Radical Prostatectomy for High-risk Prostate Cancer Defined by Preoperative Criteria: Oncologic Follow-up in National Multicenter Study in 813 Patients and Assessment of Easy-to-use Prognostic Substratification

Urology ◽  
2011 ◽  
Vol 78 (3) ◽  
pp. 607-613 ◽  
Author(s):  
Guillaume Ploussard ◽  
Alexandra Masson-Lecomte ◽  
Jean-Baptiste Beauval ◽  
Adil Ouzzane ◽  
Romain Bonniol ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Multicenter Study ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes and complications

2019 ◽  
Author(s):  
Young Suk Suk Kwon ◽  
Wei Wang ◽  
Arnav Srivast ◽  
Thomas L Jang ◽  
Singer A Eric ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Study Cohort ◽  
High Risk Prostate Cancer ◽  
Pathologic Features ◽  
Risk Prostate Cancer

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

1488 TESTOSTERONE REPLACEMENT THERAPY IN PATIENTS WITH HIGH RISK PROSTATE CANCER AFTER RADICAL PROSTATECTOMY LONG-TERM FOLLOW-UP

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Alexander W. Pastuszak ◽  
Amy M. Pearlman ◽  
Kumaran Sathyamoorthy ◽  
Joceline S. Liu ◽  
Larry I. Lipshultz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Replacement Therapy ◽  
Testosterone Replacement Therapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Long Term Follow Up

scholarly journals Long term outcomes between adjuvant radiotherapy and combined radiotherapy with hormonal treatment after radical prostatectomy in high risk prostate cancer

2021 ◽  
Vol 42 (1) ◽  
pp. 7-12
Author(s):  
Chalermchai Kiatbamrungpunt, ◽  
◽  
Chaiyong Nualyong ◽  
Sittiporn Srinualnad ◽  
Sunai Leewansangtong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Combined Treatment ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Objective: To determine the oncological outcome of adjuvant treatment between radiotherapy (RT) alone and combined radiotherapy with androgen deprivation therapy (ADT) in high risk prostate cancer patients after radical prostatectomy (RP). Materials and Methods: All medical records of high risk-prostate cancer patients (including PSA > 20 ng/ml, pT3-pT4 or Gleason score 8-10) who underwent RP in Siriraj Hospital between 2000 and 2016 were retrospectively reviewed. Demo-graphic data, pathological staging, types of adjuvant treatment, time to follow up and time to biochemical recurrence (BCR) were analyzed. Results: Undetectable PSA after RP was achieved in 1009 out of 1221 high risk prostate cancer patients who had been followed up at least 6 months after surgery. Pathological staging pT2, pT3, pT4 and N1 was 23.8%, 73%, 0.8% and 4.7%, respectively. Forty one percent received adjuvant treatment (41 adjuvant RT alone, 74 combined adjuvant RT and ADT, 303 ADT alone). Median follow up time in the adjuvant RT group and combined treatment group was 63.8 months (8.9 - 210.7). BCR rates were 22% (9 of 41) for adjuvant RT and 12.2% (9 of 74) for adjuvant combined treatment. 10-year BCR-free survival in the two groups was 70.2% and 83.8%, respectively. There was no statistical difference between adjuvant RT and adjuvant combined treatment in terms of survival benefit (Hazard Ratio 0.40; p = 0.057). Conclusion: Adjuvant radiotherapy after radical prostatectomy increases long term survival outcomes for high risk prostate cancer patients. This study shows that combined adjuvant RT and ADT may improve BCR-free survival.

Comparisons of outcomes for patients with high-risk prostate cancer treated with brachytherapy, external beam radiation, or radical prostatectomy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 63-63
Author(s):  
Jay P. Ciezki ◽  
Harguneet Singh ◽  
Chandana A. Reddy ◽  
Steven C. Campbell ◽  
James Ulchaker ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Multivariable Analysis ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

63 Background: There is no consensus on how to best treat patients (pts) with high-risk prostate cancer. Methods: The outcomes for 2,736 high-risk prostate cancer pts treated with radical prostatectomy (RP), external beam radiotherapy (RT), and I-125 brachytherapy (BT) at a single institution from 1996 to 2012 were reviewed. The majority of RT pts were treated prior to 2002 because of our preference for RP and BT over time. High-risk was defined per the NCCN criteria. The outcomes assessed were biochemical failure (bF), clinical failure (cF), and prostate cancer mortality (PCM). Results: The distribution by treatment was RP 54%, RT 27%, and BT 19%. The median follow up for all pts was 4.6 years (y) (range 0.1-19.5): 3.8 y (0.1-18.7) for RP, 7.7 y (0.1-19.4) for RT, and 4.1 y (0.1-16.8) for BT pts. No patient received RT+BT, and 44% received androgen deprivation therapy (ADT). On multivariable analysis (see table) RP pts were at higher risk for bF vs. RT; BT pts and RT pts were at higher risk for cF vs. RP; and RT pts were at higher risk for PCM vs. RP. All multivariable analyses were adjusted for clinical stage, biopsy Gleason score, pre-treatment PSA, and duration of ADT. Conclusions: RP is associated with worse bF but better cF and PCM. There is no difference between BT and RT for bF, cF, or PCM while BT and RP had similar PCM. These outcomes may be a result of selection bias or differences in follow up time among the three treatment arms so no demonstration of modality superiority is possible. [Table: see text]

Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5018-5018 ◽  
Author(s):  
Jean Felipe Prodocimo Lestingi ◽  
Giuliano Guglielmetti ◽  
Jose Pontes Jr ◽  
Anuar Ibrahim Mitre ◽  
Alvaro Sarkis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Phase Iii ◽  
Transfusion Rate ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

5018 Background: The role of extended pelvic lymph node dissection (ePLND) in treating prostate cancer (PCa) patients remains controversial, mainly by the lack of RCTs. Methods: Patients with D'Amico intermediate or high risk PCa, absence of bone metastasis and no previous treatment were prospectively computer randomised to undergo extended or limited PLND (1:1) during radical prostatectomy. Limited PLND (lPLND) included the obturator chain bilaterally; ePLND involved bilaterally chains: obturator, external-, internal-, common-iliac and pre-sacral. Surgical specimens and each chain were analyzed separately, according to College of American Pathologists. All patients signed a free and informed consent and local ethics committee approved the study. The primary endpoint was biochemical recurrence-free survival, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01812902. Results: Since May 2012 until August 2016, 291 patients were randomly assigned, 145 to ePLND and 146 to lPLND. Preoperative data were comparable between groups. Median follow-up was 35.2 months. EPLND increased significantly operative time (54 minutes), estimated blood loss (100 mL), length of hospital stays (1 day) [p≤0.001], transfusion rate [p = 0.05] and postoperative complications according to Clavien scale [p = 0.03]. There was no difference in Pathologic Gleason grade, T stage or positive surgical margin. On ePLND and lPLND groups, 59.3% and 61.7% were staged ≥ pT3a, respectively. EPLND and lPLND yielded median (mean) 17 (19.8) and 3 (4.1) nodes, respectively (p < 0.001). EPLND showed 6.3 times more lymph node metastases (p < 0.001) and only it was able to show positive nodes in intermediate risk. There were no difference in biochemical recurrence (PSA ≥ 0.2 ng/mL) using Kaplan-Meyer method (p = 0.4), Radiotherapy, Androgen Deprivation Therapy, bone metastases or death. Conclusions: Extended lymphadenectomy in intermediate- and high-risk prostate cancer patients is associated with better tumor staging, increased morbidity and no oncological benefits in this initial short follow-up time. Clinical trial information: NCT01812902.

PD34-06 DEFINING THE FREQUENCY OF FOLLOW-UP OF INTERMEDIATE AND HIGH RISK PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Daniel Yelfimov ◽  
R. Jeffrey Karnes ◽  
Matthew Tollefson ◽  
Laureano Rangel ◽  
Igor Frank ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer
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