scholarly journals Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches

2015 ◽  
Vol 94 (4) ◽  
pp. 373-382 ◽  
Author(s):  
Deliu Victor Matei ◽  
Matteo Ferro ◽  
Barbara Alicja Jereczek-Fossa ◽  
Giuseppe Renne ◽  
Nicolae Crisan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Salvage Therapy ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Selection Of

Background: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. Objective: The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. Methods: A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Results: Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Conclusions: Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.

Variations in treatment modality use for the definitive management of prostate cancer in the United States.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 174-174
Author(s):  
Jay P. Ciezki ◽  
Chandana A. Reddy ◽  
James Ulchaker ◽  
Kenneth Angermeier ◽  
Kevin L. Stephans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Treatment Modality ◽  
External Beam Radiotherapy ◽  
The United States ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Choice Of Treatment ◽  
To Receive

174 Background: No prospective, randomized comparative efficacy trial exists to guide treatment of definitively managed prostate cancer patients. Despite this, treatment selection varies nationally and we attempt to assess these patterns of use. Methods: The SEER database was queried to identify cases of prostate cancer diagnosed between 1998-2008. The modalities identified were brachytherapy (brachy), combination of brachytherapy and external beam radiation (CombRT), external beam radiotherapy (EBRT), radical prostatectomy and external beam radiotherapy (RP+RT), and radical prostatectomy (RP). The number of cases by year, patient age and SEER region was computed. Results: There were 361,135 men in this analysis: 12.4% brachy, 6.8% CombRT, 27.5% EBRT, 3.1% RP+RT, and 50.3% RP. As expected, treatment modality varied by age with younger men more likely to receive RP and older man more likely to receive EBRT or brachy. There was some variation in choice of treatment modality over time: 6.6% for brachy; 4.2% for CombRT; 1.9% for EBRT; 2.0% for RP+RT; and 7.8% for RP. The variation in treatment modality by region was surprisingly wide (table): 14.4% for brachy; 25.5% for CombRT; 28.5% for EBRT; 3.8% for RP+RT; and 26.8% for RP. Conclusions: Choice of prostate cancer treatment modality varies by age, year of treatment, and most notably geographical region. Surprisingly the changes in reimbursement rates over the study period seem to have had minimal impact on choice of treatment modality. The regional variation implies that affiliations among healthcare providers significantly impact treatment. [Table: see text]

Health Outcomes After External-Beam Radiation Therapy for Clinically Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study

2001 ◽  
Vol 19 (9) ◽  
pp. 2517-2526 ◽  
Author(s):  
A. S. Hamilton ◽  
J. L. Stanford ◽  
F. D. Gilliland ◽  
P. C. Albertsen ◽  
R. A. Stephenson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
External Beam Radiotherapy ◽  
Bowel Function ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Function Score ◽  
Urinary Function ◽  
Beam Radiation

PURPOSE: Studies reporting effects of radiotherapy for prostate cancer on sexual, bowel, and urinary function have been conducted primarily in referral centers or academic institutions. Effects of external-beam radiotherapy for prostate cancer among a population-based cohort were assessed. PATIENTS AND METHODS: The study population included 497 white, Hispanic, and African-American men with localized prostate cancer from six US cancer registries who were diagnosed between October 1, 1994, and October 31, 1995, and treated initially with external-beam radiotherapy. They were interviewed at regular intervals, and medical records were reviewed. Distributions of responses for bowel-, urinary-, and sexual-related functions at 6, 12, and 24 months after diagnosis and adjusted mean composite change scores for each domain were analyzed. RESULTS: Declines of 28.9% in the sexual function score and 5.4% in the bowel function score occurred by 24 months, whereas at this time, the urinary function score was relatively unchanged. A total of 43% of those who were potent before diagnosis became impotent after 24 months. More than two thirds of the men were satisfied with their treatment and would make the same decision again. CONCLUSION: Sexual function was the most adversely affected quality-of-life domain, with problems continuing to increase between 12 and 24 months. Bowel function problems increased at 6 months, with partial resolution observed by 24 months. Despite the side effects, satisfaction with therapy was high. These results are representative of men in community practice settings and may be of assistance to men and to clinicians when making treatment decisions.

scholarly journals Combination therapy-permanent interstitial brachytherapy and external beam radiotherapy for patients with localized prostate cancer

2005 ◽  
Vol 52 (4) ◽  
pp. 31-36 ◽  
Author(s):  
H. Matzkin ◽  
G. Keren-Paz ◽  
N.J. Mabjeesh ◽  
J. Chen
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Combination Therapy ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
Interstitial Brachytherapy ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
External Beam ◽  
Beam Radiation

Background: Combination of permanent interstitial brachytherapy based on radioactive iodine with external beam radiotherapy is an alternative to other treatment modalities, such as radical prostatectomy or external beam radiotherapy alone in patients with intermediate-risk localized prostate cancer. In this article we report our experience with this combination modality. Methods: Among patients who were treated in our institute with brachytherapy, there were 64 patients who received combination therapy for the above indication. Combination therapy enables administration of 110 Gy as brachytherapy and thereafter 45 Gy as external beam radiation. All patients received adjuvant androgen deprivation therapy for 6 months. The prospective follow-up was done with the aid of validated evaluation instruments (questionnaires). Results: Combination therapy was administered without additional urinary (IPSS-based) or sexual (IIEFbased) side effects above those with brachytherapy alone. No severe perianal and lower intestinal tract side effects were observed. Short-to-moderate-term results based on serum PSA levels are encouraging, and are not inferior to what is accepted by the literature for other radical therapies. Conclusion: Combination of permanent interstitial brachytherapy and external beam radiotherapy in the appropriate patients does not cause any additional morbidity, and its biochemical results justify its application. This modality should be offered as an accepted and good alternative to other radical treatment options, to men with prostate cancer with moderate risk factors.

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