Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes

2018 ◽  
Vol 199 (1) ◽  
pp. 140-146 ◽  
Author(s):  
Silvia Garcia-Barreras ◽  
Rafael Sanchez-Salas ◽  
Arjun Sivaraman ◽  
Eric Barret ◽  
Fernando Secin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Comparative Analysis ◽  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Partial Gland Ablation

scholarly journals Treatment outcomes of 125I low-dose-rate brachytherapy vs radical prostatectomy for patients with intermediate-risk prostate cancer

2020 ◽  
Author(s):  
Zhien Zhou ◽  
Meiting He ◽  
Yi Zhou ◽  
Weigang Yan ◽  
Xingcheng Wu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Dose Rate ◽  
Low Dose ◽  
Intermediate Risk ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Low Dose Rate ◽  
Risk Prostate Cancer ◽  
Low Dose Rate Brachytherapy

Abstract Background: Radical prostatectomy (RP) and low-dose-rate brachytherapy (LDR) are two widely used treatment options for patients with intermediate-risk prostate cancer (IRPC). However, which one is better remains controversial. Therefore, the purpose of this study was to compare the efficacy of RP vs LDR for patients with IRPC. Methods: A retrospective analysis was performed on 361 IRPC patients who underwent treatment from January 2010 and August 2017. 160 underwent RP and 201 underwent LDR using Iodine-125. Biochemical failure for RP was defined as prostate-specific antigen (PSA) levels > 0.2 ng/ml, and for LDR as nadir PSA level + 2 ng/ml. The log-rank test compared biochemical relapse-free survival (bRFS) between the two modalities, and Cox regression identified factors associated with bRFS. Results: Median follow-up was 54 months for RP and 69 months for LDR. The 5-and 8-year bRFS rates were 70.2% and 63.1% in the RP group, and 83.2% and 68.9% in the LDR group, respectively, P=0.003. There were no significant differences in terms of clinical relapse-free survival (cRFS), cancer-specific survival (CSS) or overall survival (OS) between the two groups. Conclusion: LDR is a reasonable treatment option for IRPC patients, yielding improved bRFS and equivalent rates of cRFS, CSS and OS compared with RP.

Phase 2b trial results of padeliporfin (WST11 or Tookad) vascular-targeted photodynamic therapy for partial gland ablation in men with intermediate-risk prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17006-e17006
Author(s):  
Jonathan Coleman ◽  
Daniel D. Sjoberg ◽  
Quinlan Demac ◽  
Catriona ODea ◽  
Marlena McGill ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Primary Endpoint ◽  
Low Risk ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Function Score ◽  
Trus Biopsy ◽  
Risk Prostate Cancer ◽  
Partial Gland Ablation ◽  
Targeted Photodynamic Therapy

e17006 Background: Padeliporfin (WST11) vascular-targeted photodynamic therapy (VTP) has shown significant clinical benefit as a localized partial gland ablation (PGA) therapy when compared to active surveillance for low-risk prostate cancer, by curbing progression and the need for radical treatment, leading to its regulatory approval in Europe. This phase 2b trial prospectively investigated WST11-VTP for intermediate-risk cancers. Methods: Men with unilateral Grade Group 2 (GG2) cancers (Gleason 3+4), evaluated with MRI and ultrasound-guided (TRUS) biopsy, underwent up to two WST11-VTP PGA sessions. Eligibility criteria included <cT2b, PSA < 10, and fusion biopsy for PIRADS 3+ lesions on pretreatment MRI. Contralateral very low–risk disease was observed. The primary endpoint was prevalence of any Gleason Grade 4 or 5 (≥GG2) cancer, determined by MRI and systematic, 14-core TRUS biopsy of the entire gland (+/- fusion) at 3 and 12 months after treatment. Treatment safety and patient-reported quality of life for sexual and urinary function were assessed with validated questionnaires (IIEF-15 and IPSS, respectively). The study was powered using β = 0.2 to reject the null hypothesis (r≤70%), using a one-sided exact binomial test with 5% alpha risk. To be valid, 44 evaluable patients were required for the 12-month primary endpoint assessment. Results: Of the 50 men treated, 46 were evaluable for the 12-month primary endpoint. Before 12 months, 1 man proceeded to prostatectomy (treatment failure), 2 men refused 12-month biopsy, and 1 man died of COVID-19. At 3 months, 12/49 (24%) men underwent per protocol second WST11-VTP PGA session for GG2 tumor: 9 for residual cancer and 4 for newly identified contralateral GG2 tumors (1 bilateral). The 12-month biopsy was performed in 45 men; 38 (83%) had no Gleason grade 4 or 5 cancer, including 11/12 (92%) patients who underwent 2 PGA sessions. By 3 months, median decline in erectile function score (IIEF-5) from baseline was -1.0 (IQR -7,0). Median improvement in urinary function score (IPSS) was -1.0 (IQR -1,5), with pad-free continence observed in all patients. Median change in IIEF score by 12-months was -1.0 (IQR -5,0). Grade 3 treatment-related adverse events occurred in 6 (12%) patients. All procedure-related prostate/pelvic pain resolved by 3 weeks. Conclusions: The positive results from this trial show that WST11-VTP is effective for PGA of intermediate-risk prostate cancer, with minimal toxicity or impact on urinary and sexual function, consistent with the phase 3 trial results in low-risk disease. Based on these data, this therapy bears consideration for approval as a conservative therapeutic option for selected cases of intermediate-risk disease. Clinical trial information: NCT03315754.

Pathologic Outcomes of Gleason 6 Favorable Intermediate-Risk Prostate Cancer Treated With Radical Prostatectomy: Implications for Active Surveillance

2018 ◽  
Vol 16 (3) ◽  
pp. 226-234 ◽  
Author(s):  
David D. Yang ◽  
Brandon A. Mahal ◽  
Vinayak Muralidhar ◽  
Marie E. Vastola ◽  
Ninjin Boldbaatar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Intermediate Risk ◽  
Risk Prostate Cancer

A comparison of overall and cause-specific survival among patients with low- and intermediate-risk prostate cancer treated with brachytherapy, external beam radiotherapy, or radical prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5126-5126 ◽  
Author(s):  
J. P. Ciezki ◽  
C. A. Reddy ◽  
P. A. Kupelian ◽  
E. A. Klein ◽  
C. Robinson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
Smoking History ◽  
External Beam ◽  
Intermediate Risk ◽  
Charlson Score ◽  
Risk Of Death ◽  
Risk Prostate Cancer ◽  
Cause Specific Survival

5126 Background: The factors thought to influence overall survival (OS) and cause-specific survival (CSS) in patients treated for low and intermediate-risk prostate cancer (CaP) with brachytherapy (PI), external beam radiotherapy (RT), or radical prostatectomy (RP) were evaluated. Methods: From 1996 to 2003, 2285 patients with low or intermediate-risk CaP were treated at the Cleveland Clinic with either PI (n=662), RT (n=570), or RP (n=1053). Factors thought to influence OS and CSS were recorded. These factors included: Charlson score, age, socioeconomic status, race, body mass index (BMI), presence of coronary artery disease (CAD), presence of hypertension (HTN), presence of dyslipidemia (DL), initial prostate-specific antigen (iPSA), biopsy Gleason score (bGS), clinical stage, use of androgen deprivation (AD), AD duration, smoking history including pack-years, alcohol use, and cancer treatment modality (TX). Univariate and multivariate analyses were done using Cox proportional hazards regression. Results: The median follow-up is 59 months (range: 24–119 months). The 5- year OS rate is 96.0%, and the 8-year rate is 89.9%. Multivariate analysis revealed that Charlson score, age, smoking history, and TX were significantly associated with OS. Treatment with RT was independently associated with worse OS relative to PI and RP. CSS was grouped into 4 major categories: CAD, CaP, other cancer, and other. The only significant difference between these CSS categories and the treatment modalities was CaP. The percent of deaths due to CaP in the TX groups were: PI - 3.2%, RP - 9.7%, and RT - 24.5%. Conclusions: Charlson score, age, smoking history, and TX independently affect OS in patients treated for low and intermediate-risk CaP. The cause of the lower OS rate with RT may be related to an increased risk of death due to CaP. [Table: see text] No significant financial relationships to disclose.

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