599: A Large Proportion of Patients with Advanced Prostate Cancer Continue to Die of Non-Cancer Causes After 5 Years Follow-Up

2007 ◽  
Vol 177 (4S) ◽  
pp. 200-201
Author(s):  
Vivek K. Wadhwa ◽  
Robin Weston ◽  
Nigel J. Parr
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer

Lycopene and prostate cancer risk. Methodological considerations in the epidemiologic literature

2002 ◽  
Vol 74 (8) ◽  
pp. 1427-1434 ◽  
Author(s):  
Edward Giovannucci
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Dietary Assessment ◽  
Prostate Cancer Risk ◽  
Epidemiologic Studies ◽  
Case Control Studies ◽  
Tomato Sauce ◽  
Dietary Study ◽  
Methodological Considerations

Prostate cancer is the most common cancer in U.S. males. Among potentially beneficial natural compounds is lycopene, which is derived largely from tomato-based products. Recent epidemiologic studies have suggested a potential benefit of this carotenoid against risk of prostate cancer, but not all of the studies have been supportive. The largest prospective dietary study, the Health Professionals Follow-Up Study (HPFS), had found that 2-4 servings of tomato sauce per week were associated with about a 35 % risk reduction of total prostate cancer and a 50 % reduction of advanced prostate cancer in follow-up from 1986 to 1992. Tomato sauce was by far the strongest predictor of plasma lycopene levels in this study. In the largest plasma-based study, high lycopene levels were associated with similar risk reductions for total and advanced prostate cancer. Results from other studies, mostly dietary case-control studies, have been mixed. The reasons for these inconsistencies are unclear. Because lycopene may come from a number of sources, and the bioavailability of lycopene may vary profoundly across these sources, dietary questionnaires are likely to vary markedly in their utility to estimate true variation in body lycopene stores across individuals. With further follow-up in the HPFS, we addressed some possibilities for apparently conflicting results. We confirmed our initial findings with the independent 1992­1998 follow-up period. Our results also indicated various factors may contribute to some of the inconsistencies, including insufficient sample size, low intake of lycopene, failure to account for bioavailability, reliance on a single dietary assessment, and heterogeneity of prostate cancer.

Intergroup randomized phase III study of androgen deprivation therapy (ADT) plus radiation therapy (RT) in locally advanced prostate cancer (CaP) (NCIC-CTG, SWOG, MRC-UK, INT: T94-0110; NCT00002633).

2010 ◽  
Vol 28 (18_suppl) ◽  
pp. CRA4504-CRA4504 ◽  
Author(s):  
P. R. Warde ◽  
M. D. Mason ◽  
M. R. Sydes ◽  
M. K. Gospodarowicz ◽  
G. P. Swanson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Phase Iii ◽  
Disease Specific Survival ◽  
Locally Advanced Prostate Cancer ◽  
Combined Modality ◽  
Disease Specific

CRA4504 Background: The impact of radiotherapy on overall survival (OS) in men with locally advanced CaP is unclear. The SPCG-7 trial recently showed a benefit to RT for CaP specific mortality. Our primary objective was to assess the effect of RT on OS when added to lifelong ADT in men with locally advanced CaP. Methods: Patients with T3/T4 (1057) or T2, PSA > 40 μ g/l (119) or T2 PSA > 20 μ g/l and Gleason ≥ 8 (25) and N0 /NX, M0 prostate adenocarcinoma were randomized to lifelong ADT (bilateral orchiectomy or LHRH agonist) with or without RT (65-69 Gy to prostate ± seminal vesicles with or without 45Gy to pelvic nodes). The primary endpoint was OS and secondary endpoints included disease specific survival (DSS), time to disease progression and quality of life. Results: 1205 patients were randomized from 1995 to 2005, 602 to ADT and 603 to ADT+RT (well balanced with respect to baseline characteristics). A protocol specified second interim analysis on OS was performed in Aug 2009 (data cut-off Dec 31 2008). The DSMC recommended release of the results to the Trial Committee for publication. The median follow-up is 6.0 years and 320 patients have died (175 ADT and 145 ADT+RT). 10% of patients had no follow-up data beyond 2006. The addition of RT to ADT significantly reduced the risk of death (hazard ratio [HR] 0.77, 95% CI 0.61-0.98, p=0.033). 140 patients died of disease and/or treatment (89 on ADT and 51 on ADT+RT) The disease specific survival HR was 0.57 (95% CI 0.41-0.81, p=0.001) favoring ADT+RT. The 10 year cumulative disease specific death rates were estimated at 15% with ADT+ RT and 23% with ADT alone. Grade ≥2 late GI toxicity rates were similar in both arms (proctitis, 1.3% ADT alone, 1.8% ADT+RT). Conclusions: The trial results indicate a substantial overall survival and disease specific survival benefit for the combined modality approach (ADT+RT) in the management of patients with locally advanced prostate cancer with no significant increase in late treatment toxicity. In view of this data combined modality therapy (ADT+RT) should be the standard treatment approach for these patients. Supported by NCI-US Grant #5U10CA077202-12, CCSRI Grant #15469. No significant financial relationships to disclose.

Circadian dysrhythm and advanced prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 199-199
Author(s):  
Lorelei A. Mucci ◽  
Sarah Markt ◽  
Lara Sigurdardottir ◽  
Steven W. Lockley ◽  
Katja Fall ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Circadian Rhythm ◽  
Advanced Prostate Cancer ◽  
Clock Genes ◽  
Sleep Problems ◽  
P Value ◽  
Relative Risks ◽  
Increased Risk ◽  
Falling Asleep

199 Background: The circadian rhythm regulates diverse biologic pathways including tumor oncogenes, metabolism, and cell proliferation. Dysregulation of the circadian rhythm arises from faulty input signals such as exposure to light at night, variability in core circadian rhythm genes, and variation in outputs that regulate circadian behavior including melatonin. There is compelling biologic rationale, but little human data, on circadian dysrhythm and advanced prostate cancer. Methods: We undertook an integrative molecular epidemiology study of circadian dysrhythm and advanced prostate cancer among men in the Icelandic AGES-Reykjavik cohort and the U.S. Health Professionals Follow-up Study, which allowed integration of questionnaire data, biorepositories, and long-term follow-up. We characterized circadian dysrhythm using complimentary approaches: information on sleep problems from questionnaires, prediagnostic melatonin (6-sulfatoxymelatonin) measured on first morning void urine samples, and genetic variation across twelve circadian clock genes. We used multivariable regression models to estimate relative risks (RR) and 95% confidence intervals (CI) of associations with advanced prostate cancer, adjusted for potential confounders. Results: Twenty percent of men reported sleep problems. Men who had trouble falling asleep (RR = 2.1; 95% CI 0.7-6.2) and staying asleep (RR=3.2, 95% CI 1.1-9.7) had an increased risk of developing advanced prostate cancer. Men with sleep problems had significantly lower melatonin levels compared to those without. Low melatonin levels were associated with a statistically significant 4-fold higher risk of advanced prostate cancer compared to those with high levels (95% CI: 1.25-10.0). Variant alleles in two SNPs in cryptochrome (CRY1), involved in generating and maintaining circadian rhythms, were significantly associated with risk of advanced prostate cancer in both cohorts, with a gene-level p-value<0.01. Conclusions: Our results suggest there are multiple nodes in the circadian rhythm that are associated with an increased risk of advanced prostate cancer. As such, there is the potential for complimentary strategies to target circadian disruption and reduce the risk of advanced prostate cancer.

scholarly journals Imaging Diagnosis and Follow-up of Advanced Prostate Cancer: Clinical Perspectives and State of the Art

Radiology ◽  
2019 ◽  
Vol 292 (2) ◽  
pp. 273-286 ◽  
Author(s):  
Raquel Perez-Lopez ◽  
Nina Tunariu ◽  
Anwar R. Padhani ◽  
Wim J. G. Oyen ◽  
Stefano Fanti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
State Of The Art ◽  
Imaging Diagnosis

Osteopenia (OP) induced by 6 and 18 months androgen deprivation (AD)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5123-5123
Author(s):  
J. Ball
Keyword(s):  
Prostate Cancer ◽  
Bone Mineral ◽  
Gleason Score ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Locally Advanced Prostate Cancer ◽  
Optimal Duration ◽  
Financial Relationships

5123 Background: In a trial evaluating the optimal duration of AD in locally advanced prostate cancer (PC) we sought to determine whether 18 months of zoledronate (Zd) would reverse AD induced OP and reduce bony failure. Methods: In the four arm 2x2 TROG 03.04 (RADAR) trial, men with T2b,c-4 and T2a (Gleason score >6, PSA >10) N0 M0 PC (but without osteoporosis) were randomised to leuprotide (Lp) 22.5 mgs i.m. 3 monthly for 6 months starting 5 months prior to radiotherapy (RT) in Arm A, or the same treatment with Zd mgs i.v.i. 3 months for 18 months commencing on Day 1 (in Arms B and D), or with Lp 22.5 mg i.m. 3 monthly for 12 months after RT (in Arms C and D). Hip and spinal bone mineral densities (BMD) were measured before treatment (bt) and then at 2 and 4 years using DEXA and differences between trial arms were assessed by paired t tests. OP was defined by T- scores <-1. Results: Between October 2003 and January 2006, 930 men were randomized. 124 men with BMD measures bt and at 2 years are evaluable. Mean change (±SD) in BMD between 0 and 2 years was -0.005 ±0.05 (p=0.57) in Arm A, 0.085 ±0.06 (p=<0.001) in Arm B, 0.054 ±0.07 (p=<0.001) in Arm C, and 0.065 ±0.05 (p=<0.001) in Arm D. 98 men had normal BMD bt. Of these 6 of 51 in Arms A, C (no Zd) have developed OP at 2 years while none of 47 in Arms B, D (+Zd) have as yet. Conclusions: At 2 years OP caused by 6 months AD is minimal, but remains significant after 18 months AD. This is reversed by 18 months Zd, but further follow up will determine whether this degree of OP resolves with time or causes fractures. No significant financial relationships to disclose.

Testosterone suppression: Impact of testosterone level on disease progression in advanced prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 46-46
Author(s):  
Shawn Dason ◽  
Justin Tong ◽  
Christopher Brian Allard ◽  
Bobby Shayegan
Keyword(s):  
Prostate Cancer ◽  
Disease Progression ◽  
Testosterone Level ◽  
Advanced Prostate Cancer ◽  
Risk Groups ◽  
Rank Test ◽  
Testosterone Levels ◽  
Baseline Characteristics ◽  
The Impact

46 Background: In patients with advanced prostate cancer, medical castration remains a mainstay of treatment. A testosterone level below 50 ng/dL has been previously accepted as an adequate level of androgen suppression and remains the benchmark level for clinical trials. However, there is mounting evidence that lower testosterone levels may be associated with improved clinical outcomes. We evaluated our cohort of patients with advanced prostate cancer to assess the impact of testosterone suppression on progression to castrate resistant prostate cancer (CRPC). Methods: Patient data was obtained from a prospective database of patients undergoing androgen deprivation therapy (ADT) at a tertiary centre from 2006-2011. A total of 39 patients were eligible for inclusion with at least 12 months follow-up. Patients were administered LHRH agonists or antagonist with testosterone and PSA assessments every 3 months. Patients were considered to have progressed to CRPC when there were at least 2 consecutive rises in PSA above nadir, clinical progression, or death from disease. Patients were stratified into two risk groups based on 6-month absolute and 1-year mean testosterone levels following initiation of ADT. Baseline characteristics between risk groups were compared using the Student’s t-test and chi-squared test. Probability of disease progression was assessed using the Kaplan-Meier method and compared using the log-rank test. Results: Median patient follow up was 2.3 years with 38% free of disease at last follow up. Patients with 6-month absolute testosterone less than 32 ng/dL had an increased time to CRPC (log rank p=0.06). Patients with 1-year mean testosterone less than 32 ng/dl had a significantly increased time to CRPC (log rank p=0.005). Patients did not differ significantly in their baseline characteristics. Conclusions: Adequate testosterone suppression during ADT may play a clinically significant role in delaying CRPC. While PSA levels are often used to assess for response to ADT, the current study suggests testosterone level in the first year following initiation of ADT may serve as an early predictor of disease progression.

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