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Triner D, Daignault-Newton S, Singhal U, Sessine M, Dess RT, Caram MEV, Borza T, Ginsburg KB, Lane BR, Morgan TM. Variation in management of lymph node positive prostate cancer after radical prostatectomy within a statewide quality improvement consortium. Urol Oncol 2024; 42:220.e1-220.e8. [PMID: 38570271 DOI: 10.1016/j.urolonc.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Patients with lymph node positive (pN+) disease found at the time of radical prostatectomy with pelvic lymphadenectomy for clinically localized prostate cancer (CaP) are at high risk of disease persistence and progression. Contemporary management trends of pN+ CaP are not well described. MATERIALS AND METHODS Patients in the Michigan Urologic Surgery Improvement Collaborative (MUSIC) with clinically localized prostate cancer who underwent radical prostatectomy between 2012 and 2023 with cN0/pN+ disease were identified. The primary outcome was to evaluate patient and practice-level factors associated with time to secondary post-RP treatment. Secondary outcomes included practice-level variation in management of pN+ CaP and rates of secondary treatment modality. To assess factors associated with secondary treatment, a Cox proportional hazards model of a 60-day landmark analysis was performed. RESULTS We identified 666 patients with pN+ disease. Overall, 66% underwent secondary treatment within 12 months post-RP. About 19% of patients with detectable post-RP PSA did not receive treatment. Of patients receiving secondary treatment after 60-days post-RP, 34% received androgen deprivation therapy (ADT) alone, 27% received radiation (RT) alone, 36% received combination, and 4% received other systemic therapies. In the multivariable model, pathologic grade group (GG)3 (HR 1.5; 95%CI: 1.05-2.14), GG4-5 (HR 1.65; 95%CI: 1.16-2.34), positive margins (HR 1.46; 95%CI: 1.13-1.88), and detectable postoperative PSA ≥0.1 ng/ml (HR 3.46; 95%CI: 2.61-4.59) were significantly associated with secondary post-RP treatment. There was wide variation in adjusted practice-level 12-month secondary treatment utilization (28%-79%). CONCLUSIONS The majority pN+ patients receive treatment within 12 months post-RP which was associated with high-risk pathological features and post-RP PSA. Variation in management of pN+ disease highlights the uncertainty regarding the optimal management. Understanding which patients will benefit from secondary treatment, and which type, will be critical to minimize variation in care.
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Affiliation(s)
- Daniel Triner
- Department of Urology, Michigan Medicine, Ann Arbor, MI.
| | | | - Udit Singhal
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Urology, Mayo Clinic, Rochester, MN
| | - Michael Sessine
- Department of Urology, Wayne State University School of Medicine, Detroit, MI
| | - Robert T Dess
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - Megan E V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Tudor Borza
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Kevin B Ginsburg
- Department of Urology, Wayne State University School of Medicine, Detroit, MI
| | - Brian R Lane
- Division of Urology, Corewell Health Hospital System, Grand Rapids, MI
| | - Todd M Morgan
- Department of Urology, Michigan Medicine, Ann Arbor, MI
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2
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Sood A, Zhang LT, Keeley J, Butaney M, Stricker M, Andrews JR, Grauer R, Peabody JO, Rogers CG, Menon M, Abdollah F. Optimizing anti-androgen treatment use among men with pathologic lymph-node positive prostate cancer treated with radical prostatectomy: the importance of postoperative PSA kinetics. Prostate Cancer Prostatic Dis 2024; 27:58-64. [PMID: 35794359 DOI: 10.1038/s41391-022-00572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optimal postsurgical management of prostate cancer (PCa) patients with nodal metastasis at the time of radical prostatectomy remains unclear. We sought to examine the role of postoperative PSA kinetics and pathologic tumor characteristics in guiding additional hormonal therapy use in pN1 men. METHODS In total, 297 pN1 PCa patients treated with radical prostatectomy and ePLND between 2002 and 2018 were identified within our prospectively maintained institutional cancer data-registry. Following surgery, these patients were managed with either immediate androgen deprivation therapy (iADT) or observation with deferred ADT (dADT). The former was defined as ADT given within ≤6 months of surgery and the latter as >6 months. The primary outcome was metastasis. Regression-tree analysis was used to stratify patients into novel risk-groups based on post-prostatectomy tumor characteristics and PSA kinetics and the corresponding metastasis risk. Multivariable Cox regression analyses tested the impact of iADT versus observation ± dADT on metastasis, cancer-specific mortality, and overall mortality within each risk-group separately. RESULTS The median follow-up was 6.1 years (IQR 3.2-9.0). Regression-tree analysis stratified patients into 3 novel risk-groups (Harrell's C-index 0.79) based on PSA-nadir and time to biochemical failure: group 1 (low-risk) included patients with time to biochemical recurrence >6 months (n = 115), while groups 2 and 3 included patients with biochemical failure within ≤6 months with a postoperative PSA-nadir <1.05 ng/mL (group 2 [intermediate-risk], n = 125) or ≥1.05 ng/mL (group 3 [high-risk], n = 57), respectively. No other patient or tumor characteristics were significant for risk stratification. Within each risk-group, the 10-year metastasis-free survival rates with iADT versus observation ± dADT use were: group 1, 100% versus 95.4% (Log-rank p = 0.738), group 2, 80.6% versus 53.5% (Log-rank p = 0.016), and group 3, 41.5% versus 0% (Log-rank p = 0.015), respectively. Adjusted Cox regression analyses confirmed the benefit of iADT utilization in reducing metastasis in group 2 (p = 0.029) and group 3 (p = 0.008) patients, with no benefit for group 1 patients (p = 0.918). Similar results were noted for cancer-specific and overall mortality. CONCLUSIONS Following radical prostatectomy, early postoperative PSA kinetics may provide valuable information for guiding the timing of ADT initiation-this may reduce over- and undertreatment of pN1 PCa men.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Lawrence T Zhang
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Maxwell Stricker
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James O Peabody
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Craig G Rogers
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Mani Menon
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Firas Abdollah
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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3
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Hayden C, Rahman S, Lokeshwar S, Choksi A, Kim IY. Management of Pathologic Node-Positive Prostate Cancer following Radical Prostatectomy. Curr Oncol Rep 2023; 25:729-734. [PMID: 37071296 DOI: 10.1007/s11912-023-01420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE OF REVIEW Approximately 15% of prostate cancer patients have lymph node metastases at the time of radical prostatectomy (RP). However, there is no universally accepted standard of care for these men. The options for treatment in this subset of patients range from observation to a combination of adjuvant androgen deprivation therapy (aADT) and radiation therapy (RT). RECENT FINDINGS A recent systematic review showed that there was no clear choice out of the options above to treat these patients. Studies have shown that patients treated with adjuvant radiation therapy have lower all-cause mortality when compared to patients treated with salvage radiation therapy. In this review, we summarize treatment options for pathologic node-positive (pN1) patients and discuss the urgent need for robust clinical trials that includes observation as the control group to help establish a standard of care for treating patients with node-positive prostate cancer after RP.
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Affiliation(s)
- Christopher Hayden
- Department of Urology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Syed Rahman
- Department of Urology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Soum Lokeshwar
- Department of Urology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Ankur Choksi
- Department of Urology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Isaac Y Kim
- Department of Urology, Yale School of Medicine, New Haven, CT, 06519, USA.
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4
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Current Status and Future Perspective on the Management of Lymph Node-Positive Prostate Cancer after Radical Prostatectomy. Cancers (Basel) 2022; 14:cancers14112696. [PMID: 35681676 PMCID: PMC9179902 DOI: 10.3390/cancers14112696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Pathological lymph node involvement (pN1) after a pelvic lymph node dissection represents one of the most unfavorable prognostic factors for disease recurrence and cancer-specific mortality in prostate cancer. However, optimal management for pN1 patients remains unclear. Thus, the guideline from the European Association of Urology recommends discussing three following management options with pN1 patients after an extended pelvic lymph node dissection, based on nodal involvement characteristics: (i) offer adjuvant androgen-deprivation therapy, (ii) offer adjuvant androgen-deprivation therapy with additional radiotherapy and (iii) offer observation (expectant management) to a patient with ≤2 nodes and a prostate-specific antigen <0.1 ng/mL. Treatment intensification may reduce risks of recurrence and cancer-specific mortality, but it may increase adverse events and impair quality of life. Few randomized control trials for pN1 are under investigation. In addition, there are limited reports on the quality of life and patient-reported outcomes in patients with pN1. Therefore, more research is needed to establish an optimal therapeutic strategy for patients with pN1. This review summarizes current evidence on the treatments available for men with pN1, summarizes randomized control trials that included pN1 prostate cancer, and discusses future perspectives.
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5
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Laine C, Gandaglia G, Valerio M, Heidegger I, Tsaur I, Olivier J, Ceci F, van den Bergh RCN, Kretschmer A, Thibault C, Chiu PK, Tilki D, Kasivisvanathan V, Preisser F, Zattoni F, Fankhauser C, Kesch C, Puche-Sanz I, Moschini M, Pradere B, Ploussard G, Marra G. Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence. Curr Opin Urol 2022; 32:69-84. [PMID: 34812201 DOI: 10.1097/mou.0000000000000946] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To investigate the features and optimal management of pN+ cM0 prostate cancer (PCa) according to registry-based studies. RECENT FINDINGS Up to 15% of PCa patients harbor lymph node invasion (pN+) at radical prostatectomy plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized. SUMMARY We performed a systematic review including n = 13 studies. Management strategies comprised 13 536 men undergoing observation, 11 149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men. At a median follow-up ranging 48-134months, Cancer-related death was 5% and overall-mortality 16.6%. aADT and aRT alone had no cancer-specific survival or overall survival advantages over observation only and over not performing aRT, respectively. aADT plus aRT yielded a survival benefit compared to observation and aADT, which in one study, were limited to certain intermediate-risk categories. Age, Gleason, Charlson score, positive surgical margins, pathological stage, and positive nodes number, but not prostate specific antigen, were most relevant prognostic factors. Our work further confirmed pN+ PCa is a multifaceted disease and will help future research in defining its optimal management based on different risk categories to maximize survival and patient's quality of life.
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Affiliation(s)
- Charles Laine
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Giorgio Gandaglia
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | | | - Francesco Ceci
- Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | | | | | - Constance Thibault
- Department of Medical Oncology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Peter K Chiu
- Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Derya Tilki
- Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Felix Preisser
- Department of Urology, Goethe University, Frankfurt, Germany
| | - Fabio Zattoni
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Claudia Kesch
- West German Cancer Center; Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ignacio Puche-Sanz
- Department of Urology, Bio-Health Research Institute, Hospital Universitario Virgen de las Nieves, University of Granada Granada, Spain
| | - Marco Moschini
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France and Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University, Paris, France
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6
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Giraud N, Benziane-Ouaritini N, Schick U, Beauval JB, Chaddad A, Niazi T, Faye MD, Supiot S, Sargos P, Latorzeff I. Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach? Front Oncol 2021; 11:781040. [PMID: 34881187 PMCID: PMC8647553 DOI: 10.3389/fonc.2021.781040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Approximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. Until recently, little data were available regarding the optimal RT timing, protocol, volumes to treat, and the benefit of adding androgen deprivation therapies to post-operative RT. In this review, we aim to pragmatically discuss current literature data on these points. Early salvage RT appears to be the optimal post-operative approach, improving oncological outcomes especially with low prostate-specific antigen (PSA) levels, as well as sparing several unnecessary adjuvant treatments. The standard RT dose is still 64–66 Gy to the prostate bed in conventional fractionation, but hypofractionation protocols are emerging pending on late toxicity data. Several scientific societies have published contouring atlases, even though they are heterogeneous and deserve future consensus. During salvage RT, the inclusion of pelvic lymph nodes is also controversial, but preliminary data show a possible benefit for PSA > 0.34 ng/ml at the cost of increased hematological side effects. Concomitant ADT and its duration are also discussed, possibly advantageous (at least in terms of metastasis-free survival) for PSA rates over 0.6 ng/ml, taking into account life expectancy and cardiovascular comorbidities. Intensified regimens, for instance, with new-generation hormone therapies, could further improve outcomes in carefully selected patients. Finally, recent advances in molecular imaging, as well as upcoming breakthroughs in genomics and artificial intelligence tools, could soon reshuffle the cards of the current therapeutic strategy.
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Affiliation(s)
- Nicolas Giraud
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France
| | | | - Ahmad Chaddad
- School of Artificial Intelligence, Guilin University of Electronic Technology, Guilin, China
| | - Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Mame Daro Faye
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Stéphane Supiot
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France
| | - Paul Sargos
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | - Igor Latorzeff
- Radiation Oncology Department, Clinique Pasteur, Toulouse, France
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7
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D'Rummo KA, Chen RC, Shen X. Narrative review of management strategies and outcomes in node-positive prostate cancer. Transl Androl Urol 2021; 10:3176-3187. [PMID: 34430420 PMCID: PMC8350237 DOI: 10.21037/tau-20-1031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/27/2020] [Indexed: 11/06/2022] Open
Abstract
Pelvic nodal involvement is present in 13% of new prostate cancer diagnoses each year and is associated with a poor prognosis compared to localized disease. Grouped as stage IV along with distant metastatic disease, node-positive nonmetastatic patients historically received systemic therapy alone as primary treatment. This treatment paradigm has shifted as data have demonstrated that these patients may benefit from aggressive locoregional therapy and are potentially curable. There is currently a lack of randomized evidence to define the optimal management for node-positive patients. While a few trials have included node-positive patients, the majority of data are derived from large multi-institutional series or population-based series. This narrative review summarizes the current literature supporting curative-intent management strategies for patients diagnosed with nonmetastatic clinically node-positive prostate cancer (cN1M0), as well as patients found to have pathologic nodal disease at the time of surgery (pN1M0). Treatment of both scenarios requires multimodality considerations including surgery, radiation therapy (RT) and systemic therapy to minimize the risks of both locoregional and distant recurrence. Future considerations include developments in enhanced imaging and systemic therapy. Inclusion of node-positive patients on prospective, randomized trials such as NRG GU 008 is needed to enhance our understanding of optimal management strategies.
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Affiliation(s)
- Kevin A D'Rummo
- Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Ronald C Chen
- Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Xinglei Shen
- Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS, USA
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8
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[Postoperative radiotherapy for prostate cancer: when to propose it? What is the place for androgen deprivation?]. Cancer Radiother 2021; 25:667-673. [PMID: 34391651 DOI: 10.1016/j.canrad.2021.07.005] [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: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE While there is no high-level evidence showing superiority of surgery over radiation treatment, radical prostatectomy is the most common treatment option for patients with localized, non-metastatic disease. Nearly 30% of all patients undergoing surgery will develop a biochemical recurrence in 10 years. In fact, more than 30% of contemporary patients treated with RP will harbor aggressive disease characteristics at final pathology. MATERIAL AND MEHODS We conducted a review of the literature evaluating the timing of radiotherapy and the place of androgen deprivation after prostatectomie totale. RESULTS Four trials randomizing adjuvant radiotherapy and surveillance found an advantage in biochemical relapse-free survival in favor of immediate irradiation after radical prostatectomy, called adjuvant. However, in these studies, more than 40% of patients in the arm without adjuvant radiotherapy did not relapse at 10 years of follow-up. More recently, the question of the optimal time of this post-operative, adjuvant RT or during biological relapse has arisen through three trials (RADICALS-RT, RAVES, GETUG-AFU 17). These trials did not show a benefit for adjuvant radiotherapy in terms of event-free survival, a PSA-based endpoint, while confirming the toxicities observed during irradiation immediately after surgery. The optimal duration of hormonal therapy when associated with post-prostatectomy radiation therapy remains controversial. CONCLUSION Early salvage radiotherapy is a new standard of treatment and adjuvant radiotherapy could be reserved for very selected patients. The role of hormone therapy is well defined in salvage situation, but its duration is still being studied.
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9
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Pathologically Node-Positive Prostate Cancer: Casting for Cure When the Die Is Cast? ACTA ACUST UNITED AC 2021; 26:58-63. [PMID: 31977387 DOI: 10.1097/ppo.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The postoperative management of men with lymph node involved prostate cancer (pN+) remains a challenge as there is a general lack of randomized trial data and a range of management strategies. Retrospective studies suggest a variable clinic course for patients with pN+ prostate cancer. Some men progress rapidly to metastatic disease despite further therapies, whereas other men can have a period of prolonged quiescence without adjuvant androgen deprivation therapy (ADT) or radiation therapy (RT). For men who have undergone radical prostatectomy, randomized trial data indicate that the addition of ADT in pN+ disease extends metastasis-free, prostate cancer-specific, and overall survival. Additional retrospective studies suggest that adding RT is potentially beneficial in this setting, improving overall and cancer-specific survival especially in men with certain pathologic parameters. Conversely, men with lower disease burden in their lymph nodes have longer times to progression and may be candidates for observation and salvage therapy as opposed to adjuvant ADT/RT.
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10
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Ouyang W, Zhang Y, Long G, Sun G, Liu M, Li F, Yang C, Zeng X, Yang J, Yu X, Wang Z, Liu Z, Guan W, Hu Z, Wang S, Liu X, Li H, Xu H, Ye Z. Androgen receptor splice variant 7 detected by immunohistochemical is an independent poor prognostic marker in men receiving adjuvant androgen-deprivation therapy after radical prostatectomy. Biomark Res 2021; 9:23. [PMID: 33789757 PMCID: PMC8011087 DOI: 10.1186/s40364-021-00276-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background To evaluate the predictive value of AR-V7 expression detected by immunohistochemical (IHC) in the prognosis of prostate cancer patients receiving adjuvant hormonal therapy (AHT) following radical prostatectomy (RP). Methods We retrospectively collected data of 110 patients with prostate cancer receiving RP, followed by AHT, from Tongji hospital. IHC analysis of AR-V7 expression was performed in a retrospective cohort. Results In total, 110 patients were enrolled, of whom 21 patients (19.1%) were AR-V7-positive and 89 patients (80.9%) were AR-V7-negative. No significant differences in baseline characteristics were found between the two groups. AR-V7-positive patients had shorter progression-free survival (PFS) (HR: 4.26; 95% CI, 1.55 to 11.68; P = 0.003), shorter cancer-special survival (CSS) (HR: 22.47; 95% CI, 2.912 to 173.4; P = 0.003) and shorter overall survival (OS) (HR: 6.61; 95% CI, 1.40 to 31.20; P = 0.017) compared to AR-V7-negative patients. In multivariate analysis, AR-V7 is an independent risk factor for shorter PFS (HR, 3.76; 95% CI, 1.63 to 8.70; P = 0.002), shorter CSS (HR: 9.17; 95% CI, 1.48 to 55.56; P = 0.017) and shorter OS (HR: 4.81; 95% CI, 1.28 to 17.86; P = 0.020). Conclusion The presence of AR-V7 in prostate cancer tissue is independently associated with an unfavorable prognosis for PFS, OS and CSS in patients who received AHT. Supplementary Information The online version contains supplementary material available at 10.1186/s40364-021-00276-x.
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Affiliation(s)
- Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Carrasquilla M, Creswell ML, Pepin AN, Wang E, Forsthoefel M, McGunigal M, Bullock E, Lei S, Collins BT, Lischalk JW, Esposito G, Aghdam N, Kumar D, Suy S, Leger P, Hankins RA, Dawson NA, Collins SP. Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy. Front Oncol 2021; 10:606260. [PMID: 33537236 PMCID: PMC7848164 DOI: 10.3389/fonc.2020.606260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
Lymph node recurrent prostate cancer is a common clinical scenario that is likely to increase significantly with the widespread adoption of novel positron emission tomography (PET) agents. Despite increasing evidence that localized therapy is disease modifying, most men with lymph node recurrent prostate cancer receive only systemic therapy with androgen deprivation therapy (ADT). For men who receive localized therapy the intent is often to delay receipt of systemic therapy. Little evidence exists on the optimal combination of local and systemic therapy in this patient population. In this hypothesis generating review, we will outline the rationale and propose a framework for combining involved field SBRT with risk adapted intermittent ADT for hormone sensitive nodal recurrent prostate cancer. In patients with a limited number of nodal metastases, involved field stereotactic body radiation therapy (SBRT) may have a role in eliminating castrate-resistant clones and possibly prolonging the response to intermittent ADT. We hypothesize that in a small percentage of patients, such a treatment approach may lead to long term remission or cure.
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Affiliation(s)
- Michael Carrasquilla
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | | | - Abigail N. Pepin
- George Washington University School of Medicine, Washington, DC, United States
| | - Edina Wang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Mary McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Elizabeth Bullock
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Jonathan W. Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Giuseppe Esposito
- Department of Nuclear Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deepak Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Paul Leger
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Ryan A. Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Nancy A. Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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12
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PROACTA: a survey on the actual attitude of the Italian radiation oncologists in the management and prescription of hormonal therapy in prostate cancer patients. LA RADIOLOGIA MEDICA 2020; 126:460-465. [PMID: 32852750 DOI: 10.1007/s11547-020-01264-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
AIM To investigate the actual attitude of Radiation Oncologists in the prescription of hormonal therapy in prostate cancer (PC) with or without Radiation Therapy (RT). MATERIALS AND METHODS In 2019, a survey named Prescription of Radiation Oncologists ACtual Attitude including 18 items was sent to all Italian Radiation Oncologists of the Italian Association of Radiotherapy and Clinical Oncology. The first 4 items were about the Radiation Oncology Centers characteristics and years of practice of the respondents. The remaining 14 items concerned the setting in which hormone therapy was prescribed in PC patients (radical, postprostatectomy/oligometastatic state), the kind of drug, the choice modality (Multidisciplinary Group/autonomy decision) and other factors. RESULTS A total of 127 questionnaires were returned, mainly by Northern Italy Radiation Oncology Centres (44.9%), and by experienced Radiation Oncologists (78%), who declared to prescribe independently hormone therapy in 85.8% of cases. The Androgen deprivation therapy (ADT) prescription in castration naive PC was made independently by 56.7% of respondents and associated with radical RT, postoperative or salvage RT according to various risk factors. In castration-sensitive oligorecurrent PC, the majority (51.2%) administered ADT only if local ablative treatment was not feasible, while in metastatic castration resistant disease novel hormone therapy use was established in almost half of cases within multidisciplinary board. Radiation Oncologists could prescribe these drugs independently in 64% of cases. CONCLUSION Our survey established the prescription attitude of ADT and new hormonal agents (abiraterone, enzalutamide, apalutamide) by Italian Radiation Oncologists and highlighted the importance of expertise in global PC management.
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13
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Shore ND, Antonarakis ES, Cookson MS, Crawford ED, Morgans AK, Albala DM, Hafron J, Harris RG, Saltzstein D, Brown GA, Henderson J, Lowentritt B, Spier JM, Concepcion R. Optimizing the role of androgen deprivation therapy in advanced prostate cancer: Challenges beyond the guidelines. Prostate 2020; 80:527-544. [PMID: 32130741 PMCID: PMC7154535 DOI: 10.1002/pros.23967] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND For specific clinical indications, androgen deprivation therapy (ADT) will induce disease prostate cancer (PC) regression, relieve symptoms and prolong survival; however, ADT has a well-described range of side effects, which may have a detrimental effect on the patient's quality of life, necessitating additional interventions or changes in PC treatment. The risk-benefit analysis for initiating ADT in PC patients throughout the PC disease continuum warrants review. METHODS A 14-member panel comprised of urologic and medical oncologists were chosen for an expert review panel, to provide guidance on a more judicious use of ADT in advanced PC patients. Panel members were chosen based upon their academic and community experience and expertise in the management of PC patients. Four academic members of the panel served as group leaders; the remaining eight panel members were from Large Urology Group Practice Association practices with proven experience in leading their advanced PC clinics. The panel members were assigned to four separate working groups, and were tasked with addressing the role of ADT in specific PC settings. RESULTS This article describes the practical recommendations of an expert panel for the use of ADT throughout the PC disease continuum, as well as an algorithm summarizing the key recommendations. The target for this publication is all providers (urologists, medical oncologists, radiation oncologists, or advanced practice providers) who evaluate and manage advanced PC patients, regardless of their practice setting. CONCLUSION The panel has provided recommendations for monitoring PC patients while on ADT, recognizing that PC patients will progress despite testosterone suppression and, therefore, early identification of conversion from castrate-sensitive to castration resistance is critical. Also, the requirement to both identify and mitigate side effects of ADT as well as the importance of quality of life maintenance are essential to the optimization of patient care, especially as more combinatorial therapeutic strategies with ADT continue to emerge.
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Affiliation(s)
- Neal D. Shore
- Carolina Urologic Research Center, Atlantic Urology ClinicsMyrtle BeachSouth Carolina
| | | | | | | | - Alicia K. Morgans
- Northwestern University, Robert H. Lurie Comprehensive Cancer CenterChicagoIllinois
| | | | - Jason Hafron
- Willam Beaumont School of Medicine, Oakland UniversityRochesterMichigan
- Beaumont HealthRoyal OakMichigan
- Michigan Institute of UrologyTroyMichigan
| | | | | | - Gordon A. Brown
- Rowan‐School of MedicineStratfordNew Jersey
- Jefferson Health New Jersey, New Jersey UrologySewellNew Jersey
| | | | | | | | - Raoul Concepcion
- Integra ConnectWest Palm BeachFlorida
- Department of UrologyVanderbilt University School of MedicineNashvilleTennessee
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14
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Lieng H, Kneebone A, Hayden AJ, Christie DR, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Sidhom M, Skala M, Yaxley J, Shakespeare TP. Radiotherapy for node-positive prostate cancer: 2019 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2019; 140:68-75. [DOI: 10.1016/j.radonc.2019.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 01/29/2023]
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15
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Banapour P, Schumacher A, Lin JC, Finley DS. Radical Prostatectomy and Pelvic Lymph Node Dissection in Kaiser Permanente Southern California: 15-Year Experience. Perm J 2019; 23:17-233. [PMID: 30939263 DOI: 10.7812/tpp/17-233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is the standard treatment of high-risk prostate cancer. High-risk patients and those with lymph node metastasis (LNM) require further treatment. We review outcomes of RP+PLND in Kaiser Permanente Southern California (KPSC). METHODS Patients who underwent RP+PLND in KPSC from January 1, 2001, to July 1, 2015 were included. Patient charts were retrospectively reviewed for demographic information and clinicopathologic data which were used to calculate positive surgical margin rate, LNM, adjuvant treatment, 5-year biochemical recurrence, and overall survival. Univariate and multivariate logistic regression analyses were used to identify factors associated with margin positivity. RESULTS Patients (N = 1829) underwent RP+PLND (241 high-risk, 943 intermediate-risk, 645 low-risk). Positive margin rates were 17.8%, 14.8%, and 11.9% in the high, intermediate- and low-risk groups. Biochemical recurrence rates were 22% in high-risk and 12.1% in the low-risk category. Androgen deprivation use was 4.1% in the high-risk group and 0.9% in the low-risk group. Five-year overall survival was 92.5% in lymph node-positive patients and 94.9% in lymph node-negative patients (p = 0.8). On multivariate analysis, age (odds ratio [OR] = 1.02, p = 0.02), prebiopsy prostate-specific antigen (OR = 1.02, p < 0.001), and clinical T stage (OR = 1.49, p = 0.01) were associated with margin positivity. CONCLUSION In KPSC, RP+PLND was performed in patients with low-, intermediate-, and high-risk prostate cancer. Age, prebiopsy prostate-specific antigen, and clinical stage were associated with positive surgical margins in patients with LNM. Recipients of RP+PLND with LNM and positive surgical margins required adjuvant treatment.
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Affiliation(s)
- Pooya Banapour
- Department of Urology, Sunset Medical Center, Los Angeles, CA
| | | | - Jane C Lin
- Department of Research and Evaluation, Pasadena, CA
| | - David S Finley
- Department of Urology, Sunset Medical Center, Los Angeles, CA
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16
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Balakrishnan AS, Zhao S, Cowan JE, Broering JM, Cooperberg MR, Carroll PR. Trends and Predictors of Adjuvant Therapy for Adverse Features Following Radical Prostatectomy: An Analysis From Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 2019; 131:157-165. [DOI: 10.1016/j.urology.2019.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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17
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Ma W, Poon DM, Chan C, Chan T, Cheung F, Ho L, Lee EK, Leung AK, Leung SY, So H, Tam P, Kwong PW. Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology. BJU Int 2019; 124:221-241. [PMID: 30653801 PMCID: PMC6850389 DOI: 10.1111/bju.14681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality. METHODS Through a series of meetings, the panellists discussed their clinical experience and the published evidence regarding various areas of the management of localized PCa, then drafted consensus statements. At the final meeting, each drafted statement was voted on by every panellist based on its practicability of recommendation in the locality. RESULTS A total of 76 consensus statements were ultimately accepted and established by panel voting. CONCLUSION Derived from the recent evidence and major overseas guidelines, along with local clinical experience and practicability, the consensus statements were aimed to serve as a practical reference for physicians in Hong Kong for the management of localized PCa.
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Affiliation(s)
- Wai‐Kit Ma
- Department of SurgeryQueen Mary HospitalUniversity of Hong KongHong KongHong Kong
| | - Darren Ming‐Chun Poon
- State Key Laboratory in Oncology in South ChinaDepartment of Clinical OncologySir YK Pao Centre for CancerHong Kong Cancer Institute and Prince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Chi‐Kwok Chan
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalChinese University of Hong KongHong KongHong Kong
| | - Tim‐Wai Chan
- Department of Clinical OncologyQueen Elizabeth HospitalHong KongHong Kong
| | | | | | - Eric Ka‐Chai Lee
- Department of Clinical OncologyTuen Mun HospitalHong KongHong Kong
| | | | | | - Hing‐Shing So
- Division of UrologyDepartment of SurgeryUnited Christian HospitalHong KongHong Kong
| | - Po‐Chor Tam
- Department of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Philip Wai‐Kay Kwong
- Department of Clinical OncologyQueen Mary HospitalUniversity of Hong KongHong Kong
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18
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Min K, Chung JW, Ha YS, Lee JN, Kim BS, Kim HT, Kim TH, Yoo ES, Kwon TG, Chung SK, Tanaka M, Egawa S, Kimura T, Choi SH. Efficacy of Androgen Deprivation Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel-Based Chemotherapy. World J Mens Health 2019; 38:226-235. [PMID: 31190487 PMCID: PMC7076308 DOI: 10.5534/wjmh.190029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the comparative effectiveness of androgen deprivation therapy (ADT) combined with docetaxel (DTX)-based chemotherapy in Korean and Japanese castration-resistant prostate cancer (CRPC) patient cohorts. MATERIALS AND METHODS Metastatic CRPC patients who underwent more than three DTX-based chemotherapy cycles in Korea and Japan between 2002 and 2017 were retrospectively analyzed and divided into the DTX-only (DTX, n=30) and combination (DTX+ADT, n=46) groups. Progression-free survival (PFS) was calculated as the time from the start of chemotherapy to the occurrence of either disease progression (prostate-specific antigen [PSA] progression or radiographic progression) or death. The primary end point was PFS and the secondary end point was overall survival (OS). RESULTS In the DTX and DTX+ADT groups, the median PFS was 6.0 and 11.0 months (log-rank p=0.053). The multivariate Cox regression analysis revealed that the significant predicting factors of PFS were ADT administration (hazard ratio [HR], 0.478; 95% confidence interval [CI], 0.284-0.804; p=0.005) and number of DTX-based chemotherapy cycles (HR, 0.934; 95% CI, 0.899-0.970; p<0.001). In the DTX and DTX+ADT groups, the median OS was 16.0 and 19.5 months (log-rank p=0.825). Through multiple Cox regression analysis, we found that the significant predicting factors of OS were the PSA nadir level (HR, 1.001; 95% CI, 1.000-1.002; p<0.001) and number of DTX-based chemotherapy cycles (HR, 0.932; 95% CI, 0.876-0.991; p=0.024). CONCLUSIONS Concurrent DTX-based chemotherapy and ADT may be beneficial compared with DTX-based chemotherapy alone in chemotherapy-naïve metastatic CRPC patients in terms of the PFS, but not the OS.
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Affiliation(s)
- Kyungchan Min
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jae Wook Chung
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Yun Sok Ha
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Hwan Kim
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Kwang Chung
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Masatoshi Tanaka
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Daegu, Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
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19
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Li H, Wang Z, Zhang Y, Sun G, Ding B, Yan L, Liu H, Guan W, Hu Z, Wang S, Cheng F, Xu H, Zhang X, Ye Z. The Immune Checkpoint Regulator PDL1 is an Independent Prognostic Biomarker for Biochemical Recurrence in Prostate Cancer Patients Following Adjuvant Hormonal Therapy. J Cancer 2019; 10:3102-3111. [PMID: 31289580 PMCID: PMC6603373 DOI: 10.7150/jca.30384] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/28/2019] [Indexed: 12/31/2022] Open
Abstract
Background: The programmed death 1 (PD1)/programmed death ligand 1 (PDL1) targeted therapies have gained positive outcomes in several tumors, but the evidence of the expression and prognosis value of PD1/PDL1 in high risk prostate cancer was rare. Methods: Immunohistochemical analysis of PDL1/PD1 expression by a validated antibody was performed in a retrospectively collected high risk prostate cancer cohort who received adjuvant hormonal therapy (AHT) after radical prostatectomy (RP). The association between PDL1/PD1 expression and prognosis was determined. Results: In total, 127 patients were enrolled. 49.6% patients were considered PDL1-high expression while the PD1-positive expression proportion was 24.4%. High PDL1 and negative PD1 expression were significantly associated with lower prostate specific antigen (PSA) density (p=0.010 and p=0.033, respectively). Compared with the PDL1-low expression patients, the PDL1-high expression patients had significantly shorter time to PSA nadir (TTN) (P=0.001) and biochemical recurrence (BCR) (P=0.004). In Kaplan-Meier analysis, the PDL1-high expression group (p<0.0001) and the PDL1-high/PD1-negative expression group (p<0.0001) showed markedly lower BCR-free survival in localized disease. Univariate cause-specific Cox proportional hazard regression model concluded total PSA (p=0.047), PDL1-high-expression (p<0.001), PDL1-high/PD1-negative expression (p<0.001) were significant risk factors of shorter progression time to BCR in localized disease. PDL1-high-expression was the independent predictor of time to BCR in multiple Cox regression of all patients (Hazard ratio [HR]: 3.901; 95% Confidence interval [CI]: 1.287-11.824; p=0.016). Conclusions: PDL1 expression is not only highly prevalent in high-risk prostate cancer, but is also an independent biomarker in the prognosis of high-risk prostate cancer received AHT after RP. PDL1/PD1 targeted therapy might be a potentially adjuvant treatment option for high-risk prostate cancer after RP.
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Affiliation(s)
- Heng Li
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhize Wang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yucong Zhang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guoliang Sun
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Beichen Ding
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Libin Yan
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haoran Liu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Guan
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiquan Hu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shaogang Wang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hua Xu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100000, China
| | - Zhangqun Ye
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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20
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Ni Mhaolcatha S, Power E, Mayer N, Prendeville S. Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified? J Clin Pathol 2019; 72:712-715. [DOI: 10.1136/jclinpath-2019-205839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022]
Abstract
There is currently no consensus among pathologists on the optimal method of sampling pelvic lympadenectomy specimens (PLND) in prostate cancer. We evaluated the impact of complete PLND submission on lymph node (LN) yield, detection of metastasis and laboratory workload in a series of 141 cases. Following isolation of grossly identifiable LNs/potential LNs, the remaining fatty tissue was embedded in toto. Complete PLND submission increased median LN yield from 10 (1–42) to 17 (3–57). Metastatic deposits were identified in nine non-palpable LNs, which altered the pN category in four cases (3%). The primary tumour (pT) was grade group ≥3 and/or pT3 at radical prostatectomy in 96% of pN+ cases. A median of seven additional blocks (1–28) was required for complete tissue embedding. Our findings indicate that submission of the entire fat can optimise PLND assessment but has a significant impact on laboratory workload. Complete submission of selected high-risk cases may be a reasonable alternative.
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Rose BS. Postoperative radiation and hormonal therapy for men with node-positive prostate cancer: a new standard? BJU Int 2019; 123:199-200. [PMID: 30656836 DOI: 10.1111/bju.14501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
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Siddiqui ZA, Krauss DJ. Adjuvant androgen deprivation therapy for prostate cancer treated with radiation therapy. Transl Androl Urol 2018; 7:378-389. [PMID: 30050798 PMCID: PMC6043751 DOI: 10.21037/tau.2018.01.06] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Radiation therapy is a commonly used curative modality for prostate cancer. The addition of androgen deprivation therapy (ADT) increases the curative potential of prostate radiotherapy (RT) in multiple subsets of patients. In addition to having an independent cytotoxic effect, current evidence suggests that androgen deprivation synergistically works with radiation therapy by preventing DNA repair. Given the wide-ranging toxicities of this therapy, clinicians must judiciously choose which patients may benefit from ADT and also consider the appropriate length of treatment. With recent advances in RT delivery, higher doses of radiation are currently used when compared with the dose used in historic trials, leading to the unanswered question of how RT dose interacts with ADT. Current and future clinical studies are attempting to further define the appropriate indications and patient populations for which ADT represents a clinically appropriate addition to prostate RT.
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Affiliation(s)
- Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
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Gupta M, Patel HD, Schwen ZR, Tran PT, Partin AW. Adjuvant radiation with androgen-deprivation therapy for men with lymph node metastases after radical prostatectomy: identifying men who benefit. BJU Int 2018; 123:252-260. [DOI: 10.1111/bju.14241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohit Gupta
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Hiten D. Patel
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Zeyad R. Schwen
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Phuoc T. Tran
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Radiation Oncology and Molecular Radiation Sciences and Oncology; The Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Alan W. Partin
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
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McDonald ML, Howard LE, Aronson WJ, Terris MK, Cooperberg MR, Amling CL, Freedland SJ, Kane CJ. First postoperative PSA is associated with outcomes in patients with node positive prostate cancer: Results from the SEARCH database. Urol Oncol 2018; 36:239.e17-239.e25. [DOI: 10.1016/j.urolonc.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Frydenberg M, Woo HH. Early Androgen Deprivation Therapy Improves Survival, But How Do We Determine in Whom? Eur Urol 2018; 73:519-520. [PMID: 29373214 DOI: 10.1016/j.eururo.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Urology, Monash Health, Melbourne, Victoria, Australia.
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia; Department of Uro-Oncology, Chris O'Brien Lifehouse, Sydney, Australia
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Murata Y, Tatsugami K, Yoshikawa M, Hamaguchi M, Yamada S, Hayakawa Y, Ueda K, Momosaki S, Sakamoto N. Predictive factors of biochemical recurrence after radical prostatectomy for high-risk prostate cancer. Int J Urol 2018; 25:284-289. [PMID: 29315854 DOI: 10.1111/iju.13514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify risk factors of biochemical recurrence after radical prostatectomy in high-risk patients. METHODS A total of 191 high-risk prostate cancer patients according to the D'Amico classification treated with radical prostatectomy at a single institution between April 2000 and December 2013 were enrolled. The pathological evaluation including intraductal carcinoma of prostate was reassessed, and the clinical and pathological risk factors of biochemical recurrence were analyzed. RESULTS The median follow up after radical prostatectomy was 49 months. The 5-year biochemical recurrence-free survival rate after radical prostatectomy in high-risk prostate cancer patients was 41.6%. Initial prostate-specific antigen, pathological Gleason score, seminal vesicle invasion, extraprostatic extension and intraductal carcinoma of the prostate were significantly associated with biochemical recurrence-free survival. The 5-year biochemical recurrence-free survival rates in patients with zero, one, two and three of these risk factors were 92.9%, 70.7%, 38.3% and 28.8%, respectively. In patients with four or more factors, the biochemical recurrence-free survival rate was 6.1% after 18 months. CONCLUSIONS In D'Amico high-risk patients treated with radical prostatectomy, risk factors for biochemical recurrence can be identified. Patients with fewer risk factors have longer biochemical recurrence-free survival, even among these high-risk cases.
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Affiliation(s)
- Yukiko Murata
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, , Japan
| | - Masahiro Yoshikawa
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masumitsu Hamaguchi
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigetomo Yamada
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Hayakawa
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kouhei Ueda
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Naotaka Sakamoto
- Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Pagliarulo V. Androgen Deprivation Therapy for Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:1-30. [PMID: 30324345 DOI: 10.1007/978-3-319-99286-0_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the contemporary scene, less than 5% of men with newly diagnosed prostate cancer (PC) have metastases at first presentation, compared to 20-25%, more than 20 years ago. Nonetheless, the use of androgen deprivation therapy (ADT) has increased over the years, suggesting that patients in Europe and United States may receive ADT in cases of lower disease burden, and not always according to evidence based indications. Nonetheless, PC remains the second most common cause of cancer death after lung cancer in American men. Thus, there is a need for more effective, specific and well tolerated agents which can provide a longer and good quality of life while avoiding the side effects related to disease and treatment morbidity.After mentioning the current knowledge on the endocrinology of androgens and androgen receptor, relevant to PC development, as well as the possible events occurring during PC initiation, we will compare different hormonal compounds available for the treatment of PC, both from a pharmacological standpoint, and in terms of contemporary clinical indications.
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Affiliation(s)
- Vincenzo Pagliarulo
- Department of Urology, University "Aldo Moro", Bari, Italy. .,Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy.
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De Vergie S, Gaschignard N, Baron M, Branchereau J, Luyckx F, Butel T, Perrouin-Verbe MA, Bouchot O, Rigaud J. [Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]. Prog Urol 2017; 28:25-31. [PMID: 29221663 DOI: 10.1016/j.purol.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. PATIENTS AND METHODS This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. RESULTS Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. CONCLUSION Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S De Vergie
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - N Gaschignard
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - M Baron
- Service d'urologie, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - J Branchereau
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Luyckx
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - T Butel
- Service d'oncologie pédiatrique, institut Gustave-Roussy, 94805 Villejuif, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Bouchot
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Rigaud
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Zareba P, Eastham J, Scardino PT, Touijer K. Contemporary Patterns of Care and Outcomes of Men Found to Have Lymph Node Metastases at the Time of Radical Prostatectomy. J Urol 2017. [PMID: 28625507 DOI: 10.1016/j.juro.2017.06.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE A thorough understanding of the natural history and consensus regarding the optimal management of pathological lymph node positive (pN1) prostate cancer are lacking. Our objective was to describe patterns of care and outcomes of a contemporary cohort of men with pN1 prostate cancer. MATERIALS AND METHODS We used the National Cancer Database to identify 7,791 men who were found to have lymph node metastases at radical prostatectomy. Multinomial logistic regression and Cox proportional hazards regression were used to identify patient, tumor and facility characteristics associated with the choice of management strategy after radical prostatectomy and overall survival, respectively. RESULTS Initial post-prostatectomy management was observation in 63% of the men, androgen deprivation therapy alone in 20%, radiation therapy alone in 5%, and androgen deprivation therapy and radiation therapy in 13%. Younger age, lower comorbidity burden, higher grade and stage, and positive surgical margins were associated with a higher likelihood of receiving combination therapy. Grade group 4-5 disease, pT3b-T4 disease, positive surgical margins and a higher number of positive lymph nodes were independent predictors of worse overall survival. The adjusted 10-year overall survival probability decreased from 84% to 32% with the presence of an increasing number of adverse prognostic factors. Treatment with combined androgen deprivation therapy and radiation therapy was associated with better overall survival (multivariable HR 0.69, 95% CI 0.52-0.92, p = 0.010 for combination therapy vs observation). CONCLUSIONS Patient and tumor characteristics are associated with the choice of management strategy after radical prostatectomy and survival in men with pN1 prostate cancer. Multimodal therapy may be of benefit in this patient population.
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Affiliation(s)
- Piotr Zareba
- Division of Urology, McMaster University, Hamilton, Ontario, Canada.
| | - James Eastham
- Urology Service, Memorial Sloan Kettering Cancer Center and Department of Urology, Weill Cornell Medical College, New York, New York
| | - Peter T Scardino
- Urology Service, Memorial Sloan Kettering Cancer Center and Department of Urology, Weill Cornell Medical College, New York, New York
| | - Karim Touijer
- Urology Service, Memorial Sloan Kettering Cancer Center and Department of Urology, Weill Cornell Medical College, New York, New York
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30
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Dalela D, Santiago-Jiménez M, Yousefi K, Karnes RJ, Ross AE, Den RB, Freedland SJ, Schaeffer EM, Dicker AP, Menon M, Briganti A, Davicioni E, Abdollah F. Genomic Classifier Augments the Role of Pathological Features in Identifying Optimal Candidates for Adjuvant Radiation Therapy in Patients With Prostate Cancer: Development and Internal Validation of a Multivariable Prognostic Model. J Clin Oncol 2017; 35:1982-1990. [PMID: 28350520 DOI: 10.1200/jco.2016.69.9918] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Despite documented oncologic benefit, use of postoperative adjuvant radiotherapy (aRT) in patients with prostate cancer is still limited in the United States. We aimed to develop and internally validate a risk-stratification tool incorporating the Decipher score, along with routinely available clinicopathologic features, to identify patients who would benefit the most from aRT. Patient and Methods Our cohort included 512 patients with prostate cancer treated with radical prostatectomy at one of four US academic centers between 1990 and 2010. All patients had ≥ pT3a disease, positive surgical margins, and/or pathologic lymph node invasion. Multivariable Cox regression analysis tested the relationship between available predictors (including Decipher score) and clinical recurrence (CR), which were then used to develop a novel risk-stratification tool. Our study adhered to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for development of prognostic models. Results Overall, 21.9% of patients received aRT. Median follow-up in censored patients was 8.3 years. The 10-year CR rate was 4.9% vs. 17.4% in patients treated with aRT versus initial observation ( P < .001). Pathologic T3b/T4 stage, Gleason score 8-10, lymph node invasion, and Decipher score > 0.6 were independent predictors of CR (all P < .01). The cumulative number of risk factors was 0, 1, 2, and 3 to 4 in 46.5%, 28.9%, 17.2%, and 7.4% of patients, respectively. aRT was associated with decreased CR rate in patients with two or more risk factors (10-year CR rate 10.1% in aRT v 42.1% in initial observation; P = .012), but not in those with fewer than two risk factors ( P = .18). Conclusion Using the new model to indicate aRT might reduce overtreatment, decrease unnecessary adverse effects, and reduce risk of CR in the subset of patients (approximately 25% of all patients with aggressive pathologic disease in our cohort) who benefit from this therapy.
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Affiliation(s)
- Deepansh Dalela
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - María Santiago-Jiménez
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Kasra Yousefi
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - R Jeffrey Karnes
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Ashley E Ross
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Robert B Den
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Stephen J Freedland
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Edward M Schaeffer
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Adam P Dicker
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Mani Menon
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Alberto Briganti
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Elai Davicioni
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
| | - Firas Abdollah
- Deepansh Dalela, Mani Menon, and Firas Abdollah, Henry Ford Health System, Detroit, MI; María Santiago-Jiménez, Kasra Yousefi, and Elai Davicioni, GenomeDx Biosciences, Vancouver, British Columbia, Canada; R. Jeffrey Karnes, Mayo Clinic, Rochester, MN; Ashley E. Ross, Johns Hopkins Hospital, Baltimore, MD; Adam P. Dicker and Robert B. Den, Thomas Jefferson University, Philadelphia, PA; Stephen J. Freedland, Cedars-Sinai Medical Center, Los Angeles, CA; Edward M. Schaeffer, Northwestern University Feinberg School of Medicine, Chicago, IL; and Alberto Briganti, Vita Salute San Raffaele Hospital, Milan, Italy
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Nguyen DP, Kent M, Vilaseca A, Corradi RB, Fossati N, Sjoberg DD, Benfante N, Eastham JA, Scardino PT, Touijer KA. Updated postoperative nomogram incorporating the number of positive lymph nodes to predict disease recurrence following radical prostatectomy. Prostate Cancer Prostatic Dis 2016; 20:105-109. [DOI: 10.1038/pcan.2016.60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/02/2016] [Accepted: 09/20/2016] [Indexed: 12/26/2022]
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Kumar SS, Pacey S. The role of chemotherapy and new targeted agents in the management of primary prostate cancer. JOURNAL OF CLINICAL UROLOGY 2016; 9:30-37. [PMID: 28344814 PMCID: PMC5356176 DOI: 10.1177/2051415816685211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/14/2016] [Indexed: 12/17/2022]
Abstract
While early treatment of primary prostate cancer is very effective, the incidence of primary prostate cancer continues to rise and therefore the detection of men with high-risk non-metastatic prostate cancer and their subsequent management is becoming increasingly important. There continues to be no molecularly-targeted or chemotherapeutic options with proven, statistically significant survival benefit in this setting. However, there are indications that further risk stratification using molecular features could potentially help distinguish indolent from aggressive prostate cancer, ultimately providing biological markers that could guide a more personalised approach to therapy selection.
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Affiliation(s)
| | - Simon Pacey
- Department of Oncology, Addenbrookes Hospital, Cambridge, UK
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Wong AT, Schwartz D, Osborn V, Safdieh J, Weiner J, Schreiber D. Adjuvant radiation with hormonal therapy is associated with improved survival in men with pathologically involved lymph nodes after radical surgery for prostate cancer. Urol Oncol 2016; 34:529.e15-529.e20. [DOI: 10.1016/j.urolonc.2016.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
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Tilki D, Preisser F, Tennstedt P, Tober P, Mandel P, Schlomm T, Steuber T, Huland H, Schwarz R, Petersen C, Graefen M, Ahyai S. Adjuvant radiation therapy is associated with better oncological outcome compared with salvage radiation therapy in patients with pN1 prostate cancer treated with radical prostatectomy. BJU Int 2016; 119:717-723. [DOI: 10.1111/bju.13679] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Derya Tilki
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Departments of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Patrick Tober
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Philipp Mandel
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Departments of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thorsten Schlomm
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Departments of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Rudolf Schwarz
- Radiation Oncology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Cordula Petersen
- Radiation Oncology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Ahyai
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Departments of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
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Salmasi AH, Patel N, Kim IY. Androgen Deprivation Therapy: Appropriate Patients, Timing to Initiate ADT, and Complications. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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36
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Soulié M, Salomon L. [Oncological outcomes of prostate cancer surgery]. Prog Urol 2015; 25:1010-27. [PMID: 26519965 DOI: 10.1016/j.purol.2015.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Review of the oncological results of the radical prostatectomy as initial treatment of prostate cancer, according to the surgical approach and the risk stratification using D'Amico risk groups. MATERIALS AND METHODS Review of literature using Medline databases and MedScience based on scientific relevance. Research focused on the oncological results of the radical prostatectomy in series and meta-analysis published since 10 years, taking into consideration the surgical approach if mentioned. RESULTS The characteristics of the operated tumor highly impact the local control authenticated by the pathologic stage and the rates of positive surgical margins (PSM), in addition to the survival and the biochemical recurrence. Surgical technique adapted according to the tumor treated, was a constant challenge to the urologist, who counter balance between the oncological control and the conservation of urinary and sexual function by conditioning the type of radical prostatectomy. Results of radical prostatectomy acceptable in terms of PSM and survival are not influenced by the surgical approach but by the degree of surgical experience. CONCLUSION Results of radical prostatectomy show the efficient local control of prostate cancer, taking into consideration the oncological rules and indications validated by multidisciplinary meetings, based on the national (CCAFU) and European oncological guidelines. Tendency is going toward considering radical prostatectomy indicated for patients with higher risk of disease progression, so integrating surgery in a multidisciplinary personalized approach.
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Affiliation(s)
- M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
| | - L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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Abdollah F, Karakiewicz PI, Gandaglia G, Dalela D, Klett DE, Shiffmann J, Montorsi F, Briganti A, Saad F, Graefen M, Peabody JO, Menon M, Sun M. Adjuvant Radiotherapy in Prostate Cancer Patients Treated with Surgery: The Impact of Age and Tumor Characteristics. Eur Urol Focus 2015; 1:191-199. [DOI: 10.1016/j.euf.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/24/2015] [Accepted: 06/15/2015] [Indexed: 01/23/2023]
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Muralidhar V, Mahal BA, Nezolosky MD, Beard CJ, Feng FY, Martin NE, Efstathiou JA, Choueiri TK, Pomerantz MM, Sweeney CJ, Trinh QD, Vander Heiden MG, Nguyen PL. Association between very small tumour size and increased cancer-specific mortality after radical prostatectomy in lymph node-positive prostate cancer. BJU Int 2015; 118:279-85. [PMID: 26235660 DOI: 10.1111/bju.13248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether very small prostate cancers present in patients who also have lymph node (LN) metastases represent a particularly aggressive disease variant compared with larger LN-positive tumours. PATIENTS AND METHODS We identified 37 501 patients diagnosed with prostate cancer between 1988 and 2001 treated with radical prostatectomy within the Surveillance, Epidemiology, and End Results database. The primary study variables were tumour size by largest dimension (stratified into: (i) microscopic focus only or 1 mm; (ii) 2-15 mm; (iii) 16-30 mm; (iv) >30 mm), regional LN involvement, and the corresponding interaction term. We evaluated the risk of 10-year prostate cancer-specific mortality (PCSM) using the Fine and Gray model for competing risks after controlling for race, tumour grade, T stage, receipt of radiation, number of dissected LNs, number of positive LNs, year of diagnosis, and age at diagnosis. RESULTS The median follow-up was 11.8 years. There was a significant interaction between tumour size and LN involvement (P-interaction <0.001). In the absence of LN involvement (36 561 patients), the risk of 10-year PCSM increased monotonically with increasing tumour size. Among patients with LN involvement (940), those with the smallest tumours had increased 10-year PCSM compared with patients with tumours sized 2-15 mm (24.7% vs 11.8%; adjusted hazard ratio [AHR] 2.84, 95% confidence interval [CI] 1.21-6.71; P = 0.017) or 16-30 mm (24.7% vs 15.5%; AHR 3.12, 95% CI 1.51-6.49; P = 0.002), and similar 10-year PCSM as those with tumours >30 mm (24.7% vs 24.9%; P = 0.156). CONCLUSION In patients with prostate cancer with LN involvement, very small tumour size may predict for higher PCSM compared with some larger tumours, even after controlling for other prognostic variables. These tumours might be particularly aggressive, beyond what is captured by pathological assessment of tumour grade and stage.
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Affiliation(s)
- Vinayak Muralidhar
- Harvard-MIT Division of Health Sciences and Technology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Brandon A Mahal
- Harvard Medical School, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle D Nezolosky
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Mark M Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher J Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
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Tomioka A, Tanaka N, Yoshikawa M, Miyake M, Anai S, Chihara Y, Okajima E, Hirayama A, Hirao Y, Fujimoto K. Risk factors of PSA progression and overall survival in patients with localized and locally advanced prostate cancer treated with primary androgen deprivation therapy. BMC Cancer 2015; 15:420. [PMID: 25990314 PMCID: PMC4446859 DOI: 10.1186/s12885-015-1429-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 05/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary androgen deprivation therapy (PADT) has played an important role in the treatment of prostate cancer. We sought to identify factors of PSA progression in our series of patients with localized and locally advanced prostate cancer treated with PADT. METHODS Six-hundred forty-nine patients with localized and locally advanced prostate cancer who received PADT from 1998 to 2005 by Nara Uro-Oncology Research Group were enrolled. Age, T classification, stage, PSA level at diagnosis, Gleason score, laterality of cancer detected by biopsy and seminal vesicle involvement (SVI) were adopted as parameters of PSA progression. Cox's proportional hazards model was used to determine the predictive factors for PSA progression. RESULTS The median follow-up period and the median PSA level at diagnosis were 49 months and 15 ng/mL. The 5-year disease specific survival rate, overall survival rate and PSA progression-free survival (PFS) rate were 97.9 %, 91.9 % and 71.2 %, respectively. The univariate analysis showed that the PSA level at diagnosis, Gleason score, laterality of cancer detected by biopsy and SVI were independent predictive parameters of PSA-PFS. However, by multivariate analysis, only laterality of cancer detected by biopsy (unilateral vs. bilateral) was an independent predictive parameter of PSA-PFS (p = 0.034). The patients were classified into new risk groups base on three factors: PSA level at diagnosis, Gleason score, and laterality of cancer detected by biopsy. The PSA-PFS rates at 5-years in the low- (none or one factor), intermediate- (two factors) and high-risk (three factors) groups were 78.2 %, 62.5 % and 46.9 % (p < 0.001), respectively. CONCLUSION In localized or locally advanced prostate cancer patients who received PADT, laterality of cancer detected by biopsy was a significant predictor associated with a longer PSA-PFS. Our new risk grouping indicates the usefulness of PSA-PFS.
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Affiliation(s)
- Atsushi Tomioka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motokiyo Yoshikawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Satoshi Anai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yoshitomo Chihara
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Eijiro Okajima
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Akihide Hirayama
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yoshihiko Hirao
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Qin X, Han C, Zhang H, Dai B, Zhu Y, Shen Y, Zhu Y, Shi G, Ye D. Outcomes of patients with lymph node metastasis treated with radical prostatectomy and adjuvant androgen deprivation therapy in a Chinese population: results from a cohort study. World J Surg Oncol 2015; 13:172. [PMID: 25943443 PMCID: PMC4426650 DOI: 10.1186/s12957-015-0597-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/24/2015] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND The aim of this study is to assess the prognosis of prostate cancer (PCa) with lymph node metastases (LNM) detected in pelvic lymph node dissection (PLND) after radical prostatectomy (RP) and adjuvant androgen deprivation therapy (ADT) in a Chinese population. METHODS From June 2005 to September 2012, the medical histories of 67 Chinese PCa patients with LNM detected after RP and extended PLND were collected, and all these patients received continuous adjuvant ADT. Postoperative survival was estimated using the Kaplan-Meier method. The impact of various clinicopathological factors on outcome was analyzed using Cox proportional hazard regression models. All tests were two-sided with P < 0.05 considered significant. RESULTS Median follow-up was 46.7 months, and two patients were lost to follow-up. Five-year event-free survival for patients with positive lymph nodes was 93.0%, 83.0%, and 96.0% for local recurrence, systemic progression, and cancer death, respectively. One-year, 2-year, and 3-year biochemical recurrence (BCR)-free survival was 52%, 40%, and 22%, respectively. Postoperative BCR-free survival was 25.7 months. BCR-free survival for patients with a single LNM was longer than those with two or more LNM (median 39.1 months vs. median 17.2 months, P = 0.002). In a multivariate Cox model, only two or more LNM was a significant predictor of BCR (hazard ratio 2.6, P = 0.005). CONCLUSIONS Despite low BCR-free survival, Chinese patients with LNM can benefit from RP and adjuvant ADT. Patients with low nodal metastatic burden had a favorable prognosis.
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Affiliation(s)
- Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Chengtao Han
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, Shanghai, 200032, China.
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Jarrard DF, Blute ML, Ritter MA. Potential Role for Androgen-Deprivation Therapy and Pelvic Radiation Therapy in Node-Positive Postprostatectomy Prostate Cancer. J Clin Oncol 2014; 32:3926-9. [DOI: 10.1200/jco.2014.57.8302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David F. Jarrard
- University of Wisconsin School of Medicine and Public Health; University of Wisconsin Carbone Comprehensive Cancer Center; and University of Wisconsin, Madison, WI
| | - Michael L. Blute
- University of Wisconsin School of Medicine and Public Health; University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Mark A. Ritter
- University of Wisconsin School of Medicine and Public Health; University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
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43
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Aoun F, Peltier A, van Velthoven R. A comprehensive review of contemporary role of local treatment of the primary tumor and/or the metastases in metastatic prostate cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:501213. [PMID: 25485280 PMCID: PMC4251412 DOI: 10.1155/2014/501213] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/09/2014] [Indexed: 01/09/2023]
Abstract
To provide an overview of the currently available literature regarding local control of primary tumor and oligometastases in metastatic prostate cancer and salvage lymph node dissection of clinical lymph node relapse after curative treatment of prostate cancer. Evidence Acquisition. A systematic literature search was conducted in 2014 to identify abstracts, original articles, review articles, research articles, and editorials relevant to the local control in metastatic prostate cancer. Evidence Synthesis. Local control of primary tumor in metastatic prostate cancer remains experimental with low level of evidence. The concept is supported by a growing body of genetic and molecular research as well as analogy with other cancers. There is only one retrospective observational population based study showing prolonged survival. To eradicate oligometastases, several options exist with excellent local control rates. Stereotactic body radiotherapy is safe, well tolerated, and efficacious treatment for lymph node and bone lesions. Both biochemical and clinical progression are slowed down with a median time to initiate ADT of 2 years. Salvage lymph node dissection is feasible in patients with clinical lymph node relapse after local curable treatment. Conclusion. Despite encouraging oncologic midterm results, a complete cure remains elusive in metastatic prostate cancer patients. Further advances in imaging are crucial in order to rapidly evolve beyond the proof of concept.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Roland van Velthoven
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
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44
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[Postoperative radiotherapy of prostate cancer]. Cancer Radiother 2014; 18:517-23. [PMID: 25195116 DOI: 10.1016/j.canrad.2014.07.149] [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: 06/24/2014] [Revised: 07/11/2014] [Accepted: 07/17/2014] [Indexed: 11/22/2022]
Abstract
Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery.
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45
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Heidenreich A, Pfister D. Pelvic Lymphadenectomy in Clinically Localised Prostate Cancer: Counting Lymph Nodes or Dissecting Primary Landing Zones of the Prostate? Eur Urol 2014; 66:447-9. [DOI: 10.1016/j.eururo.2013.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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46
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Mohler JL. Concept and viability of androgen annihilation for advanced prostate cancer. Cancer 2014; 120:2628-37. [PMID: 24771515 PMCID: PMC4140964 DOI: 10.1002/cncr.28675] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/17/2013] [Accepted: 01/23/2014] [Indexed: 12/22/2022]
Abstract
There remains no standard of care for patients with a rising prostate-specific antigen level after radical prostatectomy or radiotherapy but who have no radiographic metastases, even though this is the second largest group of patients with prostate cancer (CaP) in the United States. Androgen deprivation therapy (ADT) may cure some men with advanced CaP based on single-institution series and a randomized clinical trial of immediate versus delayed ADT for men found to have pelvic lymph node metastasis at the time of radical prostatectomy. ADT may be more effective when initiated for minimal disease burden, which can be detected using PSA after radical prostatectomy or radiotherapy, and if more complete disruption of the androgen axis using newer agents decreases the chance that androgen-sensitive cells survive to adapt to a low-androgen environment. Androgens may be "annihilated" simultaneously using a luteinizing hormone-releasing hormone antagonist or agonist to inhibit testicular production of testosterone, a P45017A1 (CYP17A1) inhibitor to diminish metabolism of testosterone via the adrenal pathway and dihydrotestosterone (DHT) via the backdoor pathway, a 5α-reductase (SRD5A) inhibitor to diminish testosterone reduction to DHT and backdoor metabolism of progesterone substrates to DHT, and a newer antiandrogen to compete better with DHT for the androgen receptor ligand-binding domain. Early initiation of androgen annihilation for induction as part of planned intermittent ADT should be safe, may reduce tumor burden below a threshold that allows eradication by the immune system, and may cure many men who have failed definitive local therapy.
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Affiliation(s)
- James L Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, State University of New York at Buffalo School of Medicine and Biotechnology, Buffalo, New York
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47
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Optimal timing of hormonal therapy for prostate-specific antigen recurrence after radical prostatectomy. Med Oncol 2014; 31:45. [DOI: 10.1007/s12032-014-0045-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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48
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Lam ET, Glodé LM. Neoadjuvant and Adjuvant Hormonal and Chemotherapy for Prostate Cancer. Hematol Oncol Clin North Am 2013; 27:1189-204, viii. [DOI: 10.1016/j.hoc.2013.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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De Bari B, Alongi F, Buglione M, Campostrini F, Briganti A, Berardi G, Petralia G, Bellomi M, Chiti A, Fodor A, Suardi N, Cozzarini C, Nadia DM, Scorsetti M, Orecchia R, Montorsi F, Bertoni F, Magrini SM, Jereczek-Fossa BA. Salvage therapy of small volume prostate cancer nodal failures: a review of the literature. Crit Rev Oncol Hematol 2013; 90:24-35. [PMID: 24315428 DOI: 10.1016/j.critrevonc.2013.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 10/02/2013] [Accepted: 11/13/2013] [Indexed: 11/30/2022] Open
Abstract
New imaging modalities may be useful to identify prostate cancer patients with small volume, limited nodal relapse ("oligo-recurrent") potentially amenable to local treatments (radiotherapy, surgery) with the aim of long-term control of the disease, even in a condition traditionally considered prognostically unfavorable. This report reviews the new diagnostic tools and the main published data about the role of surgery and radiation therapy in this particular subgroup of patients.
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Affiliation(s)
- Berardino De Bari
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
| | - Filippo Alongi
- Radiotherapy and Radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
| | - Michela Buglione
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | | | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Arturo Chiti
- Nuclear Medicine, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Andrei Fodor
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Nazareno Suardi
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Cesare Cozzarini
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Di Muzio Nadia
- Radiation Therapy, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan Italy and University of Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Filippo Bertoni
- Department of Radiation Therapy, Modena Hospital, Modena, Italy
| | - Stefano Maria Magrini
- Radiotherapy Department, Istituto del Radio di Brescia, University of Brescia, Brescia, Italy
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Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2013; 65:467-79. [PMID: 24321502 DOI: 10.1016/j.eururo.2013.11.002] [Citation(s) in RCA: 1009] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 11/01/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To present a summary of the 2013 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC). EVIDENCE ACQUISITION The working panel performed a literature review of the new data (2011-2013). The guidelines were updated, and levels of evidence and/or grades of recommendation were added to the text based on a systematic review of the literature that included a search of online databases and bibliographic reviews. EVIDENCE SYNTHESIS Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). LHRH antagonists decrease testosterone without any testosterone surge, and they may be associated with an oncologic benefit compared with LHRH analogues. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation results in noninferior oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir and after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT (SRT) at PSA levels <0.5 ng/ml and SRP or cryosurgical ablation of the prostate in radiation failures. Endorectal magnetic resonance imaging and 11C-choline positron emission tomography/computed tomography (PET/CT) are of limited importance if the PSA is <1.0 ng/ml; bone scans and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include analysis of PSA and testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Treatment of CRPC includes sipuleucel-T, abiraterone acetate plus prednisone (AA/P), or chemotherapy with docetaxel at 75mg/m(2) every 3 wk. Cabazitaxel, AA/P, enzalutamide, and radium-223 are available for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications. CONCLUSIONS The knowledge in the field of advanced, metastatic, and castration-resistant PCa is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. A full version is available at the EAU office or at www.uroweb.org. PATIENT SUMMARY We present a summary of the 2013 version of the European Association of Urology guidelines on treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC). Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). LHRH antagonists decrease testosterone without any testosterone surge, and they might be associated with an oncologic benefit compared with LHRH analogues. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation results in noninferior oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir and after radiation therapy. Therapy for PSA relapse after RP includes salvage radiation therapy at PSA levels <0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation failures. Multiparametric magnetic resonance imaging and 11C-choline positron emission tomography/computed tomography (PET/CT) are of limited importance if the PSA is <1.0 ng/ml; bone scans, and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include analysis of PSA and testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Treatment of castration-resistant CRPC includes sipuleucel-T, abiraterone acetate plus prednisone (AA/P), or chemotherapy with docetaxel 75 mg/m(2) every 3 wk. Cabazitaxel, AA/P, enzalutamide, and radium-223 are available for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications. The guidelines reported should be adhered to in daily routine to improve the quality of care in PCa patients. As we have shown recently, guideline compliance is only in the area of 30-40%.
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Affiliation(s)
| | | | - Joaquim Bellmunt
- Department of Medical Oncology, University Hospital Del Mar, Barcelona, Spain
| | - Michel Bolla
- Department of Radiation Therapy, CHU Grenoble, Grenoble, France
| | - Steven Joniau
- Department of Urology, University Hospital, Leuven, Belgium
| | | | - Malcolm Mason
- Department of Oncology and Palliative Medicine, Velindre Hospital, Cardiff, UK
| | - Vsevolod Matveev
- Department of Urology, Russian Academy of Medical Science, Cancer Research Center, Moscow, Russia
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Filiberto Zattoni
- Department of Urology, Santa Maria Della Misericordia Hospital, Udine, Italy
| | - Nicolas Mottet
- Department of Urology, University Hospital St Etienne, France
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