Urinary dysfunction appears to be the primary determinant of castration versus observation for prostate cancer patients with PSA failure

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14621-14621
Author(s):  
J. A. Zagory ◽  
C. Chang ◽  
S. Knight ◽  
E. A. Lyons ◽  
C. L. Bennett
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Watchful Waiting ◽  
Specific Antigen ◽  
Hormonal Treatment ◽  
Initial Therapy ◽  
Urinary Dysfunction ◽  
Definitive Treatment ◽  
Psa Failure ◽  
Decision Satisfaction

14621 Background: After undergoing definitive treatment for a primary localized disease, prostate cancer patients may experience a rise in their prostate specific antigen (PSA) levels. Treating PSA failure with hormonal treatment has many health related quality of life (HRQOL) implications, including urinary, bowel, sexual, and male hormonal problems. Predictors of choice between hormonal treatment versus watchful waiting have not been investigated. Methods: Patients were approached after consecutive rises in PSA levels (n = 31). Patients completed HRQOL and decision satisfaction questionnaires, and a literacy assessment. Results: Patients were between 56 and 85 years old; 55% were African American. 71% of African Americans and 50% of whites had low functional literacy. 58% of patients chose hormonal therapy to treat their PSA rise; 81% of patients reported urinary problems. All patients reported decision satisfaction (see Table). Factors associated with castration versus watchful waiting were primarily related to poor urologic function, and were not specifically prostate cancer related (dysuria, nocturia, urination frequency). Conclusions: Primary treatment of urinary dysfunction, rather than castration, should be evaluated as initial therapy for prostate cancer patients with PSA failure. [Table: see text] No significant financial relationships to disclose.

Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

1997 ◽  
Vol 15 (4) ◽  
pp. 1465-1469 ◽  
Author(s):  
A V D'Amico ◽  
R Whittington ◽  
S B Malkowicz ◽  
D Schultz ◽  
J E Tomaszewski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Radical Retropubic Prostatectomy ◽  
Phase Iii ◽  
Psa Failure

PURPOSE A multivariable analysis to evaluate the potential clinical and pathologic factors that predict for early biochemical failure in patients with pathologically organ-confined and margin-negative disease was performed to define patients who may benefit from adjuvant therapy. PATIENTS AND METHODS Three hundred forty-one prostate cancer patients treated with a radical retropubic prostatectomy between January 1989 and June 1995 and found to have pathologically organ-confined and margin-negative disease comprised the study population. A logistic regression multivariable analysis to evaluate the predictive value of the preoperative prostate-specific antigen (PSA) level, pathologic (prostatectomy) Gleason score, and pathologic stage on PSA failure occurring during the first postoperative year was performed. RESULTS Predictors of PSA failure during the first postoperative year in patients with pathologically organ-confined disease included pathologic Gleason score > or = 7 (P = .0007) and preoperative PSA level greater than 10 (P < .0001). Corresponding 3-year freedom-from-PSA-failure rates for these pathologic organ-confined patients with both, one, or neither of these factors were 60%, 75% to 84%, and 95%, respectively (P < .0001). CONCLUSION Prostate cancer patients with pathologically organ-confined and margin-negative disease and a preoperative PSA level greater than 10 ng/mL or a pathologic Gleason score > or = 7 have significant decrements in short-term PSA-failure-free survival. Therefore, these patients should be considered for adjuvant therapy in the setting of a phase III clinical trial.

13-cis Retinoic Acid and Complete Androgen Blockade in Advanced Hormone-Naive Prostate Cancer Patients: Report of a Phase II Randomized Study

2002 ◽  
Vol 20 (2) ◽  
pp. 538-544 ◽  
Author(s):  
Anna C. Ferrari ◽  
Nelson Stone ◽  
Richard Stock ◽  
Myron Bednar ◽  
Isaac Esseesse ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Retinoic Acid ◽  
Cancer Patients ◽  
Phase Ii ◽  
Hormonal Therapy ◽  
Randomized Study ◽  
Specific Antigen ◽  
Hormonal Treatment ◽  
Significant Toxicity ◽  
Complete Androgen Blockade

PURPOSE: 13 cis Retinoic acid (isotretinoin) is a retinoid with preclinical evidence of anti–prostate cancer activity. This phase II, cross-over, randomized study of advanced, predominantly androgen-dependent prostate cancer patients was designed to assess primarily the effect on prostate-specific antigen (PSA) decline and toxicity of adding isotretinoin to hormonal therapy and, secondarily, the potential antitumor activity of the combination. PATIENTS AND METHODS: Thirty-seven D0 to D2 patients were randomized soon after initiating luteinizing hormone–releasing hormone agonist with antiandrogen treatment to add (arm 1) or not (arm 2) isotretinoin from weeks 1 to 12. After cross-over on week 13, patients in arm 1 discontinued while patients in arm 2 added isotretinoin from weeks 14 to 25. Observation on hormonal therapy alone continued until week 49. RESULTS: Baseline and randomization median PSA for 30 assessable patients were, respectively, 34 and 18.2 ng/mL for arm 1 and 31 and 13.4 ng/mL for arm 2. Median PSA at week 13 was 0.5 ng/mL (range, < 0.05 to 136 ng/mL) for arm 1 and 0.7 ng/mL (range, < 0.05 to 4.4 ng/mL) for arm 2; at week 25, 0.1 ng/mL (range, < 0.05 to 121 ng/mL) and 0.4 ng/mL (range, < 0.05 to 3.1 ng/mL), respectively. At week 49, arm 1 had median PSA of 0.1 ng/mL (range, < 0.05 to 345 ng/mL) and arm 2, 0.3 ng/mL (range, < 0.05 to 8.8 ng/mL); seven of 15 and three of 15 patients, respectively, had undetectable PSA levels (P = .12). Frequent isotretinoin-related toxicity included grade 1 cheilitis (76%), skin dryness (43%), and elevated triglycerides (50%). CONCLUSION: Isotretinoin does not impair PSA decline or add significant toxicity to hormonal therapy. An adequately powered, randomized study would be required to determine whether the combination is superior to standard hormonal treatment.

scholarly journals Kinetics of Prostate-Specific Antigen after Carbon Ion Radiotherapy for Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 589 ◽  
Author(s):  
Narisa Dewi Maulany Darwis ◽  
Takahiro Oike ◽  
Hidemasa Kawamura ◽  
Masahiro Kawahara ◽  
Nobuteru Kubo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Carbon Ion Radiotherapy ◽  
Temporary Increase ◽  
Carbon Ion ◽  
Psa Bounce ◽  
Psa Failure ◽  
Biological Effectiveness

This study aimed to first elucidate prostate-specific antigen (PSA) kinetics in prostate cancer patients treated with carbon ion radiotherapy (CIRT). From 2010 to 2015, 131 patients with prostate adenocarcinoma treated with CIRT (57.6 Gy relative biological effectiveness (RBE) in 16 fractions) alone were recruited. PSA was measured at 1, 2, 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, and 60 months post-CIRT. PSA bounce was defined as PSA increase over a cutoff followed by spontaneous decrease to or below the pre-bounce nadir. PSA failure was determined using the Phoenix criteria (nadir + 2.0 ng/mL). As a result, non-failure-associated temporary increase in PSA exhibited two distinct patterns, namely a classical bounce and a surge at one month. PSA bounce of ≥0.2 ng/mL was observed in 55.7% of the patients. Bounce amplitude was <2.0 ng/mL in 97.6% of cases. Bounce occurred significantly earlier than PSA failure. Younger age was a significant predictor of bounce occurrence. Bounce positivity was a significant predictor of favorable 5-year PSA failure-free survival. Meanwhile, a PSA surge of ≥0.2 ng/mL was observed in 67.9% of patients. Surge amplitude was significantly larger than bounce amplitude. Larger prostate volume was a significant predictor of PSA surge occurrence. PSA surge positivity did not significantly predict PSA failure. In summary, PSA bounce was distinguishable from PSA failure with regard to timing of occurrence and amplitude (earlier and lower for bounce, respectively). These data are useful for post-CIRT surveillance of prostate cancer patients.

scholarly journals Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lindsay S. Rowe ◽  
Stephanie Harmon ◽  
Adam Horn ◽  
Uma Shankavaram ◽  
Soumyajit Roy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Pet Imaging ◽  
Biochemical Recurrence ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Definitive Treatment ◽  
Pattern Of Failure ◽  
Link Type ◽  
Psma Pet

Abstract Background Prostate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI. Methods PCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose. Results A total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose. Conclusions 18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy. Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.

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