Validation of the Combination Gleason Score as an Independent Favorable Prognostic Factor in GS 7-10 Prostate Cancer Treated With Dose-Escalated Radiation Therapy

2015 ◽  
Vol 93 (3) ◽  
pp. E190
Author(s):  
D.R. Wahl ◽  
A. McNamara ◽  
W.C. Jackson ◽  
J. Chan ◽  
F.Y. Feng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Prognostic Factor ◽  
Gleason Score ◽  
Favorable Prognostic Factor

Machine learning-based radiomic models to predict intensity-modulated radiation therapy response, Gleason score and stage in prostate cancer

2019 ◽  
Vol 124 (6) ◽  
pp. 555-567 ◽  
Author(s):  
Hamid Abdollahi ◽  
Bahram Mofid ◽  
Isaac Shiri ◽  
Abolfazl Razzaghdoust ◽  
Afshin Saadipoor ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Machine Learning ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Intensity Modulated Radiation Therapy ◽  
Therapy Response ◽  
Intensity Modulated

scholarly journals Achieving PSA < 0.2 ng/ml before Radiation Therapy Is a Strong Predictor of Treatment Success in Patients with High-Risk Locally Advanced Prostate Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Akira Kazama ◽  
Toshihiro Saito ◽  
Keisuke Takeda ◽  
Kazuhiro Kobayashi ◽  
Toshiki Tanikawa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Treatment Outcome ◽  
High Risk ◽  
Gleason Score ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Locally Advanced Prostate Cancer ◽  
T Stage

Background. To predict long-term treatment outcome of radiation therapy (RT) plus androgen deprivation therapy (ADT) for high-risk locally advanced prostate cancer. Methods. In total, 204 patients with the National Comprehensive Cancer Network (NCCN) high risk locally advanced prostate cancer (PSA > 20 ng/ml, Gleason score ≧ 8, clinical T stage ≧ 3a) were treated with definitive RT with ADT. Median follow up period was 113 months (IQR: 95–128). Median neoadjuvant ADT and total ADT duration were 7 months (IQR: 6–10) and 27 months (IQR: 14–38), respectively. Results. PSA recurrence-free survival (PSA-RFS), cancer specific survival (CSS), and overall survival (OS) rates at 5 years were 84.1%, 98.5%, and 93.6%, respectively, and 67.9%, 91.2%, and 78.1%, respectively, at 10 years. Pre-RT PSA less than 0.2 ng/ml was associated with superior outcomes of PSA-RFS (HR = 0.42, 95% CI: 0.25–0.70, p=0.001), CSS (HR = 0.27, 95% CI: 0.09–0.82, p=0.013), and OS (HR = 0.48, 95% CI: 0.26–0.91, p=0.021). On multivariate analysis, age (≥70 y.o.) and pre-RT PSA (≥0.2 ng/ml) were factors predictive of poorer OS (p=0.032) , but iPSA, T stage, Gleason score, number of NCCN high-risk criteria, a combination with anti-androgen therapy and neoadjuvant ADT duration were not predictive of treatment outcome. Conclusion. In patient with high-risk prostate cancer, RT plus ADT achieved good oncologic outcomes. PSA < 0.2 ng/ml before radiation therapy is a strong independent predictor for long overall survival.

Prognostic risk factors to predict final pathohistology in patients undergoing radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15544-15544
Author(s):  
D. Pfister ◽  
C. Ohlmann ◽  
D. Sahi ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Curative Intent ◽  
Ldr Brachytherapy ◽  
Pet Ct ◽  
The Mean ◽  
Locally Recurrent ◽  
Biopsy Gleason Score

15544 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized prostate cancer (PCA). Currently, there are very few studies correlating preoperative clinical and pathohistological variables with final pathohistology of sRPE specimens. It was the purpose of our study to identify prognosticators predicting organ confined and locally advanced PCA. Methods: 45 patients with biopsy-proven locally recurrent PCA underwent sRPE and extended pelvic lymphadenectomy (epLA) via a retropubic approach. Preoperative PSA, PSA doubling time, PSA prior to initial radiation therapy, biopsy Gleason score, number of positive biopsies, cT stage, 11choline PET/CT findings, type of radiation therapy, neoadjuvant androgen deprivation were correlated with the pathohistological stage by uni- and multivariate analysis. Results: A total of 45 patients underwent sRPE and epLA; 16 (35.5%), 12 (26.6%) and 17 (37.8%) patients had undergone external beam radiation (EBRT), HDR and LDR brachytherapy, resp. The mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). We did not encounter significant intraoperative compliations, the mean blood loss was 490 (200–950) ml. A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. By multivariate analysis the parameters significantly associated with organ confined PCA sRPE are PSADT > 12 months, = 50% positive biopsy cores, biopsy Gleason score = 7 and previous LDR brachytherapy (pT1–2pN0R0 in all men); pre-radiation and preoperative PSA, PET/CT findings had no significant impact with final pTpN-stage. Conclusions: SRPE can be performed with a low morbidity in biopsy proven locally recurrent PCA after radiotherapy. The identified prognostic parameters will help to select patients most suitable for a local secondary surgical approach with curative intent. Especially in patients with local relapse following LDR brachytherapy sRPE represents a valuable treatment option. No significant financial relationships to disclose.

Cancer-specific survival following radical prostatectomy or radiation therapy and short course hormonal therapy in men with localized, unfavorable-risk prostate cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4572-4572
Author(s):  
H. K. Tsai ◽  
M. Chen ◽  
D. G. McLeod ◽  
P. R. Carroll ◽  
J. P. Richie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Initial Therapy ◽  
External Beam Radiation ◽  
Short Course ◽  
Psa Failure ◽  
Risk Prostate Cancer

4572 Background: We estimated prostate cancer-specific mortality (PCSM) rates following radical prostatectomy (RP) or external beam radiation therapy (RT) and 6 months of androgen suppression therapy (AST) in men with unfavorable-risk prostate cancer. Methods: Between 1981 and 2002, 3,240 men with intermediate- (T2b or Gleason score 7 or prostate-specific antigen (PSA) > 10 to 20 ng/mL) or high-risk (T2c or Gleason score 8 to 10 or PSA > 20 ng/mL) prostate cancer were treated with RP (n = 2,690) or RT+AST (n = 550) and comprised the study cohort. If PSA failure occurred, defined by a postoperative PSA level > 0.2 ng/mL and rising or by the ASTRO definition following RT+AST, then men received salvage RT or life-long AST, respectively. Life-long AST was initiated if PSA failure occurred after salvage RT. Imaging of the pelvis and skeleton was negative for metastases at the time of any salvage therapy. Gray’s formulation was used to compare the cumulative incidence estimates of PCSM and to calculate the adjusted hazard ratios (HR) and associated 95% confidence intervals for initial treatment and known prognostic factors. Results: After a median follow-up time for living patients of 4.5 and 4.2 years for the RP and RT+AST cohorts, respectively, there were no significant differences in the estimates of PCSM following RP or RT+AST in men with intermediate- (p = 0.44) or high-risk (p = 0.26) disease. As shown in the Table , after adjusting for PSA level, Gleason score, and T-category, initial therapy was not significantly associated with PCSM for men with intermediate- (HR: 1.2 [95% CI: 0.3, 4.3]; p = 0.78) or high-risk (HR: 1.2 [95% CI: 0.5, 2.8]; p = 0.62) disease. Conclusion: Men with localized, unfavorable-risk prostate cancer who receive RT and short course AST as initial therapy appear to have similar PCSM rates as men who undergo initial RP followed by salvage RT and life-long AST after first and second PSA failure, respectively. [Table: see text] No significant financial relationships to disclose.

Variation in local treatment of prostate cancer by hospital within New Jersey

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14551-14551
Author(s):  
T. R. Blom ◽  
R. A. Somer ◽  
W. Shih ◽  
M. Sarno ◽  
D. McNally ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
New Jersey ◽  
Gleason Score ◽  
Local Treatment ◽  
Local Therapy ◽  
Geographic Region ◽  
Diagnosis And Treatment ◽  
Multivariate Logistic Regression Model

14551 Background: Although prostate cancer diagnosis and treatment vary through the US, few studies have assessed variations in local therapy between multiple hospitals located within a very narrow geographic region. Methods: To determine the variation of diagnosis and treatment of prostate cancer between hospitals in a local region, data was derived and analyzed from 1,301 patients from fifteen Cancer Institute of New Jersey Oncology Group network hospitals. Tumor registry data from patients with a histological confirmed diagnosis of prostate cancer accessioned over a one-year period between January 1, 2003 and December 31, 2003 was analyzed by a multivariate logistic regression model. Results: Median age of the cohort was 66 and mean number of cases diagnosed at these hospitals for this period was 87 (26–161). When the cohort was assessed overall, 192 cases assessed were African American, 1049 Caucasian, 51 Hispanic, and 32 Asian. Median Gleason score was 6. A total of 463 patients underwent Prostatectomy, and 538 had radiation therapy. Multivariate analysis demonstrated that age and hospital were associated with use of surgery versus no surgery. Race and Gleason score were not associated with use of surgery in this group of hospitals. Multivariate analysis also demonstrated that age and hospital were associated with utilizing radiation therapy versus not utilizing radiation therapy. Again, race and Gleason score were not associated with utilization of radiation therapy in these NJ hospitals. Conclusions: Overall, the most important factors predicting for surgery, and radiation therapy, were age and hospital, which were independent of race and Gleason score. These data support our ongoing assessment of hospital and geographic characteristics that may be responsible for these associations. No significant financial relationships to disclose.

Radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 47-47 ◽  
Author(s):  
Axel Heidenreich ◽  
Daniel Porres-Knoblauch ◽  
Robin Epplen ◽  
Charlotte Piper ◽  
David J. K. P. Pfister ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Functional Outcome ◽  
Gleason Score ◽  
Selection Process ◽  
Locally Advanced ◽  
Local Treatment ◽  
Curative Intent ◽  
Locally Recurrent ◽  
Biopsy Gleason Score

47 Background: Radical salvage prostatectomy (SRP) is one local treatment option with curative intent in patients failing radiation therapy (RT) for localized prostate cancer (PCA). We compared the surgical, histological and functional outcome of a large cohort of patients who underwent SRP for locally recurrent PCA following LDR – brachytherapy (BRT). Methods: 66 consecutive patients with locally recurrent PCA after BRT underwent retropubic SRP and pelvic lymphadenectomy. Preoperative PSA, PSA doubling time, PSA prior to initial RT, biopsy Gleason score, number of positive biopsies, cT stage, neoadjuvant androgen deprivation were correlated with pathohistological stage, complications and functional outcome by uni- and multivariate analysis. Results: Mean preop. PSA was 5.6 (2-13.5) ng/ml; mean preoperative biopsy Gleason score was y5.6 (4-9). 1 patient (1.5%) experienced a rectal lesion, mean blood loss was 430 (200-900) ml, none of the patients received blood transfusions. Pathohistology demonstrated organ confined prostate cancer pT2a-2c in 38 (57.5%) patients, stage pT3a and stage pT3b was identified in 14 (21.1%) patients and in 14 (21.1%) patients, respectively. Positive surgical margins were diagnosed in 9 (13.6%) patients and 12 (15.1%) patients harboured lymph node metastases. Functional outcome was good with a continence rate of 82%; the mean time until recovery of continence was 8.4 (6-14) months. After a mean follow-up of 22.5 (1-72) months, 28% of the patients experienced a PSA relapse defined as any PSA increase > 0.2 ng/ml validated by 2 consecutive measures. Conclusions: SRP can be performed safely and with a low morbidity in biopsy proven locally recurrent PCA following BRT. However, our data demonstrate an unfavourable histology with locally advanced disease in about 40% of the patients who all were diagnosed with low risk prostate cancer. These data question the quality of the selection process for patients being counselled for BRT and the data raise the possibility of both intrinsic radioresistance of prostate cancer or poorly performed BRT.

PSA levels, PSA doubling time, Gleason score and prior therapy cannot predict measured uptake of [68Ga]PSMA-HBED-CC lesion uptake in recurrent/metastatic prostate cancer

2017 ◽  
Vol 56 (06) ◽  
pp. 225-232 ◽  
Author(s):  
David Pfister ◽  
Natascha Drude ◽  
Felix Mottaghy ◽  
Florian Behrendt ◽  
Frederik Verburg
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Doubling Time ◽  
Lesion Size ◽  
Tracer Uptake ◽  
Androgen Deprivation ◽  
Pet Ct

SummaryAim: To assess whether clinical prostate cancer (PCA) related factors and therapy status can predict the degree of tracer uptake on [68Ga]PSMA-HBED-CC PET/CT.Materials & methods: We retrospectively studied 124 patients with recurrent an/or metastatic PCA who underwent [68Ga]PSMAHBED-CC PET/CT. The maximum standardized uptake value (SUVmax) was determined in the prostate bed as well as in three size categories (≤ 5 mm, > 5–15 mm, > 15 mm) in pelvic lymph node, extrapelvic lymph node, bone and visceral metastases.Results: Significant positive correlations between lesion size and SUVmax were found in pelvic lymph node metastases > 5 -≤15 mm (Spearmans rho = 0.502, p = 0.002) as well as in extrapelvic lymph node metastases5 mm (rho = 0.314, p = 0.033) and > 5 ≤-15 mm (rho = 0.614, p < 0.001). SUVmax tended to be higher in the largest diameter category in each anatomic station than in the middle and lower categories. We were unable to find evidence for a relationship between SUVmax and PSA, PSAdt, Gleason score, androgen deprivation therapy, radiation therapy or chemotherapy status.Conclusion: Measured tracer uptake in [68Ga]PSMA-HBED-CC PET/CT in patients with recurrent/metastasized prostate cancer is significantly influenced by lesion size as a result of partial volume effects in the very small lesions. Clinical indicators of aggressive prostate cancer behaviour such as PSA levels, PSA doubling time or the Gleason score of the primary tumour, as well as the androgen deprivation therapy, radiation therapy or chemotherapy status are not related to measured tracer uptake.

Ten-Year Follow-Up of Radiation Therapy Oncology Group Protocol 92-02: A Phase III Trial of the Duration of Elective Androgen Deprivation in Locally Advanced Prostate Cancer

2008 ◽  
Vol 26 (15) ◽  
pp. 2497-2504 ◽  
Author(s):  
Eric M. Horwitz ◽  
Kyounghwa Bae ◽  
Gerald E. Hanks ◽  
Arthur Porter ◽  
David J. Grignon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Locally Advanced Prostate Cancer ◽  
End Points

PurposeTo determine whether adding 2 years of androgen-deprivation therapy (ADT) improved outcome for patients electively treated with ADT before and during radiation therapy (RT).Patients and MethodsProstate cancer patients with T2c-T4 prostate cancer with no extra pelvic lymph node involvement and prostate-specific antigen (PSA) less than 150 ng/mL were included. All patients received 4 months of goserelin and flutamide before and during RT. They were randomized to no further ADT (short-term ADT [STAD] + RT) or 24 months of goserelin (long-term ADT [LTAD] + RT). A total of 1,554 patients were entered. RT was 45 Gy to the pelvic nodes and 65 to 70 Gy to the prostate. Median follow-up of all survival patients is 11.31 and 11.27 years for the two arms.ResultsAt 10 years, the LTAD + RT group showed significant improvement over the STAD + RT group for all end points except overall survival: disease-free survival (13.2% v 22.5%; P < .0001), disease-specific survival (83.9% v 88.7%; P = .0042), local progression (22.2% v 12.3%; P < .0001), distant metastasis (22.8% v 14.8%; P < .0001), biochemical failure (68.1% v 51.9%; P ≤ .0001), and overall survival (51.6% v 53.9%, P = .36). One subgroup analyzed consisted of all cancers with a Gleason score of 8 to 10 cancers. An overall survival difference was observed (31.9% v 45.1%; P = .0061), as well as in all other end points herein.ConclusionLTAD as delivered in this study for the treatment of locally advanced prostate cancer is superior to STAD for all end points except survival. A survival advantage for LTAD + RT in the treatment of locally advanced tumors with a Gleason score of 8 to 10 suggests that this should be the standard of treatment for these high-risk patients.

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