The effect of maximum tumor diameter by MRI on disease control in intermediate and high-risk prostate cancer patients treated with brachytherapy boost

2021 ◽  
Author(s):  
Matthew W. Parsons ◽  
Ryan J. Hutten ◽  
Alexander Tward ◽  
Ashley Khouri ◽  
John Peterson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Disease Control ◽  
Cancer Patients ◽  
Tumor Diameter ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost ◽  
Maximum Tumor Diameter

The effect of maximum tumor diameter on disease control in intermediate and high-risk prostate cancer patients treated with brachytherapy boost.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 252-252
Author(s):  
Matthew Parsons ◽  
Ryan Hutten ◽  
Ashley Khouri ◽  
Alexander Tward ◽  
Glen Morrell ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Prognostic Factor ◽  
Interquartile Range ◽  
Tumor Diameter ◽  
T Stage ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost ◽  
Maximum Tumor Diameter

252 Background: Larger maximum tumor diameter (MTD) has been associated with worse prostate cancer outcomes for those undergoing surgery as well as salvage radiation. MTD is also an important consideration for patients weighing active surveillance. However, the impact of MTD in intermediate and high-risk prostate cancer treated with external beam radiotherapy (EBRT) and brachytherapy boost is unknown. We set out to evaluate MTD of the dominant nodule on MRI as a prognostic factor in patients treated with EBRT and brachytherapy boost for localized prostate cancer. Methods: Patients with prostate cancer treated with EBRT and brachytherapy boost were identified from an institutional database. In patients with a pretreatment MRI, data on MTD were retrospectively collected. Clinical data including age, ADT use, pretreatment PSA, International Society of Urologic Pathology (ISUP) group, clinical T-stage, and presence of adverse pathology on imaging (either seminal vesicle invasion or extraprostatic extension) were also collected. Multivariable and univariable cox proportional hazards models for biochemical failure (BF) and distant metastasis (DM) were produced in patients with MTD grouped by receiver operating characteristic (ROC) cutpoint. Cumulative hazard functions for BF and DM were compared with log-rank test and stratified by ISUP group. Results: Of 191 patients treated with EBRT and brachytherapy boost, 113 had pretreatment MRI and available MTD measurement. Median follow up was 40 months (interquartile range 23-66 months) and median MTD was 17 mm (interquartile range 13-22mm). Increasing MTD was associated with higher T stage and increased ADT use. ROC cutpoint optimization identified MTD of 24mm to be the optimal cut-point for both BF and DM. On univariate log-rank analysis, patients with MTD > 24mm had higher 5-year BF (31% vs 4%, p = 0.004) and DM (21% vs 4%, p = 0.002) than those with MTD≤24. Stepwise multivariable cox model for BF (P = 0.130, HR 1.08, 95% CI 0.98-1.21) and DM (P = 0.115, HR 1.09, 95% CI 0.98-1.23), MTD did not demonstrate statistical significance when controlling for clinical t-stage, adverse pathologic features on imaging, ISUP group, and ADT use. However, in patients with ISUP group 4-5 disease, MTD > 24 was independently associated with increased risk of DM (P = 0.032, HR 1.18, 95% CI 1.01-1.37). Conclusions: This is the first study to evaluate MTD on MRI as a prognostic factor in the setting of brachytherapy boost. These results demonstrate that for patients treated with EBRT and brachytherapy boost, MTD is independently associated with risk for metastasis in patients with ISUP grade 4 and 5 disease. Although these results require further validation, this suggests a possible role for MTD as a factor in risk assessment models and clinical decision-making.

Stereotactic pelvic radiotherapy with HDR boost for dose escalation in intermediate and high-risk prostate cancer (SPARE): Efficacy, survival, and late toxicity outcomes.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 328-328
Author(s):  
Andrew Loblaw ◽  
Bindu Musunuru ◽  
Patrick Cheung ◽  
Danny Vesprini ◽  
Stanley K. Liu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Treatment Protocol ◽  
Late Toxicity ◽  
Hdr Brachytherapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost

328 Background: The ASCO/CCO guidelines recommend brachytherapy boost for all eligible intermediate- or high-risk localized prostate cancer patients. We present efficacy, survival and late toxicity outcomes in patients treated on a prospective, single institutional protocol of MRI dose painted HDR brachytherapy boost (HDR-BT) followed by pelvic stereotactic body radiotherapy (SBRT) and androgen deprivation therapy (ADT). Methods: A phase I/II study was performed where intermediate (IR) or high-risk (HR) prostate cancer patients received HDR-BT 15Gy x 1 to the prostate and up to 22.5Gy to the MRI nodule and followed by gantry-based SBRT 25Gy in 5 weekly fractions delivered to pelvis, seminal vesicles and prostate. ADT was used for 6-18 months. CTCAEv3 was used to assess toxicities and was captured q6months x 5 years. Biochemical failure (BF; nadir + 2 definition), nadir PSA, proportion of patients with PSA < 0.4 ng/ml at 4 years (4yPSARR), incidence of salvage therapy, cause specific survival and overall survival were calculated. Day 0 was HDR-BT date for all time-to-event analyses. Results: Thirty-two patients (NCCN 3% favorable IR, 47% unfavorable IR and 50% HR) completed the planned treatment with a median follow-up of 50 months; 31 of these had an MRI nodule. Four patients had BF with actuarial 4-year BF rate of 11.5%; 3 of these received salvage ADT. Median nPSA was 0.02 ng/ml; 4yPSARR was 68.8%. One patient died (of prostate cancer) at 45 months. For late toxicities, grade 1, 2 and 3+ GU and GI toxicities were: 40.6%, 37.5%, 3% and 28.1%, 0%, 0%, respectively. Conclusions: This novel treatment protocol incorporating MRI-dose painted HDR brachytherapy boost and SBRT pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible, effective and well tolerated. Clinical trial information: 12345678. [Table: see text]

390: Durable Cancer Control in High Risk Prostate Cancer Patients Treated with Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 130-130
Author(s):  
Markus Graefen ◽  
Jochen Walz ◽  
Andrea Gallina ◽  
Felix K.-H. Chun ◽  
Alwyn M. Reuther ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Cancer Control ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

820: Adjuvant Weekly Docetaxel for High-Risk Prostate Cancer Patients after Radical Prostatectomy

2005 ◽  
Vol 173 (4S) ◽  
pp. 222-222 ◽  
Author(s):  
Adam S. Kibel ◽  
Joel Picus ◽  
Michael S. Cookson ◽  
Bruce Roth ◽  
David F. Jarrard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Weekly Docetaxel ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals 11C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management - a retrospective study

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Sara Strandberg ◽  
Camilla Thellenberg Karlsson ◽  
Torbjörn Sundström ◽  
Mattias Ögren ◽  
Margareta Ögren ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Retrospective Study ◽  
High Risk ◽  
Disease Management ◽  
Cancer Patients ◽  
Lymph Node Staging ◽  
High Risk Prostate Cancer ◽  
Pet Ct ◽  
Risk Prostate Cancer
Sign in / Sign up

Export Citation Format

Share Document