Stereotactic robotic radiosurgery for localized prostate cancer: Initial evaluation of acute toxicities

e16006 Background: We evaluated the initial acute toxicities experienced by patients treated with cyberknife fractionated radiosurgery for low and low-intermediate risk prostate cancer. Methods: Twenty-two patients with low or low-intermediate risk prostate cancer (T2a, GG 3+3=6 or 3+4=7, PSA <10) were enrolled prospectively on an IRB approved protocol and treated the planning target volume (PTV)(prostate+5mm margin) with cyberknife fractionated radiosurgery to a dose of 36.25 Gy in 5 fractions (7.25Gy/fraction). The target volume included the prostate and seminal vesicles. PSA values, AUA symptom scores (AUA SS), and NCI CTC acute toxicities were analyzed prior to radiosurgery and at 1 month (N=16), 3 months (N=12) and 6 months (N=5)post-treatment. Results: Patients treated on study included 12 with GG 3+3=6 cancer and 10 with GG 3+4=7 cancer. Mean patient age was 66 years old (range 49–79). Mean pre-treatment PSA was 5.29 (range 0.64–9.36) declining to 3.44 (range 0.00–10.43) at 1 month post treatment, 1.99 (range 0.31–3.99) at 3 months post-treatment and 2.08 (1.05–3.13) at 6 months post-treatment. Mean pre-treatment AUA SS was 7 (range 0.–18) increasing to 12 (range 2–29) at 1 month post treatment, decreasing to 8 (range 2–17) at 3 months post-treatment and 11 (3–17). There were 5 grade 1 acute toxicities including (diarrhea, fatigue, mild urinary frequency, hemorrhoid and a rash) and 7 grade 2 toxicities including (bladder spasms, painful urinary, bowel irregularity, rectal pain, urethritis and numbness in the upper thigh), all grade 1 and 2 toxicities resolved within three months of treatment. The one patient with grade 2 thigh numbness was not thought to be study related toxicity. Two patients developed grade 3 toxicity. One developed bacteremia after the transrectal ultrasound guided placement of the fiducials, the infection completely resolved after treatment with antibiotics. One patient on Coumadin developed hematuria which resolved with conservative management. Conclusions: Cyberknife fractionated radiosurgery for patients with early stage prostate cancer appears to be safe on our early initial assessment.Continued evaluation and longer follow-up ongoing. [Table: see text]

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6 Post-treatment biopsy results following permanent transrectal ultrasound-guided interstitial brachytherapy in early stage prostate cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(95)97671-m ◽

1995 ◽

Vol 32 ◽

pp. 144 ◽

Cited By ~ 1

Author(s):

Bradley R. Prestidge ◽

John C. Blasko ◽

Peter D. Grimm ◽

David C. Hoak ◽

Bill Cavanagh ◽

...

Keyword(s):

Prostate Cancer ◽

Early Stage ◽

Transrectal Ultrasound ◽

Post Treatment ◽

Interstitial Brachytherapy ◽

Ultrasound Guided

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Prognostic value of copy-number alterations of the Cohesin complex in intermediate-risk prostate cancer recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.49 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 49-49

Author(s):

Jonathan So ◽

Melvin Chua ◽

Emilie Lalonde ◽

Osman Mahamud ◽

Alejandro Berlin ◽

...

Keyword(s):

Prostate Cancer ◽

Copy Number ◽

Intermediate Risk ◽

Cohesin Complex ◽

Biochemical Relapse ◽

Copy Number Alterations ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Risk Prostate Cancer ◽

Pre Treatment

49 Background: The Cohesin complex plays a critical role in mitotic progression and post-replicative DNA damage repair. It serves to bring together sister chromatids both in metaphase and in homologous recombination repair following ionizing radiation. The complex has also been shown to be phosphorylated in the ATM/BRCA1 pathway. The expression of various proteins in the complex are dysregulated in many cancers: breast, prostate, etc. Interestingly, in breast cancer cell lines, Cohesin is required for MYC activation in response to estrogen. Our study sought to correlate copy number alterations in this pivotal complex with biochemical relapse in prostate cancer patients. Methods: Our cohort consists of 284 patients with D’ Amico-classified intermediate-risk prostate cancer, treated with image-guided radiotherapy (IGRT, N = 143) or radical prostatectomy (RadP, N = 141). Pre-treatment biopsies and prostatectomy samples were analyzed using the Affymetrix Oncoscan array. The Phoenix and AUA criteria was used to define biochemical relapse for RadP and IGRT patients respectively. Results: Copy number alterations of RAD21, SMC1B, and STAG1 were observed in 18% (n = 52), 6.3% (n = 18), and 12% (n = 35) of the cohort respectively. They were predominantly losses in SMC1B, but gains in RAD21 and STAG1. All three genes in the Cohesin complex were associated with increased risk of biochemical relapse: RAD21 on chromosome 8 (HR = 1.93, 95% CI 1.23, 3.02, Wald’s p = 0.004), SMC1B on chromosome 22 (HR = 3.37, 95% CI 1.91, 5.94, Wald’s p < 10-4), and STAG1 on chromosome 3 (HR = 1.74, 95% CI 1.04, 2.89, Wald’s p < 0.05). However, when controlled for percent genome alteration and pre-treatment serum PSA levels, only copy number loss of SMC1B was a significant predictor of biochemical relapse (HR = 2.95, 95% CI 1.62, 5.38, Wald’s p < 10-3). Conclusions: We identified a novel association of copy-number alterations in members of the Cohesin complex with biochemical recurrence following radical prostatectomy or image-guided radiotherapy. This points to the central role of Cohesin in cell-cycle and DNA damage pathways promoting prostate cancer progression.

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Hypofractionated Proton Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer Is Not Associated With Post-treatment Testosterone Suppression

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.989 ◽

2012 ◽

Vol 84 (3) ◽

pp. S375

Author(s):

W. Kil ◽

R.C. Nichols ◽

B.S. Hoppe ◽

R.B. Marcus ◽

W.M. Mendenhall ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Post Treatment ◽

Intermediate Risk ◽

Proton Radiation ◽

Proton Radiation Therapy ◽

Risk Prostate Cancer

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Management of isolated local failures following stereotactic body radiation therapy for low to intermediate risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.66 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 66-66

Author(s):

Nicolette Drescher ◽

Nima Aghdam ◽

Malika Danner ◽

Marilyn Ayoob ◽

Thomas M. Yung ◽

...

Keyword(s):

Prostate Cancer ◽

Salvage Therapy ◽

Doubling Time ◽

Intermediate Risk ◽

Effective Treatment Option ◽

Psa Doubling Time ◽

Risk Prostate Cancer ◽

Effective Doses ◽

Psa Nadir ◽

Pre Treatment

66 Background: SBRT is a safe and effective treatment option for patients with low to intermediate risk prostate cancer (PCa). SBRT delivers high biologically effective doses resulting in very low PSA nadirs. Strategies to diagnose and confirm salvageable isolated local failures (ILF) are needed. This study aims to examine the incidence and approach to management of ILF after SBRT in a large single institution cohort. Methods: All patients with low or intermediate risk PCa treated with SBRT at our institution were eligible for this study. Treatment was delivered using the robotic SBRT with doses of 35-36.25 Gy in five fractions. ILF were diagnosed using mpMRI and/or biopsy prompted by PSA rise after achieving long-term nadir. Choice of salvage therapy and post-salvage PSA were ascertained on follow up. Results: Between December, 2008 to August, 2018, 998 men with low to intermediate risk prostate cancer were eligible for analysis. Twenty patients (low risk, n = 4; intermediate risk, n = 16) were found to have ILF on either MRI (n = 15) and/or biopsy (n = 17). Three patients with MRI-identified ILF elected active surveillance in lieu of biopsy. Median pre-treatment PSA was 7.5 ng/ml. Median time to diagnosis of ILF was 72 months (37-96 months) with median PSA at the time of ILF of 2.3 ng/ml (1.1-10 ng/ml). Median PSA doubling time was 17 months (5-22 months). Thirteen patients with biopsy proven ILF proceeded with salvage therapy (cryotherapy n = 12, HIFU n = 1). Of 12 patients who underwent cryotherapy, 8 had a post-treatment PSA of < 0.1ng/ml, two patient’s results were unavailable, one patient had a PSA nadir of 0.7 ng/ml and one patient had yet to undergo post-salvage PSA test at the time of this report. Conclusions: The incidence of ILF is rare in our series. Diagnosis and management of ILF post-SBRT continues to evolve in the era of successful salvage therapy. Our report suggests an important role for early utilization of MRI and confirmatory biopsy at relatively low PSA levels and long PSA doubling time. Additionally, undetectable PSA post-salvage therapy supports early treatment after identifying ILF. Larger trials are needed for refinement of patient selection and most appropriate salvage modality.

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