Patient Selection for Salvage Cryotherapy for Locally Recurrent Prostate Cancer After Radiation Therapy

1999 ◽  
Vol 17 (8) ◽  
pp. 2514-2514 ◽  
Author(s):  
Louis L. Pisters ◽  
Paul Perrotte ◽  
Shellie M. Scott ◽  
Graham F. Greene ◽  
Andrew C. von Eschenbach
Keyword(s):  
Radiation Therapy ◽  
Treatment Failure ◽  
Gleason Score ◽  
Hormonal Therapy ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
Prior History ◽  
History Of ◽  
Salvage Cryotherapy ◽  
Locally Recurrent

PURPOSE: Our objective was to identify clinical pretreatment factors associated with early treatment failure after salvage cryotherapy. PATIENTS AND METHODS: Between 1992 and 1995, 145 patients underwent salvage cryotherapy for locally recurrent adenocarcinoma of the prostate. Treatment failure was defined as an increasing postcryotherapy serial prostate-specific antigen (PSA) level of more than or equal to 2 ng/mL above the postcryotherapy nadir or as a positive posttreatment biopsy. We evaluated the following factors as predictors of treatment failure: tumor stage and grade at initial diagnosis, type of prior therapy, stage and grade of locally recurrent tumor, number of positive biopsy cores at recurrence, and precryotherapy PSA level. RESULTS: Among patients with a prior history of radiation therapy only, the 2-year actuarial disease-free survival (DFS) rates were 74% for patients with a precryotherapy PSA less than 10 ng/mL and 28% for patients with a precryotherapy PSA more than 10 ng/mL, P < .00001. The DFS rates were 58% for patients with a Gleason score of less than or equal to 8 recurrence and 29% for patients with a Gleason score greater than or equal to 9 recurrence, P < .004. Among patients with a precryotherapy PSA less than 10 ng/mL, DFS rates were 74% for patients with a prior history of radiation therapy only and 19% for patients with a history of prior hormonal therapy plus radiation therapy, P < .002. CONCLUSION: Patients failing initial radiation therapy with a PSA more than 10 ng/mL and Gleason score of the recurrent cancer more than or equal to 9 are unlikely to be successfully salvaged. Patients failing initial hormonal therapy and radiation therapy are less likely to be successfully salvaged than patients failing radiation therapy only.

Salvage Cryotherapy for Recurrent Prostate Cancer After Radiotherapy: Variables Affecting Patient Outcome

2002 ◽  
Vol 20 (11) ◽  
pp. 2664-2671 ◽  
Author(s):  
Jonathan I. Izawa ◽  
Lydia T. Madsen ◽  
Shellie M. Scott ◽  
Jean-Paul Tran ◽  
Edward J. McGuire ◽  
...  
Keyword(s):  
Gleason Score ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
Free Survival ◽  
Adenocarcinoma Of The Prostate ◽  
Salvage Cryotherapy ◽  
Locally Recurrent

PURPOSE: To determine the long-term disease-specific survival (DSS) and disease-free survival (DFS) rates after salvage cryotherapy for locally recurrent adenocarcinoma of the prostate and to identify pretreatment factors that have an impact on DSS and DFS. PATIENTS AND METHODS: Between July 1992 and January 1995, 131 patients who had received definitive radiation therapy (XRT) underwent salvage cryotherapy for locally recurrent adenocarcinoma of the prostate. Cryotherapy failure was defined as an increasing postcryotherapy prostate-specific antigen (PSA) level of ≥ 2 ng/mL above the postcryotherapy nadir, a positive prostate biopsy, or radiographic evidence of metastatic disease. Clinical variables were studied to determine whether there was an association with the DSS and DFS. RESULTS: The median follow-up was 4.8 years. The 5-year DSS rates were 87% for patients with a precryotherapy Gleason score ≤ 8 and 63% for those with Gleason scores of 9 and 10 (P = .012). The 5-year DFS rates were 57% for patients with a precryotherapy PSA level of ≤ 10 ng/mL and 23% for those with a PSA level greater than 10 ng/mL (P = .0004). The 5-year DSS rates for patients with a pre-XRT clinical stage of T1 to T2 and those with a clinical stage of T3 to T4 were 94% and 72%, respectively (P = .0041). The 5-year DFS rates for these groups were 90% and 69%, respectively (P = .0057). CONCLUSION: Androgen-independent local recurrences, Gleason score, and pre-XRT clinical stage were important factors that had an impact on DSS and DFS. The subset of patients cured by salvage cryotherapy seems to be small, and patient selection is important.

What is the optimal management of Gleason score 7 (GS7) prostate cancer (PC) at biopsy? A comparison of disease control for prostatectomy (RP) versus radiation therapy (RT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 250-250
Author(s):  
John Morgan Watkins ◽  
Patricia L. Watkins ◽  
Tarek A. Dufan ◽  
Nadim Koleilat
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Disease Control ◽  
Gleason Score ◽  
Tumor Staging ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
External Beam ◽  
Disease Free

250 Background: Optimal therapy for Gleason score 7 (GS7) prostate cancer (PC) remains to be defined, with consensus guidelines identifying both prostatectomy (RP) and radiation therapy (RT) as acceptable. The present investigation seeks to compare outcomes between these treatment approaches. Methods: Patients were retrospectively identified for inclusion by clinically localized disease, GS7, and a prostate-specific antigen (PSA) less than 30 at diagnosis. Comparison of demographic, tumor, staging, and outcome variables was performed. Disease recurrence was defined as per contemporary society guidelines. Kaplan-Meier method employed for disease control estimates. Results: Between 2003 and 2010, 267 patients were diagnosed with GS7 prostate cancer, of whom 207 were eligible for the current analysis (120 RP/87 RT). Excepting older age for RT patients (median age 73 vs. 62), the groups were well-balanced. For RP patients, 82 patients (60%) had at least one high-risk feature, of whom only four (5%) received adjuvant RT. For RT patients, 71 of patients (82%) received hormone therapy (median duration 6 months), and 48% (42) underwent external beam RT alone, 41% (36) brachytherapy (BT) alone, and 10% (9) external beam RT plus BT boost. At a median follow-up of 62.2 months (range, 13.1-136.6; with no difference between treatment groups), 64 patients had PSA relapse (51 RP/13 RT) and 15 had died (five of or with disease). Five-year disease-free and disease-specific survivals for RP versus RT were 55.4% versus 82.6% (p<0.0001) and 97.6% versus 98.8% (p=NS), respectively. Conclusions: For GS7 prostate cancer patients, RT is associated with superior disease-free survival at 5 years when compared with RP alone. Whether this difference remains in the setting of appropriately employed adjuvant RT remains to be determined. No difference in survival endpoints was detected, though there were few events at 5 years.

Clinical and diagnostic aspects of deep infiltrative endometriosis (diagnosis, treatment, recurrence)

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 307-313
Author(s):  
Shakhnoza K. Muftaidinova ◽  
Leonid Z. Faizullin ◽  
Vladimir D. Chuprynin ◽  
Nikolai S. Ruseikin ◽  
Tatiana I. Smolnova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hormonal Therapy ◽  
Serum Levels ◽  
Ca 125 ◽  
Prior History ◽  
Deep Endometriosis ◽  
Preoperative Serum ◽  
Peritoneal Endometriosis ◽  
History Of ◽  
Deep Infiltrative Endometriosis

Aim. To analyze the recurrence of endometriosis after surgical treatment of patients with deep endometriosis. Materials and methods. The case histories of 90 patients aged 19 to 45 years were retrospectively analyzed. The study group consisted of 70 endometriosis patients: 20 with peritoneal endometriosis and 50 with deep infiltrative endometriosis (DIЕ). The comparison group included 20 women without endometriosis. There was an in-depth study of anamnestic data in the cohort of patients under study. The results of preoperative laboratory tests, including serum levels of the CA-125 and CA 19-9 oncomarkers, were processed. Results. Analysis of the obtained data showed that about half of the DIE patients (54%) in the main group had a history of surgical interventions for endometriosis. The number of operations was significantly higher in patients compared to the peritoneal endometriosis group (68% vs 20%, respectively; р=0.0012). Two subgroups were formed from the group of women with DIE: patients who had no history of previous surgical treatment for endometriosis and those hospitalized for repeated surgical treatment of endometriosis (patients with recurrent endometriosis). Patients with recurrent endometriosis had a significantly higher incidence of heavy menstruation, pregnancy terminations (abortions), and a high proportion of gastrointestinal diseases. Analysis of the hormonal therapy received in patients with DIE showed that every second patient with relapses (18/53%) after surgical treatment and every third patient without a prior history of surgery (5/31%) received hormonal therapy. Examination of the preoperative serum levels of CA-125 and CA 19-9 serum markers in patients with DIE showed an increase in their serum levels and a correlation with the frequency of endometriosis recurrence and the size of DIE foci. Conclusion. Despite the conservative and surgical treatment of DIE patients, the recurrence rate is still high. At present, there is no satisfactory therapy for all endometriosis patients. Therefore, the development of therapy for the conservative treatment of the disease remains an urgent task.

scholarly journals Esophageal neuroendocrine carcinoma presenting as a rare cause of dysphagia

2018 ◽  
Vol 5 (2) ◽  
pp. 1
Author(s):  
Sylvester Luu ◽  
Brian C. Benson ◽  
Kelly A. Haeusler ◽  
Robert O. Brady ◽  
Katherine M. Cebe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Neuroendocrine Carcinoma ◽  
Poor Prognosis ◽  
Gastroesophageal Junction ◽  
Prior History ◽  
High Grade ◽  
Active Smoking ◽  
Platinum Based Chemotherapy ◽  
History Of ◽  
Neuroendocrine Carcinomas

A 60-year-old male with prior history of laryngeal carcinoma and active smoking presented with six months of solid food dysphagia. Endoscopy showed a large, friable gastroesophageal junction mass. Biopsies revealed a high-grade, poorlydifferentiated neuroendocrine carcinoma. He was subsequently started on platinum based chemotherapy and radiation therapy and his tumor decreased dramatically in size. This case is unique as neuroendocrine carcinomas (NECs) are rarely found in the esophagus and usually have a poor prognosis at time of diagnosis.

scholarly journals The Modulating Effects of Benign Prostate Enlargement Medications on Upgrading Predictors in Patients with Gleason 6 at Biopsy

2016 ◽  
Vol 10 (2) ◽  
pp. 97-104
Author(s):  
Seyed Behzad Jazayeri ◽  
Young S. Kwon ◽  
Russell McBride ◽  
Michael Leapman ◽  
Shemille Collingwood ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Specific Antigen ◽  
Clinical Predictors ◽  
Medication History ◽  
Alpha Blockers ◽  
Reductase Inhibitors ◽  
Prostate Size ◽  
History Of ◽  
Biopsy Gleason Score

Background: Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. Materials and Methods: A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. Results: Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. Conclusion: Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.

Abstract 16083: Risk of Preserved versus Reduced Ejection Fraction in Women With and Without History of Breast Cancer: The Pathways Heart Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamal S Rana ◽  
Heather Greenlee ◽  
Richard Cheng ◽  
Cecile A Laurent ◽  
Hanjie Shen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Ejection Fraction ◽  
Endocrine Therapy ◽  
White Women ◽  
Cox Regression ◽  
Prior History ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
History Of

Introduction: Incidence of heart failure (HF), specifically with preserved ejection fraction (HFpEF), is rising in the general population, yet is understudied. To provide a population-based estimate of HF in breast cancer (BC) survivors, we compared risk of HF in women with and without BC history in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed from 2005-2013 were identified and matched 1:5 with non-BC controls on birth year, race/ethnicity, and KPNC membership at BC diagnosis. Cox regression models assessed the hazard of HF by EF status: HFpEF (EF ≥ 45%), HF with reduced EF (HFrEF; EF < 45%), and unknown EF. Women with prior history of HF were excluded. Models were adjusted for factors known to affect BC risk or CVD and for prevalent CVD at BC diagnosis. We also examined case subgroups who received cardiotoxic chemotherapy, left-sided radiation therapy, and/or endocrine therapy, versus their controls. Results: A total of 14,804 women diagnosed with invasive BC and with no history of HF were identified and matched to 74,034 women without BC history. Women were on average 61 years at BC diagnosis and 65% white. Women with HFpEF were older and more likely to have hypertension (p<0.05). Among all cases vs. controls, there was increased risk of HFrEF (HR: 1.5, 95% CI: 1.18, 1.98) but not HFpEF or unknown EF (figure). Compared to their controls, women treated with chemotherapy were more than 3-times likely to develop HFrEF (HR: 3.26, 95% CI: 2.2, 4.8) and more than 1.5-times likely to develop HFpEF (HR=1.61, 95% CI: 1.15, 2.24). Women who received left-sided radiation therapy had nearly double the risk of developing HFrEF (HR=1.85, 95% CI: 1.20, 2.84). No associations were found among women who received endocrine therapy. Conclusions: Increased surveillance is warranted for women with BC receiving cardiotoxic chemotherapy for development of both HFrEF and HFpEF.

SALVAGE CRYOTHERAPY USING AN ARGON BASED SYSTEM FOR LOCALLY RECURRENT PROSTATE CANCER AFTER RADIATION THERAPY: THE COLUMBIA EXPERIENCE

2001 ◽  
Vol 166 (4) ◽  
pp. 1333-1338 ◽  
Author(s):  
MOHAMED A. GHAFAR ◽  
CHRISTOPHER W. JOHNSON ◽  
ALEXANDER DE LA TAILLE ◽  
MITCHELL C. BENSON ◽  
EMILIA BAGIELLA ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Recurrent Prostate Cancer ◽  
Salvage Cryotherapy ◽  
Locally Recurrent
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