Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group

2012 ◽  
Vol 109 ◽  
pp. 22-29 ◽  
Author(s):  
Peter Grimm ◽  
Ignace Billiet ◽  
David Bostwick ◽  
Adam P. Dicker ◽  
Steven Frank ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Comparative Analysis ◽  
Specific Antigen ◽  
Survival Outcomes ◽  
Study Group ◽  
Prostate Cancer Treatment ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Radical Therapy

scholarly journals Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

2016 ◽  
Vol 2 ◽  
pp. 95-103 ◽  
Author(s):  
Hideyasu Tsumura ◽  
Takefumi Satoh ◽  
Hiromichi Ishiyama ◽  
Ken-ichi Tabata ◽  
Shouko Komori ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
High Dose Rate ◽  
Survival Outcomes ◽  
High Dose ◽  
Term Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Propensity score matched analysis of metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy or radical prostatectomy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 47-47
Author(s):  
Marshall Meeks ◽  
Stephanie Subasic Markovina ◽  
Joel Vetter ◽  
Alethea Paradis ◽  
Jeff M. Michalski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Specific Antigen ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

47 Background: National Comprehensive Cancer Network (NCCN) category 1 recommendation for localized high risk prostate cancer (HR-PCa) is definitive radiation therapy (RT) and androgen deprivation therapy (ADT). Radical prostatectomy (RP) is also an accepted treatment for patients with localized HR-PCa. Here we report a propensity score-matched analysis of institutional outcomes for patients with HR-PCa treated with RP or RT. Methods: Medical recor ds of patients with localized NCCN HR-PCa treated at our institution from 2002-2011 were reviewed. RT consisted of 73.8-77.4 Gray to the prostate and seminal vesicles; regional lymph nodes were treated for pre-treatment probability of involvement ≥15%. A combination of nearest neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 score [a validated comorbidity index], prostate specific antigen (PSA), biopsy Gleason, and clinical T-stage (cT) and exact matching on PSA, biopsy Gleason, and cT was performed. Multivariate cox-proportional hazards regression was used to compare metastasis-free survival (MFS) and overall survival (OS) (calculated from date of diagnosis). Results: 246 patients were identified (160 RP and 86 RT). Propensity score matching resulted in 62 matched pairs. For the RP group, minimally invasive surgery (70.9%) and lymph node dissection (100%) were common. ADT was administered to 37.1% and 80.6% of patients receiving RP and RT, respectively. Median follow-up was longer for the RT group (51.4 vs 41 months, p = 0.004). Five-year rates of metastasis for RT and RP were 8.9% and 33% (p = 0.003), and for death were 25.9% and 17.6%, respectively (p = 0.31). MFS was significantly better for patients treated with definitive RT compared to RP, while OS was not different (Table). Conclusions: In our cohort with HR-PCa, treatment with RT resulted in a MFS advantage over RP. This was not accompanied by an improvement in OS.The difference in MFS may possibly be related to the importance of early adjuvant ADT. [Table: see text]

scholarly journals Favorable prognosis of patients who received adjuvant androgen deprivation therapy after radiotherapy achieving undetectable levels of prostate-specific antigen in high- or very high-risk prostate cancer

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248461
Author(s):  
Jae-Uk Jeong ◽  
Taek-Keun Nam ◽  
Ju-Young Song ◽  
Mee Sun Yoon ◽  
Sung-Ja Ahn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Treatment Outcomes ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Very High

Introduction To determine the prognostic significance of long-term adjuvant androgen deprivation therapy (A-ADT) over 1 year in achieving undetectable levels of prostate-specific antigen (PSA) less than 0.001 ng/mL in prostate cancer patients with high- or very high-risk prostate cancer who underwent radiotherapy (RT). Materials and methods A total of 197 patients with prostate cancer received RT, with a follow-up of ≥12 months. Biochemical failure was defined as PSA ≥nadir + 2 ng/mL after RT. We analyzed clinical outcomes, including survival, failure patterns, and prognostic factors affecting outcomes. Results Biochemical failure-free survival (BCFFS), clinical failure-free survival, distant metastasis-free survival, cancer-specific survival, and overall survival (OS) rates at 5 years were 91.1%, 95.4%, 96.9%, 99.5%, and 89.1%, respectively. Administration of long-term A-ADT significantly predicted favorable BCFFS (p = 0.027) and OS (p < 0.001) in multivariate analysis. Nadir PSA ≤0.001 ng/mL was an independent prognostic factor for BCFFS (p = 0.006) and OS (p = 0.021). The use of long-term A-ADT significantly affected nadir PSA ≤0.001 ng/mL (p < 0.001). The patients with A-ADT for 1 year or longer had better BCFFS or OS than those for less than 1 year or those without A-ADT (p < 0.001). The best prognosis was demonstrated in patients treated with long-term A-ADT and nadir PSA ≤0.001 ng/mL in BCFFS (p < 0.001). Conclusion The addition of long-term A-ADT over 1 year to RT demonstrated good treatment outcomes in patients with locally advanced prostate cancer. Achieving a nadir PSA value ≤0.001 ng/mL using combination therapy with RT and A-ADT is a powerful clinical predictor of treatment outcomes.

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.

Prostate-Only Versus Whole-Pelvic Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer (POP-RT): Outcomes From Phase III Randomized Controlled Trial

2021 ◽  
pp. JCO.20.03282
Author(s):  
Vedang Murthy ◽  
Priyamvada Maitre ◽  
Sadhana Kannan ◽  
Gitanjali Panigrahi ◽  
Rahul Krishnatry ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
High Risk ◽  
Controlled Trial ◽  
Androgen Deprivation ◽  
Phase Iii ◽  
Free Survival ◽  
Randomized Controlled ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

PURPOSE We report the clinical outcomes of a randomized trial comparing prophylactic whole-pelvic nodal radiotherapy to prostate-only radiotherapy (PORT) in high-risk prostate cancer. METHODS This phase III, single center, randomized controlled trial enrolled eligible patients undergoing radical radiotherapy for node-negative prostate adenocarcinoma, with estimated nodal risk ≥ 20%. Randomization was 1:1 to PORT (68 Gy/25# to prostate) or whole-pelvic radiotherapy (WPRT, 68 Gy/25# to prostate, 50 Gy/25# to pelvic nodes, including common iliac) using computerized stratified block randomization, stratified by Gleason score, type of androgen deprivation, prostate-specific antigen at diagnosis, and prior transurethral resection of the prostate. All patients received image-guided, intensity-modulated radiotherapy and minimum 2 years of androgen deprivation therapy. The primary end point was 5-year biochemical failure-free survival (BFFS), and secondary end points were disease-free survival (DFS) and overall survival (OS). RESULTS From November 2011 to August 2017, a total of 224 patients were randomly assigned (PORT = 114, WPRT = 110). At a median follow-up of 68 months, 36 biochemical failures (PORT = 25, WPRT = 7) and 24 deaths (PORT = 13, WPRT = 11) were recorded. Five-year BFFS was 95.0% (95% CI, 88.4 to 97.9) with WPRT versus 81.2% (95% CI, 71.6 to 87.8) with PORT, with an unadjusted hazard ratio (HR) of 0.23 (95% CI, 0.10 to 0.52; P < .0001). WPRT also showed higher 5-year DFS (89.5% v 77.2%; HR, 0.40; 95% CI, 0.22 to 0.73; P = .002), but 5-year OS did not appear to differ (92.5% v 90.8%; HR, 0.92; 95% CI, 0.41 to 2.05; P = .83). Distant metastasis-free survival was also higher with WPRT (95.9% v 89.2%; HR, 0.35; 95% CI, 0.15 to 0.82; P = .01). Benefit in BFFS and DFS was maintained across prognostic subgroups. CONCLUSION Prophylactic pelvic irradiation for high-risk, locally advanced prostate cancer improved BFFS and DFS as compared with PORT, but OS did not appear to differ.

scholarly journals Circulating mRNA signature as a marker for high-risk prostate cancer

2019 ◽  
Vol 41 (2) ◽  
pp. 139-145
Author(s):  
Marilesia Ferreira De Souza ◽  
Hellen Kuasne ◽  
Mateus De Camargo Barros-Filho ◽  
Heloísa Lizotti Cilião ◽  
Fabio Albuquerque Marchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
Treatment Decision ◽  
Tumor Stage ◽  
Aggressive Disease ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Invasive Method ◽  
Biopsy Gleason Score

Abstract Prostate cancer (PCa) is the second most common cancer in men. The indolent course of the disease makes the treatment choice a challenge for physicians and patients. In this study, a minimally invasive method was used to evaluate the potential of molecular markers in identifying patients with aggressive disease. Cell-free plasma samples from 60 PCa patients collected before radical prostatectomy were used to evaluate the levels of expression of eight genes (AMACR, BCL2, NKX3-1, GOLM1, OR51E2, PCA3, SIM2 and TRPM8) by quantitative real-time PCR. Overexpression of AMACR, GOLM1, TRPM8 and NKX3-1 genes was significantly associated with aggressive disease characteristics, including extracapsular extension, tumor stage and vesicular seminal invasion. A trio of genes (GOLM1, NKX3-1 and TRPM8) was able to identify high-risk PCa cases (85% of sensitivity and 58% of specificity), yielding a better overall performance compared with the biopsy Gleason score and prostate-specific antigen, routinely used in the clinical practice. Although more studies are required, these circulating markers have the potential to be used as an additional test to improve the diagnosis and treatment decision of high-risk PCa patients.

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