Correlation of 11c-choline PET-CT with time to treatment and disease-specific survival in men with recurrent prostate cancer after radical prostatectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 123-123
Author(s):  
A. J. Breeuwsma ◽  
J. Pruim ◽  
A. M. Leliveld ◽  
R. A. Dierckx ◽  
I. J. de Jong
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radical Prostatectomy ◽  
Disease Specific Survival ◽  
Negative Group ◽  
Recurrent Prostate Cancer ◽  
Choline Pet ◽  
Pet Ct ◽  
Disease Specific

123 Background: Restaging with PET-CT in biochemical recurrent prostate cancer after prostatectomy shows a higher frequency of (false) negative cases compared to restaging after EBRT. It is uncertain if this reflects low volume of disease and/or low grade as biopsies fail to prove recurrent cancer in 50% of cases. We followed the clinical course of men with recurrent prostate cancer (PCa) after radical prostatectomy and investigated treatment and survival. PET-CT data were correlated with clinical data, PSA kinetics and disease specific and overall survival. We also studied relative survival comparing an age matched group from the Central Dutch Statistical Office (CBS). Methods: 64 patients underwent 11C-Choline PET-CT on PSA relapse. All patients were initially treated with radical prostectomy and reached PSA nadir of <0.1ng/mL. Recurrent disease was defined as PSA <0.4ng/mL after nadir. Patients were either treated with watchful waiting, adjuvant radiotherapy and/ or androgen deprivation therapy based on individual assesments by the treating urologists. Chi-square, log-rank and Mann-Whitney-U tests were used to study this population Results: The 64 patients had median PSA of 1.4ng/mL. Median follow-up period of patients was 50 (6–124) months. Ten patients died during the course of follow-up of which 5 due to metastasized PCa. No significant differences were seen in age, time to recurrence, total PSA at recurrence and PET-CT results. Patients with abnormal PET had higher PSAVel (median 3.09 ng/mL/yr vs 10.17, p= 0.002) and and shorter PSADT (med 4.83 mo vs 0.53, p= 0.016). Median time to treatment was significantly lower in the PET-CT negative group. Age of patients at death from the whole group did not differ from the age of death in an age matched group. Disease specific survival was significantly higher in the PET-CT negative group (p0.05). Conclusions: A negative 11C-Choline PET-CT correlated with a higher disease specific survival and a lower treatment rate. Overall survival of the group was equal to the age matched cohort. No significant financial relationships to disclose.

Intergroup randomized phase III study of androgen deprivation therapy (ADT) plus radiation therapy (RT) in locally advanced prostate cancer (CaP) (NCIC-CTG, SWOG, MRC-UK, INT: T94-0110; NCT00002633).

2010 ◽  
Vol 28 (18_suppl) ◽  
pp. CRA4504-CRA4504 ◽  
Author(s):  
P. R. Warde ◽  
M. D. Mason ◽  
M. R. Sydes ◽  
M. K. Gospodarowicz ◽  
G. P. Swanson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Phase Iii ◽  
Disease Specific Survival ◽  
Locally Advanced Prostate Cancer ◽  
Combined Modality ◽  
Disease Specific

CRA4504 Background: The impact of radiotherapy on overall survival (OS) in men with locally advanced CaP is unclear. The SPCG-7 trial recently showed a benefit to RT for CaP specific mortality. Our primary objective was to assess the effect of RT on OS when added to lifelong ADT in men with locally advanced CaP. Methods: Patients with T3/T4 (1057) or T2, PSA > 40 μ g/l (119) or T2 PSA > 20 μ g/l and Gleason ≥ 8 (25) and N0 /NX, M0 prostate adenocarcinoma were randomized to lifelong ADT (bilateral orchiectomy or LHRH agonist) with or without RT (65-69 Gy to prostate ± seminal vesicles with or without 45Gy to pelvic nodes). The primary endpoint was OS and secondary endpoints included disease specific survival (DSS), time to disease progression and quality of life. Results: 1205 patients were randomized from 1995 to 2005, 602 to ADT and 603 to ADT+RT (well balanced with respect to baseline characteristics). A protocol specified second interim analysis on OS was performed in Aug 2009 (data cut-off Dec 31 2008). The DSMC recommended release of the results to the Trial Committee for publication. The median follow-up is 6.0 years and 320 patients have died (175 ADT and 145 ADT+RT). 10% of patients had no follow-up data beyond 2006. The addition of RT to ADT significantly reduced the risk of death (hazard ratio [HR] 0.77, 95% CI 0.61-0.98, p=0.033). 140 patients died of disease and/or treatment (89 on ADT and 51 on ADT+RT) The disease specific survival HR was 0.57 (95% CI 0.41-0.81, p=0.001) favoring ADT+RT. The 10 year cumulative disease specific death rates were estimated at 15% with ADT+ RT and 23% with ADT alone. Grade ≥2 late GI toxicity rates were similar in both arms (proctitis, 1.3% ADT alone, 1.8% ADT+RT). Conclusions: The trial results indicate a substantial overall survival and disease specific survival benefit for the combined modality approach (ADT+RT) in the management of patients with locally advanced prostate cancer with no significant increase in late treatment toxicity. In view of this data combined modality therapy (ADT+RT) should be the standard treatment approach for these patients. Supported by NCI-US Grant #5U10CA077202-12, CCSRI Grant #15469. No significant financial relationships to disclose.

Clinical impact of 11C-Choline PET/CT in selection and outcome of salvage cryoablation in patients with recurrent prostate cancer after radiotherapy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 276-276
Author(s):  
Marleen Suzanne Vallinga ◽  
Anthonius Breeuwsma ◽  
Maxim Rybalov ◽  
Jan Pruim ◽  
Igle J. De Jong
Keyword(s):  
Prostate Cancer ◽  
Hormonal Therapy ◽  
Biochemical Recurrence ◽  
Clinical Impact ◽  
Recurrent Prostate Cancer ◽  
Choline Pet ◽  
Pet Ct ◽  
Psa Response ◽  
The Impact

276 Background: Salvage cryoablation is an effective but toxic treatment for local recurrent prostate cancer after primary radiotherapy. To assess the location of recurrent prostate cancer, an 11C-choline PET/CT can be used. We studied the clinical impact of 11C-choline PET/CT on the choice for and the results of salvage cryoablation. Methods: A total of 141 patients with a biochemical recurrence (BCR according to ASTRO-Phoenix criteria) after radiotherapy, and thus candidates for salvage cryoablation, were included. Patients were re-staged with an 11C-choline PET/CT, complementary prostate biopsies, when indicated a pelvic lymph node dissection and/or additional imaging. Change in choice of therapy was defined as major (no salvage cryoablation because of metastases or lack of local recurrence on PET/CT), minor (local salvage treatment was performed, but different technique of after additional diagnostics) or none (salvage cryoablation was performed). The impact of selection of patients for cryoablation with PET/CT on outcome was measured by time from cryoablation to BCR (according to Astro-Phoenix), first distant metastasis and start of hormonal therapy. Results: In 71 of 141 patients (51%) a change in therapy was implemented because of the result of 11C-choline PET/CT. A major impact was observed in 48 (34%) patients. In 83 patients, a salvage cryoablation was performed (59%). 18% of this group showed no PSA response. Of the remaining patients with PSA response, 37% developed a BCR after mean 25.7 months. 47% of patients are still in remission after a mean follow-up of 43 months. In 16 of 83 patients (19%) metastases were proven after mean 55.4 months (SD 26.3). 15 patients started with hormonal therapy, mean 29.5 months (SD 20.1) after cryoablation. Conclusions: 11C-choline PET/CT showed a significant impact on selection for salvage cryoablation. The choice for local salvage therapy was abandoned in 34% of patients. Of the men who underwent a salvage cryoablation, 47% stayed free of biochemical recurrence during mean 43 months follow-up.

Radical Prostatectomy Versus Observation for Localized Prostate Cancer

2021 ◽  
pp. 37-42
Author(s):  
Philipp Dahm
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Watchful Waiting ◽  
Specific Antigen ◽  
Localized Prostate Cancer ◽  
Disease Specific Survival ◽  
Long Term Follow Up ◽  
Disease Specific

This chapter provides a summary of the landmark PIVOT trial that randomized men with clinically localized prostate cancer from the early prostate-specific antigen (PSA) era to radical prostatectomy versus watchful waiting. Based on long-term follow-up, the study found that surgery provided only small reductions in disease-specific survival but caused substantial side effects. It suggested that many men with clinically localized prostate cancer fare well with watchful waiting.

Survival Advantage From Higher-Dose Radiation Therapy for Clinically Localized Prostate Cancer Treated on the Radiation Therapy Oncology Group Trials

2000 ◽  
Vol 18 (14) ◽  
pp. 2740-2746 ◽  
Author(s):  
Richard Valicenti ◽  
Jiandong Lu ◽  
Miljenko Pilepich ◽  
Sucha Asbell ◽  
David Grignon
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Radiation Dose ◽  
Radiation Therapy Oncology Group ◽  
Localized Prostate Cancer ◽  
Disease Specific Survival ◽  
Oncology Group ◽  
Dose Radiation ◽  
Disease Specific

PURPOSE: We evaluated the effect of external-beam radiation therapy on disease-specific survival (death from causes related to prostate cancer) and overall survival in men with clinically localized prostate cancer. METHODS: From 1975 to 1992, 1,465 men with clinically localized prostate cancer received radiation therapy on four Radiation Therapy Oncology Group phase III randomized trials and were pooled for this analysis. No one received androgen-deprivation therapy with his initial treatment. All original histology had central pathologic review for grading using the Gleason classification system. Total delivered radiation dose ranged from 60 to 78 Gy (median, 68.4 Gy). The median follow-up time was 8 years. RESULTS: A Cox regression model revealed that Gleason score was an independent predictor of disease-specific survival and overall survival. The 10-year disease-specific survival rates by Gleason score were as follows: score of 2 through 5, 85%; score of 6, 79%; score of 7, 62%; and score of 8 through 10, 43%. Stratifying outcome by this important prognostic factor revealed that higher radiation dose was a significant predictor for improved disease-specific survival and overall survival only for those patients whose cancers had Gleason scores of 8 through 10 (P < .05). After adjusting for clinical T stage, nodal status, and age, treating with a higher radiation dose was associated with a 29% lower relative risk of death from prostate cancer and 27% reduced mortality rate (P < .05). CONCLUSION: These data demonstrate that higher-dose radiation therapy can significantly reduce the risk of dying from prostate cancer in men with clinically localized disease. This survival benefit is restricted to men with poorly differentiated cancers.

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