scholarly journals Endogenous testosterone density as ratio of endogenous testosterone levels on prostate volume predicts tumor upgrading in low-risk prostate cancer

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Sebastian Gallina ◽  
Alberto Bianchi ◽  
Clara Cerrato ◽  
Alessandro Tafuri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Low Risk ◽  
Surgical Specimen ◽  
Prostate Specific Antigen Density ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Tumor Load ◽  
Risk Patients

Abstract Objectives To evaluate preoperative endogenous testosterone (ET) density (ETD), defined as the ratio of ET on prostate volume, and tumor upgrading risk in low-risk prostate cancer (PCa). Materials and methods From November 2014 to December 2019, 172 low-risk patients had ET (nmol/L) measured. ETD, prostate-specific antigen density (PSAD) and the ratio of percentage of biopsy positive cores (BPC) to prostate volume (PV), defined as BPC density (BPCD), were evaluated. Associations with tumor upgrading in the surgical specimen were assessed by statistical methods. Results Overall, 121 patients (70.3%) had tumor upgrading, which was predicted by BPCD (odds ratio, OR = 4.640; 95% CI 1.903–11.316; p = 0.001; overall accuracy: 70.3%). On multivariate analysis, tumor upgrading and clinical density factors related to each other for BPCD being predicted by ETD (regression coefficient, b = 0.032; 95% CI 0.021–0.043; p < 0.0001), PSAD (b = 1.962; 95% CI 1.067–2.586; p < 0.0001) and tumor upgrading (b = 0.259; 95% CI 0.112–0.406; p = 0.001). According to the model, as BPCD increased, ETD and PSAD increased, but the increase was higher for upgraded cases who showed either higher tumor load but significantly lower mean levels of either ET or PSA. Conclusions As ETD increased, higher tumor loads were assessed; however, in upgraded patients, lower ET was also detected. ETD might stratify low-risk disease for tumor upgrading features.

Lifelong Yearly Prostate Specific Antigen Surveillance is Not Necessary for Low Risk Prostate Cancer Treated With Radical Prostatectomy

2010 ◽  
Vol 184 (3) ◽  
pp. 925-929 ◽  
Author(s):  
Matthew K. Tollefson ◽  
Michael L. Blute ◽  
Laureano J. Rangel ◽  
R. Jeffrey Karnes ◽  
Igor Frank
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Differences among Men on Active Surveillance for Very Low-Risk Prostate Cancer Detected Through Population-Based versus Opportunistic Prostate-Specific Antigen-Screening

2015 ◽  
Vol 94 (3) ◽  
pp. 330-336
Author(s):  
Marco Randazzo ◽  
Josef Beatrice ◽  
Andreas Huber ◽  
Rainer Grobholz ◽  
Lukas Manka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Screening Program ◽  
Specific Antigen ◽  
Population Based ◽  
Low Risk ◽  
Cox Regression Analysis ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Introduction: Very low-risk prostate cancer (PCa) is being increasingly managed by active surveillance (AS). Our aim was to assess the influence of the origin of diagnosis on PCa characteristics and treatment rates among men with very low-risk PCa in our prospective AS cohort. Methods: Overall, 191 men with very low-risk PCa fulfilling Epstein-criteria underwent protocol-based AS. These men originated either from the prospective population-based screening program (P-AS) or were diagnosed by opportunistic screening (O-AS). Results: Overall, n = 86 (45.0%) originated from the P-AS group, whereas n = 105 (55.0%) from the O-AS group. On univariate Cox regression analysis, age (HR 0.96, 95% CI 0.92-1.00; p = 0.05), origin of diagnosis (HR 0.72, 95% CI 0.41-1.28; p = 0.001), number of positive cores (HR 2.15, 95% CI 1.18-3.90; p = 0.01) and maximum core involvement (HR 1.03, 95% CI 0.99-1.05; p = 0.05) were predictors for treatment necessity. On multivariate analysis, age (HR 0.95, 95% CI 0.89-0.99; p = 0.05), number of positive cores (HR 2.07, 95% CI 1.10-3.88; p = 0.02), maximum core involvement (HR 1.03, 95% CI 1.00-1.06; p = 0.04) but not origin of diagnosis were independent predictors for treatment necessity. Four men developed biochemical recurrence (all from O-AS group [p = 0.05]). Conclusion: The origin of PCa diagnosis in men undergoing AS had no influence on disease progression and treatment necessity.

Prostate brachytherapy post implant dosimetry: Timing matters

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14597-14597
Author(s):  
K. J. Minehan ◽  
K. Furutani ◽  
K. McNamara ◽  
D. Groshek ◽  
E. Mitchell ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Low Risk ◽  
Prostate Brachytherapy ◽  
Planning Software ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Prescription Dose ◽  
Axial Ct

14597 Background: Permanent seed implant (PSI) brachytherapy is a common treatment modality for low-risk prostate cancer. Post implant dosimetry (PID) is utilized to asses the quality of the implant. Significant prostate swelling occurs as a result of the implant procedure, and this swelling subsides over time. PID completed on Day 0 after the implant procedure captures the prostate swelling from the procedure. Conversely, PID completed one month later does not have this swelling. PID can therefore show great variation, depending on the timing of the analysis. It is hypothesized that PID completed on Day 0 demonstrates lower dosimetric parameters than PID completed one month later. Methods: Thirteen low risk prostate cancer patients, (Stage ≤ T2, PSA < 13.9, Gleason Score ≤7) were implanted with 125Iodine seeds, with a prescription dose of 145Gy to the prostate plus a 5mm margin. Computed Tomography (CT) PID was completed for each patient on day 0 and on average 33 days following the implant. The prostate was contoured on each axial CT image and the data was analyzed using commercially available PSI planning software. The dose which encompassed 90% of the prostate volume (D90) was calculated for day 0 and day 33 PID. Results: On average, the prostate volume contoured was larger on day 0 PID (Avg. 44.9 cc; range 19–97 cc) compared to day 33 PID (Avg. 38.9 cc; range 18–59 cc) (P = 0.068). The D90 values however, were significantly higher on day 33 PID (Avg.163.7 Gy; range 125–212 Gy) than on day 0 PID (Avg.149 Gy; range 112–166 Gy) (P = 0.003). This D90 relationship was even demonstrated paradoxically in two patients whose contoured prostate volume was larger on the day 33 PID as compared to the day 0 PID. Conclusions: Timing does matter in the analysis of post implant dosimetry for PSI brachytherapy. The D90 values were significantly greater on day 33 PID compared to Day 0 PID while the contoured prostate volumes were not. Future studies which use PID planning to evaluate implant quality should specify the timing of the PID, as this would facilitate cross study comparison. No significant financial relationships to disclose.

Overtreatment of low-risk prostate cancer in the United States: Incidence, cost, complications, and implications for the screening debate.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Ayal A. Aizer ◽  
Xiangmei Gu ◽  
Toni K. Choueiri ◽  
Neil E. Martin ◽  
Jim C. Hu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Life Expectancy ◽  
Specific Antigen ◽  
Expectant Management ◽  
The United States ◽  
Low Risk ◽  
Definitive Treatment ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

161 Background: The National Comprehensive Cancer Network (NCCN) recommends active surveillance as the sole option for men with low-risk prostate cancer (LRPC) and a life expectancy <10 years. We sought to describe the incidence, risk factors, cost, and morbidity related to overtreatment of LRPC within the United States. Methods: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare Program to identify 11,744 men ≥66 years with LRPC diagnosed from 2004-2007. Expected survival was estimated using the 2007 Social Security Life Table and was increased and decreased by 50% in men in the upper and lower quartiles of comorbidity, respectively, as specified by the NCCN. Overtreatment was definitive treatment in men with LRPC and life expectancy <10 years. Costs were the amount paid by Medicare in the year following minus the year prior to diagnosis. Toxicities were defined as relevant Medicare diagnoses or interventions. Results: Of 3001 men with LRPC and a life expectancy <10 years, 2011 (67%) were treated definitively. On multivariable logistic regression, men overtreated for prostate cancer were more likely to be younger (p<.001), white (vs black, OR 1.44, 95% CI 1.03-2.02, p=.03), married (OR 1.30, 95% CI 1.05-1.61, p=.02), urban (trend, OR 1.40, 95% CI 0.98-2.00, p=.06), have higher Elixhauser comorbidity (p<.001), and have a higher clinical stage (T2 vs T1, OR 1.57, 95% CI 1.19-2.07, p=.001) and prostate-specific antigen level (OR 1.02, 95% CI 1.02-1.02, p<.001). Relative to expectant management, the mean added cost per definitive treatment was $15,308. When extrapolated nationally the cumulative net cost of overtreatment in men ≥66 years is $32 million per annum. Long-term urinary, erectile, and bowel toxicity occurred in 59.2% and 50.0%, 47.9% and 19.7%, and 7.1% and 17.8% of prostatectomy and radiation patients, respectively. Conclusions: Overtreatment of prostate cancer is partially driven by sociodemographic factors and occurs in a high percentage of men with LRPC and limited life expectancy, with marked impact on patient quality of life and health care costs. Efforts to enhance appropriate management of LRPC would reduce the harms associated with screening.

scholarly journals Radiotherapeutic Strategies in the Management of Low-Risk Prostate Cancer

2010 ◽  
Vol 10 ◽  
pp. 1854-1869 ◽  
Author(s):  
Kevin S. Choe ◽  
Stanley L. Liauw
Keyword(s):  
Prostate Cancer ◽  
Tumor Imaging ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
The United States ◽  
Low Risk ◽  
Image Guided Radiotherapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Prostate cancer is the most common nonskin malignancy among men in the United States. Since the introduction of screening with prostate-specific antigen (PSA), most patients are being diagnosed at an early stage with low-risk disease. For men with low-risk prostate cancer, there exists an array of radiotherapeutic strategies that are effective and well tolerated, such as external-beam radiotherapy and brachytherapy. In recent years, there have been tremendous advances in the field of radiation oncology that have transformed the way radiation is used to treat prostate cancer, such as intensity-modulated radiotherapy, image-guided radiotherapy, and stereotactic radiotherapy. It is now feasible to deliver high doses of radiation to the target volume with improved precision and spare more of the neighboring tissues from potentially damaging radiation. Disease outcomes are generally excellent in low-risk prostate cancer. Improvements are expected with further integration of innovative technologies in radiation delivery, tumor imaging, and target localization.

scholarly journals The Changing Face of Low-Risk Prostate Cancer: Trends in Clinical Presentation and Primary Management

2004 ◽  
Vol 22 (11) ◽  
pp. 2141-2149 ◽  
Author(s):  
Matthew R. Cooperberg ◽  
Deborah P. Lubeck ◽  
Maxwell V. Meng ◽  
Shilpa S. Mehta ◽  
Peter R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Presentation ◽  
External Beam Radiotherapy ◽  
Temporal Trends ◽  
Specific Antigen ◽  
Low Risk ◽  
Tumor Characteristics ◽  
Term Survival ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Purpose Early intervention for prostate cancer is associated with excellent long-term survival, but many affected men, especially those with low-risk disease characteristics, might not experience adverse impact to survival or quality of life were treatment deferred. We sought to characterize temporal trends in clinical presentation and primary disease management among patients with low-risk prostate cancer. Methods Data were abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a disease registry of 8,685 men with various stages of prostate cancer. Included were 2,078 men who were diagnosed between 1989 and 2001 and had a serum prostate specific antigen ≤ 10 ng/mL, Gleason sum ≤ 6, and clinical T stage ≤ 2a. Trends in risk distribution, tumor characteristics, and primary treatment were evaluated. Results The proportion of patients with low-risk tumor characteristics rose from 29.8% in 1989 to 1992, to 45.3% in 1999 to 2001 (P < .0001). There have been sharp increases in the use of brachytherapy and androgen deprivation monotherapy, from 3.1% and 3.1%, to 12.0% and 21.7%, respectively. Utilization rates for prostatectomy, external-beam radiotherapy, and observation have fallen accordingly, from 63.8%, 16.1%, and 13.8%, to 51.6%, 6.8%, and 7.9% (P < .0001 for all except prostatectomy [P = .0019]). Age and socioeconomic status were significantly associated with treatment selection, but overall, the treatment trends were echoed on subgroup analysis of patients 75 years or older. Conclusion Low-risk features characterize a growing proportion of prostate cancer patients, and there have been significant shifts in the management of low-risk disease. Overtreatment may be a growing problem, especially among older patients.

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