Impact of primary Gleason grade 4 on biochemical recurrence after permanent interstitial brachytherapy in Japanese patients with low- or intermediate-risk prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 77-77
Author(s):  
T. Saika ◽  
T. Uesugi ◽  
K. Edamura ◽  
M. Kobuke ◽  
H. Nose ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
National Comprehensive Cancer Network ◽  
Biochemical Recurrence ◽  
Japanese Patients ◽  
Localized Prostate Cancer ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Nccn Guidelines ◽  
Cancer Network

77 Background: To reveal a predictive factor for biochemical recurrence (BCR) after permanent prostate brachytherapy (PPB) using iodine-125 (125I) seed implantation in patients with localized prostate cancer classified as low or intermediate risk based on the National Comprehensive Cancer Network (NCCN) guidelines. Methods: From January 2004 to December 2009, consecutive 418 Japanese patients with clinically localized prostate cancer classified as low or intermediate risk based on the National Comprehensive Cancer Network (NCCN) guidelines were treated by PPB. The clinical factors including pathological data reviewed by central pathologist and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with BCR. Results: Median follow-up was 36.0 months. The 2, 3, 4 and 5-year BCR free rates using Phoenix definition were 98.3%, 96.0%, 91.6% and 87.0% respectively. On univariate analysis, primary Gleason grade 4 in biopsy specimen was strong predicting factor (p<0.0001), while Gleason sum, age, initial PSA, initial PSA density, T stage and D90 were insignificant factors. Multivariate analysis indicated that primary Gleason grade 4 was most powerful prognostic factor associated with BCR (hazard ratio=10.101, 95% IC 3.080-33.126, p=0.0001). Conclusions: The primary Gleason grade 4 carried a worse BCR than the primary grade 3 in Gleason score 7 prostate cancer. Therefore, the indication for PPB in patients with Gleason sum 4+3 should deserve careful and thoughtful consideration. No significant financial relationships to disclose.

Prostate brachytherapy implant quality on biochemical control.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 128-128
Author(s):  
Don Muller ◽  
Paul Monsour
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Biochemical Failure ◽  
Low Risk ◽  
Prostate Brachytherapy ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Biochemical Control ◽  
Dosimetric Analysis

128 Background: prostate brachytherapy at our institution was analyzed for implant quality on biochemical control. Methods: We treated 368 patients with clinically localized prostate cancer. All patients underwent 1 month CT based dosimetric analysis. Follow up data was available on 289 patients with a minimum follow up of 5 years. Gleason score was 6 in 80% (n=233), and 7 in 20% (n=56). Clinical stage was T1c in 90% of cases (n=260), T2a was 8% (n=23), T2b was <1% (n=3), T2c was < 1% (n=2). The initial prostate-specific antigen was < 10 ng/ml in 95% (n=274), 10.1-20 ng/ml in 5% (15).Patients with low risk disease ( clinical stage T1c, Gleason score 6 with a PSA < 10 ng/ml) n=228. Patients with intermediate risk disease Gleason 7 adenocarcinoma or with a PSA> 10 ng/ml < 20 ng/ml )n= 61. All patients were treated with I (125). All patients underwent a 1-month CT-based dosimetric analysis. The implant dose was defined as the dose delivered to 90% of the prostate volume on post implant dosimetry (D(90)). Results: At minimum follow up of 5 years overall freedom from biochemical failure was 91.4%. For Gleason grade 6 freedom from biochemical failure was 95%. For Gleason grade 7 freedom from biochemical failure was 77%. Based on PSA freedom from biochemical failure for PSA <10 ng/ml at diagnosis was 92 % and for PSA >10 ng/ml and <20 ng/ml was 80%. In patients with low risk disease ( clinical stage T1c, Gleason 6 adenocarcinoma with a PSA < 10ng/ml) the freedom from biochemical failure was 94%. In patients with intermediate risk disease (Gleason 7 adenocarcinoma or with a PSA >10 ng/ml <20 ng/ml ) freedom from biochemical failure was 84%. Patients with optimal dose implants n=264 freedom from biochemical failure was 95%. Patients with suboptimal dose implants n=25 freedom from biochemical failure was 52% Conclusions: With a minimum follow up of 5 years our data support the use of implant alone in low risk prostate cancer patients with a freedom from biochemical failure of 94%. Our data also shows the importance of implant quality in achieving optimal out comes.

Active surveillance outcomes among a cohort of county hospital patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Erika L. Wood ◽  
Steven Canfield
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
County Hospital ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Intermediate Risk ◽  
Loss To Follow Up ◽  
Hospital Patients ◽  
Lost To Follow Up

136 Background: The standard of care for managing localized prostate cancer includes offering patients active surveillance. With the 10-year prostate cancer specific survival between 96-100% for both low and low-intermediate risk patients, active surveillance has proven to be a safe and effective option. Most studies have examined cohorts of patients within a tertiary referral center but data is sparse on county hospital patients, where health insurance coverage among other concerns pose barriers for patients to receive consistent medical care. We were interested in how active surveillance was performing amongst a cohort of county hospital based patients. Methods: A retrospective chart review was conducted on fifty patients placed on active surveillance for low and low-intermediate risk prostate cancer (by D’Amico criteria) between July 1, 2007 and August 1, 2013. Overall and cause-specific survival were the main outcome measures. Data was also collected on loss to follow-up rates. Results: In the cohort, the mean age at diagnosis was 62.2, mean body mass index was 28.0, most were African American or Hispanic (50% and 46%, respectively) and the majority had low-risk disease (84%). The median length of follow-up after diagnosis was 22 months. Nearly half of patients stopped active surveillance (44%), the most common reason being reclassification of their disease after second biopsy. All patients who were reclassified received definitive treatment with the exception of one patient who was lost to follow-up. Cause-specific and overall mortality were both 100% in this cohort. Nearly a quarter of patients (22%) were lost to follow-up (either had less than 12 months of surveillance following diagnosis or had not presented to clinic within the last 12 months). Conclusions: High rates of loss to follow-up present a significant challenge to managing localized prostate cancer with active surveillance in a county hospital population. In this small cohort, active surveillance appears to be a safe and effective management option for localized prostate cancer, yet undetected disease progression remains a significant concern.

scholarly journals Neuroendocrine Immunophenotype as Predictor of Clinical Recurrence in 110 Patients with Prostate Cancer

2007 ◽  
Vol 20 (4) ◽  
pp. 765-770 ◽  
Author(s):  
R. Autorino ◽  
M.G. Lamendola ◽  
G. De Luca ◽  
M. De Sio ◽  
F. Giugliano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Median Time ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Univariate Analysis ◽  
Localized Prostate Cancer ◽  
Clinical Recurrence ◽  
Psa Recurrence ◽  
Well Differentiated

We evaluated the relationship between NE expression and well-known prognostic factors and assessed whether tumor relapse after radical surgery correlates with the extent of NE differentiation. Radical prostatectomy specimens from 110 patients with clinically localized prostate cancer were assessed. Patients were followed up every three months for the first two years after surgery and six monthly for 5 additional years until failure, or for a mean of 48 months from the time of surgery for those who did not experience failure. The percentage of cells showing CgA immunoreactivity was evaluated using a visual quantitative method. Tumor staining was categorized as positive if >10% and negative if <10% of tumor cells were stained, to ensure that only cases with significant positivity were included in the positive group. The median follow-up was 5.4 years (range 1.8 to 7.2). The median time to clinical recurrence was 7.5 years and the median time to biochemical recurrence was 2.8 years. Of 31 patients (28%) who experienced a PSA recurrence, 15 developed a clinical recurrence. The mean preoperative PSA level was 9 ng/ml (range 2.7 to 25). Most cases were well differentiated (Gleason score <7), intraprostatic (≤pT2) tumors. Immunoreactivity in ≥10% of the cells was seen in 17.2% (n=19) of the tumor specimens. The preoperative PSA level, Gleason score, use of neoadjuvant or adjuvant therapy, lymphnode positivity were not statistically associated with NE expression. Only the primary pathologic stage appeared to be associated with CgA staining in the primary tumor (p=0.001). On the univariate analysis NE expression did not predict biochemical recurrence free survival, whereas it was associated with clinical recurrence. NE differentiation in clinically localized prostate cancer can be associated with failure after definitive surgical treatment, even if no conclusions can be drawn regarding its value as an independent prognostic factor.

National Comprehensive Cancer Network® Favorable Intermediate Risk Prostate Cancer—Is Active Surveillance Appropriate?

2018 ◽  
Vol 199 (5) ◽  
pp. 1196-1201 ◽  
Author(s):  
Monty A. Aghazadeh ◽  
Jason Frankel ◽  
Matthew Belanger ◽  
Tara McLaughlin ◽  
Joseph Tortora ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
National Comprehensive Cancer Network ◽  
Active Surveillance ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Cancer Network
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