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Neoadjuvant Hormonal Therapy for Prostate Cancer: Morphologic Features and Predictive Parameters of Therapy Response. Adv Anat Pathol 2022; 29:252-258. [PMID: 35670702 DOI: 10.1097/pap.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The primary goals of neoadjuvant hormonal therapy (NHT) in prostate cancer (PCa) are to reduce the size of the tumor, lower positive surgical margin rate, attempt to reach pathologic remission, and improve survival. Although NHT has not been recommended by the National Comprehensive Cancer Network as a primary treatment option for patients with localized PCa, NHT is increasingly used in clinical trials for locally advanced PCa. More importantly, with the development of novel androgen signaling inhibitors, such as abiraterone and enzalutamide, there has been renewed interests in revisiting the role of such treatment in the neoadjuvant setting. Following NHT, the PCa tissues shows characteristic morphologic alterations. Of note, the collapse of malignant glands most likely leads to an artificial increase of Gleason score in the residual disease. Communicating these changes to the clinician in a way that can help assess the tumor's response poses a challenge for pathologists. In addition, little is known of morphologic features and predictive makers both in pretreated and posttreated specimens that can be of value in predicting tumor response to NHT. In the current review, we summarize the morphologic changes associated with neoadjuvant-treated PCa, focusing on the predictive value of pathologic parameters to therapy response. We also describe the evaluation system in the stratification of pathologic response to NHT in PCa management.
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Neoadjuvant hormonal therapy before radical prostatectomy in high-risk prostate cancer. Nat Rev Urol 2021; 18:739-762. [PMID: 34526701 DOI: 10.1038/s41585-021-00514-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
Patients with high-risk prostate cancer treated with curative intent are at an increased risk of biochemical recurrence, metastatic progression and cancer-related death compared with patients treated for low-risk or intermediate-risk disease. Thus, these patients often need multimodal therapy to achieve complete disease control. Over the past two decades, multiple studies on the use of neoadjuvant treatment have been performed using conventional androgen deprivation therapy, which comprises luteinizing hormone-releasing hormone agonists or antagonists and/or first-line anti-androgens. However, despite results from these studies demonstrating a reduction in positive surgical margins and tumour volume, no benefit has been observed in hard oncological end points, such as cancer-related death. The introduction of potent androgen receptor signalling inhibitors (ARSIs), such as abiraterone, apalutamide, enzalutamide and darolutamide, has led to a renewed interest in using neoadjuvant hormonal treatment in high-risk prostate cancer. The addition of ARSIs to androgen deprivation therapy has demonstrated substantial survival benefits in the metastatic castration-resistant, non-metastatic castration-resistant and metastatic hormone-sensitive settings. Intuitively, a similar survival effect can be expected when applying ARSIs as a neoadjuvant strategy in high-risk prostate cancer. Most studies on neoadjuvant ARSIs use a pathological end point as a surrogate for long-term oncological outcome. However, no consensus yet exists regarding the ideal definition of pathological response following neoadjuvant hormonal therapy and pathologists might encounter difficulties in determining pathological response in hormonally treated prostate specimens. The neoadjuvant setting also provides opportunities to gain insight into resistance mechanisms against neoadjuvant hormonal therapy and, consequently, to guide personalized therapy.
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Wang X, Qi M, Zhang J, Sun X, Guo H, Pang Y, Zhang Q, Chen X, Zhang R, Liu Z, Liu L, Hao X, Han B. Differential response to neoadjuvant hormonal therapy in prostate cancer: Predictive morphological parameters and molecular markers. Prostate 2019; 79:709-719. [PMID: 30825345 DOI: 10.1002/pros.23777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The predictive value of the histological parameters and molecular markers for neoadjuvant hormonal therapy (NHT) in prostate cancer (PCa) has not been well established. The aim of this study is to determine pathological variables that can predict differences in response to NHT in PCa. METHODS A total of 85 locally high risk PCa patients with matched preoperative needle biopsies and radical prostatectomy (RP) specimens were included. All patients were treated with NHT for at least 3 months. We quantified the response to NHT using a new proposed pathological grading system. The system classified tumors into five groups (grades 0-4) according to the severity of histological response. We then categorized the PCa patients into drug-sensitive (DS) group (Grades 2-4) and drug-resistant (DR) group (Grades 0-1). Two pathologists assessed each pretreated tumors for presence or absence of nine morphological features. The expression of androgen receptor (AR), ERG, and PTEN were evaluated by immunohistochemistry (IHC) as well. Statistical analysis was performed to identify significant associations between differentially histological response to NHT and morphological features as well as molecular aberrations. We evaluated different prediction models using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) analysis. RESULTS 73% (n = 62/85) of tumors in our cohort belonged to DS group, whereas 27% (n = 23/85) of tumors were DR. Univariate logistic analysis suggested four pathological variables, cribriform growth pattern, macronucleoli, ductal adenocarcinoma differentiation, and PTEN loss in needle biopsies were significantly associated with DR effect, all with P-value < 0.05. Multivariate logistic regression analysis revealed that the three parameters as significant predictive factors for predicting DR effect. These were macronucleoli (RR = 4.008, P = 0.002), ductal adenocarcinoma differentiation (RR = 11.659, P = 0.009) and PTEN loss expression (RR = 7.275, P = 0.015). The AUC of three integrated indicators model was 0.781. CONCLUSIONS Our study suggested that the presence of tumor cribriform growth pattern, macronucleoli, ductal adenocarcinoma differentiation, and PTEN loss in needle biopsies are of value in predicting tumor response to NHT regimen. Multivariate logistic regression analysis revealed the performance of combined pathological indicators in predicting DR response was better than that of model based on individual factor alone.
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Affiliation(s)
- Xueli Wang
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Binzhou City Central Hospital, Binzhou, China
| | - Mei Qi
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Jing Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiubin Sun
- Department of Statistics, Shandong University, School of Public Health, Jinan, China
| | - Hongwei Guo
- Department of Pathology, Linyi People's Hospital, Linyi, China
| | - Yu Pang
- Department of Pathology, Taian City Central Hospital, Taian, China
| | - Qian Zhang
- Department of Pathology, Binzhou Medical University, Binzhou, China
| | - Xinyi Chen
- Department of Pathology, Qingdao Central Hospital of Qingdao University Medical College, Qingdao, China
| | - Ruifeng Zhang
- Department of Pathology, Traditional Chinese Medical Hospital of Xintai, Taian, China
| | - Zhiyan Liu
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Long Liu
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Xiaomeng Hao
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
| | - Bo Han
- The Key Laboratory of Experimental Teratology, Ministry of Education and Department of Pathology, Shandong University, School of Basic Medical Sciences, Jinan, China
- Department of Pathology, Shandong University QiLu Hospital, Jinan, China
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Nosov A, Reva S, Petrov S, Mamijev E, Novikov R, Veliev E, Imkamp F, Tolkach Y, Moiseenko V. Neoadjuvant Chemotherapy Using Reduced-Dose Docetaxel Followed by Radical Prostatectomy for Patients With Intermediate and High-Risk Prostate Cancer: A Single-Center Study. Prostate 2016; 76:1345-52. [PMID: 26864707 DOI: 10.1002/pros.23165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND To assess safety, pathologic response rate, and long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemotherapy using reduced-dose docetaxel without androgen-deprivation therapy in prostate cancer (PCa) patients of intermediate- and high-risk groups. METHODS Forty-four patients with PCa (PSA > 10 ng/ml, Gleason score 7 or more, or clinical stage cT2c or more) were included with a median follow-up of 11.4 years after RP. One group (NCT/RP) received neoadjuvant treatment 3-weekly with docetaxel (36 mg/m(2) for up to six cycles, 21 patients), the other (control) group (RP, 23 patients) received RP only. RESULTS Toxicities were mild with grade 3 events not exceeding 10%. A statistically significant reduction of PSA > 50% post-chemotherapy was observed in 52.4% cases. Cancer-specific survival (CSS) was 90% in the NCT/RP group and 60.9% in the RP group (P = 0.042). The biochemical recurrence-free survival was 68.5% in the NCT/RP and 37.7% in the RP groups; overall survival was 75.5% and 54.6%, respectively (both P > 0.05). CONCLUSIONS The use of neoadjuvant chemotherapy before RP in a selected regimen and dose represents a safe strategy and results in benefits in CSS. Given the limitations of the study, this concept should be evaluated in large, prospective, controlled studies. Prostate 76: 1345-1352, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alexander Nosov
- Department of Oncological Urology, Petrov N.N. Research Institute of Oncology, Saint-Petersburg, Russia
| | - Sergey Reva
- Department of Oncological Urology, Petrov N.N. Research Institute of Oncology, Saint-Petersburg, Russia.
| | - Sergey Petrov
- Department of Oncological Urology, Petrov N.N. Research Institute of Oncology, Saint-Petersburg, Russia
| | - Eldar Mamijev
- Department of Oncological Urology, Petrov N.N. Research Institute of Oncology, Saint-Petersburg, Russia
| | - Roman Novikov
- Department of Oncological Urology, Petrov N.N. Research Institute of Oncology, Saint-Petersburg, Russia
| | - Evgeniy Veliev
- Urology Clinic of the S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Florian Imkamp
- Clinic for Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Yuri Tolkach
- Clinic for Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
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Adenovirus vector carrying REIC/DKK-3 gene: neoadjuvant intraprostatic injection for high-risk localized prostate cancer undergoing radical prostatectomy. Cancer Gene Ther 2016; 23:400-409. [PMID: 27767086 PMCID: PMC5116477 DOI: 10.1038/cgt.2016.53] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
Abstract
As the First-In-Human study of in situ gene therapy using an adenovirus vector carrying the human REIC (reduced expression in immortalized cell)/Dkk-3 gene (Ad-REIC), we conducted neoadjuvant intraprostatic injections in patients with high-risk localized prostate cancer undergoing radical prostatectomy (RP). Patients with recurrence probability of 35% or more within 5 years following RP, as calculated by Kattan's nomogram, were enrolled. Patients received two ultrasound-guided intratumoral injections at 2-week intervals, followed by RP 6 weeks after the second injection. After confirming the safety of the therapeutic interventions with initially planned three escalating doses of 1.0 × 1010, 1.0 × 1011 and 1.0 × 1012 viral particles (vp) in 1.0-1.2 ml (n=3, 3 and 6), an additional higher dose of 3.0 × 1012 vp in 3.6 ml (n=6) was further studied. All four DLs including the additional dose level-4 (DL-4) were feasible with no adverse events, except for grade 1 or 2 transient fever. Laboratory toxicities were grade 1 or 2 elevated aspartate transaminase/alanine transaminase (n=4). Regarding antitumor activities, cytopathic effects (tumor degeneration with cytolysis and pyknosis) and remarkable tumor-infiltrating lymphocytes in the targeted tumor areas were detected in a clear dose-dependent manner. Consequently, biochemical recurrence-free survival in DL-4 was significantly more favorable than in patient groups DL-1+2+3.
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Schwarzenböck SM, Knieling A, Souvatzoglou M, Kurth J, Steiger K, Eiber M, Esposito I, Retz M, Kübler H, Gschwend JE, Schwaiger M, Krause BJ, Thalgott M. [11C]Choline PET/CT in therapy response assessment of a neoadjuvant therapy in locally advanced and high risk prostate cancer before radical prostatectomy. Oncotarget 2016; 7:63747-63757. [PMID: 27572317 PMCID: PMC5325400 DOI: 10.18632/oncotarget.11653] [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: 03/08/2016] [Accepted: 08/24/2016] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Recent studies have shown promising results of neoadjuvant therapy in prostate cancer (PC). The aim of this study was to evaluate the potential of [11C]Choline PET/CT in therapy response monitoring after combined neoadjuvant docetaxel chemotherapy and complete androgen blockade in locally advanced and high risk PC patients. RESULTS In [11C]Choline PET/CT there was a significant decrease of SUVmax and SUVmean (p = 0.004, each), prostate volume (p = 0.005) and PSA value (p = 0.003) after combined neoadjuvant therapy. MRI showed a significant prostate and tumor volume reduction (p = 0.003 and 0.005, respectively). Number of apoptotic cells was significantly higher in prostatectomy specimens of the therapy group compared to pretherapeutic biopsies and the control group (p = 0.02 and 0.003, respectively). METHODS 11 patients received two [11C]Choline PET/CT and MRI scans before and after combined neoadjuvant therapy followed by radical prostatectomy and pelvic lymph node dissection. [11C]Choline uptake, prostate and tumor volume, PSA value (before/after neoadjuvant therapy) and apoptosis (of pretherapeutic biopsy/posttherapeutic prostatectomy specimens of the therapy group and prostatectomy specimens of a matched control group without neoadjuvant therapy) were assessed and tested for differences and correlation using SPSS. CONCLUSIONS The results showing a decrease in choline uptake after combined neoadjuvant therapy (paralleled by regressive and apoptotic changes in histopathology) confirm the potential of [11C]Choline PET/CT to monitor effects of neoadjuvant therapy in locally advanced and high risk PC patients. Further studies are recommended to evaluate its use during the course of neoadjuvant therapy for early response assessment.
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Affiliation(s)
- Sarah M Schwarzenböck
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany.,Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Anna Knieling
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Michael Souvatzoglou
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany.,Department of Nuclear Medicine, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Katja Steiger
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Irene Esposito
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany.,Institute of Pathology, Heinrich-Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich
| | - Hubert Kübler
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany.,Department of Nuclear Medicine, Rostock University Medical Centre, 18057 Rostock, Germany
| | - Mark Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich
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Kumon H, Sasaki K, Ariyoshi Y, Sadahira T, Araki M, Ebara S, Yanai H, Watanabe M, Nasu Y. Feasibility of Neoadjuvant Ad-REIC Gene Therapy in Patients with High-Risk Localized Prostate Cancer Undergoing Radical Prostatectomy. Clin Transl Sci 2015; 8:837-40. [PMID: 26621187 PMCID: PMC4737302 DOI: 10.1111/cts.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In a phase I/IIa study of in situ gene therapy using an adenovirus vector carrying the human REIC/Dkk‐3 gene (Ad‐REIC), we assessed the inhibitory effects of cancer recurrence after radical prostatectomy (RP), in patients with high risk localized prostate cancer (PCa). After completing the therapeutic interventions with initially planned three escalating doses of 1.0 × 1010, 1.0 × 1011, and 1.0 × 1012 viral particles (VP) in 1.0–1.2 mL (n = 3, 3, and 6), an additional higher dose of 3.0 × 1012 VP in 3.6 mL (n = 6) was further studied. Patients with recurrence probability of 35% or more within 5 years after RP as calculated by Kattan's nomogram, were enrolled. They received two ultrasound‐guided intratumoral injections at 2‐week intervals, followed by RP 6 weeks after the second injection. Based on the findings of MRI and biopsy mapping, as a rule, one track injection to the most prominent cancer area was given to initial 12 patients and 3 track injections to multiple cancer areas in additional 6 patients. As compared to the former group, biochemical recurrence‐free survival of the latter showed a significantly favorable outcome. Neoadjuvant Ad‐REIC, mediating simultaneous induction of cancer selective apoptosis and augmentation of antitumor immunity, is a feasible approach in preventing cancer recurrence after RP. (199)
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Affiliation(s)
- Hiromi Kumon
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsumi Sasaki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuichi Ariyoshi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Ebara
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masami Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
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Quinn DI, Sternberg CN. Neoadjuvant chemotherapy in the treatment of muscle-invasive bladder cancer. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Martini T, Aziz A, Roghmann F, Rink M, Chun FK, Fisch M, Trojan L, Hakenberg OW, Zastrow S, Wirth MP, Moersdorf J, Brookman-May S, Stief CG, Haferkamp A, Wagenlehner F, Hohenfellner M, Herrmann E, Lusuardi L, Grimm MO, Müller SC, Roigas J, Bastian PJ, Gierth M, Burger M, Pycha A, Seitz C, May M, Bolenz C. Prediction of Locally Advanced Urothelial Carcinoma of the Bladder Using Clinical Parameters before Radical Cystectomy - A Prospective Multicenter Study. Urol Int 2015; 96:57-64. [DOI: 10.1159/000433606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/27/2015] [Indexed: 11/19/2022]
Abstract
Introduction: We aimed at developing and validating a pre-cystectomy nomogram for the prediction of locally advanced urothelial carcinoma of the bladder (UCB) using clinicopathological parameters. Materials and Methods: Multicenter data from 337 patients who underwent radical cystectomy (RC) for UCB were prospectively collected and eligible for final analysis. Univariate and multivariate logistic regression models were applied to identify significant predictors of locally advanced tumor stage (pT3/4 and/or pN+) at RC. Internal validation was performed by bootstrapping. The decision curve analysis (DCA) was done to evaluate the clinical value. Results: The distribution of tumor stages pT3/4, pN+ and pT3/4 and/or pN+ at RC was 44.2, 27.6 and 50.4%, respectively. Age (odds ratio (OR) 0.980; p < 0.001), advanced clinical tumor stage (cT3 vs. cTa, cTis, cT1; OR 3.367; p < 0.001), presence of hydronephrosis (OR 1.844; p = 0.043) and advanced tumor stage T3 and/or N+ at CT imaging (OR 4.378; p < 0.001) were independent predictors for pT3/4 and/or pN+ tumor stage. The predictive accuracy of our nomogram for pT3/4 and/or pN+ at RC was 77.5%. DCA for predicting pT3/4 and/or pN+ at RC showed a clinical net benefit across all probability thresholds. Conclusion: We developed a nomogram for the prediction of locally advanced tumor stage pT3/4 and/or pN+ before RC using established clinicopathological parameters.
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Renal Clear Cell Carcinoma Acrometastasis. An Unusual Terminal Condition. J Hand Microsurg 2015; 7:149-51. [PMID: 26078530 DOI: 10.1007/s12593-014-0127-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
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Long-term results of a phase II study with neoadjuvant docetaxel chemotherapy and complete androgen blockade in locally advanced and high-risk prostate cancer. J Hematol Oncol 2014; 7:20. [PMID: 24598155 PMCID: PMC3974001 DOI: 10.1186/1756-8722-7-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with locally advanced and high-risk prostate cancer (LAPC) are prone to experience biochemical recurrence despite radical prostatectomy (RP). We evaluated feasibility, safety and activity of a neoadjuvant chemohormonal therapy (NCHT) with 3-weekly full dose docetaxel and complete androgen blockade (CAB) in locally advanced and high-risk prostate cancer patients (LAPC) undergoing RP. METHODS Patients (n = 30) were selected by Kattans' preoperative score and received trimestral buserelin 9,45 mg, bicalutamide 50 mg/day and 3 cycles docetaxel (75 mg/m²) followed by RP. Primary endpoints were biochemical (PSA) and local downstaging. Secondary endpoints included toxicity and operability assessments, pathological complete response (pCR), time to PSA progression, 5-year biochemical recurrence free survival (bRFS) and overall survival (OS). RESULTS Median baseline PSA was 25.8 ng/ml (2.1-293), and the predicted probability of 5-year bRFS was 10% (0-55). NCHT induced PSA-reduction was 97.3% (81.3-99.9%; p < 0.001) and post-RP 96.7% of patients were therapy responders, with undetectable PSA-values. Post- vs. pretreatment MRI indicated a median tumor volume reduction of 46.4% (-31.3-82.8; p < 0.001). A pathological downstaging was observed in 48.3%. Severe hematologic toxicities (≥CTC3) were frequent with 53.8% leucopenia, 90% neutropenia and 13.3% febrile neutropenia. RP was performed in all patients. While resectability was hindered in 26.7%, continence was achieved in 96.7%. Pathologic analyses revealed no pCR. Lymph node- and extracapsular involvement was observed in 36.7% and 56.7% with 33.3% positive surgical margins. After a median of 48.6 (19.9-87.8) months, 55.2% of therapy responders experienced PSA-recurrence. The estimated median time to PSA-progression was 38.6 months (95%CI 30.9-46.4) and 85.3 months (95%CI 39.3-131.3) for OS. The 5-year bRFS was improved to 40%, but limiting for interpretation adjuvant treatment was individualized. CONCLUSIONS NCHT is feasible despite high hematotoxicity, with excellent functional results. Significant downstaging was observed without pCR. NCHT seems to improve the cohort adjusted 5-year bRFS, but clinical value needs further investigation in randomized trials.
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McKay RR, Choueiri TK, Taplin ME. Rationale for and review of neoadjuvant therapy prior to radical prostatectomy for patients with high-risk prostate cancer. Drugs 2013; 73:1417-30. [PMID: 23943203 PMCID: PMC4127573 DOI: 10.1007/s40265-013-0107-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite state of the art local therapy, a significant portion of men with high-risk prostate cancer develop progressive disease. Neoadjuvant systemic therapy prior to radical prostatectomy (RP) is an approach that can potentially maximize survival outcomes in patients with localized disease. This approach is under investigation with a wide array of agents and provides an opportunity to assess pathologic and biologic activity of novel treatments. The aim of this review is to explore the past and present role of neoadjuvant therapy prior to definitive therapy with RP in patients with high-risk localized or locally advanced disease. The results of neoadjuvant androgen-deprivation therapy (ADT), including use of newer agents such as abiraterone, are promising. Neoadjuvant chemotherapy, primarily with docetaxel, with or without ADT has also demonstrated efficacy in men with high-risk disease. Other novel agents targeting the vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR), clusterin, and the immune system are currently under investigation and have led to variable results in early clinical trials. Despite optimistic data, approval of neoadjuvant therapy prior to RP in patients with high-risk prostate cancer will depend on positive results from well designed phase III trials.
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ICUD-EAU International Consultation on Bladder Cancer 2012: Chemotherapy for Urothelial Carcinoma—Neoadjuvant and Adjuvant Settings. Eur Urol 2013; 63:58-66. [DOI: 10.1016/j.eururo.2012.08.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/06/2012] [Indexed: 11/19/2022]
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14
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Mitra AP, Skinner EC, Miranda G, Daneshmand S. A precystectomy decision model to predict pathological upstaging and oncological outcomes in clinical stage T2 bladder cancer. BJU Int 2012; 111:240-8. [DOI: 10.1111/j.1464-410x.2012.11424.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anirban P. Mitra
- Department of Pathology and Center for Personalized Medicine; University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center; Los Angeles; CA; USA
| | - Eila C. Skinner
- Institute of Urology; University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center; Los Angeles; CA; USA
| | - Gus Miranda
- Institute of Urology; University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center; Los Angeles; CA; USA
| | - Siamak Daneshmand
- Institute of Urology; University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center; Los Angeles; CA; USA
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Schrader AJ, Steffens S, Schnoeller TJ, Schrader M, Kuczyk MA. Neoadjuvant therapy of renal cell carcinoma: a novel treatment option in the era of targeted therapy? Int J Urol 2012; 19:903-7. [PMID: 22640774 DOI: 10.1111/j.1442-2042.2012.03065.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study was carried out to evaluate the effectiveness, toxicity and optimal duration of neoadjuvant therapy for patients with organ-confined or locally advanced renal cell carcinoma in the era of targeted agents. A literature review was carried out using Medline/Pubmed articles, as well as congress reports from the last five American Society of Clinical Oncology, American Urological Association and European Association of Urology Annual Meetings. Neoadjuvant targeted therapy is feasible and shows toxicity similar to that seen in a palliative setting. Most studies recommend an application for 2-4 months. The current data situation is best for sunitinib. Surgery can apparently be carried out the day right after discontinuing the drug. However, even sunitinib leads to only a mean 10% decrease in primary tumor size, and one-quarter to one-fifth of all patients show local tumor progression during treatment. Few patients (approximately 12%) with a vena cava tumor thrombus achieve a significant decrease in its level under neoadjuvant therapy; here too, progression is observed in a significant number of cases. Even the new targeted agents show limited effectiveness in achieving relevant remissions of the primary tumor. Furthermore, tumor progression is seen in a significant percentage of patients during neoadjuvant therapy. Thus, even today in the era of targeted agents, a neoadjuvant approach should only be made in patients with localized or locally advanced renal cell carcinoma, which primarily seem to be absolutely inaccessible by (partial) nephrectomy.
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Perfusion MRI for monitoring the effect of sorafenib on experimental prostate carcinoma: a validation study. AJR Am J Roentgenol 2012; 198:384-91. [PMID: 22268182 DOI: 10.2214/ajr.11.6951] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate with immunohistochemical validation whether dynamic contrast-enhanced MRI with small-molecule contrast medium is useful for monitoring the effects of the multikinase inhibitor sorafenib on prostate carcinomas in rats. MATERIALS AND METHODS Copenhagen rats (n = 20) into which prostate carcinoma (MAT-Ly-Lu-B2) had been implanted subcutaneously were imaged on the day of implantation and 7 days later with 3-T dynamic gadobutrol-enhanced MRI. The therapy group (n = 10) received daily administration of 10 mg/kg body weight sorafenib. Quantitative measurements of tumor perfusion, tumor vascularity, and permeability-surface area product were calculated with a two-compartment model. Dynamic contrast-enhanced MRI values were correlated with immunohistochemical results for validation. RESULTS Tumor perfusion in sorafenib-treated prostate carcinoma declined significantly from day 0 to day 7 (47.9 ± 36.8 mL/100 mL/min to 24.4 ± 18.6 mL/100 mL/min; p < 0.05). No significant effect on permeability-surface area product was observed in either the therapy or the control group (p > 0.05). Tumor vascularity decreased significantly (p < 0.05) from day 0 to day 7 under sorafenib treatment (15.6% ± 11.4% to 5.4% ± 2.1%). Immunohistochemical analysis revealed significantly lower tumor vascularity in the therapy than in the control group (rat endothelial cell antigen 1, 74.4 ± 16.9 cells vs 197 ± 75.4 cells; p < 0.05). In sorafenib-treated tumors, significantly more apoptotic cells (terminal deoxynucleotidyl transferase-mediated nick end labeling, 6923 ± 3761 vs 3167 ± 1500; p < 0.05) and significantly fewer proliferating cells (Ki-67, 10,198 ± 3064 vs 15,003 ± 3674; p < 0.05) were observed than in the control group. Modest but significant correlations were observed between tumor perfusion and immunohistochemical tumor cell apoptosis (r = -0.56; p < 0.05) and between tumor perfusion and immunohistochemical tumor vascularity (r = 0.56; p < 0.05). CONCLUSION Tumor perfusion quantified with gadobutrol-enhanced dynamic contrast-enhanced MRI can be used as a noninvasive surrogate parameter for monitoring the antiangiogenic, antiproliferative, and proapoptotic effects of sorafenib on prostate carcinoma allografts as validated with immunohistochemical analysis.
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17
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Agarwal N. Editorial Comment. J Urol 2011; 186:887; author reply 888. [DOI: 10.1016/j.juro.2011.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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18
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Feifer AH, Taylor JM, Tarin TV, Herr HW. Maximizing cure for muscle-invasive bladder cancer: integration of surgery and chemotherapy. Eur Urol 2011; 59:978-84. [PMID: 21257257 PMCID: PMC3137649 DOI: 10.1016/j.eururo.2011.01.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/08/2011] [Indexed: 11/20/2022]
Abstract
CONTEXT The optimal treatment strategy for muscle-invasive bladder cancer remains controversial. OBJECTIVE To determine optimal combination of chemotherapy and surgery aimed at preserving survival of patients with locally advanced bladder cancer. EVIDENCE ACQUISITION We performed a critical review of the published abstract and presentation literature on combined modality therapy for muscle-invasive bladder cancer. We emphasized articles of the highest scientific level, combining radical cystectomy and perioperative chemotherapy with curative intent to affect overall and disease-specific survival. EVIDENCE SYNTHESIS Locally invasive, regional, and occult micrometastases at the time of radical cystectomy lead to both distant and local failure, causing bladder cancer deaths. Neoadjuvant and adjuvant chemotherapy regimens have been evaluated, as well as the quality of cystectomy and pelvic lymph node dissection. CONCLUSIONS Prospective, randomized clinical trials argue strongly for neoadjuvant cisplatin-based chemotherapy followed by high-quality cystectomy performed by an experienced surgeon operating in a high-volume center. Adjuvant chemotherapy after surgery is also effective when therapeutic doses can be given in a timely fashion. Both contribute to improved overall survival; however, many patients receive only one or none of these options, and the barriers to receiving optimal, combined, systemic therapy and surgery remain to be defined. An aging, comorbid, and often unfit population increasingly affected by bladder cancer poses significant challenges in management of individual patients.
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Affiliation(s)
- Andrew H Feifer
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Sonoda LI, Halim MY, Balan KK. Solitary phalangeal metastasis of renal cell carcinoma on bone scintigram. Clin Nucl Med 2011; 36:237-9. [PMID: 21285689 DOI: 10.1097/rlu.0b013e318208f52c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Renal cell carcinoma is known to cause lytic metastasis at various sites including axial and appendicular skeleton. However, it is unusual to find an isolated metastasis of renal cell carcinoma in the distal extremity on bone scintigraphy. A 70-year-old woman with renal cell carcinoma was referred to the Nuclear Medicine Department for a bone scintigram to exclude metastasis. The whole-body planar images were unremarkable, but the local views of the hands demonstrated a solitary metastasis in the middle phalanx of the finger. This rare experience illustrates the need for including local views of extremities in a standard whole-body study.
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Affiliation(s)
- Luke I Sonoda
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, England, United Kingdom.
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Martin JM, Supiot S, Berthold DR. Pharmacotherapeutic Management of Locally Advanced Prostate Cancer. Drugs 2011; 71:1019-41. [DOI: 10.2165/11591500-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ye L, Letchford K, Heller M, Liggins R, Guan D, Kizhakkedathu JN, Brooks DE, Jackson JK, Burt HM. Synthesis and characterization of carboxylic acid conjugated, hydrophobically derivatized, hyperbranched polyglycerols as nanoparticulate drug carriers for cisplatin. Biomacromolecules 2010; 12:145-55. [PMID: 21128674 DOI: 10.1021/bm101080p] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hyperbranched polyglycerols (HPGs) with hydrophobic cores and derivatized with methoxy poly(ethylene glycol) were synthesized and further functionalized with carboxylate groups to bind and deliver cisplatin. Low and high levels of carboxylate were conjugated to HPGs (HPG-C(8/10)-MePEG(6.5)-COOH(113) and HPG-C(8/10)-MePEG(6.5)-COOH(348)) and their structures were confirmed through NMR and FTIR spectroscopy and potentiometric titration. The hydrodynamic diameter of the HPGs ranged from 5-10 nm and the addition of COOH groups decreased the zeta potential of the polymers. HPG-C(8/10)-MePEG(6.5)-COOH(113) bound up to 10% w/w cisplatin, whereas HPG-C(8/10)-MePEG(6.5)-COOH(348) bound up to 20% w/w drug with 100% efficiency. Drug was released from HPG-C(8/10)-MePEG(6.5)-COOH(113) over 7 days at the same rate, regardless of the pH. Cisplatin release from HPG-C(8/10)-MePEG(6.5)-COOH(348) was significantly slower than HPG-C(8/10)-MePEG(6.5)-COOH(113) at pH 6 and 7.4, but similar at pH 4.5. Release of cisplatin into artificial urine was considerably faster than into buffer. Carboxylated HPGs demonstrated good biocompatibility, and drug-loaded HPGs effectively inhibited proliferation of KU-7-luc bladder cancer cells.
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Affiliation(s)
- Lucy Ye
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, British Columbia, Canada
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