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Campbell SP, Deivasigamani S, Arcot R, Adams ES, Orabi H, Elshafei A, Tan WP, Davis L, Wu Y, Chang A, Jones JS, Polascik TJ. Salvage Cryoablation for Recurrent Prostate Cancer Following Primary External Beam Radiotherapy or Primary Cryotherapy: A Propensity Score Matched Analysis of Mid-term Oncologic and Functional Outcomes. Clin Genitourin Cancer 2023; 21:555-562. [PMID: 37438234 DOI: 10.1016/j.clgc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/29/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT) were studied. METHODS Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS). Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups. RESULTS 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P = .5 and P = .7) and after matching (P = .6 and P = .3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]). On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts. CONCLUSION Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy.
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Affiliation(s)
- Scott P Campbell
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Sriram Deivasigamani
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Rohith Arcot
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Oschner Medical Center, Jefferson, LA
| | - Eric S Adams
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hazem Orabi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed Elshafei
- Department of Urology, University of Florida Health, Jacksonville, FL
| | - Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Department of Urology, New York University Medical Center, New York, NY
| | - Leah Davis
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Yuan Wu
- Duke Cancer Institute, Durham NC
| | - Andrew Chang
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Moffit Cancer Center, Tampa, FL
| | | | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham NC
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Wang N, Zhao DW, Chen D, Wu ZM, Wang YJ, Yang ZY, Zhao JL, Zhou FJ, Li YH. Clinical value of normal saline injection for expansion of the anterior perirectal space during prostate cryoablation. Eur J Surg Oncol 2023; 49:252-256. [PMID: 35817633 DOI: 10.1016/j.ejso.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The objective of this study is to describe the technique and evaluate the clinical value of normal saline (NS) injection for expanding the anterior perirectal space during prostate cryoablation for prostate cancer (PCa) patients. METHODS PCa patients who received cryoablation between August 2014 and December 2019 were enrolled, and the technique of NS injection was adopted. The complications were evaluated. The prostate-specific antigen (PSA) nadir and biochemical progression-free survival (bPFS) were measured in localized PCa patients who received cryoablation as the primary treatment. RESULTS A total of 159 PCa patients were included. Among 147 patients with the data of anterior perirectal space, the median (interquartile range [IQR]) distance of estimated iceball edge beyond the prostatic capsule was 8.3 (7.0-10.0) mm. No cases of urethrorectal fistula were reported; 29 patients developed urinary retention and 25 patients presented scrotal edema. All complications below Clavien-Dindo grade IIIb disappeared within 7 weeks after surgery. Urinary incontinence was reported in 6 patients. Among localized PCa patients, the median (IQR) follow-up time was 56.5 (36.0-73.5) months. The estimated 5-year bPFS was 82.3% overall, 82.8% for low-to intermediate-risk PCa patients, and 82.1% for high-risk PCa patients. For 52 patients received cryoablation alone, the median (IQR) PSA nadir was 0.147 (0.027-0.381) ng/mL. CONCLUSIONS The technique of NS injection for expanding the anterior perirectal space during cryoablation surgery could avoid urethrorectal fistula and might benefit localized PCa patients with lower PSA nadir and longer bPFS.
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Affiliation(s)
- Ning Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Di-Wei Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Dong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Zhi-Ming Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Yan-Jun Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Zhen-Yu Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Jun-Liang Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
| | - Yong-Hong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510075, China.
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3
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Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation. Adv Radiat Oncol 2022; 7:100849. [PMID: 35647408 PMCID: PMC9133399 DOI: 10.1016/j.adro.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
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Li Y, Wang N, Zhao D, Wang J, Jiang L, Wang Y, Chen D, Wu Z, Zhou F, Yang Z. Cytoreductive prostate cryoablation and metronomic cyclophosphamide for metastatic hormone-sensitive prostate cancer. Future Oncol 2022; 18:2373-2380. [PMID: 35440168 DOI: 10.2217/fon-2021-1424] [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: 11/21/2022] Open
Abstract
Aim: This study reports the outcomes of cytoreductive prostate cryoablation and metronomic cyclophosphamide for the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Methods: Patients with mHSPC from the authors' prostate cancer database who had received cytoreductive prostate cryoablation and metronomic cyclophosphamide were identified retrospectively. Results: Eight consecutive patients were enrolled in the study. All the patients tolerated combination therapy. The median metastatic castration-resistant prostate cancer-free survival was 62.5 months. Seven patients (87.5%) had a prostate-specific antigen nadir <0.1 ng/ml. Dysuria and hematuria before prostate cryoablation disappeared within 1 month after cryosurgery, and no incontinence was seen after prostate cryoablation. No local therapy was needed during follow-up. Conclusion: Cytoreductive prostate cryoablation and metronomic cyclophosphamide prove an effective and safe combination therapy for mHSPC.
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Affiliation(s)
- Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Ning Wang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Diwei Zhao
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jun Wang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Lijuan Jiang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yanjun Wang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Dong Chen
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhiming Wu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhenyu Yang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
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5
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van Luijtelaar A, Fütterer JJ, Bomers JG. Minimally invasive magnetic resonance image-guided prostate interventions. Br J Radiol 2021; 95:20210698. [PMID: 34723623 PMCID: PMC8978246 DOI: 10.1259/bjr.20210698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.
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Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joyce Gr Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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6
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Li G, Li Y, Wang J, Gao X, Zhong Q, He L, Li C, Liu M, Liu Y, Ma M, Wang H, Wang X, Zhu H. Guidelines for radiotherapy of prostate cancer (2020 edition). PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Junjie Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xianshu Gao
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Qiuzi Zhong
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Liru He
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou 510060 P. R. China
| | - Chunmei Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yueping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Mingwei Ma
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Hao Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Hui Zhu
- Department of Nuclear Medicine Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
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7
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Büchser D, Medina R, Mayrata E, González A, Marban M, Achard V, Alongi F, Gomez-Iturriaga A, Couñago F. Salvage local treatment for localized radio-recurrent prostate cancer: a narrative review and future perspectives. Future Oncol 2021; 17:4207-4219. [PMID: 34448402 DOI: 10.2217/fon-2021-0320] [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: 11/21/2022] Open
Abstract
Although dose escalation protocols have improved biochemical control in prostate cancer radiotherapy, 10-45% of patients will experience disease recurrence. The prostate and seminal vesicles are the most frequent site of the first relapse. Traditionally, these patients have been managed with hormonal therapy, which is not curative. Recent improvements in diagnostic tests (e.g., multiparametric magnetic resonance and molecular imaging, including PET/CT scan with choline or Ga-PSMA) and new treatment techniques (e.g., stereotactic body radiation therapy or other minimally invasive alternatives like high-intensity focus ultrasound, cryoablation or high-dose-rate brachytherapy) offer new therapeutic strategies with the potential to cure some patients with limited adverse effects. In this narrative review, the authors present the most recent evidence to help identify the most suitable candidates for salvage treatment.
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Affiliation(s)
- David Büchser
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Rafael Medina
- Urology, Virgen del Rocio University Hospital, Sevilla 41013, Spain
| | - Esther Mayrata
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Alba González
- Radiation Oncology, Basurto University Hospital, Bilbao 48013, Spain.,Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Marina Marban
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva 1205, Switzerland
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Felipe Couñago
- Radiation Oncology, Quirón Salud University Hospital, Madrid 28223, Spain.,Radiation Oncology, La Luz Hospital, Madrid 28003, Spain.,Clinical Department, Universidad Europea de Madrid, Madrid 28670, Spain
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Tracey AT, Nogueira LM, Alvim RG, Coleman JA, Murray KS. Focal therapy for primary and salvage prostate cancer treatment: a narrative review. Transl Androl Urol 2021; 10:3144-3154. [PMID: 34430417 PMCID: PMC8350247 DOI: 10.21037/tau-20-1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Despite innovations in surgical technology and advancements in radiation therapy, radical treatments for clinically localized prostate cancer are associated with significant patient morbidity, including both urinary and sexual dysfunction. This has created a vital need for therapies and management strategies that provide an acceptable degree of oncologic efficacy while mitigating these undesirable side effects. Successful developments in screening approaches and advances in prostate imaging have allowed clinicians to identify, localize, and more precisely target early cancers. This has afforded urologists with an important opportunity to develop and employ focal ablation techniques that selectively destroy tumors while preserving the remainder of the gland, thus avoiding detrimental treatment effects to surrounding sensitive structures. A lack of high-level evidence supporting such an approach had previously hindered widespread adoption of focal treatments, but there are now numerous published clinical trials which have sought to establish benchmarks for safety and efficacy. As the clinical evidence supporting a potential role in prostate cancer treatment begins to accumulate, there has been a growing acceptance of focal therapy in the urologic oncology community. In this narrative review article, we describe the techniques, advantages, and side effect profiles of the most commonly utilized focal ablative techniques and analyze published clinical trial data supporting their evolving role in the prostate cancer treatment paradigm.
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Affiliation(s)
- Andrew T Tracey
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucas M Nogueira
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo G Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie S Murray
- Division of Urology, Department of Surgery, University of Missouri, Columbia, MO, USA
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9
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Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res 2021; 33:457-463. [PMID: 33854206 DOI: 10.1038/s41443-021-00437-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022]
Abstract
Male sexual dysfunction, a common sequela following primary prostate cancer (PC) treatment, is likely to be more significant following salvage PC therapy. In general, these impairments in sexual domains can be divided into three groups, namely (1) sexual desire, sexuality and masculinity; (2) erectile function (EF); and (3) ejaculation and orgasm. However, there is considerable overlap between these sexual domains and male sexual response cycle, and various factors such as cancer status, mental well-being, medical conditions and social circumstances can adversely impact on the male sexual function. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, there is limited consensus guidelines exist regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. While penile rehabilitation may be effective to restore erectile function and the ability to have coital sex, there is lack of effective treatments in other domains of male sexual function, thereby underscoring the importance of psychological and sexual counselling in sexual rehabilitation. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men and their respective partners for better sexual health and activity.
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Abufaraj M, Siyam A, Ali MR, Suarez-Ibarrola R, Yang L, Foerster B, Shariat SF. Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review. Cancers (Basel) 2021; 13:cancers13020244. [PMID: 33440752 PMCID: PMC7826752 DOI: 10.3390/cancers13020244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. METHODS This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. RESULTS The rates of severe urinary incontinence ranged from 28-88%, 4.5-42%, 0-6.5%, 2.4-8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5-3.4, 3.5-12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. CONCLUSIONS local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.
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Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Abdelmuez Siyam
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Mustafa Rami Ali
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79098 Freiburg, Germany;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming school of medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Beat Foerster
- Department of Urology, Kantonsspital Winterthur, 8401 Winterthur, Switzerland;
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
- Institute for Urology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119992 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10075, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140-4002-6150; Fax: +43-140-4002-3320
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11
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wang N, Ye Y, Deng M, Zhao D, Jiang L, Chen D, Wu Z, Wang Y, Li Z, Yang Z, Li J, Zhou F, Li Y. Prostate cryoablation combined with androgen deprivation therapy for newly diagnosed metastatic prostate cancer: a propensity score-based study. Prostate Cancer Prostatic Dis 2021; 24:837-844. [PMID: 33664457 PMCID: PMC8384623 DOI: 10.1038/s41391-021-00335-2] [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: 09/17/2020] [Revised: 12/22/2020] [Accepted: 01/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies showed that androgen deprivation therapy (ADT) plus local treatment of prostate could improve metastatic prostate cancer (mPCa) patients' survival. To date there are few studies analyzed the value of prostate cryoablation in mPCa. The objective of our analysis is to evaluate the oncological results and clinical value of prostate cryoablation combined with ADT compared with ADT alone in newly diagnosed mPCa patients. METHODS Newly diagnosed mPCa patients undergoing cryoablation plus ADT (group A) between January 2011 and November 2018 were identified. Patients receiving ADT alone (group B) were selected from the same institutional prostate cancer database by propensity score matching based on clinical characteristics. Oncological results and clinical value in symptom control and primary lesion treatment were compared. RESULTS Fifty-four patients were included in each group. Prostate cryoablation was well tolerated. The median follow-up time was 40 (27-53) and 39 (31-54) months in group A and group B, respectively. Patients in group A had a lower median prostate-specific antigen (PSA) nadir (0.025 ng/mL vs. 0.230 ng/mL, p = 0.001), longer median failure-free survival (FFS) (39 months vs. 21 months, p = 0.005), and median metastatic castration-resistant prostate cancer (mCRPC)-free survival (39 months vs. 21 months, p = 0.007). No difference in cancer-specific survival and overall survival was found between the two groups. Multivariate Cox analysis showed combination therapy reduced the risk of FFS by 45.8% (HR = 0.542 [95% CI 0.329-0.893]; p = 0.016). Patients in group A had better clinical relief of urinary symptoms (79.1 vs. 59.1%, p = 0.044) and required less treatment of primary lesions for symptomatic relief (13.0 vs. 31.5%, p = 0.021). CONCLUSIONS Prostate cryoablation plus ADT decreases PSA nadir, prolongs FFS and mCRPC-free survival, relieves urinary symptoms and reduces the need for treating primary lesions in newly diagnosed mPCa patients compared to ADT alone.
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Affiliation(s)
- Ning wang
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Yangtian Ye
- grid.412601.00000 0004 1760 3828Department of Urology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Minhua Deng
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Diwei Zhao
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Lijuan Jiang
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Dong Chen
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Zhiming Wu
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Yanjun Wang
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - ZhiYong Li
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Zhenyu Yang
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Jibin Li
- grid.488530.20000 0004 1803 6191Department of Clinical Research, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Fangjian Zhou
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
| | - Yonghong Li
- grid.488530.20000 0004 1803 6191Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China ,grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in South China; Collaborative Innovation Cencer for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong China
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12
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Exterkate L, Peters M, Somford DM, Vergunst H. Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer. BJU Int 2020; 128:46-56. [PMID: 33043572 DOI: 10.1111/bju.15269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa). PATIENTS AND METHODS A total of 169 consecutive patients with biopsy confirmed rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006 and 2018. The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix definition (prostate-specific antigen [PSA] nadir +2 ng/mL). The secondary outcomes were overall survival, BRFS defined as a PSA level of >0.5 ng/mL, metastasis-free survival, androgen-deprivation therapy (ADT)-free survival, and functional outcomes. Complications were classified according to the Clavien-Dindo system. PSA was measured every 3-6 months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan-Meier survival analysis and uni- and multivariable Cox regression were performed. RESULTS The median (interquartile range) follow-up was 36 (18-66) months. The BRFS after 5 and 8 years was 52% (95% confidence interval [CI] 43-62%) and 45% (95% CI 35-57%), respectively. At multivariable analysis PSA level at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post-SCS PSA nadir were significant factors for BRFS. The 5-year ADT-free survival was 70% (95% CI 62-79%). Clavien-Dindo Grade ≥III complications occurred in 1.2% (two/169) of patients. In all, 19% (29/156) of patients had new-onset urinary incontinence defined as >1 pad/24 h and 92% (57/62) of patients had new-onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients. CONCLUSIONS The present study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.
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Affiliation(s)
- Leonie Exterkate
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Henk Vergunst
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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13
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Aghdam N, Pepin AN, Creswell M, Hsieh K, Smith C, Drescher N, Danner M, Ayoob M, Yung T, Lei S, Kumar D, Collins BT, Lischalk JW, Krishnan P, Suy S, Lynch J, Bandi G, Hankins RA, Collins SP. Management of Isolated Local Failures Following Stereotactic Body Radiation Therapy for Low to Intermediate Risk Prostate Cancer. Front Oncol 2020; 10:551491. [PMID: 33251131 PMCID: PMC7673419 DOI: 10.3389/fonc.2020.551491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Stereotactic body radiation therapy (SBRT) is a safe and effective treatment option for patients with low to intermediate risk prostate cancer (1). SBRT results in very low PSA nadirs secondary to the delivery of high biologically effective doses. Studies reporting on the diagnosis, confirmation, and management of salvageable isolated local failures (ILF) are limited. This study aims to determine the incidence and management approach of ILF after SBRT in a large single institution cohort. Method: All patients with low or intermediate risk localized prostate cancer treated with SBRT at Georgetown University Hospital were eligible for this study. Treatment was delivered using robotic SBRT with doses of 35-36.25 Gy in five fractions. ILF were diagnosed using multiparametric MRI and/or biopsy prompted by rising PSA levels after achieving long-term nadir. Patient's characteristics were extracted from a prospective institutional quality of life trial (IRB 2009-510). Type of salvage therapy and post-salvage PSA were determined on subsequent follow-up and chart review. Results: Between December 2008 to August 2018, 998 men with low to intermediate risk prostate cancer were eligible for inclusion in this analysis. Twenty-four patients (low risk, n = 5; intermediate risk, n = 19) were found to have ILF within the prostate on either MRI (n = 19) and/or biopsy (n = 20). Median pre-treatment PSA was 7.55 ng/ml. Median time to diagnosis of ILF was 72 months (24-110 months) with median PSA at the time of ILF of 2.8 ng/ml (0.7-33 ng/ml). Median PSA doubling time was 17 months (5-47 months). Thirteen patients with biopsy proven ILF proceeded with salvage therapy (cryotherapy n = 12, HIFU n = 1). Of 12 patients who underwent cryotherapy, 7 had a post-treatment PSA of <0.1 ng/ml. One patient experienced a urethral-cutaneous fistula (grade 3 toxicity). Conclusion: The incidence of isolated local recurrence is rare in our cohort. Diagnosis and management of isolated local failures post-SBRT continues to evolve. Our report highlights the importance of early utilization of MRI and confirmatory biopsy at relatively low PSA levels and long PSA doubling time (1). Additionally, undetectable PSA levels after salvage therapy supports the role of early treatment in ILF (1). Further research is needed to determine appropriate patient selection and salvage modality in this population.
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Affiliation(s)
- Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Abigail N. Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
- George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Michael Creswell
- Georgetown University School of Medicine, Washington, DC, United States
| | - Kristin Hsieh
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
- Columbia University Valegos College of Physicians and Surgeons, New York, NY, United States
| | - Clayton Smith
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicolette Drescher
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Malika Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Deepak Kumar
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Brian Timothy Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Jonathan W. Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Pranay Krishnan
- Department of Radiology, Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Guarav Bandi
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Ryan Andrew Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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14
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Boissier R, Sanguedolce F, Territo A, Gaya JM, Huguet J, Rodriguez-Faba O, Regis F, Gallioli A, Vedovo F, Martinez C, Palou J, Breda A. Partial salvage cryoablation of the prostate for local recurrent prostate cancer after primary radiotherapy: Step-by-step technique and outcomes. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Mantica G, Chierigo F, Suardi N, Gomez Rivas J, Kasivisvanathan V, Papalia R, Fiori C, Porpiglia F, Terrone C, Esperto F. Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review. MINERVA UROL NEFROL 2020; 72:563-578. [PMID: 32748617 DOI: 10.23736/s0393-2249.20.03783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this review was to conduct a comprehensive analysis of the role of minimally invasive salvage modalities in radio-recurrent prostate cancer and the associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Scopus databases in January 2020. All papers published after 2000, concerning studies conducted on humans for radio-recurrent prostate cancer were considered for the review. EVIDENCE SYNTHESIS Overall, 545 studies were identified. After duplicate exclusion, initial screening, and eligibility evaluation, a total of 80 studies were included in the qualitative analysis, corresponding to a cohort of 6681 patients. The median age at initial diagnosis ranged from 59 to 75.5. Pre-treatment PSA ranged from 6.2 to 27.4 ng/mL. All patients underwent primary radiotherapy for localized prostate cancer. Cryotherapy, Brachytherapy, EBRT, HIFU were the minimally invasive options mostly used as salvage therapy. They showed to be promising approaches for recurrent prostate cancer (PCa) control, with acceptable toxicities. CONCLUSIONS Minimally invasive therapeutic options offer promising results in terms of biochemical control in the local recurrence setting. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish which method is the best in terms of oncological and safety outcomes.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Nazareno Suardi
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid, Spain
| | - Veeru Kasivisvanathan
- UCL Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
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16
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Khoo CC, Miah S, Connor MJ, Tam J, Winkler M, Ahmed HU, Shah TT. A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer. Transl Androl Urol 2020; 9:1535-1545. [PMID: 32676441 PMCID: PMC7354313 DOI: 10.21037/tau.2019.08.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10–15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61–75 years; prostate-specific antigen (PSA) range, 2.8–5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1–72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.
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Affiliation(s)
- Christopher C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joseph Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
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17
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Jiang C, Godette K, Hall WA, Bennett JK, Rossi P, Cooper S, Jani AB, Patel PR. Early Comparative Toxicity Outcomes of Patients With Prostate Cancer Receiving Initial Cryotherapy and Radiotherapy Salvage. Clin Genitourin Cancer 2020; 19:267-270.e1. [PMID: 33191148 DOI: 10.1016/j.clgc.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Karen Godette
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Peter Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sherrie Cooper
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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18
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Abstract
Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
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19
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Tan WP, ElShafei A, Aminsharifi A, Khalifa AO, Polascik TJ. Salvage Focal Cryotherapy Offers Similar Short-term Oncologic Control and Improved Urinary Function Compared With Salvage Whole Gland Cryotherapy for Radiation-resistant or Recurrent Prostate Cancer. Clin Genitourin Cancer 2019; 18:e260-e265. [PMID: 31892490 DOI: 10.1016/j.clgc.2019.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND We compared the short-term oncologic and functional outcomes of salvage focal cryotherapy (SFC) with those of salvage total cryotherapy (STC) for radiotherapy (RT)-persistent/recurrent prostate cancer. MATERIALS AND METHODS We queried the Cryo On-Line Database registry for men who had undergone SFC and STC of the prostate for RT-persistent or recurrent disease. Propensity score weighting was used to match age at treatment, presalvage therapy prostate-specific antigen level, Gleason sum, and presalvage cryotherapy androgen deprivation therapy status. The primary outcome was progression-free survival. RESULTS A total of 385 men with biopsy-proven persistent or recurrent prostate cancer after primary RT were included in the present study. The median follow-up, age, prostate-specific antigen, and Gleason sum before salvage cryotherapy was 24.4 months (first and third quartile, 9.8 and 60.3), 70 years (first and third quartile, 66 and 74 years), 4 ng/dL (first and third quartile, 2.7 and 5.6 ng/dL), and 7 (first and third quartile, 6 and 8), respectively. After propensity score weighting, the difference in progression-free survival was not statistically significant between the patients who had undergone STC and those who had undergone SFC (79.8% vs. 76.98%; P = .11 on weighted log-rank test). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs. 22.4%; P < .001). No significant differences were found in the incidence of rectal fistula (1.4% vs. 3.8; P = .30), new-onset urinary incontinence within 12 months (9.3% vs. 15.1%; P = .19), or new-onset erectile dysfunction within 12 months (52.6% vs. 59.6%; P = .47) between the SFC and STC groups, respectively. CONCLUSIONS STC resulted in similar 2-year oncologic outcomes compared with SFC in the RT-persistent/recurrent disease population. However, the patients who had undergone SFC had a lower urinary retention rate compared with those who had undergone STC.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmed ElShafei
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Medical School, Cairo University, Cairo, Egypt
| | - Alireza Aminsharifi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
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20
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Bomers JGR, Overduin CG, Jenniskens SFM, Cornel EB, van Lin ENJT, Sedelaar JPM, Fütterer JJ. Focal Salvage MR Imaging-Guided Cryoablation for Localized Prostate Cancer Recurrence after Radiotherapy: 12-Month Follow-up. J Vasc Interv Radiol 2019; 31:35-41. [PMID: 31735483 DOI: 10.1016/j.jvir.2019.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate safety, quality of life (QoL), and local cancer control after focal salvage MR imaging-guided cryoablation in patients with local recurrence of prostate cancer (PCa) after radiotherapy. MATERIALS AND METHODS A retrospective, single-center study was performed in 62 patients with radiorecurrent PCa who underwent MR imaging-guided cryoablation since May 2011 with a follow-up ≥12 months in December 2017. Rates and descriptions of adverse events were reported. Ablation complications were classified according to the Clavien and SIR systems. Validated questionnaires were used to observe functional outcomes and QoL before therapy and 6 and 12 months after therapy. Cancer control was defined as no biochemical failure according to Phoenix criteria and no other clinical evidence for local or metastatic disease. RESULTS All procedures were technically feasible. The number of complications requiring major therapy (Clavien grade 3b/4 or SIR grade D/E/F) was low (2 [3.2%] and 1 [1.6%], respectively). After 12 months, the International Consultation of Incontinence Questionnaire-Short Form (P < .001) and 5-item International Index of Erectile Function (P = .001) scores became significantly worse, indicating increased symptoms of incontinence and diminished erectile function, without compromising QoL. Six patients developed metastases within 6 months. After 12 months, 36 patients (63%) were disease-free. CONCLUSIONS Focal salvage MR imaging-guided cryoablation is safe and is associated with a high technical success rate, preservation of QoL, and local PCa control. This treatment can be a reasonable alternative to salvage radical prostatectomy in properly selected patients with low morbidity and preservation of QoL; however, longer follow-up is needed.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik B Cornel
- Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | | | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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21
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Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, Rachinsky I, Kapoor A, Metser U, Loblaw A, Morton G, Sexton T, Lock M, Helou J, Berlin A, Boylan C, Archer S, Pond GR, Bauman G. A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy. Int J Radiat Oncol Biol Phys 2019; 106:546-555. [PMID: 31730876 DOI: 10.1016/j.ijrobp.2019.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Radio-recurrent prostate cancer is typically detected by a rising prostate-specific antigen and may reflect local or distant disease. Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen, such as 18F-DCFPyL have shown promise in restaging men with recurrent disease postprostatectomy but are less well characterized in the setting of radio-recurrent disease. METHODS AND MATERIALS A prospective, multi-institutional study was conducted to evaluate the effect of 18F-DCFPyL PET/computed tomography (CT) when added to diagnostic imaging (DI; CT abdomen and pelvis, bone scan, multiparametric magnetic resonance imaging pelvis) for men with radio-recurrent prostate cancer. All men were imaged with DI and subsequently underwent 18F-DCFPyL PET/CT with local and central reads. Tie break reads were performed as required. Management questionnaires were completed after DI and again after 18F-DCFPyL PET/CT. Discordance in patterns of disease detected with 18F-DCFPyL PET/CT versus DI and changes in management were characterized. RESULTS Seventy-nine men completed the study. Most men had T1 disease (62%) and Gleason score <7 (95%). Median prostate-specific antigen at diagnosis was 7.4 ng/mL and at relapse was 4.8 ng/mL. DI detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 9 out of 79 (11%), distant disease in 12 out of 79 (15%), and no disease in 26 out of 79 (33%). 18F-DCFPyL PET/CT detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 21 out of 79 (27%), distant disease in 24 out of 79 (30%), and no disease in 10 out of 79 (13%). DI identified 8 out of 79 (10%) patients to have oligometastatic disease, compared with 21 out of 79 (27%) with 18F-DCFPyL PET/CT. 18F-DCFPyL PET/CT changed proposed management in 34 out of 79 (43%) patients. CONCLUSIONS 18F-DCFPyL PET/CT identified extraprostatic disease in twice as many men with radio-recurrent prostate cancer compared with DI and detected a site of recurrence in 87% of men compared with 67% with DI. Furthermore, 18F-DCFPyL PET/CT identified potentially actionable disease (prostate only recurrence or oligometastatic disease) in 75% of men and changed proposed management in 43% of men.
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Affiliation(s)
- Wei Liu
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Katherine Zukotynski
- Department of Radiology, Hamilton Health Sciences Centre and McMaster University, Hamilton, Canada
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital and University of New South Wales, Sydney, Australia
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Wolfson
- Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Ontario
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; University of Toronto, Institute of Health Care Policy and Evaluation, Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Michael Lock
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Colm Boylan
- Department of Diagnostic Imaging, St. Joseph's Healthcare and McMaster University, Hamilton, Canada
| | - Susan Archer
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada.
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22
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Pasquier D, Martinage G, Janoray G, Rojas DP, Zerini D, Goupy F, De Crevoisier R, Bogart E, Calais G, Toledano A, Chauveinc L, Scher N, Bondiau PY, Hannoun-Levi JM, Silva M, Meyer E, Nickers P, Lacornerie T, Jereczek-Fossa BA, Lartigau E. Salvage Stereotactic Body Radiation Therapy for Local Prostate Cancer Recurrence After Radiation Therapy: A Retrospective Multicenter Study of the GETUG. Int J Radiat Oncol Biol Phys 2019; 105:727-734. [DOI: 10.1016/j.ijrobp.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022]
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23
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Salvage Hemiablation High Intensity Focused Ultrasound for unilateral radio-recurrent prostate cancer. Prog Urol 2019; 29:627-633. [DOI: 10.1016/j.purol.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/16/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022]
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24
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de Marini P, Cazzato RL, Garnon J, Shaygi B, Koch G, Auloge P, Tricard T, Lang H, Gangi A. Percutaneous MR-guided prostate cancer cryoablation technical updates and literature review. BJR Open 2019; 1:20180043. [PMID: 33178928 PMCID: PMC7592492 DOI: 10.1259/bjro.20180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed.
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Affiliation(s)
- Pierre de Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Behnam Shaygi
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
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25
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Salvage treatment for radio-recurrent prostate cancer: a review of literature with focus on recent advancements in image-guided focal salvage therapies. Int Urol Nephrol 2019; 51:1101-1106. [DOI: 10.1007/s11255-019-02114-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
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26
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De Marini P, Cazzato RL, Garnon J, Tricard T, Koch G, Tsoumakidou G, Ramamurthy N, Lang H, Gangi A. Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients. Br J Radiol 2019; 92:20180965. [PMID: 30845821 DOI: 10.1259/bjr.20180965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA). METHODS AND MATERIALS Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5.13 years) with histologically proven, organ-confined (≤ T2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean prostate specific antigen 6.05 ± 3.74 ng ml-1 ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free survival (LPFS) and overall survival (OS) were retrospectively investigated. RESULTS Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir prostate specific antigen was 0.24 ± 1.5 ng ml-1 (mean follow-up 3.8 years; range: 2 - 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 - 2014). Mean clinical follow-up was 3.8 years (range 1-2915 days). LPFS was 92.0, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients in salvage treatment, LPFS was 100%, 75%, and 75% at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa. CONCLUSION Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management. ADVANCES IN KNOWLEDGE MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate.
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Affiliation(s)
- Pierre De Marini
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Roberto Luigi Cazzato
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Julien Garnon
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Thibault Tricard
- 2 Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Guillaume Koch
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Georgia Tsoumakidou
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France.,3 Department of Interventional Radiology, University Hospital of Lausanne , Switzerland
| | - Nitin Ramamurthy
- 4 Department of Radiology, Norfolk and Norwich University Hospital , Norwich , UK
| | - Hervé Lang
- 2 Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
| | - Afshin Gangi
- 1 Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital , Strasbourg , France
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27
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Oishi M, Gill IS, Ashrafi AN, Lin-Brande M, Nassiri N, Shin T, Bove A, Cacciamani GE, Ukimura O, Bahn DK, de Castro Abreu AL. Primary Whole-gland Cryoablation for Prostate Cancer: Biochemical Failure and Clinical Recurrence at 5.6 Years of Follow-up. Eur Urol 2019; 75:208-214. [PMID: 30274702 PMCID: PMC9827755 DOI: 10.1016/j.eururo.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/04/2018] [Indexed: 01/11/2023]
Abstract
We retrospectively evaluated complications and functional and oncologic outcomes of 94 consecutive men who underwent primary whole-gland cryoablation for localized prostate cancer (PCa) from 2002 to 2012. Kaplan-Meier and multivariable Cox regression analyses were performed using a landmark starting at 6 mo of follow-up. In total, 75% patients had D'Amico intermediate- (48%) or high- (27%) risk PCa. Median follow-up was 5.6 yr. Median time to prostate-specific antigen (PSA) nadir was 3.3 mo, and 70 patients reached PSA <0.2ng/ml postcryoablation. The 90-d high-grade (Clavien Grade IIIa) complication rate was 3%, with no rectal fistulas reported. Continence and potency rates were 96% and 11%, respectively. The 5-yr biochemical failure-free survival (PSA nadir+2ng/ml) was 81% overall and 89% for low-, 78% for intermediate-, and 80% for high-risk PCa (p=0.46). The median follow-up was 5.6 and 5.1 yr for patients without biochemical failure and with biochemical failure, respectively. The 5-yr clinical recurrence-free survival was 83% overall and 94% for low-, 84% for intermediate-, and 69% for high-risk PCa (p=0.046). Failure to reach PSA nadir <0.2ng/ml within 6 mo postcryoablation was an independent predictor for biochemical failure (p=0.006) and clinical recurrence (p=0.03). The 5-yr metastases-free survival was 95%. Main limitation is retrospective evaluation. Primary whole-gland cryoablation for PCa provides acceptable medium-term oncologic outcomes and could be an alternative for radiation therapy or radical prostatectomy. PATIENT SUMMARY: Cryoablation is a safe, minimally-invasive procedure that uses cold temperatures delivered via probes through the skin to kill prostate cancer (PCa) cells. Whole-gland cryoablation may offer an alternative treatment option to surgery and radiotherapy. We found that patients had good cancer outcomes 5 yr after whole-gland cryoablation, and those with a prostate-specific antigen value ≥0.2ng/ml within 6 mo after treatment were more likely to have PCa recurrence.
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Affiliation(s)
- Masakatsu Oishi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Inderbir S. Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Akbar N. Ashrafi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Lin-Brande
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nima Nassiri
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Toshitaka Shin
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alfredo Bove
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E. Cacciamani
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Duke K. Bahn
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Prostate Institute of America, Community Memorial Hospital, Ventura, CA, USA
| | - Andre Luis de Castro Abreu
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Corresponding author. USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, USA. Tel. +1 323 865 3700; Fax: +1 323 865 0120. (A.L. de Castro Abreu)
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28
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Ingrosso G, Becherini C, Lancia A, Caini S, Ost P, Francolini G, Høyer M, Bottero M, Bossi A, Zilli T, Scartoni D, Livi L, Santoni R, Giacomelli I, Detti B. Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2019; 3:183-197. [PMID: 31411996 DOI: 10.1016/j.euo.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT Different nonsurgical therapeutic strategies can be adopted for intraprostatic relapse of prostate cancer after primary radiotherapy, including re-irradiation (with brachytherapy [BT] or external beam radiotherapy [EBRT]), high-intensity focused ultrasound (HIFU), and cryotherapy. The main issues to consider when choosing nonsurgical salvage local therapies are local tumor control and significant genitourinary toxicity. OBJECTIVE To conduct a systematic review and meta-analysis of the role of nonsurgical salvage modalities in patients with radiorecurrent prostate cancer and associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION We performed a critical review of the Medline, Scopus, and ClinicalKey databases from January 1, 2000 through February 1, 2018 according to the Preferred Reporting Items and Meta-Analyses statement. To assess the overall quality of the literature reviewed, we used a modified Delphi tool for case-series studies. EVIDENCE SYNTHESIS A total of 64 case-series studies were included, corresponding to a cohort of 5585 patients. The modified Delphi checklist evidenced high methodological quality overall (mean quality score of 80.6%). Biochemical control rates were lowest for patients treated with HIFU (58%, 95% confidence interval [CI] 47-68%) and highest for patients treated with BT (69%, 95% CI 62-76%) and EBRT (69%, 95% CI 53-83%). The lowest prevalence of incontinence was for patients treated with BT (3%, 95% CI 0-6%; I2=63.4%) and the highest was among patients treated with HIFU (28%, 95% CI 19-38%; I2=89.7%). CONCLUSIONS Nonsurgical therapeutic options, especially BT, showed good outcomes in terms of biochemical control and tolerability in the local recurrence setting. PATIENT SUMMARY The current analysis demonstrated that nonsurgical salvage local therapies offer a chance of a curative local approach in radiorecurrent prostate cancer. However, high-quality data from prospective trials are needed to validate long-term outcomes from nonsurgical strategies for the treatment of intraprostatic recurrence after previous radiotherapy.
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Affiliation(s)
- Gianluca Ingrosso
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Carlotta Becherini
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Networking, Florence, Italy
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Giulio Francolini
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Morten Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marta Bottero
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Alberto Bossi
- Department of Radiotherapy, Gustave-Roussy Institute, Villejuif, France
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Daniele Scartoni
- Proton Treatment Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
| | - Riccardo Santoni
- Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Irene Giacomelli
- Proton Treatment Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Beatrice Detti
- Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy
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29
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Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives. Cancers (Basel) 2018; 10:cancers10120480. [PMID: 30513915 PMCID: PMC6316339 DOI: 10.3390/cancers10120480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022] Open
Abstract
Over the last decades, primary prostate cancer radiotherapy saw improving developments, such as more conformal dose administration and hypofractionated treatment regimens. Still, prostate cancer recurrences after whole-gland radiotherapy remain common, especially in patients with intermediate- to high-risk disease. The vast majority of these patients are treated palliatively with androgen deprivation therapy (ADT), which exposes them to harmful side-effects and is only effective for a limited amount of time. For patients with a localized recurrent tumor and no signs of metastatic disease, local treatment with curative intent seems more rational. However, whole-gland salvage treatments such as salvage radiotherapy or salvage prostatectomy are associated with significant toxicity and are, therefore, uncommonly performed. Treatments that are solely aimed at the recurrent tumor itself, thereby better sparing the surrounding organs at risk, potentially provide a safer salvage treatment option in terms of toxicity. To achieve such tumor-targeted treatment, imaging developments have made it possible to better exclude metastatic disease and accurately discriminate the tumor. Currently, focal salvage treatment is being performed with different modalities, including brachytherapy, cryotherapy, high-intensity focused ultrasound (HIFU), and stereotactic body radiation therapy (SBRT). Oncologic outcomes seem comparable to whole-gland salvage series, but with much lower toxicity rates. In terms of oncologic control, these results will improve further with better understanding of patient selection. Other developments, such as high-field diagnostic MRI and live adaptive MRI-guided radiotherapy, will further improve precision of the treatment.
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30
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da Silva RD, Kim FJ. Prostate Cancer - Local Treatment after Radiorecurrence: Salvage Cryoablation. Int Braz J Urol 2018; 44:435-439. [PMID: 29792652 PMCID: PMC5996813 DOI: 10.1590/s1677-5538.ibju.2018.03.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rodrigo Donalisio da Silva
- Division of Urology, Denver Health Medical Center, Denver, CO, USA.,Division of Urology, University of Colorado Denver, Denver, CO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA.,Division of Urology, University of Colorado Denver, Denver, CO, USA
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31
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Tisseverasinghe SA, Crook JM. The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:414-435. [PMID: 30050801 PMCID: PMC6043745 DOI: 10.21037/tau.2018.05.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer is the most prevalent cancer amongst men. For localized disease, there currently exist several reliable treatment modalities including surgery, radiotherapy and brachytherapy. Our growing understanding of this disease indicates that local control plays a very important role in prevention of subsequent dissemination. Many improvements to external beam radiotherapy over recent years have decreased toxicity and improved outcomes, but nonetheless, local relapse remains common. Many salvage options exist for locally recurrent prostate cancer, but are rarely offered, partly because of the fear of toxicity. Many men with isolated local recurrence therefore do not receive potentially curative second line treatment and are instead treated with palliative androgen suppression. Selection plays an important role in determining which individuals are likely to benefit from salvage. Those at high risk of pre-existing micro-metastatic disease despite negative staging scans are unlikely to benefit. Prostate brachytherapy has evolved over the more than 3 decades of experience. Modern techniques allow more precise tumor localization and dose delivery. Better understanding of dosimetric parameters can distinguish optimal from suboptimal implants. Salvage brachytherapy can be an effective treatment for locally recurrent prostate cancer after prior external beam radiotherapy. We review the literature pertaining to both low dose rate (LDR) and high dose rate (HDR) salvage brachytherapy and discuss patient selection, optimal dose, treatment volume and toxicity avoidance.
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Affiliation(s)
- Steven A Tisseverasinghe
- BC Cancer Agency Centre for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
| | - Juanita M Crook
- BC Cancer Agency Centre for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
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Gevorgyan A, Hétet JF, Robert M, Duchattelle-Dussaule V, Corno L, Boulay I, Baumert H. [Salvage cryotherapy of prostate cancer after failed external radiotherapy and brachytherapy: Morbidity and mid-term oncological results]. Prog Urol 2018; 28:291-301. [PMID: 29551263 DOI: 10.1016/j.purol.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 06/19/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the oncologic and functional results of salvage cryotherapy after failure of external radiotherapy and brachytherapy. MATERIALS AND METHODS Patients treated by total salvage cryotherapy (3rd generation) in 2 centers (Groupe Hospitalier Saint-Joseph in Paris and Clinique Jule-Verne Nantes) in between January 2008 and April 2016 were included. The biochemical recurrence-free survival (BRFS) was calculated using the Phoenix criteria (PSA>nadir+2ng/mL). The functional results were assessed clinically. RESULTS Ninety-seven patients with an average follow up of 39.4months were evaluated retrospectively. The 5-year biochemical recurrence-free survival (5y-BRFS) among all patients was 58.1% (IC à 95% [45.9-68.5]). Low and intermediate risk patients (d'Amico classification) were less prone to biochemical recurrence than high risk (81.05% (IC à 95% [64.1-90.5]) 5y-BRFS as opposed to 35.09% (IC à 95% [20.1-50.4]) respectively) (P<0.0001). As were patients with a Gleason score≤7 75.35% (IC à 95% [59.7-85.6]) compared to 32.31% (IC à 95% [16.5-49.2]) for higher Gleason (>7 scores [P=0.0002]). A Gleason score>7 (OR=6.9; P=0.002), PSA nadir>1ng/mL (OR=25.8; P=0.0026) and peri-urethral invasion (OR=35.8; P<0.001) were major risk factors for local recurrence in univariate analysis. In multivariate analysis, only PSA nadir>1ng/mL (OR=12.9; P=0.042) and peri-urethral invasion (OR=21.6; P=0.0003) remain major risk factors for recurrence. About 13 (16.46%) patients were incontinent of which 3 (3.79%) required placement of an artificial urinary sphincter. Erectile dysfunction was present in 66 (83.5%) patients. Recto-urethral fistula was uncommon in 1 patient (1.27%). CONCLUSION Salvage cryotherapy after failure of external radiotherapy and brachytherapy is a reliable and reproducible technique with promising oncological and functional results. Study of prognostic factors will help better select eligible patients in the future. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Gevorgyan
- Service d'urologie, CHRU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - J-F Hétet
- Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314 Nantes cedex 3, France
| | - M Robert
- Service d'urologie, CHRU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - V Duchattelle-Dussaule
- Service d'urologie, CHRU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - L Corno
- Service d'urologie, CHRU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - I Boulay
- Service d'urologie, CHRU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314 Nantes cedex 3, France; Service d'urologie, groupe hospitalier Paris Saint-Joseph, 18, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - H Baumert
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 18, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Golbari NM, Katz AE. Salvage Therapy Options for Local Prostate Cancer Recurrence After Primary Radiotherapy: a Literature Review. Curr Urol Rep 2018; 18:63. [PMID: 28688020 DOI: 10.1007/s11934-017-0709-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW While recurrence after primary treatment of prostate cancer (PCa) is not uncommon, there is currently no consensus on the most appropriate management after radiation treatment failure. This article seeks to explore the currently utilized modalities for salvage treatment for radiorecurrent PCa. We focused our review on the oncologic outcomes and reported toxicity rates in the latest studies examining salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage high-intensity focused ultrasound (HIFU) and re-irradiation. RECENT FINDINGS There does not appear to be any significant difference in overall survival for more invasive salvage radical prostatectomy compared to the minimally invasive salvage approaches. Additionally, there seems to be a trend towards lower morbidity rates associated with minimally invasive and focal salvage treatment. We are encouraged by the results presented in this review and find that there is clearly a role for emerging minimally invasive and focal therapies as durable options for salvage treatment in patients with radiorecurrent PCa.
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Miki K, Kimura S, Ohnuma H, Sakanaka K, Sasaki H, Kimura T, Takahashi H, Egawa S. [SALVAGE CRYOABLATION TARGETING RECURRENT LESIONS AFTER DEFINITIVE RADIOTHERAPY FOR PROSTATE CANCER: IMPACT OF POST CRYOABLATION CHANGE IN URINARY AND SEXUAL FUNCTION]. Nihon Hinyokika Gakkai Zasshi 2018; 109:184-193. [PMID: 31631081 DOI: 10.5980/jpnjurol.109.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Purpose) To describe our initial experience in salvage cryoablation targeting recurrent lesions after definitive irradiation for prostate cancer. (Methods) Eligible patients for this treatment were those who developed biochemical failure after definitive radiotherapy for localized prostate cancer, but without distant metastasis, and with solid lesions identifiable on multiparametric magnetic resonance imaging (mpMRI). Histological proof of recurrence with mapping biopsy covering corresponding sites was obtained. Two to four cryoprobes were inserted transperineally into the prostate under general anesthesia with extensive lithotomy position. The rapid expansion of argon gas cryogen through a small opening within the cryoprobe cools itself to make an ice ball and the quick exchange to helium gas induces an active thawing phase. Entire procedure is monitored and guided with the use of transrectal ultrasonography. Postoperative follow-up included patient interview, digital rectal examination, prostate specific antigen (PSA) testing and quality of life (QOL) monitoring using IPSS and IIEF-5 at 1, 3, 6 and 12 months postoperatively. Changes of mpMRI findings with time, particularly at one month, were used to judge immediate treatment impact. (Results) Five patients underwent salvage cryoablation between October 2015 and September 2016. No grade 3/4 complications such as rectal fistula or urethral stenosis were experienced. Mean and maximal percent decline of PSA from baseline levels at 1, 3, 6 and 12 months following cryoablation were 72.2 and 94.7%, 79.4% and 93.9%, 78.2% and 92.1%, 79.6% and 90.9%, respectively. Posttreatment IPSS showed temporary worsening with average changes in score of 1.8, 1.5, 1.6, and 1.0 times over baseline levels, respectively. IPSS score returned to the baseline in one at six months and two at 12 months. Two of 5 patients were sexually active prior to therapy and thus evaluable. Both showed significant decline in IIEF score by 95% at 12 months. No patients showed any signs of recurrence. mpMRI at one month following cryoablation confirmed complete disappearance of visible lesions in all cases. (Conclusions) Salvage cryoablation for recurrent lesions of prostate cancer after definitive radiotherapy is feasible with minimal morbidity. Both oncological outcome and adverse events should be monitored carefully with longer follow up.
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Affiliation(s)
- Kenta Miki
- Department of Urology, Jikei University School of Medicine
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine
| | - Hajime Ohnuma
- Department of Urology, Jikei University School of Medicine
| | - Keigo Sakanaka
- Department of Urology, Jikei University School of Medicine
| | - Hiroshi Sasaki
- Department of Urology, Jikei University School of Medicine
| | | | | | - Shin Egawa
- Department of Urology, Jikei University School of Medicine
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Fakhrejahani F, Madan RA, Dahut WL. Management Options for Biochemically Recurrent Prostate Cancer. Curr Treat Options Oncol 2017; 18:26. [PMID: 28434181 DOI: 10.1007/s11864-017-0462-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.
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Affiliation(s)
- Farhad Fakhrejahani
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA.
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Whole-Gland Prostate Cancer Cryoablation with Magnetic Resonance Imaging Guidance: One-Year Follow-Up. Cardiovasc Intervent Radiol 2017; 41:344-349. [PMID: 29043385 DOI: 10.1007/s00270-017-1799-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients who develop prostate cancer after prior abdominal perineal resection are poor surgical candidates, and have limited treatment options. Therefore, our goal is to present results from a single institutional experience of four patients who underwent whole gland MRI-guided cryoablation with a history complicated by prior abdominoperineal resection. MATERIALS AND METHODS Four MRI-guided cryoablative treatments (mean age 64, range 59-69 years) for primary and locally recurrent prostate adenocarcinoma were retrospectively reviewed in patients with prior abdominal perineal resection for colorectal cancer (3) and juvenile polyposis (1). Average prostate volume prior to ablation was 23 cc, with an average PSA of 5.6 ng/mL. For each gland, 7-10 cryoprobes were placed approximately 0.5 cm apart in the prostate gland under MRI guidance by a transperineal approach with 3-4 freeze-thaw cycles performed. Each patient had follow up imaging and PSA measurements out to 12 months post ablation. RESULTS All four patient's PSA dropped below 0.1 ng/mL at 3-6 month post-ablation and remained at these levels at 12 months. Three of the 4 patients had PSA measurements to 33 months post-ablation, with no evidence of recurrence. No patient developed urinary incontinence due to the whole gland cryoablation. CONCLUSION With all four patients in our study having undetectable PSAs 12 months post ablation, and with no patient developing urinary incontinence due to the cryoablation, MRI-guided cryoablation appears to be a promising treatment option in patients who are poor surgical candidates due to prior pelvic surgery and/or radiation.
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Hopper AB, Sandhu APS, Parsons JK, Rose B, Einck JP. Salvage image guided radiation therapy to the prostate after cryotherapy failure. Adv Radiat Oncol 2017; 3:52-56. [PMID: 29556580 PMCID: PMC5856984 DOI: 10.1016/j.adro.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose Cryotherapy is an option for the primary treatment of localized prostate cancer, along with radical prostatectomy, external beam radiation therapy, and brachytherapy. Although it is known that local recurrence can occur in >20% of patients treated with primary cryotherapy, unfortunately there is a paucity of data on later salvage treatments. The use of external beam radiation therapy is an attractive option after cryotherapy failure, but there is little data on its efficacy and toxicity. We evaluated the biochemical control and complication rates of salvage dose-escalated image guided intensity modulated radiation therapy (IG-IMRT) after cryotherapy failure. Methods and materials Patients who were treated at our institution from 2005 to 2016 were reviewed for those who underwent cryotherapy as initial treatment followed by salvage IGRT. Patients were treated with dose-escalated IG-IMRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily cone beam computed tomography or kv imaging to implanted fiducial markers. Biochemical progression was defined in accordance with the Phoenix consensus conference definition. Results Eight patients were identified as having received post-cryotherapy salvage radiation within the study period. The median total dose was 77.7 Gy (range, 75.6-81.0 Gy). Median follow-up was 55 months (range, 6-88 months). Six patients remained biochemically controlled at the latest follow-up. One patient developed distant metastases after 22 months and one experienced biochemical failure at 30 months with no evidence of distant metastases. No patients experienced acute gastrointestinal toxicities of grade 2 or higher. There were no cases of late gastrointestinal or genitourinary toxicity. Conclusions High-dose IG-IMRT results in high rates of salvage and extremely low rates of serious late toxicity for patients with locally recurrent prostate cancer after cryotherapy. Although the results are encouraging, given the small number of patients in this and other series, we remain cautious with regard to this treatment and believe the use of salvage radiation therapy after cryotherapy warrants further study.
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Affiliation(s)
- Austin B Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ajay P S Sandhu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, California
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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Renard-Penna R, Sanchez-Salas R, Barret E, Cosset JM, de Vergie S, Sapetti J, Ingels A, Gangi A, Lang H, Cathelineau X. [Evaluation and results of ablative therapies in prostate cancer]. Prog Urol 2017; 27:887-908. [PMID: 28939336 DOI: 10.1016/j.purol.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed. RESULTS Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization. CONCLUSION The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.
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Affiliation(s)
- R Renard-Penna
- Service d'imagerie, hôpitaux Tenon-Pitié Salpêtrière, AP-HP, UPMC université Paris VI, 75013 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - E Barret
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - J M Cosset
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - S de Vergie
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - J Sapetti
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - A Ingels
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Scheltema MJ, van den Bos W, Siriwardana AR, Kalsbeek AM, Thompson JE, Ting F, Böhm M, Haynes AM, Shnier R, Delprado W, Stricker PD. Feasibility and safety of focal irreversible electroporation as salvage treatment for localized radio-recurrent prostate cancer. BJU Int 2017; 120 Suppl 3:51-58. [DOI: 10.1111/bju.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthijs J. Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Willemien van den Bos
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Amila R. Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Anton M.F. Kalsbeek
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | | | - Francis Ting
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Ron Shnier
- Southern Radiology; Randwick NSW Australia
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[Indications and limits of ablative therapies in prostate cancer]. Prog Urol 2017; 27:865-886. [PMID: 28918871 DOI: 10.1016/j.purol.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed. RESULTS The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization. CONCLUSION Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.
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Leroy T, Lacornerie T, Bogart E, Nickers P, Lartigau E, Pasquier D. Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center. Radiat Oncol 2017; 12:95. [PMID: 28599663 PMCID: PMC5466739 DOI: 10.1186/s13014-017-0833-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Currently, there is no standard option for local salvage treatment for local prostate cancer recurrence after radiotherapy. Our objective was to investigate the feasibility and efficiency of Robotic Stereotactic Body Radiation Therapy (SBRT) in this clinical setting. METHODS/MATERIALS We retrospectively reviewed patients who were treated at our institution with SBRT for local prostate cancer recurrence after External Beam Radiation Therapy (EBRT) or brachytherapy. Multidisciplinary staff approved the treatment, and recurrence was biopsy-proven when feasible. A dose of 36 Gy was prescribed in six fractions. Treatment was delivered every other day. RESULTS Between August 2011 and February 2014, 23 patients were treated with SBRT for intra-prostate cancer recurrence with a median follow up of 22 months (6 to 40). Twenty patients had biopsy-proven recurrence. For 19 patients, EBRT was the initial treatment and in four patients, brachytherapy was the initial treatment; the median relapse-time from initial treatment was 65 months (28 to 150). At relapse, 10 patients had an extra-capsular extension. Fourteen patients were treated with androgen deprivation that could be stopped after a median of 1 month after SBRT (range 0-24). A PSA decrease occurred in 82.6% of the patients after SBRT. The 2-year disease-free survival and overall survival rates were 54 and 100%, respectively. Disease progression was observed for nine patients (39.1%) (five local, three metastatic and one nodal progression) after a median of 20 months (7-40 months). The median nadir PSA was 0.35 ng/ml and was achieved after a median of 8 months (1 to 30) after treatment. We observed no grade 4 or 5 toxicity. Two patients presented with grade 3 toxicities (two Cystitis and one neuralgia). Other toxicities included urinary toxicities (five grade 2 and nine grade 1) and rectal toxicities (two grade 2 and two grade 1). CONCLUSION SBRT for local prostate cancer recurrence seems feasible and well tolerated with a short follow up. Prospective evaluation is needed.
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Affiliation(s)
- Thomas Leroy
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Thomas Lacornerie
- Department of Radiation Physics, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Emilie Bogart
- Department of Statistic, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Philippe Nickers
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Eric Lartigau
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
| | - David Pasquier
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
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Percutaneous MR-guided focal cryoablation for recurrent prostate cancer following radiation therapy: retrospective analysis of iceball margins and outcomes. Eur Radiol 2017; 27:4828-4836. [PMID: 28409355 PMCID: PMC5635095 DOI: 10.1007/s00330-017-4833-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To evaluate iceball margins after magnetic resonance (MR)-guided focal salvage prostate cryoablation and determine the correlation with local outcome. METHODS A retrospective review was performed on 47 patients that underwent percutaneous MR-guided focal cryoablation for biopsy-proven locally recurrent prostate cancer after primary radiotherapy. Preprocedural diagnostic and intraprocedural MR images were analysed to derive three-directional iceball margins. Local tumour progression after cryoablation was defined as evident tumour recurrence on follow-up MRI, positive MR-guided biopsy or biochemical failure without radiological evidence of metastatic disease. RESULTS Mean iceball margins were 8.9 mm (range -7.1 to 16.2), 10.1 mm (range 1.1-20.3) and 12.5 mm (range -1.5 to 22.2) in anteroposterior, left-right and craniocaudal direction respectively. Iceball margins were significantly smaller for tumours that were larger (P = .008) or located in the posterior gland (P = .047). Significantly improved local progression-free survival at 1 year post focal cryoablation was seen between patients with iceball margin >10 mm (100%), 5-10 mm (84%) and <5 mm (15%) (P < .001). CONCLUSIONS Iceball margins appear to correlate with local outcome following MR-guided focal salvage prostate cryoablation. Our initial data suggest that freezing should be applied at minimum 5 mm beyond the border of an MR-visible recurrent prostate tumour for successful ablation, with a wider margin appearing desirable. KEY POINTS • Shortest iceball margin most often occurred in anteroposterior direction • Margins were smaller in tumours that were larger or posteriorly located • Minimum iceball margin was a predictor of early local tumour progression • A minimum 5-mm margin seems required for effective cryoablation of recurrent PCa.
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Abstract
There is growing consensus that multiparametric magnetic resonance imaging (mpMRI) is an effective modality in the detection of locally recurrent prostate cancer after prostatectomy and radiation therapy. The emergence of magnetic resonance (MR)-guided focal therapies, such as cryoablation, high-intensity focused ultrasound, and laser ablation, have made the use of mpMRI even more important, as the normal anatomy is inevitably altered and the detection of recurrence is made more difficult. The aim of this article is to review the utility of mpMRI in detecting recurrent prostate cancer in patients following radical prostatectomy, radiation therapy, and focal therapy and to discuss expected post-treatment mpMRI findings, the varied appearance of recurrent tumors, and their mimics.
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Kongnyuy M, Berg CJ, Kosinski KE, Habibian DJ, Schiff JT, Corcoran AT, Katz AE. Salvage focal cryosurgery may delay use of androgen deprivation therapy in cryotherapy and radiation recurrent prostate cancer patients. Int J Hyperthermia 2017; 33:810-813. [DOI: 10.1080/02656736.2017.1306121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Siddiqui KM, Billia M, Arifin A, Li F, Violette P, Chin JL. Pathological, Oncologic and Functional Outcomes of a Prospective Registry of Salvage High Intensity Focused Ultrasound Ablation for Radiorecurrent Prostate Cancer. J Urol 2017; 197:97-102. [DOI: 10.1016/j.juro.2016.06.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Khurram M. Siddiqui
- Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michele Billia
- Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrew Arifin
- Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Fan Li
- Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Joseph L. Chin
- Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Peters M, Piena MA, Steuten LM, van der Voort van Zyp JR, Moerland MA, van Vulpen M. Comparative cost-effectiveness of focal and total salvage 125I brachytherapy for recurrent prostate cancer after primary radiotherapy. J Contemp Brachytherapy 2016; 8:484-491. [PMID: 28115953 PMCID: PMC5241382 DOI: 10.5114/jcb.2016.64808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Focal salvage (FS) iodine 125 (125I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. MATERIAL AND METHODS A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. RESULTS Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. CONCLUSIONS Focal salvage 125I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity.
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Affiliation(s)
- Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
- Both authors contributed equally to this research
| | - Marjanne A. Piena
- University of Twente, Enschede, The Netherlands
- Both authors contributed equally to this research
| | | | | | - Marinus A. Moerland
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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Cryosurgery would be An Effective Option for Clinically Localized Prostate Cancer: A Meta-analysis and Systematic Review. Sci Rep 2016; 6:27490. [PMID: 27271239 PMCID: PMC4895342 DOI: 10.1038/srep27490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/17/2016] [Indexed: 02/05/2023] Open
Abstract
Cryosurgery (CS) has been used on patients with clinically localized PCa for more than 10 years. However, clinical studies evaluating its effectiveness and safety have reported conflicting results. This systematic assessment was performed to obtain comprehensive evidence regarding the potential benefits and safety of CS compared with those of radiotherapy (RT) and radical prostatectomy (RP), respectively. All controlled trials comparing CS with RT or RP and single-arm studies reporting results of CS therapy were identified through comprehensive searches of PubMed, the Cochrane Library and Embase. Ten publications from seven trials, with totally 1252 patients, were included in the meta-analysis, which revealed no significant differences in comparisons of CS vs RT and CS vs RP for overall survival and disease specific survival. However, a significantly lower disease-free survival could be observed for CS than RP. Moreover, a systematic review of literature focusing on comparative data of databases and materials of single-arm trials revealed satisfactory survival results in both primary and salvage CS. Our results showed that cryosurgery would be a relatively effective method for clinically localized prostate cancer with survival results comparable to radiotherapy and radical prostatectomy. However, the large percentage of complications caused by cryosurgery should be carefully monitored.
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol 2016; 34:1521-1531. [PMID: 27012712 PMCID: PMC5063906 DOI: 10.1007/s00345-016-1811-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background/Aim Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. Methods A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. Results One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69–100, 49–100, 50–91 and 46.5–54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0–33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. Conclusion Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1811-9) contains supplementary material, which is available to authorized users.
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Rectal dose constraints for salvage iodine-125 prostate brachytherapy. Brachytherapy 2016; 15:85-93. [DOI: 10.1016/j.brachy.2015.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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Chipollini J, Punnen S. Salvage Cryoablation of the Prostate. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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