aimed to establish and validate a nomogram for ductal adenocarcinoma of the prostate (DAC) to accurately predict the prognosis of DAC patients. The data of 834 patients with confirmed DAC were obtained from the Surveillance, Epidemiology, and End Results database. The cases were randomly assigned to the training and internal validation cohorts. Data from patients attending our institution as an external validation cohort (n = 35). Nomogram and web-based dynamic nomogram were constructed based on Cox regression analysis, and their prediction accuracy was evaluated by concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis. Multivariate analyses identified age, T-stage, N-stage, M-stage, surgery, lymph node dissection, Gleason score, and PSA as independent prognostic factors for overall survival. The C-index and calibration curves demonstrate the good discriminative performance of the prediction model. The area under the curve further confirmed the accuracy of the nomogram in predicting survival. In addition, the area under the curve and decision curve analysis were better than the 7th tumor-node-metastasis staging system. The Kaplan-Meier curves of the nomogram-based risk groups showed significant differences (P < .001). We constructed and validated the first nomogram to predict patients with DAC.

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

BACKGROUND/AIM

Radiotherapy represents an important therapeutic option in the management of prostate cancer (PCa). As helical tomotherapy may improve toxicity outcomes, we aimed to evaluate and report the toxicity and clinical outcomes of localized PCa patients treated with moderately hypofractionated helical tomotherapy.

PATIENTS AND METHODS

We retrospectively analyzed 415 patients affected by localized PCa and treated with moderately hypofractionated helical tomotherapy in our department from January 2008 to December 2020. All patients were stratified according to the D'Amico risk classification: low-risk 21%, favorable intermediate-risk 16%, unfavorable intermediate-risk 30.4%, and high-risk 32.6%. The dose prescription for high-risk patients was 72.8 Gy to the prostate (planning tumor volume-PTV1), 61.6 Gy to the seminal vesicles (PTV2), and 50.4 Gy to the pelvic lymph nodes (PTV3) in 28 fractions; for low- and intermediate-risk patients 70 Gy for PTV1, 56 Gy for PTV2, and 50.4 Gy for PTV3 in 28 fractions. Image-guided radiation therapy was performed daily in all patients by mega-voltage computed tomography. Forty-one percent of patients received androgen deprivation therapy (ADT). Acute and late toxicity was assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v.5.0 (CTCAE).

RESULTS

Median follow-up was 82.7 months (range=12-157 months) and the median age of patients at diagnosis was 72.5 years (range=49-84 years). The 3, 5, and 7 yr overall survival (OS) rates were 95%, 90%, and 84%, respectively, while 3, 5, and 7 yr disease-free survival (DFS) were 96%, 90%, and 87%, respectively. Acute toxicity was as follows: genitourinary (GU) G1 and G2 in 35.9% and 24%; gastrointestinal (GI) in 13.7% and 8%, with G3 or more acute toxicities less than 1%. The late GI toxicity G2 and G3 were 5.3% and 1%, respectively, and the late GU toxicity G2 and G3 were 4.8% and 2.1%, respectively, and only three patients had a G4 toxicity.

CONCLUSION

Hypofractionated helical tomotherapy for PCa treatment appeared to be safe and reliable, with favorable acute and late toxicity rates and encouraging results in terms of disease control.