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Kang HW, Jung HD, Lee JY, Kwon JK, Jeh SU, Cho KS, Ham WS, Choi YD. Prediction of organ-confined disease after robot-assisted radical prostatectomy in patients with clinically locally-advanced prostate cancer. Asian J Surg 2017; 42:120-125. [PMID: 29274670 DOI: 10.1016/j.asjsur.2017.10.005] [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: 08/15/2017] [Revised: 09/30/2017] [Accepted: 10/25/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the preoperative predictive factors that could identify subsets of favorable patients who can be possibly cured with robot-assisted radical prostatectomy (RARP) alone in locally advanced prostate cancer (LAPCa). Our study was designed to identify clinical predictors of pathologic organ-confined disease (pOCD) in RARP setting. METHODS Between 2007 and 2013, clinicopathological and oncological data from 273 consecutive men undergoing robot-assisted RP with extended PLND for clinically LAPCa were reviewed in a single-institution, retrospectively. After exclusion of patients who received neoadjuvant hormone treatment before surgery, 186 subjects satisfied the final inclusion criteria. RESULTS Fourty-three patients (23.1% of total cohort) with preoperative clinically LAPCa patients were down-staged to pOCD following RARP. Preoperative prostate-specific antigen (PSA) level, preoperative PSAD, positive core percent, maximal tumor volume in any core, and biopsy Gleason score were significantly associated with down-staging into pOCD following RARP. Multivariate logistic regression analysis revealed that lower preoperative PSA (≤10 ng/mL) and maximal tumor volume in any core (≤70%) were independent predictors of pOCD following RARP. CONCLUSIONS Approximately 23% of preoperative clinically LAPCa patients were down-staged to pOCD following RARP. Preoperative PSA and maximal tumor volume in any biopsy core might be useful clinical predictors of pOCD in clinically LAPCa patients in RARP setting.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, South Korea
| | - Hae Do Jung
- Department of Urology, Yong-In Severance Hospital, Yonsei University College of Medicine, Yong-In, South Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, South Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Akakura K, Tsuji H, Suzuki H, Ichikawa T, Ishikawa H, Okada T, Kamada T, Harada M, Tsujii H, Shimazaki J. Usefulness of J-CAPRA Score for High-risk Prostate Cancer Patients Treated with Carbon Ion Radiotherapy Plus Androgen Deprivation Therapy. Jpn J Clin Oncol 2014; 44:360-5. [DOI: 10.1093/jjco/hyu006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yamamichi F, Shigemura K, Morishita S, Yamanaka K, Tanaka K, Miyake H, Fujisawa M. Significance of neoadjuvant hormonal therapy in radical retropubic prostatectomy: a retrospective single-surgeon study. Yonsei Med J 2013; 54:410-5. [PMID: 23364975 PMCID: PMC3575985 DOI: 10.3349/ymj.2013.54.2.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether neo-adjuvant hormonal therapy (NHT) prior to radical retropubic prostatectomy (RRP) for prostate cancer (PCa) is beneficial in terms of surgical outcomes and for preventing or delaying biochemical recurrence via single-surgeon case series study. MATERIALS AND METHODS Fifty-three men underwent RRP by a single surgeon. The patients were divided into two groups according to whether or not NHT was performed prior to RRP. The study was analyzed retrospectively. We evaluated clinical parameters, surgical parameters, and biochemical recurrence rate. Group 1 (n=34) was treated with RRP only, while Group 2 (n=19) underwent RRP along with NHT. RESULTS There were no significant differences in clinical, operation-related and pathological factors between the two groups (p>0.05). There was also no significant difference in biochemical recurrence rate between the two groups at the last follow-up, although Group 2 tended to have a lower PCa recurrence rate than Group 1 and the initial prostate-specific antigen (PSA) level was significantly higher in Group 2 than Group 1 (p=0.0496). CONCLUSION The present single-surgeon case series study revealed a trend toward a lower rate of PCa recurrence in NHT+RRP treated patients compared to those treated with RRP alone, but this did not reach statistical significance, despite the fact that NHT+RRP patients exhibited higher serum PSA levels preoperatively. Prospective studies with a longer duration of observation and a greater number of patients would be helpful in evaluating NHT more definitively.
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Affiliation(s)
- Fukashi Yamamichi
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Urology, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Kunito Yamanaka
- Department of Urology, Akashi Municipal Hospital, Akashi, Japan
| | - Kazushi Tanaka
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Rogers CG, Sammon JD, Sukumar S, Diaz M, Peabody J, Menon M. Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urol Oncol 2013; 31:193-7. [DOI: 10.1016/j.urolonc.2010.11.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/23/2010] [Accepted: 11/30/2010] [Indexed: 11/26/2022]
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Long-term outcomes of three-dimensional conformal radiation therapy combined with neoadjuvant hormonal therapy for Japanese patients with T1c-T2N0M0 prostate cancer. Int J Clin Oncol 2011; 17:562-8. [PMID: 21968911 DOI: 10.1007/s10147-011-0326-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/09/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The outcomes of three-dimensional conformal radiation therapy (3D-CRT) combined with neoadjuvant hormonal therapy (NAHT) in Japanese patients with T1c-T2N0M0 prostate cancer, with initiation of salvage hormonal therapy (SHT) at a relatively early phase, were analyzed. METHODS Fifty-nine Japanese patients with T1c-T2N0M0 prostate cancer who received radical 3D-CRT between January 1999 and January 2003 were evaluated. The median age, initial prostate-specific antigen (PSA) level, and duration of NAHT were: 72 years, 9.4 ng/ml, and 6 months, respectively. Seventy Gy was given in 35 fractions confined to the prostate ± seminal vesicles. AHT was not administered after 3D-CRT in any patients. RESULTS The median follow-up period was 89 months. The median PSA value at the time of initiation of SHT was 4.7 ng/ml (range 0.1-21.6 ng/ml). The overall, disease-specific, PSA failure-free (based on the Phoenix definition), and SHT-free survival rates at 8 years were 82.8% (95% confidence interval [CI] 72.4-93.2), 100%, 62.4% (47.1-77.8), and 82.6% (71.3-94.0), respectively. Only one patient developed grade 3 late toxicity. CONCLUSIONS The PSA control rates in our series of Japanese patients with stage T1c-T2N0M0 prostate cancer treated with the standard dose of 3D-CRT combined with NAHT seemed at least comparable to those reported from Western countries; as well, the patients had excellent outcomes. The present outcomes can be used as basic data for evaluating the impact of dose escalation with intensity-modulated radiation therapy for Japanese patients with prostate cancer in the future.
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Peinemann F, Grouven U, Hemkens LG, Bartel C, Borchers H, Pinkawa M, Heidenreich A, Sauerland S. Low-dose rate brachytherapy for men with localized prostate cancer. Cochrane Database Syst Rev 2011:CD008871. [PMID: 21735436 DOI: 10.1002/14651858.cd008871.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Localized prostate cancer is a slow growing tumor for many years for the majority of affected men. Low-dose rate brachytherapy (LDR-BT) is short-distance radiotherapy using low-energy radioactive sources. LDR-BT has been recommended for men with low risk localized prostate cancer. OBJECTIVES To assess the benefit and harm of LDR-BT compared to radical prostatectomy (RP), external beam radiotherapy (EBRT), and no primary therapy (NPT) in men with localized prostatic cancer. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1950), and EMBASE (from 1980) were searched in June 2010 as well as online trials registers and reference lists of reviews. SELECTION CRITERIA Randomized, controlled trials comparing LDR-BT versus RP, EBRT, and NPT in men with clinically localized prostate cancer. DATA COLLECTION AND ANALYSIS Data on study methods, participants, treatment regimens, observation period and outcomes were recorded by two reviewers independently. MAIN RESULTS We identified only one RCT (N = 200; mean follow up 68 months). This trial compared LDR-BT and RP. The risk of bias was deemed high. Primary outcomes (overall survival, cause-specific mortality, or metastatic-free survival) were not reported. Biochemical recurrence-free survival at 5 years follow up was not significantly different between LDR-BT (78/85 (91.8%)) and RP (81/89 (91.0%)); P = 0.875; relative risk 0.92 (95% CI: 0.35 to 2.42).For severe adverse events reported at 6 months follow up, results favored LDR-BT for urinary incontinence (LDR-BT 0/85 (0.0%) versus RP 16/89 (18.0%); P < 0.001; relative risk 0) and favored RP for urinary irritation (LDR-BT 68/85 (80.0%) versus RP 4/89 (4.5%); P < 0.001; relative risk 17.80, 95% CI 6.79 to 46.66). The occurrence of urinary stricture did not significantly differ between the treatment groups (LDR-BT 2/85 (2.4%) versus RP 6/89 (6.7%); P = 0.221; relative risk 0.35, 95% CI: 0.07 to 1.68). Long-term information was not available.We did not identify significant differences of mean scores between treatment groups for patient-reported outcomes function and bother as well as generic health-related quality of life. AUTHORS' CONCLUSIONS Low-dose rate brachytherapy did not reduce biochemical recurrence-free survival versus radical prostatectomy at 5 years. For short-term severe adverse events, low-dose rate brachytherapy was significantly more favorable for urinary incontinence, but radical prostatectomy was significantly more favorable for urinary irritation. Evidence is based on one RCT with high risk of bias.
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Affiliation(s)
- Frank Peinemann
- Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, Cologne, Germany, 51105
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Loeb S, Smith ND, Roehl KA, Catalona WJ. Intermediate-Term Potency, Continence, and Survival Outcomes of Radical Prostatectomy for Clinically High-Risk or Locally Advanced Prostate Cancer. Urology 2007; 69:1170-5. [PMID: 17572209 DOI: 10.1016/j.urology.2007.02.054] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 01/19/2007] [Accepted: 02/26/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Controversy exists about the preferred treatment of patients with high-risk or locally advanced prostate cancer. We examined the intermediate-term cancer control and quality-of-life outcomes after radical retropubic prostatectomy (RRP) in selected patients. METHODS From 1984 to 2003, 288 men with Stage cT2b (Gleason score 8 to 10 or a prostate-specific antigen level greater than 15 ng/mL) or T3 disease underwent RRP by a single surgeon. The 7 and 10-year actuarial progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), potency, and continence rates were recorded. RESULTS The actuarial 7-year PFS, CSS, and OS rate after surgery was 39%, 92%, and 91%, respectively. The corresponding actuarial 10-year rates were 35%, 88%, and 74%. Only OS differed significantly by age group. On multivariate analysis, the pathologic stage was a significant independent predictor of progression. Ultimately, 31 men (11%) required hormonal therapy, 58 (20%) underwent postoperative radiotherapy, and 67 (23%) received both. Potency and continence were preserved in 64% and 92%, respectively. CONCLUSIONS Overall, RRP offers excellent intermediate-term cancer control for selected men of all ages who present with high-risk or locally advanced disease. The PFS was significantly greater for men with high-risk Stage cT2b than for those with cT3 disease, but the CSS and OS were similar. Both continence and potency were preserved in most patients, although the potency rates were significantly greater for the younger men. RRP with appropriate postoperative radiotherapy and/or hormonal therapy is a reasonable treatment option for selected men with high-risk or locally advanced disease.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, Georgetown University School of Medicine, Washington, DC, USA
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Abstract
Locally advanced prostate cancer is a treatment dilemma. As with prostate cancer in general, there is no clear evidence that aggressive intervention (ie, surgery or radiation) is superior to noninvasive interventions (eg, delayed treatment or androgen ablation). Because patients with locally advanced prostate cancer have a high risk of local and systemic recurrence, there is some argument to proceed with androgen ablation as the sole modality of treatment. The data using this approach are limited, but an understanding of the degree and duration of response is helpful in selecting patients for primary androgen ablation.
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Affiliation(s)
- Gregory P Swanson
- University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, MC 7889, San Antonio, TX 78229, USA.
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Akakura K, Suzuki H, Ichikawa T, Fujimoto H, Maeda O, Usami M, Hirano D, Takimoto Y, Kamoto T, Ogawa O, Sumiyoshi Y, Shimazaki J, Kakizoe T. A Randomized Trial Comparing Radical Prostatectomy Plus Endocrine Therapy versus External Beam Radiotherapy Plus Endocrine Therapy for Locally Advanced Prostate Cancer: Results at Median Follow-up of 102 Months. Jpn J Clin Oncol 2006; 36:789-93. [PMID: 17082219 DOI: 10.1093/jjco/hyl115] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. METHODS One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. RESULTS Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01). CONCLUSIONS For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer.
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Saito T, Kitamura Y, Komatsubara S, Matsumoto Y, Sugita T, Hara N. Outcomes of locally advanced prostate cancer: a single institution study of 209 patients in Japan. Asian J Androl 2006; 8:555-61. [PMID: 16847528 DOI: 10.1111/j.1745-7262.2006.00175.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To investigate the outcomes for Asian populations with locally advanced/clinical stage III prostate cancer (PCa) treated with currently prevailing modalities. METHODS We reviewed the record of 209 patients with clinical stage III PCa, who were treated at Niigata Cancer Center Hospital between 1992 and 2003. Treatment options included hormone therapy-combined radical prostatectomy (RP+HT), hormone therapy-combined external beam irradiation (EBRT+HT) and primary hormone therapy (PHT). RESULTS The 5- and 10-year overall survival rates were 80.3% and 46.1% in all cohorts, respectively. The survival rates were 87.3% and 66.5% in the RP+HT group, 94.9% and 70.0% in the EBRT+HT group and 66.1% and 17.2% in the PHT group, respectively. A significant survival advantage was found in the EBRT+HT group compared with that in the PHT group (P < 0.0001). Also, the RP+HT group had better survival than the PHT group (P = 0.0107). The 5- and 10-year disease-specific survival rates for all cases were 92.5% and 80.0%, respectively. They were 93.8% and 71.4% in the RP+HT group, 96.6% and 93.6% in the EBRT+HT group and 88.6% and 62.3% in the PHT group, respectively. A survival advantage was found in the EBRT+HT group compared with the PHT group (P = 0.029). No significant difference was found in disease-specific survival between the EBRT+HT and RP+HT groups or between the RP+HT and PHT groups. CONCLUSION Although our findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa, we recommend therapies that take into account the patients'social and medical conditions for Asian men with clinical stage III PCa.
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Affiliation(s)
- Toshihiro Saito
- Division of Urology, Niigata Cancer Center Hospital, Niigata 951-8510, Japan
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Spiess PE, Leibovici D, Pisters LL. Surgery for locally advanced disease. Curr Urol Rep 2006; 7:209-16. [PMID: 16630524 DOI: 10.1007/s11934-006-0023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Locally advanced prostate cancer is diagnosed in approximately one in four new cases of prostate cancer. The estimated disease-specific mortality rate resulting from monotherapy with either surgery or radiotherapy is a disappointing 75%. A multimodality treatment approach could offer more promising results. In addition, several key factors related to surgical treatment of locally advanced prostate cancer may optimize the oncologic results and minimize patient morbidity. In this report, we summarize some of the anatomic features and technical concepts associated with the surgical management of this disease and review recently published results of the outcomes of surgery and neoadjuvant or adjuvant chemohormonal therapy for locally advanced prostate cancer.
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Affiliation(s)
- Philippe E Spiess
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
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