The impact of low free testosterone on prostate cancer: High-risk disease, biochemical recurrence, and testosterone replacement after radical prostatectomy

2019 ◽  
Vol 18 (6) ◽  
pp. e2588-e2590
Author(s):  
L.M. Huynh ◽  
M. Towe ◽  
K.J. See ◽  
J. Tran ◽  
F. El Khatib ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Free Testosterone ◽  
Testosterone Replacement ◽  
High Risk Disease ◽  
The Impact

The impact of multifocal perineural invasion on biochemical recurrence and timing of adjuvant androgen-deprivation therapy in high-risk prostate cancer following radical prostatectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e595-e595
Author(s):  
Pengfei Shen ◽  
Guangxi Sun ◽  
Hao Zeng ◽  
Xingming Zhang
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Androgen Deprivation Therapy ◽  
Biochemical Recurrence ◽  
Perineural Invasion ◽  
Androgen Deprivation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
The Impact

e595 Background: Perineural invasion (PNI) is a distinct pathologic entity and a recognized source of tumor spread. However, the role of PNI in high-risk prostate cancer (PCa) has not been explored. We investigated the impact of the severity of PNI on biochemical recurrence (BCR) and optimal timing of adjuvant androgen deprivation therapy (ADT) post radical prostatectomy (RP). Methods: Of 265 prostatectomies, median follow-up 45 months, were assessed for the presence of PNI and its intensity (unifocal PNI and multifocal PNI) in RP specimen. Kaplan-Merier curves were used to estimate BCR probabilities. Cox proportional hazard models were used to address predictors of BCR. Harrell’s C-index was conducted to further validate prognostic value of multi-PNI. Results: A total of 123 patients (46.4%) were PNI positive, among which, 91 (74%) and 32 (26%) had unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. Other than uni-PNI, the presence of multi-PNI was strongly associated with increasing incidence of BCR (HR = 3.87, 95% CI: 1.66-9.01, p = 0.002). Patients with uni-PNI seemed to have a similar BCR rate to those without PNI after adjuvant ADT. For men with multi-PNI, immediate ADT obviously appeared to be superior to delayed ADT in decreasing biochemical failure. Conclusions: Multi-PNI detected in high-risk RP specimens could be a prognosticator for early biochemical relapse post-surgery. Our findings suggest that patients with multi-PNI appear appropriate to choose adjuvant therapy as soon as possible after surgery.

Neoadjuvant Strategies Before Radical Prostatectomy for High Risk Prostate Cancer in the Era of New Hormonal Agents

2020 ◽  
Vol 22 (1) ◽  
pp. 68-76
Author(s):  
Alessandro Tafuri ◽  
Maria Angela Cerruto ◽  
Alessandro Antonelli
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Local Therapy ◽  
Definitive Answer ◽  
High Risk Prostate Cancer ◽  
High Risk Disease ◽  
Risk Prostate Cancer ◽  
The Impact

: Prostate cancer (PCa) is a hormone dependent disease including several different patterns from indolent and clinically meaningless to aggressive and lethal disease. Among non-metastatic PCa, high-risk disease represents a therapeutically challenge, given the unfavorable oncological outcomes after exclusive local therapy. Deprivation therapy in the neoadjuvant setting is not recommended prior to radical prostatectomy since it did not provide any survival advantage, although reducing tumor volume, surgical margins rate, local and nodal stage. However, in the few recent years, new hormonal treatments for metastatic PCa emerged, and showed a relevant increase of overall survival with respect to classical androgen deprivation therapy (ADT). Thus, neo-adjuvant regimens of ADT based on these novel molecules are now under investigation and the results of ongoing clinical trials are expected in order to provide a definitive answer on the real role of neoadjuvant hormonal therapy in the treatment of high-risk localized prostate cancer. In this narrative review, we underline the role of neoadjuvant therapy before radical prostatectomy in high-risk PCa patients considering the impact of the new available hormonal agents.

scholarly journals Oncologic impact of delaying radical prostatectomy in men with intermediate- and high-risk prostate cancer: a systematic review

2021 ◽  
Author(s):  
Ekaterina Laukhtina ◽  
Reza Sari Motlagh ◽  
Keiichiro Mori ◽  
Fahad Quhal ◽  
Victor M. Schuettfort ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Survival Outcomes ◽  
Control Group ◽  
High Risk Prostate Cancer ◽  
Pubmed Database ◽  
Risk Prostate Cancer ◽  
The Impact

Abstract Purpose To summarize the available evidence on the survival and pathologic outcomes after deferred radical prostatectomy (RP) in men with intermediate- and high-risk prostate cancer (PCa). Methods The PubMed database and Web of Science were searched in November 2020 according to the PRISMA statement. Studies were deemed eligible if they reported the survival and pathologic outcomes of patients treated with deferred RP for intermediate- and high-risk PCa compared to the control group including those patients treated with RP without delay. Results Overall, nineteen studies met our eligibility criteria. We found a significant heterogeneity across the studies in terms of definitions for delay and outcomes, as well as in patients’ baseline clinicopathologic features. According to the currently available literature, deferred RP does not seem to affect oncological survival outcomes, such as prostate cancer-specific mortality and metastasis-free survival, in patients with intermediate- or high-risk PCa. However, the impact of deferred RP on biochemical recurrence rates remains controversial. There is no clear association of deferring RP with any of the features of aggressive disease such as pathologic upgrading, upstaging, positive surgical margins, extracapsular extension, seminal vesicle invasion, and lymph node invasion. Deferred RP was not associated with the need for secondary treatments. Conclusions Owing to the different definitions of a delayed RP, it is hard to make a consensus regarding the safe delay time. However, the current data suggest that deferring RP in patients with intermediate- and high-risk PCa for at least around 3 months is generally safe, as it does not lead to adverse pathologic outcomes, biochemical recurrence, the need for secondary therapy, or worse oncological survival outcomes.

Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy

2015 ◽  
Vol 95 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Luigi Mearini ◽  
Elisabetta Nunzi ◽  
Carla Ferri ◽  
Guido Bellezza ◽  
Carolina Lolli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Health Index ◽  
Final Pathology ◽  
High Risk Disease ◽  
Prostate Health Index ◽  
Prostate Health

Introduction: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the final pathology with respect to reference standards. Materials and Methods: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were fitted to test the predictors of pT3 stage, pathologic Gleason score ≥8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. Results: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. Conclusions: p2PSA and its derivatives, primarily PHI, were significant predictors of unfavorable PC characteristics as detected at the final pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

Predictive factors of biochemical recurrence after radical prostatectomy for high-risk prostate cancer

2018 ◽  
Vol 25 (3) ◽  
pp. 284-289 ◽  
Author(s):  
Yukiko Murata ◽  
Katsunori Tatsugami ◽  
Masahiro Yoshikawa ◽  
Masumitsu Hamaguchi ◽  
Shigetomo Yamada ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Predictive Factors ◽  
Biochemical Recurrence ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals MP07-02 THE IMPACT OF QUANTITY AND TYPE OF GLEASON PATTERN 4 ON BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY FOR PROSTATE CANCER

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Blake Anderson ◽  
Shane Pearce ◽  
Bonnie Choy ◽  
Gregory Zagaja ◽  
Gladell Paner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Gleason Pattern ◽  
The Impact
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