1
|
Liu R, Zhao Y, Su S, Kwabil A, Njoku PC, Yu H, Li X. Unveiling cancer dormancy: Intrinsic mechanisms and extrinsic forces. Cancer Lett 2024; 591:216899. [PMID: 38649107 DOI: 10.1016/j.canlet.2024.216899] [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: 03/19/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
Tumor cells disseminate in various distant organs at early stages of cancer progression. These disseminated tumor cells (DTCs) can stay dormant/quiescent without causing patient symptoms for years or decades. These dormant tumor cells survive despite curative treatments by entering growth arrest, escaping immune surveillance, and/or developing drug resistance. However, these dormant cells can reactivate to proliferate, causing metastatic progression and/or relapse, posing a threat to patients' survival. It's unclear how cancer cells maintain dormancy and what triggers their reactivation. What are better approaches to prevent metastatic progression and relapse through harnessing cancer dormancy? To answer these remaining questions, we reviewed the studies of tumor dormancy and reactivation in various types of cancer using different model systems, including the brief history of dormancy studies, the intrinsic characteristics of dormant cells, and the external cues at the cellular and molecular levels. Furthermore, we discussed future directions in the field and the strategies for manipulating dormancy to prevent metastatic progression and recurrence.
Collapse
Affiliation(s)
- Ruihua Liu
- School of Life Sciences, Inner Mongolia University, Hohhot, Inner Mongolia Autonomous Region, 010070, China; Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA
| | - Yawei Zhao
- Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA
| | - Shang Su
- Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA
| | - Augustine Kwabil
- Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA
| | - Prisca Chinonso Njoku
- Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA
| | - Haiquan Yu
- School of Life Sciences, Inner Mongolia University, Hohhot, Inner Mongolia Autonomous Region, 010070, China.
| | - Xiaohong Li
- Department of Cell and Cancer Biology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43614, USA.
| |
Collapse
|
2
|
ACCURATE PREDICTION OF LONG-TERM RISK OF BIOCHEMICAL FAILURE AFTER SALVAGE RADIOTHERAPY INCLUDING THE IMPACT OF PELVIC NODE IRRADIATION. Radiother Oncol 2022; 175:26-32. [DOI: 10.1016/j.radonc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
|
3
|
Asso R, Degrande F, Fernandes da Silva J, Leite E. Postoperative radiotherapy in prostate cancer: When and how? – An update review. Cancer Radiother 2022; 26:742-748. [DOI: 10.1016/j.canrad.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
|
4
|
Campbell SR, Tom MC, Agrawal S, Efstathiou JA, Michalski JM, Abramowitz MC, Pollack A, Spratt DE, Hearn JWD, Stephans KL, Gao T, Li J, Tendulkar RD. Integrating Prostate-specific Antigen Kinetics into Contemporary Predictive Nomograms of Salvage Radiotherapy After Radical Prostatectomy. Eur Urol Oncol 2021; 5:304-313. [PMID: 34016556 DOI: 10.1016/j.euo.2021.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Salvage radiotherapy (SRT) is an established treatment for men with biochemical recurrence following radical prostatectomy (RP). There are several risk factors associated with adverse outcomes; however, the value of postoperative prostate-specific antigen (PSA) kinetics is less clear in the ultrasensitive PSA era. OBJECTIVE To characterize the impact of PSA kinetics on outcomes following SRT and generate nomograms to aid in identifying patients with an increased risk of adverse clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional analysis was conducted of 1005 patients with prostate cancer treated with SRT after RP, with a median follow-up of 5 years. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Variables examined include immediate postoperative PSA, postoperative PSA doubling time (DT), and pre-SRT PSA, in addition to previously identified predictive factors. Multivariable survival analyses were completed using Fine-Gray competing risk regression. Rates of biochemical failure (BF), distant metastasis (DM), and prostate cancer-specific mortality (PCSM) were estimated by the cumulative incidence method. Nomograms were generated from multivariable competing risk regression with bootstrap cross-validation. RESULTS AND LIMITATIONS Factors associated with BF after SRT include PSA DT <6 mo, initial postoperative PSA ≥0.2 ng/ml, higher pre-SRT PSA, lack of androgen deprivation therapy, a higher Gleason score (GS), negative margins, seminal vesicle invasion, lack of pelvic nodal radiation, radiation total dose <66 Gy, a longer RP to SRT interval, and older age (p < 0.05 for each). Factors associated with DM include PSA DT <6 mo, pre-SRT PSA, a higher GS, and negative margins. Factors associated with PCSM include PSA DT not calculable or <6 mo and a higher GS. Nomograms were generated to estimate the risks of BF (concordance index [CI] 0.74), DM (CI 0.77), and PCSM (CI 0.77). Limitations include retrospective nature, broad treatment eras, institutional variations, and multiple methods available for the estimation of PSA DT. CONCLUSIONS Postoperative PSA kinetics, particularly pre-SRT PSA and PSA DT, are strongly associated with adverse oncologic outcomes following SRT and should be considered in management decisions. PATIENT SUMMARY In this report of men with prostate cancer who developed a prostate-specific antigen (PSA) recurrence after prostatectomy, we found that PSA levels after surgery and how quickly a PSA level doubles significantly impact the chance of prostate cancer recurrence after salvage radiation therapy. Based on this information, we created a tool to calculate a man's chance of cancer recurrence after salvage radiation therapy, and these estimations can be used to discuss whether additional treatment with radiation should be considered.
Collapse
Affiliation(s)
- Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Martin C Tom
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Shree Agrawal
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Dana-Farber/Harvard Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Siteman Cancer Center, Washington University, St. Louis, MO, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
| | - Jason W D Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Tianming Gao
- Global Medical Affairs Statistics, AbbVie, Chicago, IL, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul D Tendulkar
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
5
|
Vigna‐Taglianti R, Boriano A, Gianello L, Melano A, Bergesio F, Merlotti AM, Reali A, Petrucci R, Russi EG. Predictive value of Prostate Specific Antigen variations in the last week of salvage radiotherapy for biochemical recurrence of prostate cancer after surgery: A practical approach. Cancer Rep (Hoboken) 2020; 3:e1285. [PMID: 32881424 PMCID: PMC7941543 DOI: 10.1002/cnr2.1285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 08/02/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND About a third of patients who underwent radical prostatectomy for prostate cancer (Pca) develop a biochemical failure (BF) within 10 years from surgery, and about a half of them receive salvage radiation therapy (SRT). Factors to predict risk to relapse after SRT are still lacking. Dynamic models, based on the assessment of changes in Prostate Specific Antigen (PSA) postsurgery seem to show good reliability. AIMS The goal of the study was to identify a simple analytical method for the postsalvage radiation therapy biochemical failure (post-SRTBF) prediction before the end of the SRT, regardless of the PSA value at the beginning of the treatment (PSA start), measuring the PSA values at the start and 1 week before the end of SRT. METHODS In a series of 83 patients treated with SRT for BF of Pca we measured PSA values at the first day and 1 week before the end of SRT. These values were used to define an analytical method for the post-SRTBF prediction. RESULTS PSA value in patients without post-SRTBF show a significant difference in term of difference during the SRT with respect to patients with post-SRTBF. Starting from this difference, we identified a simple and practical analytical method for the post-SRTBF prediction before the end of the SRT. The data corresponds with the model and the analytical method is highly predictive (Sensitivity = 81%, Specificity = 85%, Accuracy = 83%). CONCLUSION This study offers a new tool to early predict Pca relapse overtime and to select patients who can benefit from an early additional systemic treatment.
Collapse
Affiliation(s)
| | - Alberto Boriano
- Medical Physics DepartmentSanta Croce and Carle HospitalCuneoItaly
| | - Luca Gianello
- Radiation Oncology DepartmentSanta Croce and Carle HospitalCuneoItaly
| | - Antonella Melano
- Radiation Oncology DepartmentSanta Croce and Carle HospitalCuneoItaly
| | | | | | - Alessia Reali
- Radiation Oncology DepartmentSanta Croce and Carle HospitalCuneoItaly
| | - Rachele Petrucci
- Radiation Oncology DepartmentSanta Croce and Carle HospitalCuneoItaly
| | - Elvio G. Russi
- Radiation Oncology DepartmentSanta Croce and Carle HospitalCuneoItaly
| |
Collapse
|
6
|
Rans K, Berghen C, Joniau S, De Meerleer G. Salvage Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2020; 32:156-162. [PMID: 32035581 DOI: 10.1016/j.clon.2020.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
For patients experiencing biochemical recurrence in the absence of distant metastasis, salvage radiotherapy (SRT) with or without androgen deprivation therapy (ADT) is currently the only possible curative treatment option. Prostate-specific antigen (PSA) monitoring and the selected use of SRT has some advantages when compared with adjuvant radiotherapy. The most important one is avoidance of a potential overtreatment of patients who would never have disease progression, even in the presence of high-risk pathological features. The identification of a specific PSA cut-off seems to be incorrect. In patients with more adverse pathological features, early SRT administered at the very first sign of a PSA rise granted better disease control. Dose-intensified SRT is feasible and well tolerated with no significant difference in grade 2 or more acute and late toxicity. At least 66 Gy must be given in the salvage setting. ADT has a radio-sensitising effect on the radiotherapy by inhibiting the repair of DNA double-strand breaks. The use of ADT in the salvage setting results in a better oncological outcome. Hormonal therapy is associated with a decrease in quality of life and side-effects depending on the duration of hormone therapy. The oncological benefit of hormone therapy duration depends on their clinical and pathological characteristics. 68-Ga-prostate-specific membrane antigen positron emission tomography-computed tomography is the gold standard in staging prostate cancer patients with biochemical persistence or recurrence after radical prostatectomy. The implementation of 18F-labelled PSMA tracers can provide a further improvement.
Collapse
Affiliation(s)
- K Rans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - C Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - S Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - G De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
7
|
Berghen C, Joniau S, Laenen A, Devos G, Rans K, Goffin K, Haustermans K, Meerleer GD. Long- versus short-term androgen deprivation therapy with high-dose radiotherapy for biochemical failure after radical prostatectomy: a randomized controlled trial. Future Oncol 2020; 16:2035-2044. [DOI: 10.2217/fon-2020-0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Radical prostatectomy is a well-established treatment option in the management of localized and locally advanced prostate cancer. An extended lymphadenectomy is performed in case of substantial risk for lymph node involvement. When biochemical recurrence (BCR) occurs, salvage radiotherapy (SRT) is performed. The benefit in terms of BCR-free survival (FS) and metastasis-FS by adding 6 months of androgen deprivation therapy (ADT) compared with SRT only has already been established. Retrospective evidence suggests that a longer schedule of ADT may be more beneficial compared with 6 months. This multicenter open-label randomized trial will include patients who need SRT after experiencing BCR post-radical prostatectomy with lymphadenectomy and pN0-status. Patients will be randomized for ADT duration (6 vs 24 months). Primary end point is distant metastasis-FS. Clinical Trial Registration: NCT04242017 ( ClinicalTrials.gov )
Collapse
Affiliation(s)
| | | | - Annouschka Laenen
- Department of Public Health & Primary Care, Interuniversity Institute for Biostatistics & Statistical Bioinformatics, KU Leuven, Leuven, Belgium
| | - Gaetan Devos
- Department of Urology, KU Leuven, Leuven, Belgium
| | - Kato Rans
- Department of Radiation Oncology, KU Leuven, Leuven, Belgium
| | | | | | | |
Collapse
|
8
|
Carrie C, Magné N, Burban-Provost P, Sargos P, Latorzeff I, Lagrange JL, Supiot S, Belkacemi Y, Peiffert D, Allouache N, Dubray BM, Servagi-Vernat S, Suchaud JP, Crehange G, Guerif S, Brihoum M, Barbier N, Graff-Cailleaud P, Ruffion A, Dussart S, Ferlay C, Chabaud S. Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial. Lancet Oncol 2019; 20:1740-1749. [DOI: 10.1016/s1470-2045(19)30486-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022]
|
9
|
Bonin K, McGuffin M, Lechtman E, Cumal A, Harth T, Calabrese E, Feldman-Stewart D, Burnett J, Ellis J, Di Prospero L, Szumacher E. Evaluation of an Online Education Resource on Radiation Therapy Created for Patients with Postprostatectomy Prostate Cancer and Their Caregivers. J Med Imaging Radiat Sci 2018; 49:365-370. [PMID: 30514552 DOI: 10.1016/j.jmir.2018.07.007] [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: 04/07/2018] [Revised: 06/26/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Radiation therapy (RT) after prostatectomy is an important curative treatment option for patients with prostate cancer. It can be delivered immediately after surgery as adjuvant treatment, or after biochemical PSA failure as salvage treatment. There is currently a lack of consensus regarding whether salvage RT in the event of biochemical failure or immediate adjuvant RT is the optimal postprostatectomy RT treatment. Although both types of postprostatectomy RT are generally well tolerated, patients may develop some toxicity that can impact their quality of life and the duration and frequency of treatments can be challenging for patients. It is imperative that patients be provided with evidence-based information so that they are able to make a treatment decision most aligned with their values. METHODS To help address patients' informational needs, an online education resource was created for patients with prostate cancer considering postoperative RT. Patients and their families were asked to evaluate the effectiveness of this resource using a validated purpose-based information assessment. RESULTS Nineteen patients were approached and 14 participated, but only five patients returned their evaluations (35%). Sixty percent found the information to be important with regards to each of the six commonly identified purposes in the purpose-based information assessment: organizing, understanding, decision-making, planning, emotional support, and discussing. Only one participant found the information hard to understand and had difficulty finding specific information. DISCUSSION Patients should be encouraged to actively participate in their treatment decision-making process involving postprostatectomy RT. For patients to make well-informed decisions, patients must be provided with clear and accessible information so that they may understand their disease and the treatment options. CONCLUSION An online education resource has been developed that most study respondents found clear and helpful for a variety of identified purposes. Overall, this online education resource has the potential to reach a large number of patients and their caregivers who desire specific information and involvement in future treatment decisions.
Collapse
Affiliation(s)
- Katija Bonin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Merrylee McGuffin
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eli Lechtman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Cumal
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Harth
- Patient Education, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eirena Calabrese
- Oncology Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Julie Burnett
- Department of Patient and Family Support, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Janet Ellis
- Department of Psychiatry, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Kishan AU, Tendulkar RD, Tran PT, Parker CC, Nguyen PL, Stephenson AJ, Carrie C. Optimizing the Timing of Salvage Postprostatectomy Radiotherapy and the Use of Concurrent Hormonal Therapy for Prostate Cancer. Eur Urol Oncol 2018; 1:3-18. [PMID: 31100226 DOI: 10.1016/j.euo.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Currently, salvage radiotherapy (SRT) is the only known curative intervention for men with recurrent disease following prostatectomy. Critical issues in the optimal selection and management of men being considered for SRT include the threshold prostate-specific antigen (PSA) value at which to initiate treatment (ie, pre-SRT PSA) and the role of concurrent hormonal therapy (HT). OBJECTIVE To review the published evidence pertaining to the optimal timing for SRT and the role of concurrent HT. EVIDENCE ACQUISITION MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and guideline statements from professional organizations were queried from January 1, 2000 through January 10, 2018. EVIDENCE SYNTHESIS Thirty-three independent reports, including two randomized trials evaluating HT with SRT, were identified. Retrospective data suggest that SRT initiation at lower pre-SRT PSA levels is associated with better clinical outcomes. Prospective data suggest an overall survival benefit with concurrent HT that manifests during long-term follow-up, with the caveat that hypothesis-generating subgroup analyses suggest that this benefit may be limited to patients with higher pre-SRT PSA levels. Patients with adverse risk factors, such as Gleason grade group 4-5 disease, are likely to benefit the most from earlier SRT initiation and/or the use of HT. CONCLUSIONS Given the limitations of the available data, it is imperative that physicians participate in shared decision-making, with the recommendation tailored for each man's desire to maximize oncologic benefit (with a risk of overtreatment) versus potential quality-of-life optimization (with a risk of undertreatment). Within that framework, a significant body of retrospective data supports initiation of SRT at low pre-SRT PSA values, without an arbitrary absolute threshold. Prospective data suggest a benefit of HT, but this benefit may be greatest in patients with a pre-SRT PSA that is higher than the typical level in most patients receiving "early" SRT. Further research is necessary before absolute recommendations can be made. PATIENT SUMMARY Two ways to potentially improve outcomes following salvage radiotherapy for prostate cancer that recurs after prostatectomy are to start treatment at a lower prostate-specific antigen level and to use concurrent hormonal therapy. Our review suggests that the available evidence is imperfect, but highlights that both measures are likely to improve clinical outcomes in general, but perhaps not uniformly and/or consistently for all patients. Physician-patient shared decision-making and further research are critical.
Collapse
Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, USA.
| | | | - Phuoc T Tran
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher C Parker
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
11
|
Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, Hearn JW, Koontz BF, Lee WR, Michalski JM, Pisansky TM, Liauw SL, Abramowitz MC, Pollack A, Moghanaki D, Anscher MS, Den RB, Zietman AL, Stephenson AJ, Efstathiou JA. Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer With Adverse Pathological Features. JAMA Oncol 2018; 4:e175230. [PMID: 29372236 PMCID: PMC5885162 DOI: 10.1001/jamaoncol.2017.5230] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/16/2017] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer with adverse pathological features (ie, pT3 and/or positive margins) after prostatectomy may be managed with adjuvant radiotherapy (ART) or surveillance followed by early-salvage radiotherapy (ESRT) for biochemical recurrence. The optimal timing of postoperative radiotherapy is unclear. Objective To compare the clinical outcomes of postoperative ART and ESRT administered to patients with prostate cancer with adverse pathological features. Design, Setting, and Participants This multi-institutional, propensity score-matched cohort study involved 1566 consecutive patients who underwent postprostatectomy ART or ESRT at 10 US academic medical centers between January 1, 1987, and December 31, 2013. Propensity score 1-to-1 matching was used to account for covariates potentially associated with treatment selection. Data were collected from January 1 to September 30, 2016. Data analysis was conducted from October 1, 2016, to October 21, 2017. Main Outcomes and Measures Freedom from postirradiation biochemical failure, freedom from distant metastases, and overall survival. All outcomes were measured from date of surgery to address lead-time bias. Results Of 1566 patients, 1195 with prostate-specific antigen levels of 0.1 to 0.5 ng/mL received ESRT and 371 patients with prostate-specific antigen levels lower than 0.1 ng/mL received ART. The median age (interquartile range) was 60 (55-65) years. After propensity score matching, the median (interquartile range) follow-up after surgery was similar between the ESRT and ART groups (73.3 [44.9-106.6] months vs 65.8 [40-107] months; P = .22). Adjuvant RT, compared with ESRT, was associated with higher freedom from biochemical failure (12-year actuarial rates: 69% [95% CI, 60%-76%] vs 43% [95% CI, 35%-51%]; effect size, 26%), freedom from distant metastases (95% [95% CI, 90%-97%] vs 85% [95% CI, 76%-90%]; effect size, 10%), and overall survival (91% [95% CI, 84%-95%] vs 79% [95% CI, 69%-86%]; effect size, 12%). Adjuvant RT, lower Gleason score and T stage, nodal irradiation, and postoperative androgen deprivation therapy were favorable prognostic features on multivariate analysis for biochemical failure. Sensitivity analysis demonstrated that the decreased risk of biochemical failure associated with ART remained significant unless more than 56% of patients in the ART group were cured by surgery alone. This threshold is greater than the estimated 12-year freedom from biochemical failure rate of 33% to 52% after radical prostatectomy alone, as determined by a contemporary dynamic nomogram. Conclusions and Relevance Adjuvant RT, compared with ESRT, was associated with reduced biochemical recurrence, distant metastases, and death for high-risk patients, pending prospective validation. These findings suggest that a greater proportion of patients with prostate cancer who have adverse pathological features may benefit from postprostatectomy ART rather than surveillance followed by ESRT.
Collapse
Affiliation(s)
- William L. Hwang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rahul D. Tendulkar
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shree Agrawal
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kevin L. Stephans
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Jason W. Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Bridget F. Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - W. Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | | | - Stanley L. Liauw
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | | | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Drew Moghanaki
- Department of Radiation Oncology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Mitchell S. Anscher
- Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond
| | - Robert B. Den
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J. Stephenson
- Departments of Radiation Oncology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Miyake M, Tanaka N, Asakawa I, Owari T, Hori S, Morizawa Y, Nakai Y, Inoue T, Anai S, Torimoto K, Hasegawa M, Fujii T, Konishi N, Fujimoto K. The impact of the definition of biochemical recurrence following salvage radiotherapy on outcomes and prognostication in patients with recurrent prostate cancer after radical prostatectomy: a comparative study of three definitions. Prostate Int 2018; 7:47-53. [PMID: 31384605 PMCID: PMC6664305 DOI: 10.1016/j.prnil.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/30/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose The clinical management and follow-up of patients with recurrent prostate cancer after salvage radiotherapy (SRT) has not yet been established, and no standardized definition of biochemical recurrence (BCR) after SRT exists. We compared the impact of applying three different definitions of BCR following SRT on patient outcomes and prognostication. Subjects Patients who received salvage androgen-deprivation therapy before the completion of SRT were excluded. The data of 118 men who had undergone salvage radiation as monotherapy for BCR after radical prostatectomy were reviewed. In all patients, SRT comprised irradiation to the prostatic bed (70 Gy) using three-dimensional conformal radiotherapy techniques. Treatment outcomes, including BCR-free survival and prognostic factors, were analyzed and compared among three definitions: The Nara, Radiation Therapy Oncology Group (RTOG) 9601, and GETUG-AFU 16 definitions. Results The BCR rate differed significantly among the applied definitions. Multivariate analyses identified the same four independent prognostic factors, including primary Gleason pattern 4 or 5, negative resection margin, prostate-specific antigen (PSA) level before SRT 0.5 or more, and PSA doubling time before SRT <6 months, using the RTOG 9601 and GETUG-AFU 16 definitions, whereas only two of the four factors were identified using the Nara definition. Although the results obtained using the RTOG 9601 and GETUG-AFU 16 definitions were similar, the prognostic value of the four factors differed. According to the RTOG 9601 definition of BCR, a negative resection margin on prostatectomy specimens and short PSA doubling time before SRT were associated with no subsequent response in PSA level. Conclusions The applied definition of BCR after SRT can influence the reported BCR-free rate and the potential prognostic factors. Establishment of the standardized definition is needed for the optimal management of patients with recurrent prostate cancer undergoing SRT.
Collapse
Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Noboru Konishi
- Department of Pathology, Kouseikai Takai Hospital, Tenri, Nara 632-0006, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| |
Collapse
|
13
|
Stish BJ, Pisansky TM, Harmsen WS, Davis BJ, Tzou KS, Choo R, Buskirk SJ. Improved Metastasis-Free and Survival Outcomes With Early Salvage Radiotherapy in Men With Detectable Prostate-Specific Antigen After Prostatectomy for Prostate Cancer. J Clin Oncol 2017; 34:3864-3871. [PMID: 27480153 DOI: 10.1200/jco.2016.68.3425] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To describe outcomes of salvage radiotherapy (SRT) for men with detectable prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer and identify associations with outcomes. Patients and Methods A total of 1,106 patients received SRT between January 1987 and July 2013, with median follow-up 8.9 years. Outcomes were estimated using Kaplan-Meier for overall survival (OS) and cumulative incidence for biochemical recurrence (BcR), distant metastases (DM), and cause-specific mortality (CSM). Variable associations with outcomes used Cox or Fine-Gray methods, as appropriate. Multiple variable analyses used backward selection with P < .05 for retention. Results In multiple variable analyses, pathologic tumor stage, Gleason score, and pre-SRT PSA were associated with BcR, DM, CSM, and OS; androgen suppression and SRT doses > 68 Gy were associated with BcR; and age was associated with OS. Each pre-SRT PSA doubling increased significantly the relative risk of BcR (hazard ratio [HR], 1.30; P < .001), DM (HR, 1.32; P < .001), CSM (HR, 1.40; P < .001), and all-cause mortality (HR, 1.12; P = .02). Using a pre-SRT PSA cutoff ≤ 0.5 versus > 0.5 ng/mL, 5-year and 10-year cumulative incidences for BcR were 42% versus 56% and 60% versus 68% ( P < .001), DM 7% versus 14% and 13% versus 25% ( P < .001), CSM 1% versus 4% and 6% versus 13% ( P < .001), and OS of 94% versus 92% and 83% versus 73% ( P > .05). Conclusion SRT outcomes are in part affected by factors associated with prostatectomy findings but may be positively affected by using SRT at lower PSA levels, including reductions in BcR, DM, CSM, and all-cause mortality. These findings argue against prolonged monitoring of detectable postprostatectomy PSA levels that delay initiation of SRT.
Collapse
Affiliation(s)
- Bradley J Stish
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - Thomas M Pisansky
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - William S Harmsen
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - Brian J Davis
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - Katherine S Tzou
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - Richard Choo
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| | - Steven J Buskirk
- Bradley J. Stish, Thomas M. Pisansky, William S. Harmsen, Brian J. Davis, and Richard Choo, Mayo Clinic, Rochester MN; and Katherine S. Tzou and Steven J. Buskirk, Mayo Clinic, Jacksonville FL
| |
Collapse
|
14
|
Drug development for noncastrate prostate cancer in a changed therapeutic landscape. Nat Rev Clin Oncol 2017; 15:168-182. [PMID: 29039422 DOI: 10.1038/nrclinonc.2017.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The unprecedented progress in the treatment of metastatic castration-resistant prostate cancer is only beginning to be realized in patients with noncastrate disease. This slow progress in part reflects the use of trial objectives focused on time-to-event end points, such as time to metastasis and overall survival, which require long follow-up durations and large sample sizes, and has been further delayed by the use of approved therapies that are effective at the time of progression. Our central hypotheses are that progress can be accelerated, and that outcomes can be improved by shifting trial objectives to response measures occurring early that solely reflect the effects of the treatment. To test these hypotheses, a continuously enrolling multi-arm, multi-stage randomized trial design, analogous to that used in the STAMPEDE trial, has been developed. Eligibility is focused on patients with incurable disease or those with a high risk of death with any form of monotherapy alone. The primary objective is to eliminate all disease using a multimodality treatment strategy. End points include pathological complete response and an undetectable level of serum prostate-specific antigen, with recovery of serum testosterone levels. Both are binary, objective, and provide an early, quantitative indication of efficacy.
Collapse
|
15
|
Isharwal S, Stephenson AJ. Post-prostatectomy radiation therapy for locally recurrent prostate cancer. Expert Rev Anticancer Ther 2017; 17:1003-1012. [PMID: 28922958 DOI: 10.1080/14737140.2017.1378575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Approximately 15-30% of men with localized prostate cancer will experience biochemical recurrence (BCR) after radical prostatectomy. Postoperative radiation therapy is used in men with adverse pathological features to reduce the risk of BCR or with curative intent in men with known BCR. In this study, we review the evidence for the adjuvant and salvage radiation therapy after radical prostatectomy. Areas covered: A literature review of the Medline and Embase databases was performed. The search strategy included the following terms: prostate cancer, adjuvant radiotherapy, salvage radiotherapy, radical prostatectomy, biochemical recurrence, and prostate cancer recurrence. Prospective randomized trials for the adjuvant radiotherapy and observational studies supporting salvage radiotherapy were included for discussion. Expert commentary: As postoperative radiotherapy is associated with non-trivial risks of acute and long-term toxicity and given the absence of compelling data supporting adjuvant over early salvage radiotherapy, the authors advocate, with rare exceptions, close observation and timely (early) salvage radiotherapy for patients with BCR and long life expectancy. Adjuvant radiotherapy may be considered in patients at high-risk for recurrence. Observation is appropriate in patients with limited life expectancy and/or absence of adverse features.
Collapse
Affiliation(s)
- Sudhir Isharwal
- a Department of Urology , Glickman Urology and Kidney Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Andrew J Stephenson
- a Department of Urology , Glickman Urology and Kidney Institute, Cleveland Clinic , Cleveland , OH , USA
| |
Collapse
|
16
|
Fossati N, Karnes RJ, Colicchia M, Boorjian SA, Bossi A, Seisen T, Di Muzio N, Cozzarini C, Noris Chiorda B, Fiorino C, Gandaglia G, Dell'Oglio P, Shariat SF, Goldner G, Joniau S, Battaglia A, Haustermans K, De Meerleer G, Fonteyne V, Ost P, Van Poppel H, Wiegel T, Montorsi F, Briganti A. Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy. Eur Urol 2017; 73:436-444. [PMID: 28779974 DOI: 10.1016/j.eururo.2017.07.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/20/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Salvage radiation therapy (SRT) is a recommended treatment option for biochemical recurrence after radical prostatectomy (RP). However, its effectiveness may be limited to specific categories of patients. OBJECTIVE We aimed to identify the optimal candidates for early SRT after RP. DESIGN, SETTING, AND PARTICIPANTS The study included 925 node-negative patients treated with SRT after RP at seven institutions. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP that was defined as PSA level ≥0.1 ng/ml at 1 mo after surgery. All patients received local radiation to the prostate and seminal vesicle bed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome measured was distant metastasis after SRT. Regression tree analysis was used to develop a risk-stratification tool. Multivariable Cox regression analysis and nonparametric curve fitting methods were used to explore the relationship between PSA level at SRT and the probability of metastasis-free survival at 8 yr. RESULTS AND LIMITATIONS At a median follow-up of 8.0 yr, 130 patients developed distant metastasis. At multivariable analysis, pre-SRT PSA level was significantly associated with distant metastasis (hazard ratio: 1.06, p<0.0001). However, when patients were stratified into five risk groups using regression tree analysis (area under the curve: 85%), early SRT administration provided better metastasis-free survival in three groups only: (1) low risk: undetectable PSA after RP, Gleason score ≤7, and tumour stage ≥pT3b, (2) intermediate risk: undetectable PSA after RP with Gleason score ≥8, (3) high risk: PSA persistence after RP with Gleason score ≤7. CONCLUSIONS We developed an accurate risk stratification tool to facilitate the individualised recommendation for early SRT based on prostate cancer characteristics. Early SRT proved to be beneficial only in selected groups of patients who are more likely to be affected by clinically significant but not yet systemic recurrence at the time of salvage treatment administration. PATIENT SUMMARY In patients affected by prostate cancer recurrence after radical prostatectomy, the early administration of salvage radiation therapy is beneficial only for selected subgroups of patients. In this study, these groups of patients were identified.
Collapse
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | | | | | | | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Thomas Seisen
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Nadia Di Muzio
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Claudio Fiorino
- Department of Medical Physics, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Dell'Oglio
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Gregor Goldner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Karin Haustermans
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Valérie Fonteyne
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | | | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
17
|
Budäus L, Schiffmann J, Graefen M, Huland H, Tennstedt P, Siegmann A, Böhmer D, Budach V, Bartkowiak D, Wiegel T. Defining biochemical recurrence after radical prostatectomy and timing of early salvage radiotherapy : Informing the debate. Strahlenther Onkol 2017; 193:692-699. [PMID: 28470414 DOI: 10.1007/s00066-017-1140-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal prostate-specific antigen (PSA) level after radical prostatectomy (RP) for defining biochemical recurrence and initiating salvage radiation therapy (SRT) is still debatable. Whereas adjuvant or extremely early SRT irrespective of PSA progression might be overtreatment for some patients, SRT at PSA >0.2 ng/ml might be undertreatment for others. The current study addresses the optimal timing of radiation therapy after RP. PATIENTS AND METHODS Cohort 1 comprised 293 men with PSA 0.1-0.19 ng/ml after RP. Cohort 2 comprised 198 men with SRT. PSA progression and metastases were assessed in cohort 1. In cohort 2, we compared freedom from progression according to pre-SRT PSA (0.03-0.19 vs. 0.2-0.499 ng/ml). Multivariable Cox regression analyses predicted progression after SRT. RESULTS In cohort 1, 281 (95.9%) men had further PSA progression ≥0.2 ng/ml and 27 (9.2%) men developed metastases within a median follow-up of 74.3 months. In cohort 2, we recorded improved freedom from progression according to lower pre-SRT PSA (0.03-0.19 vs. 0.2-0.499 ng/ml: 69 vs. 53%; log-rank p = 0.051). Patients with higher pre-SRT PSA ≥0.2 ng/ml were at a higher risk of progression after SRT (hazard ratio: 1.8; p < 0.05). CONCLUSION The vast majority of patients with PSA ≥0.1 ng/ml after RP will progress to PSA ≥0.2 ng/ml. Additionally, early administration of SRT at post-RP PSA level <0.2 ng/ml might improve freedom from progression. Consequently, we suggest a PSA threshold of 0.1 ng/ml to define biochemical recurrence after RP.
Collapse
Affiliation(s)
- Lars Budäus
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Siegmann
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité University Hospital, Berlin, Germany
| | - Detlef Bartkowiak
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
18
|
Seisen T, Briganti A, Blanchard P, Abdollah F. Salvage Radiation Therapy for Biochemical Recurrence After Radical Prostatectomy: Is Earlier Always Better? J Clin Oncol 2017; 35:1489-1490. [PMID: 28135149 DOI: 10.1200/jco.2016.70.6879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas Seisen
- Thomas Seisen, Henry Ford Health System, Detroit, MI; Alberto Briganti, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele; and Vita-Salute San Raffaele University, Milan, Italy; Pierre Blanchard, Institut Gustave Roussy, Villejuif, France; and Firas Abdollah, Henry Ford Health System, Detroit, MI
| | - Alberto Briganti
- Thomas Seisen, Henry Ford Health System, Detroit, MI; Alberto Briganti, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele; and Vita-Salute San Raffaele University, Milan, Italy; Pierre Blanchard, Institut Gustave Roussy, Villejuif, France; and Firas Abdollah, Henry Ford Health System, Detroit, MI
| | - Pierre Blanchard
- Thomas Seisen, Henry Ford Health System, Detroit, MI; Alberto Briganti, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele; and Vita-Salute San Raffaele University, Milan, Italy; Pierre Blanchard, Institut Gustave Roussy, Villejuif, France; and Firas Abdollah, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- Thomas Seisen, Henry Ford Health System, Detroit, MI; Alberto Briganti, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele; and Vita-Salute San Raffaele University, Milan, Italy; Pierre Blanchard, Institut Gustave Roussy, Villejuif, France; and Firas Abdollah, Henry Ford Health System, Detroit, MI
| |
Collapse
|
19
|
Buscariollo DL, Drumm M, Niemierko A, Clayman RH, Galland-Girodet S, Rodin D, Feldman AS, M Dahl D, McGovern FJ, F Olumi A, Eidelman A, Shipley WU, Zietman AL, Efstathiou JA. Long-term results of adjuvant versus early salvage postprostatectomy radiation: A large single-institutional experience. Pract Radiat Oncol 2016; 7:e125-e133. [PMID: 28274403 DOI: 10.1016/j.prro.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/05/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate freedom from biochemical failure (FFBF), freedom from androgen deprivation therapy (FFADT), freedom from distant metastases (FFDM), and overall survival (OS) after adjuvant radiation therapy (ART) versus early salvage radiation therapy (ESRT) in men with prostate cancer and adverse pathologic features (pT3 and/or positive surgical margins). METHODS AND MATERIALS Of 718 patients consecutively treated with postoperative radiation therapy (RT) for prostate cancer between 1992 and 2013, we retrospectively identified 171 men receiving ART and 230 receiving ESRT (RT delivered at a prostate-specific antigen level ≤0.5 ng/mL) who had adverse pathologic features. Postirradiation FFBF (BF was defined as prostate-specific antigen level rise to ≥0.2 ng/mL), FFADT, FFDM, and OS were compared using Kaplan-Meier and Cox regression methods. Propensity score (PS)-matching was performed to estimate treatment effects while accounting for covariates predicting treatment allocation. RESULTS Median follow-up was 7.4 and 8.0 years for patients treated with ART and ESRT, respectively. Ten-year FFBF (69% vs 56%, P = .003) and 10-year FFADT (88% vs 81%, P = .046) rates were higher after ART; however, FFDM and OS did not significantly differ. After PS-matching, ART was associated with improved FFBF (P < .0001), FFADT (P = .0001), and FFDM (P = .02). Findings were confirmed in multivariable analyses in unmatched and PS-matched cohorts. Sensitivity analyses showed that FFBF benefit associated with ART lost statistical significance only after 38% of ART patients were assumed to have been cured by surgery and excluded from the model. This corresponds to the upper bound of patients with adverse pathologic features who did not recur after observation in prior randomized trials. CONCLUSIONS Postoperative RT confers excellent long-term cancer control. These results suggest ART may be associated with improved FFBF, FFADT, and FFDM, but comparable OS. Given the retrospective study design, these findings should be interpreted with caution. Optimal timing of postoperative RT further awaits results of ongoing trials.
Collapse
Affiliation(s)
- Daniela L Buscariollo
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Drumm
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis J McGovern
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Aria F Olumi
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alec Eidelman
- Tufts University School of Dental Medicine, Boston, Massachusetts
| | - William U Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
20
|
Fiorino C, Broggi S, Fossati N, Cozzarini C, Goldner G, Wiegel T, Hinkelbein W, Karnes RJ, Boorjian SA, Haustermans K, Joniau S, Palorini F, Shariat S, Montorsi F, Van Poppel H, Di Muzio N, Calandrino R, Briganti A. Predicting the 5-Year Risk of Biochemical Relapse After Postprostatectomy Radiation Therapy in ≥PT2, pN0 Patients With a Comprehensive Tumor Control Probability Model. Int J Radiat Oncol Biol Phys 2016; 96:333-340. [DOI: 10.1016/j.ijrobp.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 05/23/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
|
21
|
Sobol I, Zaid HB, Haloi R, Mynderse LA, Froemming AT, Lowe VJ, Davis BJ, Kwon ED, Karnes RJ. Contemporary Mapping of Post-Prostatectomy Prostate Cancer Relapse with 11C-Choline Positron Emission Tomography and Multiparametric Magnetic Resonance Imaging. J Urol 2016; 197:129-134. [PMID: 27449262 DOI: 10.1016/j.juro.2016.07.073] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE We identify sites and patterns of cancer recurrence in patients with post-prostatectomy biochemical relapse using 11C-choline positron emission tomography/computerized tomography and endorectal coil multiparametric magnetic resonance imaging. MATERIALS AND METHODS Between January 2008 and June 2015, 2,466 men underwent choline positron emission tomography for suspected prostate cancer relapse at our institution. Of these men 202 did not receive hormone or radiation therapy, underwent imaging with choline positron emission tomography and multiparametric magnetic resonance imaging, and were found to have disease recurrence. Overall patterns of recurrence were described, and factors associated with local only recurrence were evaluated using univariable and multivariable logistic regression. RESULTS Median prostate specific antigen at positive scan was 2.3 ng/ml (IQR 1.4-5.5) with a median time from prostate specific antigen relapse to lesion visualization of 15 months (IQR 4.8-34.2). Of these 202 men 68 (33%) exhibited local only, 45 (22%) local plus metastatic and 89 (45%) metastatic only relapse. Pelvic node only relapse was observed in 39 (19%) men. Median prostate specific antigen at positive imaging for patients with local only, metastatic only and local plus metastatic relapse was 2.3, 2.7 and 2.2 ng/ml (p=0.46), with a median interval from biochemical recurrence to positive scan of 33.5, 7.0 and 15.0 months, respectively (p <0.001). On multivariable analysis time from biochemical recurrence to positive imaging was independently associated with local only recurrence (OR 1.10 for every 6-month increase, p=0.012). CONCLUSIONS Combined choline positron emission tomography and multiparametric magnetic resonance imaging evaluation of biochemical recurrence after prostatectomy reveals an anatomically diverse pattern of recurrence. These findings have implications for optimizing the salvage treatment of patients with prostate cancer with relapse following surgery.
Collapse
Affiliation(s)
- Ilya Sobol
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Harras B Zaid
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Rimki Haloi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
22
|
Morphology and MMP-9, AR and IGFR-1 responses of the seminal vesicle in TRAMP mice model. Tissue Cell 2016; 48:217-23. [DOI: 10.1016/j.tice.2016.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 01/06/2023]
|
23
|
Herrera FG, Berthold DR. Radiation Therapy after Radical Prostatectomy: Implications for Clinicians. Front Oncol 2016; 6:117. [PMID: 27242957 PMCID: PMC4860423 DOI: 10.3389/fonc.2016.00117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Depending on the pathological findings, up to 60% of prostate cancer patients who undergo radical prostatectomy (RP) will develop biochemical relapse and require further local treatment. Radiotherapy (RT) immediately after RP may potentially eradicate any residual localized microscopic disease in the prostate bed, and it is associated with improved biochemical, clinical progression-free survival, and overall survival in patients with high-risk pathological features according to published randomized trials. Offering immediate adjuvant RT to all men with high-risk pathological factors we are over-treating around 50% of patients who would anyway be cancer-free, exposing them to unnecessary toxicity and adding costs to the health-care system. The current dilemma is, thus, whether to deliver adjuvant immediate RT solely on the basis of high-risk pathology, but in the absence of measurable prostate-specific antigen, or whether early salvage radiotherapy would yield equivalent outcomes. Randomized trials are ongoing to definitely answer this question. Retrospective analyses suggest that there is a dose–response favoring doses >70 Gy to the prostate bed. The evidence regarding the role of androgen deprivation therapy is emerging, and ongoing randomized trials are underway.
Collapse
Affiliation(s)
- Fernanda G Herrera
- Radiation Oncology Services, Department of Oncology, Lausanne University Hospital , Lausanne , Switzerland
| | - Dominik R Berthold
- Medical Oncology Services, Department of Oncology, Lausanne University Hospital , Lausanne , Switzerland
| |
Collapse
|
24
|
Ervandian M, Høyer M, Petersen SE, Sengeløv L, Hansen S, Holmberg M, Sveistrup J, Meidahl Petersen P, Borre M. Salvage radiation therapy following radical prostatectomy. A national Danish study. Acta Oncol 2016; 55:598-603. [PMID: 26399602 DOI: 10.3109/0284186x.2015.1088170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this observational cohort study was to evaluate the outcome and prognostic factors following salvage radiotherapy (SRT) in a consecutive national cohort. MATERIAL AND METHODS Between 2006 and 2010, 259 patients received SRT in Denmark. Patient- and cancer-related characteristics were retrospectively retrieved from patient charts. The primary end point was biochemical progression-free survival (b-PFS). RESULTS At the end of follow-up, 51% of the patients displayed a prostate-specific antigen (PSA) level <0.1 ng/ml. The three-year b-PFS rate for the total cohort was 57.0%. Nearly half of the patients (44%) received androgen deprivation therapy (ADT) in combination with SRT. Positive surgical tumour margins (p = 0.025) and ADT (p = 0.001) were the only markers independently correlated with b-PFS. In patients who received SRT without ADT, both a pre-SRT PSA level ≤0.5 ng/ml (p = 0.003) and pathological tumour stage T1-T2 (p = 0.036) independently correlated with b-PFS. Moreover, a duration between radical prostatectomy (RP) and SRT ≤29 months (p = 0.035) independently correlated with b-PFS in patients treated with ADT in combination with RT. CONCLUSIONS In patients treated for biochemical failure after RP, positive surgical tumour margins and PSA levels ≤0.5 ng/mL at the time of SRT were associated with a favourable outcome. Despite less favourable tumour characteristics, patients receiving SRT and ADT demonstrated improved b-PFS, and in particular, patients with PSA levels >0.2 ng/ml benefitted from additional ADT.
Collapse
Affiliation(s)
- Maria Ervandian
- Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | | | - Lisa Sengeløv
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Steinbjørn Hansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Mats Holmberg
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark, and
| | - Joen Sveistrup
- Department of Oncology, Rigshospitalet, København Ø, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
25
|
Heckman MG, Robinson JL, Tzou KS, Parker AS, Wu KJ, Hilton TW, Howat WJ, Miller JL, Kreinest PA, Pisansky TM, Schild SE, Peterson JL, Vallow LA, Carroll JS, Buskirk SJ. An Examination of the Association between FOXA1 Staining Level and Biochemical Recurrence following Salvage Radiation Therapy for Recurrent Prostate Cancer. PLoS One 2016; 11:e0151785. [PMID: 26986977 PMCID: PMC4795739 DOI: 10.1371/journal.pone.0151785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Standardly collected clinical and pathological patient information has demonstrated only moderate ability to predict risk of biochemical recurrence (BCR) of prostate cancer in men undergoing salvage radiation therapy (SRT) for a rising PSA after radical prostatectomy (RP). Although elevated FOXA1 staining has been associated with poor patient outcomes following RP, it has not been studied in the specific setting of SRT after RP. The aim of this study was to evaluate the association between FOXA1 staining level and BCR after SRT for recurrent prostate cancer. METHODS A total of 141 men who underwent SRT at our institution were included. FOXA1 staining levels in primary tumor samples were detected using immunohistochemistry. FOXA1 staining percentage and intensity were measured and multiplied together to obtain a FOXA1 H-score (range 0-12) which was our primary staining measure. P-values ≤ 0.0056 were considered as statistically significant after applying a Bonferroni correction for multiple comparisons. RESULTS There was not a significant association between FOXA1 H-score and risk of BCR when considering H-score as an ordinal variable or as a categorical variable (all P ≥ 0.090). Similarly, no significant associations with BCR were observed for FOXA1 staining percentage or staining intensity (all P ≥ 0.14). CONCLUSIONS FOXA1 staining level does not appear to have a major impact on risk of BCR after SRT.
Collapse
Affiliation(s)
- Michael G. Heckman
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Jessica L. Robinson
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Katherine S. Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Alexander S. Parker
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Kevin J. Wu
- Department of Pathology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Tracy W. Hilton
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, United States of America
| | - William J. Howat
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Jodi L. Miller
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Pamela A. Kreinest
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Thomas M. Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Jennifer L. Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Jason S. Carroll
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, United States of America
| |
Collapse
|
26
|
Jackson WC, Schipper MJ, Johnson SB, Foster C, Li D, Sandler HM, Palapattu GS, Hamstra DA, Feng FY. Duration of Androgen Deprivation Therapy Influences Outcomes for Patients Receiving Radiation Therapy Following Radical Prostatectomy. Eur Urol 2016; 69:50-7. [DOI: 10.1016/j.eururo.2015.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 05/05/2015] [Indexed: 11/28/2022]
|
27
|
Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
|
28
|
Fossati N, Karnes RJ, Cozzarini C, Fiorino C, Gandaglia G, Joniau S, Boorjian SA, Goldner G, Hinkelbein W, Haustermans K, Tombal B, Shariat S, Karakiewicz PI, Montorsi F, Van Poppel H, Wiegel T, Briganti A. Assessing the Optimal Timing for Early Salvage Radiation Therapy in Patients with Prostate-specific Antigen Rise After Radical Prostatectomy. Eur Urol 2015; 69:728-733. [PMID: 26497924 DOI: 10.1016/j.eururo.2015.10.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience a prostate-specific antigen (PSA) rise after radical prostatectomy (RP); however, the optimal PSA level for eSRT administration is still unclear. OBJECTIVE To test the impact of PSA level on cancer control after eSRT according to pathologic tumour characteristics. DESIGN, SETTING, AND PARTICIPANTS The study included 716 node-negative patients with undetectable postoperative PSA who experienced a PSA rise after RP. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at PSA ≤ 0.5 ng/ml. Biochemical recurrence (BCR) after eSRT was defined as two consecutive PSA values ≥ 0.2 ng/ml. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable Cox regression analysis tested the association between pre-eSRT PSA level and BCR after eSRT. Covariates consisted of pathologic stage (pT2 vs pT3a vs pT3b or higher), pathologic Gleason score (≤ 6, 7, or ≥ 8), and surgical margin status (negative vs positive). We tested an interaction with PSA level and baseline pathologic risk for the hypothesis that BCR-free survival differed by pre-eSRT PSA level. Three pathologic risk factors were identified: pathologic stage pT3b or higher, pathologic Gleason score ≥ 8, and negative surgical margins. RESULTS AND LIMITATIONS Median follow-up among patients who did not experience BCR after eSRT was 57 mo (interquartile range: 27-105). At 5 yr after eSRT, BCR-free survival rate was 82% (95% confidence interval [CI], 78-85). At multivariable Cox regression analysis, pre-eSRT PSA level was significantly associated with BCR after eSRT (hazard ratio: 4.89; 95% CI, 1.40-22.9; p < 0.0001). When patients were stratified according to the number of risk factors at final pathology, patients with at least two pathologic risk factors showed an increased risk of 5-yr BCR as high as 10% per 0.1 ng/ml of PSA level compared with only 1.5% in patients with one or no pathologic risk factors. CONCLUSIONS In this retrospective study, cancer control after eSRT greatly depended on pretreatment PSA. The absolute PSA level had a different prognostic value depending on the pathologic characteristics of the tumour. In patients with more adverse pathologic features, eSRT conferred better cancer control when administered at the very first sign of PSA rise. Conversely, the benefit of eSRT was less evident in men with favourable disease at RP. PATIENT SUMMARY In this retrospective study, cancer control after early salvage radiation therapy (eSRT) was influenced by pretreatment prostate-specific antigen (PSA) level. This effect was highest in men with at least two of the following pathologic features: pT3b/pT4 disease, pathologic Gleason score ≥ 8, and negative surgical margins. In these patients, eSRT conferred better cancer control when administered at the very first sign of PSA rise.
Collapse
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | | | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steven Joniau
- University Hospitals Leuven, Department of Urology, Leuven, Belgium
| | | | - Gregor Goldner
- Klinik für Radioonkologie, Medizinische Universität Wien, Vienna, Austria
| | - Wolfgang Hinkelbein
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Karin Haustermans
- University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Université Catholique de Louvain, Brussels, Belgium
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Hein Van Poppel
- University Hospitals Leuven, Department of Urology, Leuven, Belgium
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
29
|
Buge F, Chiavassa S, Hervé C, Rigaud J, Delpon G, Supiot S. Preclinical Evaluation of Intraoperative Low-Energy Photon Radiotherapy Using Spherical Applicators in Locally Advanced Prostate Cancer. Front Oncol 2015; 5:204. [PMID: 26442216 PMCID: PMC4569969 DOI: 10.3389/fonc.2015.00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/01/2015] [Indexed: 11/13/2022] Open
Abstract
Background Surgery plus adjuvant radiotherapy is standard care for locally advanced prostate cancer (stage pT3R1). Intraoperative low-energy photon radiotherapy offers several advantages over external beam radiotherapy, and several systems are now available for its delivery, using spherical applicators, which require only limited shielding. The aim of this study was to evaluate the feasibility of this technique for the prostate bed. Materials and methods Applicators were assessed using MRI image data and cadaveric dissection. In cadavers, targeted tissues, defined as a urethral section, both neurovascular bundle sections, the bladder neck and the beds of the seminal vesicles, were marked with metallic surgical clips. Distances between clips and applicator were measured using CT. A dosimetric study of the application of 12 Gy at 5 mm depth was performed using CT images of prostatectomized cadavers. Results Using MRI images from 34 prostate cancer patients, we showed that the ideal applicator diameter ranges from 45 to 70 mm. Using applicators of different sizes to encompass the prostate bed in nine cadavers, we showed that the distance between target tissues and applicator was <2 mm for all target tissues except the upper extremity of the seminal vesicles (19 mm). Dosimetric study showed a good dose distribution in all target tissues in contact with the applicator, with a low probability of rectum and bladder complication. Conclusion Intraoperative radiotherapy of the prostate bed is feasible, with good coverage of targeted tissues. Clinical study of safety and efficacy is now required.
Collapse
Affiliation(s)
- François Buge
- Department of Urology, Centre Hospitalier Universitaire de Nantes , Nantes , France
| | - Sophie Chiavassa
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Medical Physics, Institut de Cancérologie de l'Ouest , St-Herblain , France
| | - Chloé Hervé
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France
| | - Jérôme Rigaud
- Department of Urology, Centre Hospitalier Universitaire de Nantes , Nantes , France
| | - Grégory Delpon
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Medical Physics, Institut de Cancérologie de l'Ouest , St-Herblain , France
| | - Stéphane Supiot
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , St-Herblain , France
| |
Collapse
|
30
|
Lowes LE, Lock M, Rodrigues G, D'Souza D, Bauman G, Ahmad B, Venkatesan V, Allan AL, Sexton T. The significance of circulating tumor cells in prostate cancer patients undergoing adjuvant or salvage radiation therapy. Prostate Cancer Prostatic Dis 2015; 18:358-64. [PMID: 26238233 PMCID: PMC4788488 DOI: 10.1038/pcan.2015.36] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Abstract
Background: Following radical prostatectomy, success of adjuvant and salvage radiation
therapy (RT) is dependent on the absence of micrometastatic disease.
However, reliable prognostic/predictive factors for determining this are
lacking. Therefore, novel biomarkers are needed to assist with clinical
decision-making in this setting. Enumeration of circulating tumor cells
(CTCs) using the regulatory-approved CellSearch System (CSS) is prognostic
in metastatic prostate cancer. We hypothesize that CTCs may also be
prognostic in the post-prostatectomy setting. Methods: Patient blood samples (n=55) were processed on the CSS to
enumerate CTCs at 0, 6, 12 and 24 months after completion of RT. CTC values
were correlated with predictive/prognostic factors and progression-free
survival. Results: CTC status (presence/absence) correlated significantly with positive
margins (increased likelihood of CTCneg disease;
P=0.032), and trended toward significance with the presence
of seminal vesicle invasion (CTCpos; P=0.113) and
extracapsular extension (CTCneg; P=0.116).
Although there was a trend toward a decreased time to biochemical failure
(BCF) in baseline CTC-positive patients (n=9), this trend
was not significant (hazard ratio (HR)=0.3505;
P=0.166). However, CTC-positive status at any point
(n=16) predicted for time to BCF (HR=0.2868;
P=0.0437). Conclusions: One caveat of this study is the small sample size utilized
(n=55) and the low number of patients with CTC-positive
disease (n=16). However, our results suggest that CTCs may
be indicative of disseminated disease and assessment of CTCs during RT may
be helpful in clinical decision-making to determine, which patients may
benefit from RT versus those who may benefit more from systemic
treatments.
Collapse
Affiliation(s)
- L E Lowes
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - M Lock
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - G Rodrigues
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - D D'Souza
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - G Bauman
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - B Ahmad
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - V Venkatesan
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A L Allan
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - T Sexton
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
31
|
Showalter TN, Hegarty SE, Rabinowitz C, Maio V, Hyslop T, Dicker AP, Louis DZ. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy. Int J Radiat Oncol Biol Phys 2015; 91:752-9. [DOI: 10.1016/j.ijrobp.2014.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/23/2014] [Accepted: 11/30/2014] [Indexed: 01/17/2023]
|
32
|
Wiegel T, Bartkowiak D, Bottke D, Thamm R, Hinke A, Stöckle M, Rübe C, Semjonow A, Wirth M, Störkel S, Golz R, Engenhart-Cabillic R, Hofmann R, Feldmann HJ, Kälble T, Siegmann A, Hinkelbein W, Steiner U, Miller K. Prostate-Specific Antigen Persistence After Radical Prostatectomy as a Predictive Factor of Clinical Relapse-Free Survival and Overall Survival: 10-Year Data of the ARO 96-02 Trial. Int J Radiat Oncol Biol Phys 2015; 91:288-94. [DOI: 10.1016/j.ijrobp.2014.09.039] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/22/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
|
33
|
A comprehensive assessment of the prognostic utility of the Stephenson nomogram for salvage radiation therapy postprostatectomy. Pract Radiat Oncol 2014; 4:422-9. [DOI: 10.1016/j.prro.2014.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
|
34
|
Miyake M, Tanaka N, Asakawa I, Morizawa Y, Anai S, Torimoto K, Aoki K, Yoneda T, Hasegawa M, Konishi N, Fujimoto K. Proposed salvage treatment strategy for biochemical failure after radical prostatectomy in patients with prostate cancer: a retrospective study. Radiat Oncol 2014; 9:208. [PMID: 25331298 PMCID: PMC4283125 DOI: 10.1186/1748-717x-9-208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment options for patients with recurrent disease after radical prostatectomy include salvage radiotherapy of the prostatic bed and/or androgen deprivation therapy. To establish an effective treatment strategy for recurrent disease after radical prostatectomy, we retrospectively analyzed the outcome of salvage radiation monotherapy in such cases. METHODS Data from 61 men who had undergone salvage radiation monotherapy for biochemical recurrent disease after radical prostatectomy were retrospectively reviewed. In all patients, salvage radiotherapy consisted of iraradiation to the prostatic bed (70 Gy) using three-dimensional conformal radiotherapy techniques. Treatment outcome was analyzed to identify predictive factors of salvage radiotherapy. RESULTS The biochemical recurrence-free survival after salvage radiation monotherapy at 2 and 5 years was 55% and 38%, respectively. Cox proportional regression models revealed that the independent predictive factors for biochemical recurrence were Gleason Score ≥ 8, negative surgical margin, and PSA velocity ≥ 0.38 ng/mL/year. Negative surgical margin and PSA velocity ≥ 0.8 ng/mL/year were significantly associated with poor response in the serum PSA levels after salvage radiotherapy. CONCLUSIONS Based on our findings, we propose a treatment strategy for biochemical recurrent disease after radical prostatectomy. Patients with Gleason score ≤ 7, positive surgical margin, and PSA velocity < 0.38 ng/mL/year are categorized the most favorable group, so that eradication by salvage radiation monotherapy could be expected. Other patients could be divided to two groups depending on surgical margin status and PSA velocity: 1) patients who might require combination of SRT and short-term androgen deprivation therapy and 2) patients who should be treated by androgen deprivation monotherapy.
Collapse
Affiliation(s)
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara 634-8522, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Kwon O, Kim KB, Lee YI, Byun SS, Kim JS, Lee SE, Hong SK. Salvage radiotherapy after radical prostatectomy: prediction of biochemical outcomes. PLoS One 2014; 9:e103574. [PMID: 25072938 PMCID: PMC4114753 DOI: 10.1371/journal.pone.0103574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction A significant proportion of patients undergoing salvage radiotherapy (RT) for biochemical recurrence (BCR) following radical prostatectomy (RP) may again experience BCR after salvage RT. Thus, we evaluated the clinical significances of different parameters on the biochemical outcome of RT in salvage setting. Methods We reviewed the records of 212 patients who underwent salvage RT between November 2003 and December 2012 for BCR following primary RP. BCR-free survivals after salvage RT were estimated using the Kaplan–Meier method. Cox proportional hazard regression models were used to evaluate the impacts of clinicopathologic parameters on BCR following salvage RT. Results The overall median follow-up duration was 63.5 months. The BCR-free survival rate after salvage RT was 58.2% at 5 years. Multivariate analysis showed that a pre-RT prostate-specific antigen (PSA) level of ≤0.5 ng/mL, a pre-RT PSA doubling time (PSADT) of >4.5 months, concomitant androgen deprivation therapy (ADT) with salvage RT, and a positive surgical margin were independent predictors of favorable biochemical outcomes after salvage RT (hazard ratios [HR] = 3.012, 1.132, 2.000, and 1.805, respectively, p = less than 0.001, 0.013, 0.005, and 0.036, respectively). In the early (pre-RT PSA ≤0.5 ng/mL) salvage RT setting, concomitant ADT administration was also shown to be significantly associated with higher risk of BCR-free survival following salvage RT (HR = 2.611, p = 0.038). Conclusion Lower pre-RT PSA value, longer PSADT before salvage RT, concomitant ADT administration, and a positive surgical margin were significant predictors of favorable biochemical outcomes following salvage RT performed for BCR after primary RP.
Collapse
Affiliation(s)
- Ohseong Kwon
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Bom Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ik Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| |
Collapse
|
36
|
Castellucci P, Ceci F, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, Pettinato C, Celli M, Lodi F, Fanti S. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-Choline PET/CT scan before salvage radiation therapy? J Nucl Med 2014; 55:1424-9. [PMID: 24935990 DOI: 10.2967/jnumed.114.138313] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED The aim of the study was to assess which factors may influence (11)C-choline PET/CT detection rate in a population of recurrent prostate cancer (PCa) patients listed for salvage radiation therapy (S-RT) in an early phase of biochemical relapse, to select which patients could obtain the most benefit by performing restaging (11)C-choline PET/CT before S-RT. METHODS The study comprised 605 patients, treated with radical prostatectomy (RP) with curative intent for PCa who showed rising PSA levels after primary therapy and listed for S-RT. Prostate-specific antigen (PSA) values were >0.2 ng/mL and <2 ng/mL (mean, 1.05 ng/mL; median, 1.07 ng/mL; range, 0.2-2 ng/m; SD, ±0.59). All patients were classified as N0 after RP. Seventeen of 605 patients received adjuvant RT together with RP, whereas 148 of 605 patients received androgen-deprivation therapy (ADT) at the time of PET/CT. PSA, PSA kinetics, Gleason score, age, time to biochemical relapse, ADT, and initial tumor stage were statistically analyzed to assess which factor could influence PET/CT positivity and the detection of local versus distant relapse. RESULTS (11)C-choline PET/CT was positive in 28.4% of patients (172/605). Eighty-three of 605 patients were positive in the pelvis (group A), distant metastasis (group B) were detected in 72 of 605 patients, and local and distant sites of relapse were detected in 17 of 605 patients (group C). At multivariate analysis, PSA, PSA doubling time (PSAdt), and ongoing ADT were significant predictors for positive scan results, whereas PSA and PSAdt were significantly related to distant relapse detection (P < 0.05). At the receiver-operating-characteristic analysis, a PSA value of 1.05 ng/mL and PSAdt of 5.95 mo were determined to be the optimal cutoff values in the prediction of a positive (11)C-choline PET/CT scan, with an area under the curve (AUC) of 0.625 for PSA and 0.677 for PSAdt. CONCLUSION (11)C-choline PET/CT may be suggested before S-RT during the early phase of biochemical relapse, to select patients who may benefit from this aggressive treatment. Particularly, patients showing fast PSA kinetics or PSA increasing levels despite ongoing ADT should be studied with (11)C-choline PET/CT before S-RT, considering the higher probability to detect positive findings outside the pelvis.
Collapse
Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Tiziano Graziani
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy; and
| | - Eugenio Brunocilla
- Department of Urology, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy; and
| | - Renzo Mazzarotto
- Service of Radiotherapy, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Cinzia Pettinato
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Monica Celli
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Filippo Lodi
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| |
Collapse
|
37
|
Morgan TM, Meng MV, Cooperberg MR, Cowan JE, Weinberg V, Carroll PR, Lin DW. A risk-adjusted definition of biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis 2014; 17:174-9. [DOI: 10.1038/pcan.2014.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/07/2014] [Accepted: 01/12/2014] [Indexed: 11/09/2022]
|
38
|
Roach M. Current trends for the use of androgen deprivation therapy in conjunction with radiotherapy for patients with unfavorable intermediate-risk, high-risk, localized, and locally advanced prostate cancer. Cancer 2014; 120:1620-9. [PMID: 24591080 DOI: 10.1002/cncr.28594] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/06/2022]
Abstract
Androgen deprivation therapy (ADT) is now a well-established standard of care in combination with definitive radiotherapy for patients with unfavorable intermediate-risk to high-risk locally advanced prostate cancer. It is also well established that combination modality treatment with ADT and radiotherapy is superior to either of these modalities alone for the treatment of patients with high-risk locally advanced disease. Current treatment guidelines for prostate cancer in the United States are based on the estimated risk of recurrence and death. This review examines the clinical evidence underpinning the use of ADT and radiotherapy among patients with high-risk localized and locally advanced disease in the United States. This review also considers the rationale for moving from traditional luteinizing hormone-releasing hormone agonists to more recently developed gonadotrophin-releasing hormone antagonists.
Collapse
Affiliation(s)
- Mack Roach
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, California; Department of Urology, University of California at San Francisco, San Francisco, California
| |
Collapse
|
39
|
Briganti A, Karnes RJ, Joniau S, Boorjian SA, Cozzarini C, Gandaglia G, Hinkelbein W, Haustermans K, Tombal B, Shariat S, Sun M, Karakiewicz PI, Montorsi F, Van Poppel H, Wiegel T. Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol 2013; 66:479-86. [PMID: 24345725 DOI: 10.1016/j.eururo.2013.11.045] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early salvage radiotherapy (eSRT) represents the only curative option for prostate cancer patients experiencing biochemical recurrence (BCR) for local recurrence after radical prostatectomy (RP). OBJECTIVE To develop and internally validate a novel nomogram predicting BCR after eSRT in patients treated with RP. DESIGN, SETTING, AND PARTICIPANTS Using a multi-institutional cohort, 472 node-negative patients who experienced BCR after RP were identified. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at prostate-specific antigen (PSA) ≤ 0.5 ng/ml. OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS BCR after eSRT was defined as two consecutive PSA values ≥ 0.2 ng/ml. Uni- and multivariable Cox regression models predicting BCR after eSRT were fitted. Regression-based coefficients were used to develop a nomogram predicting the risk of 5-yr BCR after eSRT. The discrimination of the nomogram was quantified with the Harrell concordance index and the calibration plot method. Two hundred bootstrap resamples were used for internal validation. RESULTS AND LIMITATIONS Mean follow-up was 58 mo (median: 48 mo). Overall, 5-yr BCR-free survival rate after eSRT was 73.4%. In univariable analyses, pathologic stage, Gleason score, and positive surgical margins were associated with the risk of BCR after eSRT (all p ≤ 0.04). These results were confirmed in multivariable analysis, where all the previously mentioned covariates as well as pre-RT PSA were significantly associated with BCR after eSRT (all p ≤ 0.04). A coefficient-based nomogram demonstrated a bootstrap-corrected discrimination of 0.74. Our study is limited by its retrospective nature and use of BCR as an end point. CONCLUSIONS eSRT leads to excellent cancer control in patients with BCR for presumed local failure after RP. We developed the first nomogram to predict outcome after eSRT. Our model facilitates risk stratification and patient counselling regarding the use of secondary therapy for individuals experiencing BCR after RP. PATIENT SUMMARY Salvage radiotherapy leads to optimal cancer control in patients who experience recurrence after radical prostatectomy. We developed a novel tool to identify the best candidates for salvage treatment and to allow selection of patients to be considered for additional forms of therapy.
Collapse
Affiliation(s)
- Alberto Briganti
- Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
| | | | - Steven Joniau
- University Hospitals Leuven, Department of Urology, Leuven, Belgium
| | | | - Cesare Cozzarini
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
| | - Wolfgang Hinkelbein
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Karin Haustermans
- University Hospitals Leuven, Department of Radiotherapy, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Université Catholique de Louvain, Brussels, Belgium
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Canada
| | - Francesco Montorsi
- Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Hein Van Poppel
- University Hospitals Leuven, Department of Urology, Leuven, Belgium
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
40
|
Salvage Low-Dose-Rate Brachytherapy for Prostate Cancer Local Recurrence after Radical Prostatectomy: Our First three Patients. Urologia 2013; 81:46-50. [DOI: 10.5301/urologia.5000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
Abstract
Purpose of the Study To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP). Methods From December 2009 to May 2010, three patients underwent salvage BT due to local recurrences of high risk PCa after extrafascial RRP without additional adjuvant therapies. Local recurrence was confirmed by prostate biopsy and the relapse was well defined by endorectal ultrasonography and magnetic resonance imaging. Metastatic screening was negative. The patients were followed-up according to the American Brachytherapy Society guidelines. Results The median dose delivered to 90% of the local relapse (D90) was 115 Gy. The three patients reached a prostate specific antigen (PSA) nadir value within the first year that remained stable at a mean follow-up of 32 months. As regards morbidity, moderate de novo urgency was reported by only one patient. Conclusions We think that our data confirms the feasibility and safety of salvage BT as a possible alternative option to external beam radiotherapy (EBRT) for the treatment of locally recurrent PCa in selected patients when performed by experienced centers. However, larger series of patients with longer follow-ups are needed to define the oncologic role of this procedure.
Collapse
|
41
|
D'Alimonte L, Koo K, Chen E, Feldman-Stewart D, Court A, Fitch M, Di Prospero L, Maamoun J, Kiss A, Szumacher E. Opinions from the experts: exploring what prostate cancer patients should know about post-operative radiotherapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:509-515. [PMID: 23793963 DOI: 10.1007/s13187-013-0494-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present study investigated health professionals' opinions about important questions that should be discussed with patients who may require post-prostatectomy radiotherapy. A 74-question survey was conducted among radiation oncologists, urologists, nurses, and radiation therapists involved in the care of prostate cancer patients. Survey questions covered six domains: understanding my situation and prostate cancer diagnosis, making a decision, radiotherapy: procedures involved, potential benefits, side effects, and my support network during radiation treatment. Respondents rated the importance of addressing these questions as either essential, important, no opinion, or avoid with a hypothetical post-prostatectomy case. The majority of questions were rated as either essential or important. There was disagreement between professions on essential questions, mostly between nurses and urologists in the side-effects domain. There was agreement between all professions regarding which questions should be avoided.
Collapse
Affiliation(s)
- Laura D'Alimonte
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Jackson W, Hamstra DA, Johnson S, Zhou J, Foster B, Foster C, Li D, Song Y, Palapattu GS, Kunju LP, Mehra R, Feng FY. Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer-specific death in patients receiving salvage radiation therapy following radical prostatectomy. Cancer 2013; 119:3287-94. [PMID: 23821578 DOI: 10.1002/cncr.28215] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND The presence of Gleason pattern 5 (GP5) at radical prostatectomy (RP) has been associated with worse clinical outcome; however, this pathologic variable has not been assessed in patients receiving salvage radiation therapy (SRT) after a rising prostate-specific antigen level. METHODS A total of 575 patients who underwent primary RP for localized prostate cancer and subsequently received SRT at a tertiary medical institution were reviewed retrospectively. Primary outcomes of interest were biochemical failure (BF), distant metastasis (DM), and prostate cancer-specific mortality (PCSM), which were assessed via univariate analysis and Fine and Grays competing risks multivariate models. RESULTS On pathologic evaluation, 563 (98%) patients had a documented Gleason score (GS). The median follow-up post-SRT was 56.7 months. A total of 60 (10.7%) patients had primary, secondary, or tertiary GP5. On univariate analysis, the presence of GP5 was prognostic for BF (hazard ratio [HR] 3.3; P < .0001), DM (HR:11.1, P < .0001), and PCSM (HR:8.8, P < .0001). Restratification of the Gleason score to include GP5 as a distinct entity resulted in improved prognostic capability. Patients with GP5 had clinically worse outcomes than patients with GS8(4+4). On multivariate analysis, the presence of GP5 was the most adverse pathologic predictor of BF (HR 2.9; P < .0001), DM (HR 14.8; P < .0001), and PCSM (HR 5.7; P < .0001). CONCLUSION In the setting of SRT for prostate cancer, the presence of GP5 is a critical pathologic predictor of BF, DM, and PCSM. Traditional GS risk stratification fails to fully utilize the prognostic capabilities of individual Gleason patterns among men receiving SRT post-RP.
Collapse
Affiliation(s)
- William Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
The Interval to Biochemical Failure Is Prognostic for Metastasis, Prostate Cancer-Specific Mortality, and Overall Mortality After Salvage Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2013; 86:554-61. [DOI: 10.1016/j.ijrobp.2013.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 11/23/2022]
|
44
|
Riou O, Laliberté B, Azria D, Menkarios C, Llacer Moscardo C, Dubois JB, Aillères N, Fenoglietto P. Implementing intensity modulated radiotherapy to the prostate bed: Dosimetric study and early clinical results. Med Dosim 2013; 38:117-21. [DOI: 10.1016/j.meddos.2012.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/23/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
|
45
|
Ishiyama H, Teh BS, Blanco AI, Paulino AC, Mai WY, Caillouet J, Xu B, Butler EB. Salvage intensity modulated radiotherapy using endorectal balloon after radical prostatectomy: clinical outcomes. Int J Urol 2013; 20:1178-83. [PMID: 23573867 DOI: 10.1111/iju.12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate biochemical non-evidence of disease and adverse events of salvage intensity-modulated radiotherapy using an endorectal balloon for prostate cancer patients after radical prostatectomy. METHODS Data of 107 patients (median age 65 years) with persistent (>0.1 ng/mL) or rising prostate-specific antigen after radical prostatectomy were retrospectively analyzed. The mean dose to clinical target volume was 70 Gy in 32 fractions (the equivalent dose in 2 Gy fraction is 73.2 Gy based on α:β = 2). Biochemical non-evidence of disease and predictive factors were assessed. Genitourinary toxicity and gastrointestinal toxicity were also evaluated using the Radiation Therapy Oncology Group toxicity criteria. RESULTS The median follow up was 37 months (range 6-126 months). A total of 48 patients developed biochemical recurrence. The 3- and 5-year biochemical non-evidence of disease rates of all patients were 52.6% and 48.8%, respectively. The Gleason score (≥4 + 3, ≤3 + 4) and pre-intensity-modulated radiotherapy prostate-specific antigen level (≥0.5 ng/mL, <0.5 ng/mL) were significant predictive factors for biochemical non-evidence of disease in univariate analysis. In multivariate analysis, only the Gleason score was detected as a significant variable. The highest late genitourinary toxicities were grade 2 in 13% and grade 3 in 6% of patients. The highest late gastrointestinal toxicities were grade 2 in 6% and grade 3 in 3% of patients. CONCLUSION Despite a relatively high radiation dose, intensity-modulated radiotherapy with an endorectal balloon can be delivered with acceptable toxicity and efficacy for patients developing biochemical recurrence after radical prostatectomy.
Collapse
Affiliation(s)
- Hiromichi Ishiyama
- Department of Radiation Oncology, The Methodist Hospital, Research Institute and Cancer Center, Houston, Texas, USA; Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Heckman MG, Parker AS, Wu KJ, Hilton TW, Ko SJ, Pisansky TM, Schild SE, Khor LY, Hammond EH, Pollack A, Buskirk SJ. Evaluation of MDM2, p16, and p53 staining levels as biomarkers of biochemical recurrence following salvage radiation therapy for recurrent prostate cancer. Prostate 2012; 72:1757-66. [PMID: 22513981 DOI: 10.1002/pros.22528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 03/24/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The selection of appropriate candidates for salvage radiation therapy (SRT) to address a rising PSA following radical prostatectomy remains challenging. Herein, we provide the first evaluation of the ability of staining levels of the tumor based biomarkers MDM2, p16, and p53 to aid in prediction of biochemical recurrence (BCR) among men undergoing SRT for recurrent prostate cancer. MATERIAL AND METHODS We identified 152 patients who were treated with SRT between July 1987 and July 2003. Staining levels of MDM2, p16, and p53 in primary tumor samples removed during prostatectomy were detected using monoclonal antibodies and quantified by use of a computer-assisted method. Associations of staining levels with BCR were evaluated using Cox proportional hazards regression models; relative risks (RRs) and 95% confidence intervals (CIs) were estimated. RESULTS Compared to patients with low staining (≤median) as measured by percentage of cells with nuclear staining, there was no significant difference in risk of BCR for patients with high MDM2 staining (RR: 0.90, 95% CI: 0.57-1.45, P = 0.67), high p16 staining (RR: 0.88, 95% CI: 0.54-1.44, P = 0.62), or high p53 staining (RR: 1.33, 95% CI: 0.84-2.11, P = 0.23) in multivariable analysis. These results were consistent when considering alternate percentile cutpoints and alternate quantifications of biomarker staining. CONCLUSIONS Our results provide evidence that MDM2, p16, and p53 staining levels are not useful in the prediction of BCR after SRT. As such, these biomarkers are of little clinical use in the selection of appropriate candidates for SRT.
Collapse
Affiliation(s)
- Michael G Heckman
- Biostatistics Unit, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Sapre N, Pedersen J, Hong MK, Harewood L, Peters J, Costello AJ, Hovens CM, Corcoran NM. Re-evaluating the biological significance of seminal vesicle invasion (SVI) in locally advanced prostate cancer. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11477.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
CORTÉS-GONZÁLEZ JEFFR, CASTELLANOS ENRIQUE, SANDBERG KATINKA, ERIKSSON MARIEHJELM, WIKLUND PETER, CARLSSON STEFAN, COHN-CEDERMARK GABRIELLA, HARMENBERG ULRIKA, GUSTAFSSON OVE, LEVITT SEYMOURH, LENNERNÄS BO, BRANDBERG YVONNE, MÁRQUEZ MARCELA, KÄLKNER KARLMIKAEL, NILSSON STEN. Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy. Int J Oncol 2012; 42:109-17. [DOI: 10.3892/ijo.2012.1694] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/21/2012] [Indexed: 11/12/2022] Open
|
49
|
Upfront Androgen Deprivation Therapy With Salvage Radiation May Improve Biochemical Outcomes in Prostate Cancer Patients With Post-Prostatectomy Rising PSA. Int J Radiat Oncol Biol Phys 2012; 83:1493-9. [DOI: 10.1016/j.ijrobp.2011.10.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 10/20/2011] [Accepted: 10/25/2011] [Indexed: 11/22/2022]
|
50
|
Gaztañaga M, Crook JM. Permanent seed brachytherapy for locally recurrent prostate cancer after radical prostatectomy: a case report and review of the literature. Brachytherapy 2012; 12:338-42. [PMID: 22748289 DOI: 10.1016/j.brachy.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the management of a patient with locally recurrent prostate cancer in the prostate bed, 10 years after a radical prostatectomy. METHODS AND MATERIALS A 71-year-old man had a radical prostatectomy for a Gleason 7 clinical T2a carcinoma of the prostate in 2000. Final pathologic stage was pT3a pN0. Postoperatively his prostate-specific antigen was undetectable, but by 2008 it was 1.0ng/mL and in 2011 it reached to 1.43ng/mL. He was referred for consideration of salvage radiotherapy. Staging workup was negative but transrectal ultrasound revealed a 15cc recurrence in the prostate bed. A combination of external beam radiation therapy (4600/23/4.5 weeks to the pelvis) and a brachytherapy boost (115Gy) was selected for definitive management. Androgen ablation was not used. RESULTS The treatment was well tolerated. The brachytherapy boost was planned in a similar fashion to a de novo implant for an intact prostate. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. Acute toxicity was minimal. Six months after brachytherapy, the prostate-specific antigen had fallen from 1.43 to 0.05ng/mL. CONCLUSIONS Dose escalation with combined external beam and brachytherapy may be feasible if recurrent disease can be visualized using transrectal ultrasound and encompassed in an implanted volume. Although longer followup and a larger series of patients are required to demonstrate safety and efficacy, consideration should be given this approach.
Collapse
Affiliation(s)
- Miren Gaztañaga
- Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
| | | |
Collapse
|