Analysis of hormonal receptor status in tissue from prostate cancer that developed 26 years after bilateral orchiectomy and following 41 years of estrogen therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14610-14610
Author(s):  
R. A. Miksad ◽  
G. Bubley ◽  
P. Church ◽  
A. Cooper ◽  
N. Rofsky ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Estrogen Therapy ◽  
Progesterone Receptors ◽  
External Beam Radiation ◽  
Locally Advanced Prostate Cancer ◽  
Beam Radiation ◽  
Bilateral Orchiectomy

14610 Background: The development of prostate cancer in the absence of normal male testosterone levels and in the presence of elevated estrogen levels is rare and poorly understood. Methods: The androgen, estrogen and progesterone receptors were evaluated in prostate cancer tissue from a 60-year-old, long-term transgender woman. Her serum hormone levels were assessed and the prostate specific antigen (PSA) level was followed during hormonal and radiation treatment. This patient began estrogen therapy at age 19 and underwent bilateral orchiectomy at age 34 during gender re-assignment surgery. Work-up for gross hematuria revealed a Gleason 8, locally advanced prostate cancer. Results: The tumor showed abundant staining for androgen receptors (AR), with a nuclear pattern consistent with hormone refractory prostate cancer. The tumor did not stain for estrogen receptors (ER) or progesterone receptors (PR). Compared to reference values for men, this transgender woman had low serum testosterone (44 ng/dl) and free testosterone (0.9 pg/mL) levels and elevated estradiol (53 pg/mL) and estrone (377 pg/mL) levels. Prior to the initiation of radiation, treatment with bicalutamide and dutasteride reduced her PSA from 240 ng/ml to 77 ng/ml at week 6 (see Table). After treatment with external beam radiation her PSA fell to 4.6 ng/mL. At week 24, her PSA was 0.8 ng/mL. Conclusions: This high-grade, locally advanced prostate cancer in a transgender woman represents the longest reported duration of a castrate state preceding the development of prostate cancer, exceeding prior reports by several decades. The AR positive and ER/PR negative status of this tumor in the setting of low testosterone and elevated estrogen levels challenge long-standing paradigms regarding the testosterone requirement for prostatic carcinogenesis. In addition, these findings raise questions about the role of estrogens in prostate cancer. [Table: see text] [Table: see text]

Long-term outcome of randomized trial between cryoablation and external beam therapy for locally advanced prostate cancer (T2C-T3B).

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 78-78 ◽  
Author(s):  
A. A. Al-zahrani ◽  
A. Autran Gomez ◽  
A. Williams ◽  
G. Bauman ◽  
J. Izawa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Trial ◽  
Advanced Prostate Cancer ◽  
Prostate Volume ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
External Beam ◽  
Locally Advanced Prostate Cancer ◽  
Beam Radiation

78 Background: Our primary objective is to assess and compare the survival outcomes between cryoablation (CRYO) and external beam radiation therapy (EBRT) in locally advanced prostate cancer. Methods: This is a single institution, retrospective study. Our institution ethics board had approved this study. Patients were initially recruited for the trial between 1999 and 2002. The inclusion criteria for the trial were patients with cT2c–cT3b prostate cancer, PSA < 25ng/ml, with negative metastatic evaluation on CT and bone scan. Patients with evidence of metastasis, prior pelvic radiotherapy or hormone therapy, prostate volume > 75 ml or American Society of Anesthesiology Risk class > 3 were excluded. The biochemical failure was based on the Phoenix criteria (PSA nadir + 2ng/dl). Patients were subjected for regular trans-rectal ultrasound and biopsy until 24 months of follow-up (at 3, 6, 12, 18, 24 months for CRYO and at 18, 24 months for EBRT) and then as clinically indicated. Biochemical disease-free survival (bDFS), disease-specific survival (DSS) and overall survival (OS) were analyzed with Kaplan-Meier curve. Results: Sixty-two patients completed the trial with a median follow-up of 105.2 (± 35.8) months. Preoperative demographic and clinicopathological characteristics of both groups were comparable. All patients received neoadjuvant hormonal therapy for 3 months prior and continued for 3 months after the procedures. The prostate volume before the therapy was smaller in the CRYO group (31.3 ml vs 40.9 ml; p≤0.01). There was greater reduction in the prostate volume in the CRYO group after the intervention (–54% vs 34%; p≤0.01).Three patients in the cryotherapy arm and 2 patients in the radiotherapy arm were crossed over to the other modality at the time of biochemical or biopsy proven progression. The DSS and the OS were comparable between both groups. The 8-year bDFS rate was significant lower in the CRYO group (17.4% vs 59.1%; p=0.01). Conclusions: This randomized trial showed that CRYO was suboptimal in attaining bDFS at 8 years in patients with locally advanced prostate cancer (cT3). Other recent randomized trial showed favorable outcome with CRYO for localized prostate cancer. No significant financial relationships to disclose.

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