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Tashiro Y, Akamatsu S, Ueno K, Kamoto T, Terada N, Hida T, Kurahashi R, Kamba T, Saito A, Lee T, Morita S, Kobayashi T. A retrospective study of prognostic factors and prostate-specific antigen dynamics in Japanese patients with metastatic hormone-sensitive prostate cancer who received combined androgen blockade therapy with bicalutamide. Int J Clin Oncol 2024; 29:1564-1573. [PMID: 39153094 PMCID: PMC11420257 DOI: 10.1007/s10147-024-02597-x] [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: 03/03/2024] [Accepted: 07/30/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND This retrospective observational study explored the therapeutic potential of combined androgen blockade (CAB) with bicalutamide (Bic-CAB) as an initial treatment for metastatic hormone-sensitive prostate cancer (mHSPC) in Japan. METHODS The electronic health records of 159 patients with mHSPC from three Japanese institutions who received initial treatment with Bic-CAB between 2007 and 2017 were analyzed. The time to prostate-specific antigen (PSA) progression, duration of Bic-CAB treatment, and overall survival (OS), with various definitions for PSA progression, were assessed. A multivariate Cox proportional hazards model was constructed using clinical parameters to predict time to the end of Bic-CAB treatment and OS. RESULTS The median observation period was 46.4 months, and the median age of patients at diagnosis was 71 years. A total of 46.5% patients experienced PSA progression with a median survival duration of 29 months (according to Prostate Cancer Clinical Trials Working Group 3 criteria), and 49.1% patients achieved a PSA nadir < 0.2 ng/mL in a median time of 4.7 months. When stratified by PSA nadir and PSA change, patients at low risk for disease progression with a small PSA change due to low initial PSA had a 5-year OS of 100% and a 10-year OS of 75%. The OS during the observation period was 72.9 months. CONCLUSION These findings highlight the potential effect of Bic-CAB in patients with mHSPC who were at low risk for disease progression. Initial treatment with Bic-CAB and adjusting treatment early based on PSA dynamics may be a reasonable treatment plan for these patients.
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Affiliation(s)
- Yu Tashiro
- Department of Urology, Japanese Red Cross Otsu Hospital, 1 Chome-1-35 Nagara, Otsu, Shiga, 520-0046, Japan.
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Urology, Nagoya University Graduate School of Medicine, 2 Chome-1-10 Kitachikusa, Chikusa Ward, Nagoya, Aichi, 464-0083, Japan
| | - Kentaro Ueno
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Yoshidakonoecho, Sakyo Ward, Kyoto, 606-8303, Japan
| | - Toshiyuki Kamoto
- Department of Urology, University of Miyazaki, Kihara-5200 Kiyotakecho, Miyazaki, 889-1601, Japan
| | - Naoki Terada
- Department of Urology, University of Fukui, 3 Chome-9-1 Bunkyo, Fukui, 910-0017, Japan
| | - Takuya Hida
- Department of Urology, University of Miyazaki, Kihara-5200 Kiyotakecho, Miyazaki, 889-1601, Japan
| | - Ryoma Kurahashi
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, 2 Chome-40-1 Kurokami, Chuo Ward, Kumamoto, 860-0862, Japan
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, 2 Chome-40-1 Kurokami, Chuo Ward, Kumamoto, 860-0862, Japan
| | - Atsushi Saito
- Astellas Pharma Inc, 2-5-1, Nihonbashi-Honcho, Chuo-Ku, Tokyo, 103-8411, Japan
| | - Takumi Lee
- Astellas Pharma Inc, 2-5-1, Nihonbashi-Honcho, Chuo-Ku, Tokyo, 103-8411, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Yoshidakonoecho, Sakyo Ward, Kyoto, 606-8303, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Fukuda I, Aoki M, Kimura T, Ikeda K. Radiotherapy after radical prostatectomy for prostate cancer: clinical outcomes and factors influencing biochemical recurrence. Ir J Med Sci 2023; 192:2663-2671. [PMID: 37097540 DOI: 10.1007/s11845-023-03356-z] [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: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Radiotherapy (RT) after radical prostatectomy (RP) includes adjuvant radiotherapy (ART) and salvage radiotherapy (SRT), which can prevent or cure biochemical recurrence. AIMS To evaluate long-term outcomes of RT after RP and to examine factors affecting biochemical recurrence-free survival (bRFS). METHODS Sixty-six received ART and 73 received SRT between 2005 and 2012 were included. The clinical outcomes and late toxicities were evaluated. Univariate and multivariate analyses were performed to examine factors affecting bRFS. RESULTS Median follow-up from RP was 111 months. Five-year bRFS and 10-year distant metastasis-free survival from RP were 82.8% and 84.5% in ART, and 74.6% and 92.4% in SRT, respectively. The most frequent late toxicity was hematuria, which was higher in ART (p = .01). No recurrence within RT field was occurred. On univariate analysis, pelvic RT was associated with favorable bRFS in ART (p = .048). In SRT, post-RP prostate-specific antigen (PSA) level (< 0.05 ng/mL), PSA nadir after RT (≤ 0.01 ng/mL), and time to PSA nadir (≥ 10 months) were associated with favorable bRFS (p = .03, p < .001, and p = .002, respectively). On multivariate analysis, post-RP PSA level and time to PSA nadir were independent predictive factors for bRFS in SRT (p = .04 and p = .005). CONCLUSIONS ART and SRT had favorable outcomes with no recurrence within RT field. In SRT, the time to PSA nadir after RT (≥ 10 months) was found to be a new predictor for favorable bRFS and useful in assessing treatment efficacy.
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Affiliation(s)
- Ichiro Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koshi Ikeda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
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Yang D, Chen W, Lai F, Qiu M, Li J. Feasibility of apalutamide combined with androgen deprivation therapy and short-course low-dose prednisone in treating metastatic hormone-sensitive prostate cancer: a pilot randomized controlled trial. Front Oncol 2023; 13:1110807. [PMID: 38023146 PMCID: PMC10657800 DOI: 10.3389/fonc.2023.1110807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The role of prednisone in the prevention of androgen receptor antagonist-related rash and treatment for metastatic hormone-sensitive prostate cancer (mHSPC) is unclear. This pilot trial (ChiCTR2200060388) aimed to investigate the feasibility of apalutamide combined with androgen deprivation therapy (ADT) and short-course low-dose prednisone in the treatment of mHSPC. Methods All patients received apalutamide and ADT and were randomly divided into two groups based on the administration of oral prednisone or not (control group). The primary endpoint was the incidence of rash. The secondary endpoint included the proportions of patients with a decline in PSA ≥50% from baseline, PSA ≥90% from baseline, and decreased to PSA ≤0.2 ng/mL. Results Between June 2021 and March 2022, a total of 83 patients were enrolled (41 in the prednisone group and 42 in the control group). During the 6-month follow-up, the incidence of rash was significantly lower in the prednisone group compared with the control group (17.1% vs. 38.1%, P=0.049). There were no significant differences in the incidence of other adverse events, the number of patients who required dose adjustment (reduction, interruption, or discontinuation) of apalutamide due to rash, the number of patients with prostate-specific antigen (PSA) decreased by ≥50%, the number of patients with PSA decrease ≥90%, and the number of patients with PSA ≤0.2 ng/mL between the two groups. All patients with diabetes had stable glycemic control with no glucose-related adverse events. Discussion In patients with mHSPC, the addition of short-course low-dose prednisolone to apalutamide plus ADT can reduce the incidence of rash without risk of other adverse events.
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Affiliation(s)
- Dingyuan Yang
- Urinary Surgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Wenqiang Chen
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
| | - Fei Lai
- Urinary Surgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Mingxing Qiu
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
| | - Jun Li
- Urinary Surgery, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, Chengdu, China
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Freedland SJ, de Almeida Luz M, De Giorgi U, Gleave M, Gotto GT, Pieczonka CM, Haas GP, Kim CS, Ramirez-Backhaus M, Rannikko A, Tarazi J, Sridharan S, Sugg J, Tang Y, Tutrone RF, Venugopal B, Villers A, Woo HH, Zohren F, Shore ND. Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. N Engl J Med 2023; 389:1453-1465. [PMID: 37851874 DOI: 10.1056/nejmoa2303974] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Patients with prostate cancer who have high-risk biochemical recurrence have an increased risk of progression. The efficacy and safety of enzalutamide plus androgen-deprivation therapy and enzalutamide monotherapy, as compared with androgen-deprivation therapy alone, are unknown. METHODS In this phase 3 trial, we enrolled patients with prostate cancer who had high-risk biochemical recurrence with a prostate-specific antigen doubling time of 9 months or less. Patients were randomly assigned, in a 1:1:1 ratio, to receive enzalutamide (160 mg) daily plus leuprolide every 12 weeks (combination group), placebo plus leuprolide (leuprolide-alone group), or enzalutamide monotherapy (monotherapy group). The primary end point was metastasis-free survival, as assessed by blinded independent central review, in the combination group as compared with the leuprolide-alone group. A key secondary end point was metastasis-free survival in the monotherapy group as compared with the leuprolide-alone group. Other secondary end points were patient-reported outcomes and safety. RESULTS A total of 1068 patients underwent randomization: 355 were assigned to the combination group, 358 to the leuprolide-alone group, and 355 to the monotherapy group. The patients were followed for a median of 60.7 months. At 5 years, metastasis-free survival was 87.3% (95% confidence interval [CI], 83.0 to 90.6) in the combination group, 71.4% (95% CI, 65.7 to 76.3) in the leuprolide-alone group, and 80.0% (95% CI, 75.0 to 84.1) in the monotherapy group. With respect to metastasis-free survival, enzalutamide plus leuprolide was superior to leuprolide alone (hazard ratio for metastasis or death, 0.42; 95% CI, 0.30 to 0.61; P<0.001); enzalutamide monotherapy was also superior to leuprolide alone (hazard ratio for metastasis or death, 0.63; 95% CI, 0.46 to 0.87; P = 0.005). No new safety signals were observed, with no substantial between-group differences in quality-of-life measures. CONCLUSIONS In patients with prostate cancer with high-risk biochemical recurrence, enzalutamide plus leuprolide was superior to leuprolide alone with respect to metastasis-free survival; enzalutamide monotherapy was also superior to leuprolide alone. The safety profile of enzalutamide was consistent with that shown in previous clinical studies, with no apparent detrimental effect on quality of life. (Funded by Pfizer and Astellas Pharma; EMBARK ClinicalTrials.gov number, NCT02319837.).
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Affiliation(s)
- Stephen J Freedland
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Murilo de Almeida Luz
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Ugo De Giorgi
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Martin Gleave
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Geoffrey T Gotto
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Christopher M Pieczonka
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Gabriel P Haas
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Choung-Soo Kim
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Miguel Ramirez-Backhaus
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Antti Rannikko
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Jamal Tarazi
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Swetha Sridharan
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Jennifer Sugg
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Yiyun Tang
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Ronald F Tutrone
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Balaji Venugopal
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Arnauld Villers
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Henry H Woo
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Fabian Zohren
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
| | - Neal D Shore
- From the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles (S.J.F.); the Durham Veterans Affairs Health Care System, Durham, NC (S.J.F.); the Division of Urologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil (M.A.L.); IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy (U.D.G.); the Vancouver Prostate Centre, University of British Columbia, Vancouver (M.G.), and the Southern Alberta Institute of Urology, University of Calgary, Calgary (G.T.G.) - both in Canada; U.S. Urology Partners and Associated Medical Professionals of New York, Syracuse (C.M.P.); Global Development (G.P.H.) and Biostatistics (J.S.), Astellas Pharma, Northbrook, IL; Ewha Womans University Mokdong Hospital, Seoul, South Korea (C.-S.K.); Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain (M.R.-B.); the Department of Urology and Research Program in Systems Oncology, University of Helsinki, and Helsinki University Hospital - both in Helsinki, Finland (A.R.); Global Product Development, Pfizer, Collegeville, PA (J.T.); the Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW (S.S.), the Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, NSW (H.H.W.), and the College of Health and Medicine, Australian National University, Canberra, ACT (H.H.W.) - all in Australia; Global Product Development, Pfizer, San Francisco (Y.T.); Chesapeake Urology Research Associates, Towson, MD (R.F.T.); the Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom (B.V.); the Department of Urology, University of Lille, Claude Huriez Hospital, Centre Hospitalier Universitaire Lille, Lille, France (A.V.); Global Product Development, Pfizer, Cambridge, MA (F.Z.); and the Carolina Urologic Research Center and GenesisCare US, Myrtle Beach, SC (N.D.S.)
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Kafka M, Burtscher T, Fritz J, Schmitz M, Bektic J, Ladurner M, Horninger W, Heidegger I. Real-world comparison of Docetaxel versus new hormonal agents in combination with androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer descrying PSA Nadir ≤ 0.05 ng/ml as marker for treatment response. World J Urol 2023; 41:2043-2050. [PMID: 36287244 PMCID: PMC10415491 DOI: 10.1007/s00345-022-04189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022] Open
Abstract
PROPOSE Using Docetaxel chemotherapy or new hormonal agents (NHT) to intensify upfront systemic therapy resulted in improved survival rates compared to androgen deprivation monotherapy (ADT). Hence, combination therapies have become the new standard of care (SOC) in metastatic hormone-sensitive prostate cancer (mHSPC). However, head-to-head trails comparing different therapies as well as treatment-guiding biomarkers are still lacking. Thus, the aim of the present study was to compare clinical outcomes of Docetaxel versus NHT therapy in the real-world setting as well as to elaborate biomarkers predicting clinical outcome. METHODS We retrospectively assessed overall-survival (OS), progression-free survival 1 and 2 (PFS1/2) and time to progression (TTP) in 42 patients treated by either ADT + NHT or ADT + Docetaxel. In addition, we investigated clinical prognostic biomarkers. RESULTS Our survival analysis revealed 3-year OS of 89.4% in the NHT group compared to 82.4% in the Docetaxel group. 3-year PFS1 was 59.6% in the NHT group compared to 32.2% in the Docetaxel group and the TTP was 53.8% vs 32.2% (pOS = 0.189; pPFS1 = 0.082; pTTP = 0.055). In addition, castration-resistance occurred more often in the Docetaxel group (78.6% vs 25%, p = 0.004). Interestingly, a PSA-Nadir ≤ 0.05 ng/ml during therapy was associated with increased survival rates (p < 0.001) while PSA levels at primary diagnosis had no influence on therapy outcome. Furthermore, a thyroid-stimulating hormone (TSH) increase during therapy was associated with improved clinical outcome (p = 0.06). CONCLUSION We observed a trend towards a higher benefit of NHT as first-line treatment compared to Docetaxel in men with mHSPC. Of note, a PSA-Nadir ≤ 0.05 ng/ml or a TSH-increase during therapy were predictors for therapy response.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Burtscher
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Tseng CS, Yang JH, Huang SW, Wang YJ, Chen CH, Pu YS, Cheng JCH, Huang CY. Survival outcomes and prognostic factors for first-line abiraterone acetate or enzalutamide in patients with metastatic castration-resistant prostate cancer. BMC Cancer 2023; 23:568. [PMID: 37340337 DOI: 10.1186/s12885-023-10885-4] [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: 10/17/2022] [Accepted: 04/25/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE To investigate the survival outcomes of metastatic castration-resistant prostate cancer (mCRPC) patients receiving first-line novel androgen receptor axis-targeted therapies (ARATs) and prognostic factors for patient survival. METHODS This retrospective study obtained data from 202 patients who started abiraterone acetate or enzalutamide as first-line therapy for mCRPC between 2016 and 2021 from a single academic center. The primary endpoint was overall survival (OS) defined as the interval from the start of ARAT to death, loss to follow-up, or the end of the study period. The secondary endpoints were PSA decline, PSA nadir, and time to nadir (TTN) after ARATs. Kaplan-Meier survival analyses were applied for depicting OS. Cox proportional hazards model with inversed probability of treatment weighing-adjustment was used to validate the effect of patient, disease, and treatment response factors on OS. RESULTS Among 202 patients, 164 patients were treated with first-line ARATs alone and 38 patients received second-line chemotherapy. The median OS was not reached in patients with first-line ARATs alone and was 38.8 months in those with subsequent chemotherapy after failure from ARATs. OS was not different between the use of abiraterone and enzalutamide, though enzalutamide showed a higher rate of PSA decline ≧ 90% (56% versus 40%, p = 0.021) and longer TTN (5.5 versus 4.7 months, p = 0.019). Multivariable analysis showed that PSA nadir > 2 ng/mL [hazard ratio (HR) 7.04, p < 0.001] and TTN<7 months (HR 2.18, p = 0.012) were independently associated with shorter OS. Patients with both of these poor prognostic factors had worse OS compared to those who had 0-1 factors (HR 9.21, p < 0.001). CONCLUSIONS Patients with mCRPC who received first-line ARATs had better survival if they had a PSA nadir[Formula: see text]2 ng/mL or a TTN[Formula: see text]7 months. Further study is needed to determine if an early switch in therapy for those in whom neither is achieved may impact OS.
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Affiliation(s)
- Chi-Shin Tseng
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No.1, Jen Ai road, Section 1, Taipei, Taiwan
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Jui-Han Yang
- Department of Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Shi-Wei Huang
- Department of Urology, National Taiwan University Hospital Yun-Lin Branch, Taipei, Taiwan
| | - Yu-Jen Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Radiation Oncology, School of Medicine, Fu-Jen Catholic University Hospital and College of Medicine, New Taipei City, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Jason Chia-Hsien Cheng
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, No.1, Jen Ai road, Section 1, Taipei, Taiwan.
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Nakane K, Watanabe H, Naiki T, Takahara K, Yasui T, Miyake H, Shiroki R, Koie T. Trends in the Use of Second-Generation Androgen Receptor Axis Inhibitors for Metastatic Hormone-Sensitive Prostate Cancer and Clinical Factors Predicting Biological Recurrence. Diagnostics (Basel) 2023; 13:diagnostics13091661. [PMID: 37175052 PMCID: PMC10178034 DOI: 10.3390/diagnostics13091661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023] Open
Abstract
The advent of second-generation androgen receptor axis-targeted agents (ARATs) has revolutionized the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Biochemical recurrence-free survival (BRFS) was used to compare the efficacy of each ARAT. This multicenter retrospective study included 581 patients with newly diagnosed mHSPC who received first-line hormone therapy. The characteristics of patients treated with different ARATs were compared as well as changes in the usage of each drug over time. For BRFS, the apalutamide (Apa) and enzalutamide (Enza) groups, as well as the abiraterone acetate (Abi) and Apa/Enza groups, were compared. In addition, multivariate analysis was performed to determine predictive factors for biochemical recurrence (BCR). The use of second-generation ARATs tended to increase after May 2020. No significant difference in BRFS was found between patients receiving Apa and Enza (p = 0.490) and those receiving Abi or Apa/Enza (p = 0.906). Multivariate analysis revealed that the neutrophil-to-lymphocyte ratio (NLR) ≥ 2.76 and PSA ≥ 0.550 ng/mL were independent predictors of BCR. There were no significant differences in patient characteristics or BRFS in patients with mHSPC receiving different ARATs as first-line treatment. NLR and PSA may be prognostic factors following the first-line treatment of patients with mHSPC.
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Affiliation(s)
- Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan
| | - Taku Naiki
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 4678601, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake 4701192, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 4678601, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake 4701192, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
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Hu M, Mao Y, Guan C, Tang Z, Bao Z, Li Y, Liang G. Dynamic changes in PSA levels predict prognostic outcomes in prostate cancer patients undergoing androgen -deprivation therapy: A multicenter retrospective analysis. Front Oncol 2023; 13:1047388. [PMID: 36845723 PMCID: PMC9948006 DOI: 10.3389/fonc.2023.1047388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Background Androgen-deprivation therapy (ADT) is used for the treatment of prostate cancer. However, the specific risk factors for the development of castration-resistant disease are still unclear. The present study sought to identify predictors of patient prognostic outcomes through analyses of clinical findings in large numbers of prostate cancer patients following ADT treatment. Methods Data pertaining to 163 prostate cancer patients treated at the Second Affiliated Hospital of Bengbu Medical University and Maoming People's Hospital from January 1, 2015, to December 30, 2020, were retrospectively analyzed. Dynamic changes in prostate-specific antigen (PSA) levels were regularly assessed, including both time to nadir (TTN) and nadir PSA (nPSA). Univariate and multivariate analyses were performed with Cox risk proportional regression models, while differences in biochemical progression-free survival (bPFS) were compared among groups with Kaplan-Meier curves and log-rank tests. Results The bPFS values over the median 43.5-month follow-up period differed significantly between patients with nPSA levels < 0.2 ng/mL and ≥ 0.2 ng/mL, being 27.6 months and 13.5 months, respectively (log-rank P < 0.001). A significant difference in median bPFS was also observed when comparing patients with a TTN ≥ 9 months (27.8 months) to those with a TTN < 9 months (13.5 months) (log-rank P < 0.001). Conclusions TTN and nPSA are valuable predictors of prognosis in prostate cancer patients after ADT treatment, with better outcomes evident in patients with nPSA < 0.2 ng/mL and TTN > 9 months.
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Affiliation(s)
- Mingqiu Hu
- Department of Urology, Maoming People’s Hospital, Maoming, China,Department of Urology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, China,*Correspondence: Mingqiu Hu,
| | - Yifeng Mao
- Department of Urology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Chao Guan
- Department of Urology, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zhizhong Tang
- Department of Urology, Maoming People’s Hospital, Maoming, China,Department of Center of science, Maoming People’s Hospital, Guangdong, China
| | - Zhihang Bao
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, China
| | - Yingbang Li
- Department of Center of science, Maoming People’s Hospital, Guangdong, China
| | - Guowu Liang
- Department of Center of science, Maoming People’s Hospital, Guangdong, China
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İnci BK, Gürler F, Sütcüoğlu O, Baştuğ V, Yazıcı O, Üner A, Özet A, Özdemir N. Prognostic significance of nadir PSA value and time to nadir PSA in patients with metastatic castration-naive prostate cancer receiving first-line hormonotherapy. J Cancer Res Ther 2023; 19:S845-S850. [PMID: 38102905 DOI: 10.4103/jcrt.jcrt_1527_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/26/2022] [Indexed: 12/17/2023]
Abstract
BACKGROUND The current study aimed to evaluate the effect of the time duration to reach the lowest prostate-specific antigen (PSA) from the onset of first-line hormonal treatment (time to nadir PSA, TTNpsa) on survival in castration-naive metastatic prostate cancer (CN-MPC) patients. METHODS Eighty patients who had PSA response >80% with first-line hormonal therapy (luteinizing hormone-releasing hormone, LH-RH analog +/- bicalutamide) were included in this study. RESULTS Under androgen deprivation therapy (ADT), a significant positive correlation was found between TTNpsa, nadir PSA (Npsa) duration, and progression-free survival (PFS) ( p < 0.001) and overall survival (OS) ( p < 0.001). There was no correlation between TTNpsa and Npsa duration. TTNpsa and Npsa durations were independently correlated with PFS and OS. In patients with TTNpsa value ≥19 weeks, the median PFS was 126 (95% CI, 68-184) weeks compared with TTNpsa <19-week group in which the median PFS was 44 (95% CI, 26-62) weeks ( p = 0.033). In patients with TTNpsa value ≥19 weeks, the median OS was 242 (95% CI, 169-315) weeks compared with TTNpsa <19-week group in which the OS was 156 (95% CI, 89-223) weeks ( p = 0.018). The median nadir PSA value was 1 ng/mL. The median PFS was significantly longer in the patient group with ≤1 ng/mL (137 weeks, 95% CI, 50-224) compared with the group with >1 ng/mL (41 weeks, 95% CI, 34-48) ( p < 0.001). The median OS was significantly longer in the patient group with nadir PSA ≤1 ng/mL (296 weeks, 95% CI, 220-272) compared to the group with >1 ng/mL (131 weeks, 95% CI, 84-178) ( p = 0.002). In patients with nadir PSA ≤1 ng/mL ( n = 40), there was no relationship between TTNpsa and Npsa duration with both PFS and OS. However, in patients with nadir PSA >1 ng/mL ( n = 40) subgroup, there was a significant positive correlation between TTNpsa and PFS, and OS ( p < 0.001, P = 0.016, respectively). CONCLUSION In CN-MPC who received first-line ADT, especially in the group with the nadir PSA value >1 ng/mL, the duration of TTNpsa was positively correlated with PFS and OS.
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Affiliation(s)
- Bediz Kurt İnci
- Department of Medical Oncology, Gazi University Hospital, Ankara, Turkey
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10
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Malaspina S, Ettala O, Tolvanen T, Rajander J, Eskola O, Boström PJ, Kemppainen J. Flare on [ 18F]PSMA-1007 PET/CT after short-term androgen deprivation therapy and its correlation to FDG uptake: possible marker of tumor aggressiveness in treatment-naïve metastatic prostate cancer patients. Eur J Nucl Med Mol Imaging 2023; 50:613-621. [PMID: 36161511 PMCID: PMC9816233 DOI: 10.1007/s00259-022-05970-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Short-term androgen deprivation therapy (ADT) is known to increase heterogeneously prostate-specific membrane antigen (PSMA) expression. This phenomenon might indicate the potential of cancer lesions to respond to ADT. In this prospective study, we evaluated the flare on [18F]PSMA-1007 PET/CT after ADT in metastatic prostate cancer (PCa). Given that aggressive PCa tends to display FDG uptake, we particularly investigated whether the changes in PSMA uptake might correlate with glucose metabolism. METHODS Twenty-five men with newly diagnosed treatment-naïve metastatic PCa were enrolled in this prospective registered clinical trial. All the patients underwent [18F]PSMA-1007 PET/CT immediately before and 3-4 weeks after ADT initiation (degarelix). Before ADT, [18F]FDG PET/CT was also performed. Standardized uptake values (SUV)max of primary and metastatic lesions were calculated in all PET scans. Serum PSA and testosterone blood samples were collected before the two PSMA PET scans. The changes in PSMA uptake after ADT were represented as ΔSUVmax. RESULTS All the patients reached castration levels of testosterone at the time of the second [18F]PSMA-1007 PET/CT. Overall, 57 prostate, 314 lymph nodes (LN), and 406 bone lesions were analyzed. After ADT, 104 (26%) bone, 33 (11%) LN, and 6 (11%) prostate lesions showed an increase (≥ 20%) in PSMA uptake, with a median ΔSUVmax of + 50%, + 60%, and + 45%, respectively. Among the lesions detected at the baseline [18F]PSMA-1007 PET/CT, 63% bone and 46% LN were FDG-positive. In these metastases, a negative correlation was observed between the PSMA ΔSUVmax and FDG SUVmax (p < 0.0001). Moreover, a negative correlation between the ΔSUVmax and the decrease in serum PSA after ADT was noted (p < 0.0001). CONCLUSIONS A heterogeneous increase in PSMA uptake after ADT was detected, most evidently in bone metastases. We observed a negative correlation between the PSMA flare and the intensity of glucose uptake as well as the decrease of serum PSA, suggesting that lesions presenting with such flare might potentially be less aggressive. TRIAL REGISTRATION NCT03876912, registered 15 March 2019.
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Affiliation(s)
- Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Medical Physics and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Johan Rajander
- Turku PET Centre, Accelerator Laboratory, Åbo Akademi University, Turku, Finland
| | - Olli Eskola
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
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11
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Zhao YX, Yao GL, Sun J, Wang XL, Wang Y, Cai QQ, Kang HL, Gu LP, Yu JS, Li WM, Zhang B, Wang J, Mei JJ, Jiang Y. Nomogram Incorporating Contrast-Enhanced Ultrasonography Predicting Time to the Development of Castration-Resistant Prostate Cancer. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:11795549211049750. [PMID: 34646064 PMCID: PMC8504687 DOI: 10.1177/11795549211049750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
Abstract
Background It is valuable to predict the time to the development of castration-resistant prostate cancer (CRPC) in patients with advanced prostate cancer (PCa). This study aimed to build and validate a nomogram incorporating the clinicopathologic characteristics and the parameters of contrast-enhanced ultrasonography (CEUS) to predict the time to CRPC after androgen deprivation therapy (ADT). Methods Patients with PCa were divided into the training (n = 183) and validation cohorts (n = 37) for nomogram construction and validation. The clinicopathologic characteristics and CEUS parameters were analyzed to determine the independent prognosis factors and serve as the basis of the nomogram to estimate the risk of 1-, 2-, and 3-year progress to CRPC. Results T stage, distant metastasis, Gleason score, area under the curve (AUC), prostate-specific antigen (PSA) nadir, and time to PSA nadir were the independent predictors of CRPC (all P < 0.05). Three nomograms were built to predict the time to CRPC. Owing to the inclusion of CEUS parameter, the discrimination of the established nomogram (C-index: 0.825 and 0.797 for training and validation datasets) was improved compared with the traditional prediction model (C-index: 0.825 and 0.797), and when it excluded posttreatment PSA, it still obtained an acceptable discrimination (C-index: 0.825 and 0.797). Conclusions The established nomogram including regular prognostic indicators and CEUS obtained an improved accuracy for the prediction of the time to CRPC. It was also applicable for early prediction of CRPC when it excluded posttreatment PSA, which might be helpful for individualized diagnosis and treatment.
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Affiliation(s)
- Yun-Xin Zhao
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Guang-Li Yao
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Jian Sun
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Xiao-Lian Wang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Ying Wang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Qiu-Qiong Cai
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Hui-Li Kang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Li-Ping Gu
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Jia-Shun Yu
- Department of Urology, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Wen-Min Li
- Department of Urology, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Bei Zhang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Jian Wang
- Department of Urology, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Jiang-Jun Mei
- Department of Ultrasound, Zhoupu Hospital, Shanghai Medical College, Shanghai, China
| | - Yi Jiang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, China
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Prostate-Specific Antigen Kinetics Effects on Outcomes of Low-Volume Metastatic Prostate Cancer Patients Receiving Androgen Deprivation Therapy. JOURNAL OF ONCOLOGY 2021; 2021:9648579. [PMID: 34484340 PMCID: PMC8416377 DOI: 10.1155/2021/9648579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/14/2021] [Indexed: 12/01/2022]
Abstract
Background The present study aimed to analyse factors influencing the effects of androgen deprivation therapy (ADT) in patients with newly diagnosed metastatic castration-naïve prostate cancer (mCNPC), especially in low-volume disease (LVD), according to subclassification of metastatic prostate cancer established by the CHAARTED trial. Materials and Methods We reviewed 648 patients with newly diagnosed mCNPC receiving ADT at Chang Gung Memorial Hospital from January 2007 to December 2016. Basic characteristics and PSA kinetics profile were subsequently evaluated. Results 48.3% of LVD patients progressed to castration-resistant prostate cancer (mCRPC). Among them, CRPC group had significantly shorter time to PSA nadir (TTN) and faster time from PSA nadir to CRPC (TFNTC) (p < 0.001) compared to non-CRPC group. PSA doubling time (PSADT) < 4 months tended to be associated with faster disease progression and shorter overall survival (OS). Among all patients with metastatic prostate cancer, those with shorter TTN <9 months, higher nadir PSA level ≥1 ng/mL, and shorter PSADT <3 months had increased tendency for biochemical progression. Conclusions PSADT is an effective clinical predictor for disease progression and survival in LVD. Other PSA kinetics including TTN and TFNTC, though not the major predictors for disease progression or OS in LVD, might be the predictors for disease control status.
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Fujimoto N, Shiota M, Matsukawa T, Minato A, Tomisaki I, Ohnishi R, Eto M. Three-month Prostate-specific Antigen Level After Androgen Deprivation Therapy Predicts Survival in Patients With Metastatic Castration-sensitive Prostate Cancer. In Vivo 2021; 35:1101-1108. [PMID: 33622907 DOI: 10.21873/invivo.12355] [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] [Received: 11/14/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Although upfront combination therapies with androgen deprivation are recommended for patients with castration-sensitive prostate cancer (CSPC), combination therapies may be excessive for some patients. The aim of this study was to identify patients with favorable outcome under androgen deprivation therapy (ADT) alone. PATIENTS AND METHODS This study consisted of 242 patients with CSPC who received ADT alone. The association between 3-month prostate-specific antigen (PSA) value after ADT and survival was analyzed. RESULTS The median overall survival for men with high-volume and/or high-risk cancer and those with low-volume low-risk cancer were 48.0 months and 103.0 months, respectively (p≤0.0001). Notably, in patients with low-volume low-risk cancer, the median overall survival for patients who achieved PSA ≤2 ng/ml at 3 months after ADT initiation was quite long at 112.0 months. CONCLUSION Conventional ADT may be sufficient and upfront combination therapy may be excessive for those patients with favorable outcome.
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Affiliation(s)
- Naohiro Fujimoto
- Department of Urology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan;
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuo Matsukawa
- Department of Urology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Minato
- Department of Urology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ikko Tomisaki
- Department of Urology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rei Ohnishi
- Department of Urology School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Briones J, Khan M, Sidhu AK, Zhang L, Smoragiewicz M, Emmenegger U. Population-Based Study of Docetaxel or Abiraterone Effectiveness and Predictive Markers of Progression Free Survival in Metastatic Castration-Sensitive Prostate Cancer. Front Oncol 2021; 11:658331. [PMID: 34026638 PMCID: PMC8138065 DOI: 10.3389/fonc.2021.658331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Both Docetaxel (DOC) and Abiraterone (ABI) improve the survival of men with metastatic, castration sensitive prostate cancer (mCSPC). However, the outcome among mCSPC patients is highly variable, while there is a lack of predictive markers of therapeutic benefit. Furthermore, there is limited data on the comparative real-world effectiveness of adding DOC or ABI to androgen deprivation therapy (ADT). METHODS We conducted a retrospective analysis of 121 mCSPC patients treated at Odette Cancer Centre (Toronto, ON, Canada) between Dec 2014 and Mar 2021 (DOC n = 79, ABI n = 42). The primary endpoint studied was progression free survival (PFS), defined as the interval from start of ADT to either (i) biochemical, radiological, or symptomatic progression, (ii) start of first-line systemic therapy for castration-resistant prostate cancer (CRPC), or (iii) death, whichever occurred first. To identify independent predictive factors for PFS in the entire cohort, a Cox proportional hazard model (stepwise selection) was applied. Overall survival (OS) was among secondary endpoints. RESULTS After a median follow-up of 39.6 and 25.1 months in the DOC and ABI cohorts, respectively, 79.7% of men in the DOC and 40.5% in the ABI group experienced a progression event. PFS favored the ABI cohort (p = 0.0038, log-rank test), with 78.0% (95%CI 66.4-91.8%) of ABI versus 67.1% (57.5-78.3%) of DOC patients being free of progression at 12 months. In univariate analysis superior PFS was significantly related to older age at diagnosis of mCSPC, metachronous metastatic presentation, low-volume (CHAARTED), and low-risk (LATITUDE) disease, ≥90% PSA decrease at 3 months (PSA90), and PSA nadir ≤0.2 at 6 months. Age (HR = 0.955), PSA90 (HR = 0.462), and LATITUDE risk stratification (HR = 1.965) remained significantly associated with PFS in multivariable analysis. OS at 12 months was 98.7% (96.3-100%) and 92.7% (85.0-100%) in the DOC and ABI groups (p = 0.97), respectively. CONCLUSIONS In this real-world group of men undergoing treatment intensification with DOC or ABI for mCSPC, we did not find a significant difference in OS, but PFS was favoring ABI. Age at diagnosis of mCSPC, PSA90 at 3 months and LATITUDE risk classification are predictive factors of PFS in men with mCSPC.
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Affiliation(s)
- Juan Briones
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maira Khan
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amanjot K. Sidhu
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Liying Zhang
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Martin Smoragiewicz
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Su SH, Chang YH, Huang LK, Chu YC, Kan HC, Liu CY, Lin PH, Yu KJ, Wu CT, Pang ST, Chuang CK, Shao IH. Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy. TUMORI JOURNAL 2021; 108:270-277. [PMID: 33845702 DOI: 10.1177/03008916211007928] [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: 11/17/2022]
Abstract
OBJECTIVE Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). METHODS We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. RESULTS Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 (p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) (p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. CONCLUSIONS In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.
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Affiliation(s)
- Shih-Huan Su
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Kang Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Cheng Chu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan.,Cancer Genome Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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16
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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: 7] [Impact Index Per Article: 2.3] [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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17
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Coexpression Network Analysis Identifies a Novel Nine-RNA Signature to Improve Prognostic Prediction for Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4264291. [PMID: 32953881 PMCID: PMC7482004 DOI: 10.1155/2020/4264291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
Background Prostate cancer (PCa) is the most common malignancy and the leading cause of cancer death in men. Recent studies suggest the molecular signature was more effective than the clinical indicators for the prognostic prediction, but all of the known studies focused on a single RNA type. The present study was to develop a new prognostic signature by integrating long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) and evaluate its prognostic performance. Methods The RNA expression data of PCa patients were downloaded from The Cancer Genome Atlas (TCGA) or Gene Expression Omnibus database (GSE17951, GSE7076, and GSE16560). The PCa-driven modules were identified by constructing a weighted gene coexpression network, the corresponding genes of which were overlapped with differentially expressed RNAs (DERs) screened by the MetaDE package. The optimal prognostic signature was screened using the least absolute shrinkage and selection operator analysis. The prognostic performance and functions of the combined prognostic signature was then assessed. Results Twelve PCa-driven modules were identified using TCGA dataset and validated in the GSE17951 and GSE7076 datasets, and six of them were considered to be preserved. A total of 217 genes in these 6 modules were overlapped with 699 DERs, from which a nine-gene prognostic signature was identified (including 3 lncRNAs and 6 mRNAs), and the risk score of each patient was calculated. The overall survival was significantly shortened in patients having the risk score higher than the cut-off, which was demonstrated in TCGA (p = 5.063E − 03) dataset and validated in the GSE16560 (p = 3.268E − 02) dataset. The prediction accuracy of this risk score was higher than that of clinical indicators (the Gleason score and prostate-specific antigen) or the single RNA type, with the area under the receiver operator characteristic curve of 0.945. Besides, some new therapeutic targets and mechanisms (MAGI2-AS3-SPARC/GJA1/CYSLTR1, DLG5-AS1-DEFB1, and RHPN1-AS1-CDC45/ORC) were also revealed. Conclusion The risk score system established in this study may provide a novel reliable method to identify PCa patients at a high risk of death.
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18
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Deantoni CL, Fodor A, Cozzarini C, Fiorino C, Brombin C, Di Serio C, Calandrino R, Di Muzio N. Prostate cancer with low burden skeletal disease at diagnosis: outcome of concomitant radiotherapy on primary tumor and metastases. Br J Radiol 2020; 93:20190353. [PMID: 31971828 DOI: 10.1259/bjr.20190353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate toxicity and clinical outcome in synchronous bone only oligometastatic (≤2 lesions) prostate cancer patients, simultaneously irradiated to prostate/prostatic bed, lymph nodes and bone metastases. METHODS From 2/2009 to 6/2015, 39 bone only prostate cancer patients underwent radiotherapy (RT) at "radical" doses to bone metastases (median 2 Gy equivalent dose, EQD2>40Gy, α/β = 1,5), nodes, and prostate/prostatic bed, within the same RT course, in association with androgen deprivation therapy (ADT).Biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were evaluated. RESULTS After a median follow-up of 46.5 (1.2-103.6) months, 5 patients died from disease progression, 10 experienced biochemical relapse, 19, still in ADT, presented undetectable prostate-specific antigen (PSA) at the last follow-up. Five patients who discontinued ADT after a median of 34 months (5.8-41) are free from biochemical relapse.The 4 year Kaplan-Meier estimates of biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were 53.3%, 65.7%, 73.4% and 82.4% respectively.No Grade > 2 acute events and only two severe late urinary events were recorded, not due to the concomitant treatment of primary and metastatic disease. CONCLUSION Our results suggest that "radical" and synchronous irradiation of primitive tumor and metastatic disease may be a valid approach in synchronous bone only prostate cancer patients, showing mild toxicity profile and promising survival results. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first analysis of clinical outcome in synchronous bone-only metastasis (neither nodal nor visceral) patients at diagnosis, treated with radical RT to all disease, associated to ADT.
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Affiliation(s)
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Calandrino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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19
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Longitudinal model-based meta-analysis for survival probabilities in patients with castration-resistant prostate cancer. Eur J Clin Pharmacol 2020; 76:589-601. [PMID: 31925454 DOI: 10.1007/s00228-020-02829-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/03/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The aims of this longitudinal model-based meta-analysis (MBMA) were to indirectly compare the time courses of survival probabilities and to identify corresponding potential significant covariates across approved drugs in patients with castration-resistant prostate cancer (CRPC). METHODS A systematic literature review for monotherapy studies in patients with CRPC was conducted up to August 8, 2018. The time courses of progression-free survival (PFS) and overall survival (OS) were fitted with parametric survival models. Covariate analyses were performed to determine the impact of treatment drugs, dosing regimens, and patient characteristics on the survival probabilities. Simulations were carried out to quantify the magnitude of covariate effects. RESULTS A total of 146 studies including clinical trials and real-world data on longitudinal survival probabilities in 20,712 patients with CRPC were included in our meta-database. The time courses of PFS and OS probabilities were best described by the log-logistic model. There was no significant difference in median OS and PFS between docetaxel, cabazitaxel, abiraterone acetate, and enzalutamide. There was no significant dose-response relationship in PFS or OS for docetaxel at 50 to 120 mg/m2 every 3 weeks (Q3W) and cabazitaxel at 20 to 25 mg/m2 Q3W. Model-based simulations indicated that PFS probability was associated with chemotherapy, Gleason score, and baseline prostate-specific antigen (BLPSA), while OS probability was associated with chemotherapy, Gleason score, visceral metastasis, Eastern Cooperative Oncology Group performance status, and BLPSA. CONCLUSION Our modeling and simulation framework can be applied to support indirect comparison, dose selection, and go/no-go decision-making for new agents targeting CRPC.
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20
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Matsubara N, Chi KN, Özgüroğlu M, Rodriguez-Antolin A, Feyerabend S, Fein L, Alekseev BY, Sulur G, Protheroe A, Li S, Mundle S, De Porre P, Tran N, Fizazi K. Correlation of Prostate-specific Antigen Kinetics with Overall Survival and Radiological Progression-free Survival in Metastatic Castration-sensitive Prostate Cancer Treated with Abiraterone Acetate plus Prednisone or Placebos Added to Androgen Deprivation Therapy: Post Hoc Analysis of Phase 3 LATITUDE Study. Eur Urol 2019; 77:494-500. [PMID: 31843335 DOI: 10.1016/j.eururo.2019.11.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND LATITUDE, a randomized, double-blind trial, compared abiraterone acetate and prednisone (AAP) + androgen deprivation therapy (ADT) versus placebo (PBO) + ADT in high-risk metastatic castration-sensitive prostate cancer (mCSPC). OBJECTIVE To assess the correlation of prostate-specific antigen (PSA) kinetics with overall survival (OS) and radiological progression-free survival (rPFS). DESIGN, SETTING, AND PARTICIPANTS A post hoc analysis of data from 597 men receiving AAP + ADT and 602 receiving PBO + ADT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The associations of PSA-related outcomes (rates of confirmed 50% [PSA50] and 90% [PSA90] decline from baseline PSA [Prostate Cancer Working Group 2 criteria], rates of PSA < 0.2 ng/ml, median nadir PSA, time to PSA nadir [TPN], and time to PSA progression [TPP] with long-term outcomes [OS and rPFS]) were evaluated. Hazard ratios (HRs) were estimated using Cox proportional hazard model. Correlations of TPP with coprimary endpoints rPFS and OS were evaluated using Kendall's tau (KT). RESULTS AND LIMITATIONS AAP + ADT significantly delayed median TPP versus PBO + ADT (33.2 vs 7.4 mo; HR: 0.3, p < 0.001). TPP correlated with rPFS (KT = 0.921) and OS (KT = 0.666). In the AAP + ADT group, 91% had PSA50 and 79% had PSA90 responses (relative risk [RR]: 1.36 and 2.30, respectively; p < 0.001 for both comparisons vs PBO + ADT). Compared with nonresponders, PSA50 and PSA90 responders had reduced risk of death (RR: 0.44 and 0.12, respectively). At 6 mo, 40% receiving AAP + ADT and 6.5% receiving PBO + ADT achieved PSA ≤0.1 ng/ml, which was significantly associated with longer rPFS and OS. Median nadir PSA was 0.09 ng/ml with AAP + ADT versus 2.36 ng/ml with PBO + ADT. Median TPN (AAP + ADT, 6.4 mo; PBO + ADT, 3.8 mo) positively correlated with rPFS and OS. CONCLUSIONS Superior PSA response dynamics with AAP + ADT versus ADT + PBO strongly correlated with long-term outcomes of rPFS and OS in high-risk mCSPC. PATIENT SUMMARY We found that low prostate-specific antigen levels (≤0.1 ng/ml) after 6 mo may indicate a good long-term response to treatment. Our results need confirmation.
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Affiliation(s)
| | - Kim N Chi
- BC Cancer Agency, Vancouver, BC, Canada
| | - Mustafa Özgüroğlu
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Luis Fein
- Instituto de Oncologia de Rosário, Rosário, Argentina
| | - Boris Y Alekseev
- P.A. Hertsen Moscow Cancer Research Institute, Moscow, Russian Federation
| | - Giri Sulur
- Janssen Research & Development, Los Angeles, CA, USA
| | | | - Susan Li
- Janssen Research & Development, Spring House, PA, USA
| | | | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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21
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Association of Long-Term Dynamics in Circulating Testosterone with Serum PSA in Prostate Cancer-Free Men with Initial-PSA < 4 ng/mL. Discov Oncol 2019; 10:168-176. [PMID: 31621000 DOI: 10.1007/s12672-019-00369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/30/2019] [Indexed: 12/31/2022] Open
Abstract
We previously reported that an accelerated decline in circulating testosterone level is associated with a higher risk of prostate cancer (PCa). This study is to examine whether testosterone change rate is related to serum prostate-specific antigen (PSA) concentration among PCa-free men. Longitudinal data were derived from electronic medical records at a tertiary hospital in the Southeastern USA. PCa-free men with initial-PSA < 4 ng/mL and ≥ 2 testosterone measurements were included (n = 632). Three PSA measures (peak, the most recent, and average PSA) during the study period (from first testosterone measurement to the most recent hospital visit) were examined using multivariable-adjusted geometric means and were compared across quintiles of testosterone change rate (ng/dL/month) and current testosterone level (cross-sectional). Mean (standard deviation, SD) age at baseline was 59.3 (10.5) years; mean study period was 93.0 (55.3) months. After adjusting for covariates including baseline testosterone, the three PSA measures all significantly increased across quintile of testosterone change rate from increase to decline (peak PSA: quint 1 = 1.09, quint 5 = 1.41; the most recent PSA: quint 1 = 0.85, quint 5 = 1.00; average PSA: quint 1 = 0.89, quint 5 = 1.02; all Ptrend < 0.001). But current testosterone level was not associated with PSA levels. Stratified analyses indicated men with higher adiposity (body mass index > 24.1 kg/m2) or lower baseline testosterone (≤ 296 ng/dL) were more sensitive to testosterone change in regard to PSA. Among PCa-free men, accelerated testosterone decline might correlate with higher serum PSA concentration. It will help to elucidate the mechanisms relating aging-accompanying testosterone dynamics to prostate carcinogenesis.
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22
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Fukuoka K, Teishima J, Nagamatsu H, Inoue S, Hayashi T, Mita K, Shigeta M, Kobayashi K, Kajiwara M, Kadonishi Y, Tacho T, Matsubara A. Predictors of poor response to first-generation anti-androgens as criteria for alternate treatments for patients with non-metastatic castration-resistant prostate cancer. Int Urol Nephrol 2019; 52:77-85. [PMID: 31552574 DOI: 10.1007/s11255-019-02281-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE There are no criteria for administering first- or second-generation anti-androgens (FGA and SGA, respectively) to patients with non-metastatic castration-resistant prostate cancer (nmCRPC). This study aimed to assess the efficacy of alternative FGA therapy in nmCRPC patients and the prognosis of these patients and to identify factors for predicting patients potentially responsive to FGA. METHODS Data from 63 men with nmCRPC who underwent alternative FGA therapy (bicalutamide, flutamide, or chlormadinone acetate) as first-line therapy after failure of primary androgen-deprivation therapy (PADT) between 2004 and 2017 at Hiroshima University Hospital and affiliated hospitals were retrospectively investigated. The associations of clinicopathological parameters with overall survival (OS) and prostate-specific antigen (PSA) progression-free survival (PFS) of alternative FGA-treated patients were analyzed. RESULTS Time to CRPC [p = 0.007, hazard ratio (HR) = 4.77], regional lymph node involvement at the diagnosis of CRPC (p = 0.022, HR = 2.42), and PSA-PFS of alternative FGA therapy ≤ 6 months (p = 0.020, HR = 2.39) were identified as prognostic factors using a multivariate analysis. Additionally, Cox proportional hazard models revealed that PSA nadir value > 1 ng/mL during PADT (p = 0.034, HR = 2.40) and time from starting PADT to PSA nadir ≤ 1 year (p = 0.047, HR = 1.85) were predictive factors for worse PSA-PFS in alternative FGA therapy. CONCLUSIONS Shorter time to CRPC, regional lymph node involvement, PSA nadir during PADT > 1 ng/mL, and time from starting PADT to PSA nadir ≤ 1 year might suggest the potential benefit of immediate commencement of SGA, compared to FGA administration after nmCRPC diagnosis.
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Affiliation(s)
- Kenichiro Fukuoka
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.,Department of Urology, Nakatsu Daiichi Hospital, 252-2 Miyabu, Nakatsu, Oita, 871-0012, Japan
| | - Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Hirotaka Nagamatsu
- Department of Urology, Nakatsu Daiichi Hospital, 252-2 Miyabu, Nakatsu, Oita, 871-0012, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Koji Mita
- Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asakita-ku, Hiroshima, Hiroshima, 731-0293, Japan
| | - Masanobu Shigeta
- Department of Urology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, Hiroshima, 737-0023, Japan
| | - Kanao Kobayashi
- Department of Urology, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, Hiroshima, 734-8530, Japan
| | - Yuichi Kadonishi
- Department of Urology, JA Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Takatoshi Tacho
- Department of Urology, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama, Ehime, 790-8524, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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Hah YS, Lee JS, Rha KH, Hong SJ, Chung BH, Koo KC. Effect of Prior Local Treatment and Prostate-Specific Antigen Kinetics during Androgen-Deprivation Therapy on the Survival of Castration-Resistant Prostate Cancer. Sci Rep 2019; 9:11899. [PMID: 31417160 PMCID: PMC6695395 DOI: 10.1038/s41598-019-48424-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Abstract
Prostate-specific antigen (PSA) kinetics predicts survival in castration-resistant prostate cancer (CRPC); however, the influence of prior treatment on this relationship is unclear. Patients with CRPC were stratified according to time to PSA nadir and time to CRPC progression to investigate their prognostic significance on prostate cancer-specific survival (PCSS) and whether PSA kinetics may serve as prognosticators regardless of prior local treatment. This multicenter retrospective study included 295 patients diagnosed with CRPC between September 2009 and November 2017. PSA kinetics during androgen-deprivation therapy (ADT) including %PSA decline, PSA nadir level, time to PSA nadir, and time to CRPC progression was investigated. Subgroup analysis was performed according to the prior history of local curative treatment. Patients who did not receive prior local treatment with ≥6 months to PSA nadir and <12 months to CRPC, showed lower PCSS rates than those with <6 months to PSA nadir (23.3% vs. 45.3%; p = 0.031) and ≥12 months to CRPC (20.0% vs. 47.8%; p = 0.001). In patients who had received local treatment, PSA kinetic parameters did not influence PCSS. Our results indicate that time to PSA nadir and time to CRPC progression are prognosticators of PCSS in patients with CRPC who did not previously receive curative local treatment.
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Affiliation(s)
- Yoon Soo Hah
- Department of Urology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Jong Soo Lee
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wu KJ, Pei XQ, Tian G, Wu DP, Fan JH, Jiang YM, He DL. PSA time to nadir as a prognostic factor of first-line docetaxel treatment in castration-resistant prostate cancer: evidence from patients in Northwestern China. Asian J Androl 2019; 20:173-177. [PMID: 28905815 PMCID: PMC5858103 DOI: 10.4103/aja.aja_34_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Docetaxel-based chemotherapy remains the first-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) in China; however, the prognostic factors associated with effects in these patients are still controversial. In this study, we retrospectively reviewed the data from 71 eligible Chinese patients who received docetaxel chemotherapy from 2009 to 2016 in our hospital and experienced a reduction of prostate-specific antigen (PSA) level ≥50% during the treatment and investigated the potential role of time to nadir (TTN) of PSA. TTN was defined as the time from start of chemotherapy to the nadir of PSA level during the treatment. Multivariable Cox regression models and Kaplan–Meier analysis were used to predict overall survival (OS). In these patients, the median of TTN was 17 weeks. Patients with TTN ≥17 weeks had a longer response time to chemotherapy compared to TTN <17 weeks (42.83 vs 21.50 weeks, P < 0.001). The time to PSA progression in patients with TTN ≥17 weeks was 11.44 weeks compared to 5.63 weeks when TTN was <17 weeks. We found several factors to be associated with OS, including TTN (hazard ratio [HR]: 3.937, 95% confidence interval [CI]: 1.502–10.309, P = 0.005), PSA level at the diagnosis of cancer (HR: 4.337, 95% CI: 1.616–11.645, P = 0.004), duration of initial androgen deprivation therapy (HR: 2.982, 95% CI: 1.104–8.045, P = 0.031), neutrophil-to-lymphocyte ratio (HR: 3.963, 95% CI: 1.380–11.384, P = 0.011), and total PSA response (Class 1 [<0 response] compared to Class 2 [0–50% response], HR: 3.978, 95% CI: 1.278–12.387, P = 0.017). In conclusion, TTN of PSA remains an important prognostic marker in predicting therapeutic outcome in Chinese population who receive chemotherapy for mCRPC and have >50% PSA remission.
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Affiliation(s)
- Kai-Jie Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xin-Qi Pei
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ge Tian
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Da-Peng Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jin-Hai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yu-Mei Jiang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Da-Lin He
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
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Peng H, Luo X. Prognostic significance of elevated pretreatment systemic inflammatory markers for patients with prostate cancer: a meta-analysis. Cancer Cell Int 2019; 19:70. [PMID: 30962764 PMCID: PMC6434630 DOI: 10.1186/s12935-019-0785-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background Pretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa). However, the prognostic effects remain controversial. Therefore, the goal of this study was evaluate the prognostic values of these markers for PCa patients using a meta-analysis. Methods Potentially relevant publications in PubMed and Cochrane Library were searched. Pooled hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), recurrence free survival (RFS) and distant metastases-free survival (DMFS) were determined using a fixed or random effects model by STATA 13.0 software. Results Thirty-two studies involving 21,949 participants were included. Our pooled results demonstrated that a high pretreatment NLR (HR = 1.55, 95% CI 1.37–1.76), PLR (HR = 1.72; 95% CI 1.36–2.18), neutrophil (HR = 1.10; 95% CI 1.03–1.18 and monocyte counts (HR = 2.25; 95% CI 1.67–3.05) predicted inferior OS, while elevated pretreatment LMR (HR = 2.27; 95% CI 1.76–2.94) was correlated with favorable OS. Furthermore, the higher NLR (HR = 1.62; 95% CI 1.29–2.04) and monocyte counts (HR = 1.75; 95% CI 1.36–2.25), but lower LMR predicted worse PFS (HR = 2.18; 95% CI 1.58–3.02); poor RFS was only associated with NLR (HR = 1.12; 95% CI 1.04–1.20). The subgroup analysis showed that the higher NLR may be a predictive factor for OS only in patients with mCRPC and undergoing chemotherapy; while the higher PLR was only significantly associated with OS in localized PCa regardless of treatment. Conclusion This meta-analysis reveals that pretreatment NLR, PLR, LMR, neutrophil, and monocyte counts may be effective predictive biomarkers for prognosis in patients with PCa.
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Affiliation(s)
- Hao Peng
- Department of Urological Surgery, Zhoukou Central Hospital of Henan Province, No. 26 Renmin East Road, Chuanhui District, Zhoukou, 466000 China
| | - Xiaogang Luo
- 2State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, 201620 China
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Impact of nadir PSA level and time to nadir during initial androgen deprivation therapy on prognosis in patients with metastatic castration-resistant prostate cancer. World J Urol 2019; 37:2365-2373. [PMID: 30729312 DOI: 10.1007/s00345-019-02664-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/31/2019] [Indexed: 01/26/2023] Open
Abstract
PURPOSE We determine whether the nadir prostate-specific antigen level (PSA nadir) and time to nadir (TTN) during initial androgen deprivation therapy (ADT) are prognostic factors in metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS We reviewed the Michinoku Japan Urological Cancer Study Group database, including 321 mCRPC patients. Optimal cutoff values for PSA nadir and TTN on survival were calculated with the receiver operating characteristic (ROC) curve. Patients were stratified into unfavorable (higher PSA nadir and/or shorter TTN) and favorable (lower PSA nadir and longer TTN) groups. The inversed probability of treatment weighing (IPTW)-adjusted Cox proportional hazard model was performed to evaluate the impact of the unfavorable group on overall survival (OS) after CRPC diagnosis. RESULTS Median age and follow-up period were 71 years and 35 months, respectively. ROC curve analysis demonstrated cutoffs of PSA nadir > 0.64 ng/mL and TTN < 7 months. The unfavorable group included 248 patients who had significantly shorter OS after mCRPC. The IPTW-adjusted multivariate model revealed that the unfavorable group had a negative impact on OS in mCRPC patients [hazards ratio (HR) 2.98, P < 0.001]. CONCLUSIONS Higher PSA nadir and shorter TTN during the initial ADT are poor prognostic factors in patients with mCRPC.
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[CLINICAL STUDY OF THE PROSTATE CANCERS WITH A SERUM PROSTATE SPECIFIC ANTIGEN LEVEL OF MORE THAN 100 ng/ml AT THE FIRST DIAGNOSIS]. Nihon Hinyokika Gakkai Zasshi 2019; 110:168-176. [PMID: 32684577 DOI: 10.5980/jpnjurol.110.168] [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: 01/08/2023]
Abstract
In patients with prostate cancer high serum prostate specific antigen (PSA) at diagnosis was generally regarded as a strong impression of advanced disease with distant metastasis and poor prognosis. (Objective) We reported a retrospective study of prognostic factor and Overall survival (OS) in patients with prostate specific antigen (PSA) level of greater than 100 ng/ml (PSA≥100 ng/ml). (Subjects and methods) Between January 2002 and December 2015, 60 patients were diagnosed prostate cancer with PSA≥100 ng/ml and performed hormonal monotherapy at Kanazawa Medical University hospital. We evaluated initial PSA level, Gleason score, Gleason Grading Group, clinical stage, site of metastasis, PSA nadir level, Time to PSA nadir (TTN), serum Hemoglobin (Hb) level, serum C-Reactive Protein (CRP) level, serum Lactate Dehydrogenase (LDH) level, serum Alkaline Phosphatase (ALP) level, clinical passage and survival time. (Results) The median age of the patients was 73 years old (54-90) and the initial PSA levels ranged from 100 ng/ml to 15,823 ng/ml (median 390).Prognostic factors of overall survival were site of metastasis, Gleason score, Gleason Grading Group, PSA nadir level, TTN, serum CRP level, serum LDH level and serum ALP level at the diagnosis. In multivariate analysis serum LDH level remained an independent predictor of OS.
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The Importance of Time to Prostate-Specific Antigen (PSA) Nadir after Primary Androgen Deprivation Therapy in Hormone-Naïve Prostate Cancer Patients. J Clin Med 2018; 7:jcm7120565. [PMID: 30567361 PMCID: PMC6306761 DOI: 10.3390/jcm7120565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Prostate-specific antigen (PSA) is currently the most useful biomarker for detection of prostate cancer (PCa). The ability to measure serum PSA levels has affected all aspects of PCa management over the past two decades. The standard initial systemic therapy for advanced PCa is androgen-deprivation therapy (ADT). Although PCa patients with metastatic disease initially respond well to ADT, they often progress to castration-resistant prostate cancer (CRPC), which has a high mortality rate. We have demonstrated that time to PSA nadir (TTN) after primary ADT is an important early predictor of overall survival and progression-free survival for advanced PCa patients. In in vivo experiments, we demonstrated that the presence of fibroblasts in the PCa tumor microenvironment can prolong the period for serum PSA decline after ADT, and enhance the efficacy of ADT. Clarification of the mechanisms that affect TTN after ADT could be useful to guide selection of optimal PCa treatment strategies. In this review, we discuss recent in vitro and in vivo findings concerning the involvement of stromal–epithelial interactions in the biological mechanism of TTN after ADT to support the novel concept of “tumor regulating fibroblasts”.
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Salji M, Hendry J, Patel A, Ahmad I, Nixon C, Leung HY. Peri-prostatic Fat Volume Measurement as a Predictive Tool for Castration Resistance in Advanced Prostate Cancer. Eur Urol Focus 2018; 4:858-866. [PMID: 28753854 PMCID: PMC6314965 DOI: 10.1016/j.euf.2017.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity and aggressive prostate cancer (PC) may be linked, but how local peri-prostatic fat relates to tumour response following androgen deprivation therapy (ADT) is unknown. OBJECTIVE To test if peri-prostatic fat volume (PPFV) predicts tumour response to ADT. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective study on consecutive patients receiving primary ADT. From staging pelvic magnetic resonance imaging scans, the PPFV was quantified with OsirixX 6.5 imaging software. Statistical (univariate and multivariate) analysis were performed using R Version 3.2.1. RESULTS AND LIMITATIONS Of 224 consecutive patients, 61 with advanced (≥T3 or N1 or M1) disease had (3-mm high resolution axial sections) pelvic magnetic resonance imaging scan before ADT. Median age=75 yr; median PPFV=24.8cm3 (range, 7.4-139.4cm3). PPFV was significantly higher in patients who developed castration resistant prostate cancer (CRPC; n=31), with a median of 37.9cm3 compared with 16.1cm3 (p <0.0001, Wilcoxon rank sum test) in patients who showed sustained response to ADT (n=30). Multivariate analysis using Cox proportional hazards models were performed controlling for known predictors of CRPC. PPFV was shown to be independent of all included factors, and the most significant predictor of time to CRPC. Using our multivariate model consisting of all known factors prior to ADT, PPFV significantly improved the area under the curve of the multivariate models receiver operating characteristic analysis. The main study limitation is a relatively small cohort to account for multiple variables, necessitating a future large-scale prospective analysis of PPFV in advanced PC. CONCLUSIONS PPFV quantification in patients with advanced PC predicts tumour response to ADT. PATIENT SUMMARY The amount of fat around the prostate predicts prostate cancer response to hormone treatment.
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Affiliation(s)
- Mark Salji
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Jane Hendry
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Amit Patel
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Imran Ahmad
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Colin Nixon
- CRUK Beatson Institute, Glasgow, Scotland, UK
| | - Hing Y Leung
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK.
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Gao C, Zhou C, Zhuang J, Liu L, Wei J, Liu C, Li H, Sun C. Identification of key candidate genes and miRNA‑mRNA target pairs in chronic lymphocytic leukemia by integrated bioinformatics analysis. Mol Med Rep 2018; 19:362-374. [PMID: 30431072 PMCID: PMC6297738 DOI: 10.3892/mmr.2018.9636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a malignant clonal proliferative disorder of B cells. Inhibition of cell apoptosis and cell cycle arrest are the main pathological causes of this disease, but its molecular mechanism requires further investigation. The purpose of the present study was to identify biomarkers for the early diagnosis and treatment of CLL, and to explore the molecular mechanisms of CLL progression. A total of 488 differentially expressed genes (DEGs) and 32 differentially expressed microRNAs (miRNAs; DEMs) for CLL were identified by analyzing the gene chips GSE22529, GSE39411 and GSE62137. Functional and pathway enrichment analyses of DEGs demonstrated that DEGs were mainly involved in transcriptional dysregulation and multiple signaling pathways, such as the nuclear factor‑κB and mitogen‑activated protein kinase signaling pathways. In addition, Cytoscape software was used to visualize the protein‑protein interactions of these DEGs in order to identify hub genes, which could be used as biomarkers for the early diagnosis and treatment of CLL. Cytoscape software was also used to analyze the association between the predicted target mRNAs of DEMs and DEGs and increase knowledge about the miRNA‑mRNA regulatory network associated with the progression of CLL. Taken together, the present study provided a bioinformatics basis for advancing our understanding of the pathogenesis of CLL by identifying differentially expressed hub genes, miRNA‑mRNA target pairs and molecular pathways. In addition, hub genes may be used as novel biomarkers for the diagnosis of CLL and to guide the selection of CLL drug combinations.
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Affiliation(s)
- Chundi Gao
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Chao Zhou
- Cancer Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Jing Zhuang
- Cancer Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Lijuan Liu
- Cancer Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Junyu Wei
- Cancer Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Cun Liu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Huayao Li
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Changgang Sun
- Cancer Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
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Afriansyah A, Hamid ARAH, Mochtar CA, Umbas R. Prostate specific antigen (PSA) kinetic as a prognostic factor in metastatic prostate cancer receiving androgen deprivation therapy: systematic review and meta-analysis. F1000Res 2018; 7:246. [PMID: 29904592 PMCID: PMC5964636 DOI: 10.12688/f1000research.14026.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 01/25/2023] Open
Abstract
Aim: Metastatic prostate cancer (mPCa) has a poor outcome with median survival of two to five years. The use of androgen deprivation therapy (ADT) is a gold standard in management of this stage. Aim of this study is to analyze the prognostic value of PSA kinetics of patient treated with hormonal therapy related to survival from several published studies Method: Systematic review and meta-analysis was performed using literature searching in the electronic databases of MEDLINE, Science Direct, and Cochrane Library. Inclusion criteria were mPCa receiving ADT, a study analyzing Progression Free Survival (PFS), Overall Survival (OS), or Cancer Specific Survival (CSS) and prognostic factor of survival related to PSA kinetics (initial PSA, PSA nadir, and time to achieve nadir (TTN)). The exclusion criteria were metastatic castration resistant of prostate cancer (mCRPC) and non-metastatic disease. Generic inverse variance method was used to combine hazard ratio (HR) within the studies. Meta-analysis was performed using Review Manager 5.2 and a p-value <0.05 was considered statistically significant. Results: We found 873 citations throughout database searching with 17 studies were consistent with inclusion criteria. However, just 10 studies were analyzed in the quantitative analysis. Most of the studies had a good methodological quality based on Ottawa Scale. No significant association between initial PSA and PFS. In addition, there was no association between initial PSA and CSS/ OS. We found association of reduced PFS (HR 2.22; 95% CI 1.82 to 2.70) and OS/ CSS (HR 3.31; 95% CI 2.01-5.43) of patient with high PSA nadir. Shorter TTN was correlated with poor result of survival either PFS (HR 2.41; 95% CI 1.19 - 4.86) or CSS/ OS (HR 1.80; 95%CI 1.42 - 2.30) Conclusion: Initial PSA before starting ADT do not associated with survival in mPCa. There is association of PSA nadir and TTN with survival.
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Affiliation(s)
- Andika Afriansyah
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
| | - Agus Rizal Ardy Hariandy Hamid
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
| | - Chaidir Arif Mochtar
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
| | - Rainy Umbas
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
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Kang YJ, Jang WS, Kwon JK, Yoon CY, Lee JY, Ham WS, Choi YD. Intermediate PSA half-life after neoadjuvant hormone therapy predicts reduced risk of castration-resistant prostate cancer development after radical prostatectomy. BMC Cancer 2017; 17:789. [PMID: 29169347 PMCID: PMC5701379 DOI: 10.1186/s12885-017-3775-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 11/13/2017] [Indexed: 12/01/2022] Open
Abstract
Background The magnitude and rapidity of the tumor response to androgen deprivation is known to predict the durability of the therapy. We have investigated the predictive value of categorizing patients by the half-life of PSA under neoadjuvant androgen deprivation therapy in patients with biochemical recurrence after radical prostatectomy. Methods Medical records of 317 patients who received neoadjuvant androgen deprivation therapy before radical prostatectomy and developed biochemical recurrence were analyzed. The patients were categorized into five groups according to PSA half-life. Risk of developing castration resistance was evaluated by Kaplan-Meier analysis and by Cox proportional risk regression analysis. Results The median follow-up duration was 50.1 months (IQR 31.8–68.7) and median PSA half-life was 22.1 days (IQR 12.7–38.4). Comparison of survival curves revealed that patients in the intermediate response group showed significantly lower 5-year castration-resistant prostate cancer rate (37.5%) compared to non-response and ultra-rapid response groups (63.6%, p = 0.007; 56.1%, p = 0.031; respectively). In the multivariate regression model, intermediate response compared to non-response was associated with significantly reduced risk of castration resistance development (hazard ratio 0.397, 95% confidence interval 0.191–0.823, p = 0.013) and overall mortality (hazard ratio 0.138, 95% confidence interval 0.033–0.584, p = 0.007). When subcategorized by Gleason score, Kaplan-Meier curve revealed that, in the high Gleason score stratum, 5-year castration-resistant prostate cancer rate for intermediate response group (44.0%) was exceptionally lower than that in non-response group (66.7%, p = 0.047), while castration resistance increased in other groups. Conclusion Short PSA half-life as well as no response after androgen deprivation is associated with increased risk of treatment failure compared to intermediate PSA half-life. Electronic supplementary material The online version of this article (10.1186/s12885-017-3775-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yong Jin Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jong Kyou Kwon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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Factors Predicting the Off-treatment Duration in Patients with Prostate Cancer Receiving Degarelix as Intermittent Androgen Deprivation Therapy. Eur Urol Focus 2017; 3:470-479. [DOI: 10.1016/j.euf.2015.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/07/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
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34
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Ji G, Song G, Huang C, He S, Zhou L. Rapidly decreasing level of prostate-specific antigen during initial androgen deprivation therapy is a risk factor for early progression to castration-resistant prostate cancer: A retrospective study. Medicine (Baltimore) 2017; 96:e7823. [PMID: 28885333 PMCID: PMC6392679 DOI: 10.1097/md.0000000000007823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To build a practical model for predicting the progression to castration-resistant prostate cancer (CRPC) after androgen deprivation therapy (ADT).In all, 185 patients with prostate cancer who had received ADT as the primary therapy at our institution, from 2003 to 2014, were retrospectively enrolled. The following clinical variables were included in the analysis: age, clinical tumor, node, metastasis stage, Gleason score, risk groups of prostate cancer, prostate-specific antigen (PSA) at the initiation of ADT, PSA nadir after ADT, velocity of PSA decline, and the time to PSA nadir. Cox proportional-hazards regression models were calculated to estimate effects of these variables on the time of progression to CRPC.On univariate and multivariate analyses, the presence of distant metastasis before ADT (hazard ratio [HR] 6.030, 95% confidence interval (CI) 3.229-11.263, P = .001), higher PSA nadir (HR 1.185, 95% CI 1.080-1.301, P = .001), a velocity of PSA decline >11 ng/mL per month (HR 2.124, 95% CI 1.195-3.750, P = .001), and a time to PSA nadir ≤9 months (HR 0.276, 95% CI 0.162-0.469, P = .004) were significantly associated with an increased risk of progression to CRPC.Patients with a rapidly decreasing PSA level in the initial phase of ADT are more likely to progress to CRPC. Our findings provide a practical approach to screen patients during ADT for early identification of those likely to progress to CRPC, allowing treatment to be modified to improve outcomes.
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Becker JA, Berg KD, Røder MA, Brasso K, Iversen P. Cytoreductive prostatectomy in metastatic prostate cancer: a systematic review. Scand J Urol 2017; 52:1-7. [PMID: 28818014 DOI: 10.1080/21681805.2017.1363816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The impact of cytoreductive radical prostatectomy on oncological outcome in patients with prostate cancer and limited number of bone metastases is unclear. Data from cancer registries, multi-institutional databases and a single institutional case-control study indicate a possible benefit of combined cytoreduction and hormonal therapy compared to hormonal therapy alone. However, the results may be biased by a number of factors. The evidence from studies on cytoreductive prostatectomy is reviewed.
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Affiliation(s)
- Joachim Aidt Becker
- a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen, Denmark
| | - Kasper Drimer Berg
- a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen, Denmark
| | - Martin Andreas Røder
- a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen, Denmark
| | - Klaus Brasso
- a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen, Denmark
| | - Peter Iversen
- a Copenhagen Prostate Cancer Center, Department of Urology , Rigshospitalet, University of Copenhagen , Copenhagen, Denmark
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Kan HC, Hou CP, Lin YH, Tsui KH, Chang PL, Chen CL. Prognosis of prostate cancer with initial prostate-specific antigen >1,000 ng/mL at diagnosis. Onco Targets Ther 2017; 10:2943-2949. [PMID: 28652776 PMCID: PMC5476709 DOI: 10.2147/ott.s134411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Prostate cancer patients with surprisingly high prostate-specific antigen (PSA) are encountered clinically. However, descriptions of this group of patients are extremely rare in the published literature. This study reports treatment outcome and long-term prognosis for this group of patients. PATIENTS AND METHODS Between January 2007 and December 2012, 2,064 patients with PCa diagnosed at a tertiary medical center were retrospectively reviewed. A total of 90 PCa cases were identified with initial PSA (iPSA) >1,000 ng/mL at diagnosis. A retrospective study was conducted in this cohort, with comparison among stratified patient age groups, PSA, treatment options, and overall survival. RESULTS The mean PSA at PCa diagnosis in this cohort was 3,323 ng/mL (1,003-23,126, median: 2,050 ng/mL). Most patients were in the age group 65-79 years (55/90, 61%). Males older than 80 years had a poor prognosis (P<0.001). Forty-six patients (51%) underwent orchiectomy with a median follow-up period of 16.2 (1.3-72.7) months, compared to 44 patients treated with medical castration and a median follow-up of 9.1 (0.3-70.5) months. Kaplan-Meier analysis revealed survival benefit from treatment with orchiectomy (P<0.001). PSA reduction >90% of iPSA following primary androgen deprivation therapy (reaching true nadir) could be a predictor of longer survival (P<0.001). Cox regression revealed the hazard ratio (HR) of variables were age (HR: 4.57, 95% confidence interval [CI]: 1.45-14.37, P=0.009), reaching true nadir (HR: 0.12, 95% CI: 0.03-0.58, P=0.008), and the treatment option with orchiectomy (HR: 0.22, 95% CI: 0.65-0.76, P=0.016). CONCLUSION Age ≥80 years indicated poor overall survival in PCa patients with iPSA >1,000 ng/mL. Reaching a true nadir of PSA following primary androgen deprivation therapy could be a predictor of longer survival. Bilateral orchiectomy is recommended for this group of patients.
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Affiliation(s)
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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Bello JO. Predictors of survival outcomes in native sub Saharan black men newly diagnosed with metastatic prostate cancer. BMC Urol 2017; 17:39. [PMID: 28558685 PMCID: PMC5450414 DOI: 10.1186/s12894-017-0228-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Though it is well established that black men are at higher risk of prostate cancer (PCa) very little is known about the disease in native sub Saharan black men. Newly diagnosed metastatic PCa patients treated with primary androgen deprivation therapy were identified and predictors of progression-free survival (PFS) assessed. Methods Patients diagnosed with metastatic PCa between 2010 and 2015 in a sub Saharan black population were included in the study. Primary outcome measure was PFS defined as time from primary androgen deprivation therapy to clinical progression or death. Demographic, clinical and PSA kinetic variables were evaluated for their prognostic power using Cox proportional hazard regression models. Results Seventy-nine patients met the eligibility criteria and were analyzed. Median age, median overall survival and PFS was 69 years, 40 months and 27 months respectively. A PSA nadir >4 ng/mL was found to predict an earlier clinical progression. Median PFS was shorter in those with PSA nadir >4 ng/mL (15 months) compared to those with PSA nadir ≤4 ng/mL (29 months); log rank p value = 0.003. Conclusions The PSA nadir achieved following primary androgen deprivation therapy predicts progression-free survival in sub Saharan black men newly diagnosed with metastatic PCa. PSA nadir >4 ng/mL was found to be associated with a more rapid clinical progression.
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Guijarro A, Hernández V, de la Morena JM, Jiménez-Valladolid I, Pérez-Fernández E, de la Peña E, Llorente C. Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients. Actas Urol Esp 2017; 41:226-233. [PMID: 27773340 DOI: 10.1016/j.acuro.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. MATERIALS AND METHODS A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. RESULTS We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. CONCLUSIONS The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.
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Affiliation(s)
- A Guijarro
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - V Hernández
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J M de la Morena
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - I Jiménez-Valladolid
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E Pérez-Fernández
- Unidad de investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E de la Peña
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - C Llorente
- Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Myung JK, Wang G, Chiu HHL, Wang J, Mawji NR, Sadar MD. Inhibition of androgen receptor by decoy molecules delays progression to castration-recurrent prostate cancer. PLoS One 2017; 12:e0174134. [PMID: 28306720 PMCID: PMC5357013 DOI: 10.1371/journal.pone.0174134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/23/2017] [Indexed: 12/20/2022] Open
Abstract
Androgen receptor (AR) is a member of the steroid receptor family and a therapeutic target for all stages of prostate cancer. AR is activated by ligand binding within its C-terminus ligand-binding domain (LBD). Here we show that overexpression of the AR NTD to generate decoy molecules inhibited both the growth and progression of prostate cancer in castrated hosts. Specifically, it was shown that lentivirus delivery of decoys delayed hormonal progression in castrated hosts as indicated by increased doubling time of tumor volume, prolonged time to achieve pre-castrate levels of serum prostate-specific antigen (PSA) and PSA nadir. These clinical parameters are indicative of delayed hormonal progression and improved therapeutic response and prognosis. Decoys reduced the expression of androgen-regulated genes that correlated with reduced in situ interaction of the AR with androgen response elements. Decoys did not reduce levels of AR protein or prevent nuclear localization of the AR. Nor did decoys interact directly with the AR. Thus decoys did not inhibit AR transactivation by a dominant negative mechanism. This work provides evidence that the AR NTD plays an important role in the hormonal progression of prostate cancer and supports the development of AR antagonists that target the AR NTD.
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Affiliation(s)
- Jae-Kyung Myung
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Gang Wang
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Helen H. L. Chiu
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jun Wang
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Nasrin R. Mawji
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marianne D. Sadar
- Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- * E-mail:
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Predictive factor of androgen deprivation therapy for patients with advanced stage prostate cancer. Prostate Int 2017; 5:35-38. [PMID: 28352622 PMCID: PMC5357969 DOI: 10.1016/j.prnil.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to identify the predictive factors for the efficacy of androgen deprivation therapy (ADT) in men with hormone-sensitive prostate cancer (PC) with or without distant metastasis. Methods A retrospective review of PC patients was conducted of the medical records. We enrolled 246 patients who received primary ADT. PC patients treated with ADT for presumed nonlocalized PC were evaluated on the efficacy of ADT using prostate-specific antigen (PSA) time to progression (TTP) and compared factors associated with TTP in patients with distant metastasis and patients without distant metastasis. Results A total of 246 patients were treated primarily with ADT. The median follow-up period was 20.2 months. One hundred and ninety-one patients had metastatic disease. The median TTP on ADT for the distant metastasis group was 14.8 months versus 60.1 months in the without distant metastasis group (P < 0.0001). In the univariate analysis only, PSA nadir after ADT was associated with longer TTP (hazard ratio, 10.69; 95% confidence interval, 5.56–20.57). In the multivariate analysis, high grade tumor and PSA nadir were independent factors associated with a shorter TTP. Conclusion In this study of hormone-sensitive PC patients treated with ADT for nonlocalized PC, high grade tumor and PSA nadir were predicting factors of this treatment.
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Shevach J, Gallagher EJ, Kochukoshy T, Gresia V, Brar M, Galsky MD, Oh WK. Concurrent Diabetes Mellitus may Negatively Influence Clinical Progression and Response to Androgen Deprivation Therapy in Patients with Advanced Prostate Cancer. Front Oncol 2015; 5:129. [PMID: 26125012 PMCID: PMC4467174 DOI: 10.3389/fonc.2015.00129] [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] [Received: 03/30/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To determine if a concurrent diagnosis of diabetes mellitus is associated with worse outcomes in advanced prostate cancer (PC). The effect diabetes may have on the progression of advanced PC is poorly understood. Methods Data on 148 advanced PC patients (35 with concurrent diabetes) were collected from an institutional database to obtain diabetic status, data on treatment types and durations, and prostate-specific antigen (PSA) values before, during, and after treatment. Time to castration resistance following the onset of androgen deprivation therapy (ADT) and overall survival (OS) in patients with and without diabetes were compared using univariate Cox regression analyses as the primary endpoints. Differences in PSA response to treatments were compared using chi-squared tests as a secondary endpoint. Results With a median follow-up of 29 months, time to castration resistance did not differ significantly between patients with and without diabetes who underwent ADT. However, in a subset of patients who received ADT without radiographic evidence of metastases (N = 47), those with diabetes progressed to castration-resistant disease more quickly than those without DM (hazard ratio for progression with diabetes = 4.58; 95% CI: 1.92–10.94; p = 0.0006). Also, a lower percentage of patients undergoing ADT with diabetes had PSA declines of at least 50% (p = 0.17) and reached a nadir PSA <0.2 ng/mL (p = 0.06). OS did not differ based on diabetic status. No differences were seen in response to first-line therapy for castration-resistant prostate cancer. Conclusion Diabetes mellitus may have a detrimental effect on progression of advanced PC, particularly in those patients without radiographic evidence of metastases. Further study is necessary to fully elucidate the effect of diabetes on PC outcomes.
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Affiliation(s)
- Jeffrey Shevach
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Emily Jane Gallagher
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Teena Kochukoshy
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Victoria Gresia
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Manpreet Brar
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, NY , USA
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Thalgott M, Rack B, Eiber M, Souvatzoglou M, Heck MM, Kronester C, Andergassen U, Kehl V, Krause BJ, Gschwend JE, Retz M, Nawroth R. Categorical versus continuous circulating tumor cell enumeration as early surrogate marker for therapy response and prognosis during docetaxel therapy in metastatic prostate cancer patients. BMC Cancer 2015; 15:458. [PMID: 26051431 PMCID: PMC4459665 DOI: 10.1186/s12885-015-1478-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 06/01/2015] [Indexed: 01/13/2023] Open
Abstract
Background Circulating tumor cell (CTCs) counts might serve as early surrogate marker for treatment efficacy in metastatic castration-resistant prostate cancer (mCRPC) patients. We prospectively assessed categorical and continuous CTC-counts for their utility in early prediction of radiographic response, progression-free (PFS) and overall survival (OS) in mCRPC patients treated with docetaxel. Methods CTC-counts were assessed in 122 serial samples, as continuous or categorical (<5 vs. ≥5 CTCs) variables, at baseline (q0) and after 1 (q1), 4 (q4) and 10 (q10) cycles of docetaxel (3-weekly, 75 mg/m2) in 33 mCRPC patients. Treatment response (TR) was defined as non-progressive (non-PD) and progressive disease (PD), by morphologic RECIST or clinical criteria at q4 and q10. Binary logistic and Cox proportional hazards regression analyses were used as statistical methods. Results Categorical CTC-count status predicted PD at q4 already after one cycle (q1) and after 4 cycles (q4) of chemotherapy with an odds ratio (OR) of 14.9 (p = 0.02) and 18.0 (p = 0.01). Continuous CTC-values predicted PD only at q4 (OR 1.04, p = 0.048). Regarding PFS, categorical CTC-counts at q1 were independent prognostic markers with a hazard ratio (HR) of 3.85 (95 % CI 1.1-13.8, p = 0.04) whereas early continuous CTC-values at q1 failed significance (HR 1.02, 95 % CI 0.99-1.05, p = 0.14). For OS early categorical and continuous CTC-counts were independent prognostic markers at q1 with a HR of 3.0 (95 % CI 1.6-15.7, p = 0.007) and 1.02 (95 % CI 1.0-1.040, p = 0.04). Conclusions Categorical CTC-count status is an early independent predictor for TR, PFS and OS only 3 weeks following treatment initiation with docetaxel whereas continuous CTC-counts were an inconsistent surrogate marker in mCRPC patients. For clinical practice, categorical CTC-counts may provide complementary information towards individualized treatment strategies with early prediction of treatment efficacy and optimized sequential treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1478-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Thalgott
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Klinikum Innenstadt, Maistrasse 11, 80337, Munich, Germany.
| | | | | | - Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Caroline Kronester
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Klinikum Innenstadt, Maistrasse 11, 80337, Munich, Germany.
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Bernd J Krause
- Department of Nuclear Medicine, Universitätsklinikum Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Jurgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Roman Nawroth
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
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Prostate-specific antigen kinetic profiles during androgen deprivation therapy as prognostic factors in castration-resistant prostate cancer. Urol Oncol 2015; 33:203.e1-9. [PMID: 25726498 DOI: 10.1016/j.urolonc.2015.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify pretreatment prognostic factors for patients with castration-resistant prostate cancer (CRPC) undergoing docetaxel (DCT) chemotherapy. MATERIALS AND METHODS We retrospectively analyzed 102 patients with CRPC who underwent DCT chemotherapy (dosage: 60-75 mg/m(2)) from December 2001 to August 2013. The parameters evaluated as prognostic factors were as follows: age, body mass index, Gleason score, clinical TNM stage, prior radical prostatectomy, prior radiation therapy, performance status, presence of pain, laboratory results at the start of DCT, and prostate-specific antigen (PSA) kinetics during prior androgen deprivation therapy (ADT), including PSA level at the start of ADT (PSA-ADT), PSA half-time (PSAT1/2), time to nadir, PSA level at nadir (PSA-Nadir), duration of nadir, PSA doubling time (PSADT), and PSA level at the start of DCT (PSA-DCT). Univariate and multivariate analyses were performed to identify independent prognostic factors. RESULTS Median cancer-specific survival (CSS) duration following CRPC diagnosis was 28.0 months. In univariate analyses, performance status, serum albumin, serum creatinine, PSAT1/2, time to nadir, PSA-Nadir, duration of nadir, PSADT, and PSA-DCT showed a potential association with prognosis (P<0.001-0.077). Multivariate analyses of these parameters showed that performance status (hazard ratio [HR] = 0.046; P = 0.046), serum creatinine (HR = 3.028; P = 0.036), PSAT1/2 (HR = 0.172; P = 0.007), PSA-Nadir (HR = 4.884; P = 0.033), PSADT (HR = 0.148; P<0.001), and PSA-DCT (HR = 5.222; P = 0.004) remained independent predictors of CSS in CRPC. CONCLUSIONS PSA kinetic parameters measured during prior ADT are significant surrogate markers predicting CSS in patients undergoing DCT chemotherapy for CRPC.
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