Early results of prostate cancer radiation therapy at Korle Bu Teaching Hospital: An analysis with emphasis on research strategies to improve treatment delivery and outcomes among patients in Ghana.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15163-e15163
Author(s):  
Kosj Yamoah ◽  
Kwamena Beecham ◽  
Sarah Hegarty ◽  
Terry Hyslop ◽  
Timothy Norman Showalter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Disease ◽  
External Beam Radiotherapy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Local Therapy ◽  
The United States ◽  
Related Factors ◽  
Early Results

e15163 Background: Although there is interest in racial disparities in prostate cancer outcomes among persons of African descent living in the United States there is scant data available regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT). Methods: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy and Nuclear Medicine, Ghana, from January 2003 to December 2009. Data were collected regarding patient- and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score, clinical stage, and use of hormonal therapy. For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using Kaplan-Meier analysis. Results: The median age at diagnosis was 65 years. Of 379 patients referred for treatment 69.6% of all patients had initial PSA >20ng/ml, and the median iPSA was 39.0 ng/ml. A total of 128 men representing 33.8% of overall cohort were diagnosed with metastatic disease at time of referral. We identified 166 men treated with EBRT or brachytherapy +/- androgen depravation therapy (ADT), and an additional 139 men treated with ADT alone (including orchiectomy in 38 patients). The median EBRT dose was 70 Gy, in 2 Gy per fraction. Among all EBRT patients with at least 2 years of follow-up after treatment (n=52; median follow-up time: 38.9 months), 5-year actuarial FFbF was 65.1%: 67.0% for patients with PSA < 30.0 ng/mL and 63.2% for PSA ≥ 30.0 ng/mL [log-rank, p=0.586]. Conclusions: This is the largest series reporting on outcomes for prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection of prostate cancer to permit curative-intent local therapy. Data from this study will aid in the strategic development of a prostate cancer research roadmap in Ghana, with a focus on improving therapeutic approach as well as fostering a prudent allocation of scarce resources.

scholarly journals Vasectomy and Risk of Aggressive Prostate Cancer: A 24-Year Follow-Up Study

2014 ◽  
Vol 32 (27) ◽  
pp. 3033-3038 ◽  
Author(s):  
Mohummad Minhaj Siddiqui ◽  
Kathryn M. Wilson ◽  
Mara M. Epstein ◽  
Jennifer R. Rider ◽  
Neil E. Martin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Specific Antigen ◽  
Prostate Cancer Risk ◽  
The United States ◽  
Low Grade ◽  
High Grade ◽  
Follow Up Study ◽  
Increased Risk

Purpose Conflicting reports remain regarding the association between vasectomy, a common form of male contraception in the United States, and prostate cancer risk. We examined prospectively this association with extended follow-up and an emphasis on advanced and lethal disease. Patients and Methods Among 49,405 US men in the Health Professionals Follow-Up Study, age 40 to 75 years at baseline in 1986, 6,023 patients with prostate cancer were diagnosed during the follow-up to 2010, including 811 lethal cases. In total, 12,321 men (25%) had vasectomies. We used Cox proportional hazards models to estimate the relative risk (RR) and 95% CIs of total, advanced, high-grade, and lethal disease, with adjustment for a variety of possible confounders. Results Vasectomy was associated with a small increased risk of prostate cancer overall (RR, 1.10; 95% CI, 1.04 to 1.17). Risk was elevated for high-grade (Gleason score 8 to 10; RR, 1.22; 95% CI, 1.03 to 1.45) and lethal disease (death or distant metastasis; RR, 1.19; 95% CI, 1.00 to 1.43). Among a subcohort of men receiving regular prostate-specific antigen screening, the association with lethal cancer was stronger (RR, 1.56; 95% CI, 1.03 to 2.36). Vasectomy was not associated with the risk of low-grade or localized disease. Additional analyses suggested that the associations were not driven by differences in sex hormone levels, sexually transmitted infections, or cancer treatment. Conclusion Our data support the hypothesis that vasectomy is associated with a modest increased incidence of lethal prostate cancer. The results do not appear to be due to detection bias, and confounding by infections or cancer treatment is unlikely.

scholarly journals Vaccines for prostate cancer : a new era?

2016 ◽  
Vol 28 (3) ◽  
pp. i-iii
Author(s):  
Julius I Mulia
Keyword(s):  
Prostate Cancer ◽  
Clinical Symptoms ◽  
Specific Antigen ◽  
Local Therapy ◽  
The United States ◽  
External Beam Radiation ◽  
Western World ◽  
Beam Radiation ◽  
Hormone Refractory ◽  
Androgen Independent

Prostate adenocarcinoma is the most prevalent type of noncutaneous cancer in the Western world, with an estimated 218,890 new cases and 27,050 deaths in the United States in 2007. Currently prostate cancer is detected by measurement of prostate-specific antigen (PSA), a serine protease synthesized by the prostatic epithelium. PSA is an organ-specific and tumor-associated antigen (TAA) but it is not tumor-specific.(1) Partly because of increased cancer screening with PSA, prostatic cancer may now be diagnosed when it is still localized. Localized tumors of the prostate are generally treated with radical prostatectomy, external-beam radiation therapy (EBRT), brachytherapy, or watchful waiting. Unfortunately, up to 30%-40% of patients fail local therapy. The standard treatment of recurrent or metastatic disease is androgen-deprivation therapy (ADT), but this is only a temporary measure as in the majority of cases the cancer ultimately becomes hormone refractory, the condition being termed androgen-independent prostate cancer (AIPC) or hormone refractory prostate cancer (HRPC), which then progresses rapidly. The only available nonpalliative therapy for androgen-independent prostate cancer is docetaxel in combination with prednisone. However, ADT given prior to the onset of clinical symptoms results in rising PSA levels with castrate levels of testosterone, often with a relatively low tumor burden. This systemic treatment earlier in the disease course combined with effective palliative chemotherapy is implicated in the improvement in median survival time of patients with AIPC from an average of about 12 months to about 17-18 months.

Prostate cancer

2017 ◽  
Author(s):  
Matthew Cooperberg ◽  
Peter Carroll
Keyword(s):  
Prostate Cancer ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Mortality Rates ◽  
Low Risk ◽  
Gleason Grade ◽  
Aggressive Treatment ◽  
Careful Monitoring ◽  
Biopsy Tissue

Management of prostate cancer remains controversial, in large part because of its wide heterogeneity in terms of aggressiveness and prognosis. Early detection efforts based on prostate specific antigen (PSA) and aggressive treatment of high-risk cancers have yielded major improvements in mortality rates, but overtreatment of low-risk cancers—those unlikely to cause symptoms or threaten life if they were never detected—is associated with high rates of avoidable toxicity and cost. Prostate cancer can be effectively risk-stratified based on tools (e.g. nomograms, CAPRA score) integrating the PSA level, Gleason grade, clinical stage, and extent of biopsy tissue involvement. Most men with low-risk tumours are eligible for active surveillance, a programme of careful monitoring based on PSA and follow-up biopsies. Men with higher-risk cancers are best served with radical prostatectomy or radiation therapy.

Association of ARV7 expression with molecular and clinical characteristics in prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 109-109 ◽  
Author(s):  
Himanshu Joshi ◽  
Jacek K. Pinski
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Clinical Characteristics ◽  
Clinical Stage ◽  
Specific Antigen ◽  
The United States ◽  
Clinicopathological Parameters ◽  
Mesenchymal Transition ◽  
Regulatory Pathways ◽  
Custom Made

109 Background: Prostate cancer (PC) is the most common cancer in men over the age of 60 and the second leading cause of cancer mortality in the United States. Clinicopathological parameters such as Gleason score, tumor volume, surgical margins, prostate-specific antigen (PSA), Ki-67 index and clinical stage are used as prognostic markers for clinical outcomes. Identification of novel molecular markers could improve our understanding of the clinical behavior of this disease. Androgen receptor isoforms, in particular variant 7 (ARV7 or AR3) have been recently studied for elucidating their potential role in PC progression, associated with epithelial-mesenchymal transition (EMT), disease aggressiveness, increased proliferation and therapeutic resistance. Our study is analyzing the association of ARV7 mRNA expression to clinical characteristics and is analyzing the genomic data to identify differentially altered genes by ARV expression status, summarized as a potential functional network. Methods: We obtained the TCGA public dataset of prostate adenocarcinoma tumors (N=499) that included the clinical data, gene and isoform expression and mutation data. Cases were categorized into ARV7 over-expressing (ARV+) and normal or low expression (ARV –/N) by using a cut-off of upper 25th percentile of the background genomic expression. Analysis was performed in R and Perl by using custom-made scripts. Differentially altered genes and pathways were identified and were summarized as potential functional networks. Results: We categorized 30 out of the 499 tumors as ARV+. ARV7 over-expression was found to be significantly associated with older age at diagnosis (>70), advanced clinical stage, nodal involvement, high Gleason score and a poor therapeutic response. We also observed a trend towards shorter disease-free survival among ARV+ tumors. In addition, ARV+ tumors showed significantly higher number of mutations in 20 key regulatory pathways including Jak-STAT signaling, homologous recombination, ErbB and Wnt signaling pathways. Conclusions: ARV7 overexpression is associated with genomic alterations in key regulatory pathways and poorer clinical outcome in PC patients.

scholarly journals Radiotherapeutic Strategies in the Management of Low-Risk Prostate Cancer

2010 ◽  
Vol 10 ◽  
pp. 1854-1869 ◽  
Author(s):  
Kevin S. Choe ◽  
Stanley L. Liauw
Keyword(s):  
Prostate Cancer ◽  
Tumor Imaging ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
The United States ◽  
Low Risk ◽  
Image Guided Radiotherapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Prostate cancer is the most common nonskin malignancy among men in the United States. Since the introduction of screening with prostate-specific antigen (PSA), most patients are being diagnosed at an early stage with low-risk disease. For men with low-risk prostate cancer, there exists an array of radiotherapeutic strategies that are effective and well tolerated, such as external-beam radiotherapy and brachytherapy. In recent years, there have been tremendous advances in the field of radiation oncology that have transformed the way radiation is used to treat prostate cancer, such as intensity-modulated radiotherapy, image-guided radiotherapy, and stereotactic radiotherapy. It is now feasible to deliver high doses of radiation to the target volume with improved precision and spare more of the neighboring tissues from potentially damaging radiation. Disease outcomes are generally excellent in low-risk prostate cancer. Improvements are expected with further integration of innovative technologies in radiation delivery, tumor imaging, and target localization.

Postoperative Nomogram for Disease Recurrence After Radical Prostatectomy for Prostate Cancer

1999 ◽  
Vol 17 (5) ◽  
pp. 1499-1499 ◽  
Author(s):  
Michael W. Kattan ◽  
Thomas M. Wheeler ◽  
Peter T. Scardino
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Disease Recurrence ◽  
Gleason Grade ◽  
Antigen Level ◽  
Serum Prostate Specific Antigen

PURPOSE: Although models exist that place patients into discrete groups at various risks for disease recurrence after surgery for prostate cancer, we know of no published work that combines pathologic factors to predict an individual's probability of disease recurrence. Because clinical stage and biopsy Gleason grade only approximate pathologic stage and Gleason grade in the prostatectomy specimen, prediction of prognosis should be more accurate when postoperative information is added to preoperative variables. Therefore, we developed a postoperative nomogram that allows more accurate prediction of probability for disease recurrence for patients who have received radical prostatectomy as treatment for prostate cancer, compared with the preoperative nomogram we previously published. PATIENTS AND METHODS: By Cox proportional hazards regression analysis, we modeled the clinical and pathologic data and disease follow-up for 996 men with clinical stage T1a-T3c NXM0 prostate cancer who were treated with radical prostatectomy by a single surgeon at our institution. Prognostic variables included pretreatment serum prostate-specific antigen level, specimen Gleason sum, prostatic capsular invasion, surgical margin status, seminal vesicle invasion, and lymph node status. Treatment failure was recorded when there was either clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy. Validation was performed on this set of men and a separate sample of 322 men from five other surgeons' practices from our institution. RESULTS: Cancer recurrence was noted in 189 of the 996 men, and the recurrence-free group had a median follow-up period of 37 months (range, 1 to 168 months). The 7-year recurrence-free probability for the cohort was 73% (95% confidence interval, 68% to 76%). The predictions from the nomogram appeared to be accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (ie, a comparison of the predicted probability with the actual outcome) of 0.89. CONCLUSION: A postoperative nomogram has been developed that can be used to predict the 7-year probability of disease recurrence among men treated with radical prostatectomy.

Preliminary Results of a Randomized Radiotherapy Dose-Escalation Study Comparing 70 Gy With 78 Gy for Prostate Cancer

2000 ◽  
Vol 18 (23) ◽  
pp. 3904-3911 ◽  
Author(s):  
Alan Pollack ◽  
Gunar K. Zagars ◽  
Lewis G. Smith ◽  
J. Jack Lee ◽  
Andrew C. von Eschenbach ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dose Escalation ◽  
Proportional Hazards ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Cox Proportional Hazards ◽  
Phase Iii ◽  
Dose Escalation Study ◽  
Radiotherapy Dose

PURPOSE: To determine the effect of radiotherapy dose on prostate cancer patient outcome and biopsy positivity in a phase III trial. PATIENTS AND METHODS: A total of 305 stage T1 through T3 patients were randomized to receive 70 Gy or 78 Gy of external-beam radiotherapy between 1993 and 1998. Of these, 301 were assessable; stratification was based on pretreatment prostate-specific antigen level (PSA). Dose was prescribed to the isocenter at 2 Gy per fraction. All patients underwent planning pelvic computed tomography scan to confirm prostate position. Treatment failure was defined as an increasing PSA on three consecutive follow-up visits or the initiation of salvage treatment. Median follow-up was 40 months. RESULTS: One hundred fifty patients were randomized to the 70-Gy arm and 151 to the 78-Gy arm. The difference in freedom from biochemical and/or disease failure (FFF) rates of 69% and 79% for the 70-Gy and 78-Gy groups, respectively, at 5 years was marginally significant (log-rank P = .058). Multiple-covariate Cox proportional hazards regression showed that the study randomization was an independent correlate of FFF, along with pretreatment PSA, Gleason score, and stage. The patients who benefited most from the 8-Gy dose escalation were those with a pretreatment PSA of more than 10 ng/mL; 5-year FFF rates were 48% and 75% (P = .011) for the 70-Gy and 78-Gy arms, respectively. There was no difference between the arms (∼80% 5-year FFF) when the pretreatment PSA was ≤ 10 ng/mL. CONCLUSION: A modest dose increase of 8 Gy using conformal radiotherapy resulted in a substantial improvement in prostate cancer FFF rates for patients with a pretreatment PSA of more than 10 ng/mL. These findings document that local persistence of prostate cancer in intermediate- to high-risk patients is a major problem when doses of 70 Gy or less are used.

scholarly journals Pattern of Prostate Cancer Recurrence Assessed by 68Ga-PSMA-11 PET/CT in Men Treated with Primary Local Therapy

2021 ◽  
Vol 10 (17) ◽  
pp. 3883
Author(s):  
Ismaheel O. Lawal ◽  
Thabo Lengana ◽  
Gbenga O. Popoola ◽  
Akintunde T. Orunmuyi ◽  
Mankgopo M. Kgatle ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Biochemical Recurrence ◽  
External Beam Radiotherapy ◽  
Prostate Gland ◽  
Local Treatment ◽  
Specific Antigen ◽  
Cancer Recurrence ◽  
Local Therapy ◽  
Lesion Detection ◽  
Pet Ct

Imaging plays a vital role in detecting the recurrence of prostate cancer (PCa) to guide the choice of salvage therapy. Gallium-68 prostate-specific membrane antigen positron-emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) is useful for detecting PCa recurrence. We assessed the pattern of PCa recurrence stratified by serum prostate-specific antigen level and type of primary local treatment in men with biochemical recurrence (BCR) after primary local therapy with radical prostatectomy or external beam radiotherapy (EBRT) using 68Ga-PSMA-11 PET/CT. We reviewed patients imaged with 68Ga-PSMA-11 PET/CT for the localization of the site of PCa recurrence. We determined the site and number of lesions due to PCa recurrence at different PSA levels. A total of 247 men (mean age of 65.72 ± 7.51 years and median PSA of 2.70 ng/mL (IQR = 0.78–5.80)) were included. 68Ga-PSMA-11 PET/CT detected the site of recurrence in 81.4% of patients with a median number of lesions per patient of 1 (range = 1–5). 68Ga-PSMA-11 PET/CT positivity was 43.6%, 75.7%, 83.3%, 90.0%, and 95.8% at PSA levels of <0.5, 0.5–1.0., 1.1–2.0, 2.1–5.0, and 5.0–10.0, respectively. The most common site of recurrence was in the prostate gland/bed at all PSA levels. Pelvic, extra-pelvic, and combined pelvic and extra-pelvic sites of recurrence were seen in 118, 50, and 33 patients, respectively. The risk of extra-pelvic recurrence increases with rising PSA levels. 68Ga-PSMA-11 PET/CT has a high lesion detection rate for biochemical recurrence of PCa in patients previously treated with primary local therapy.

scholarly journals Prospective Study of Determinants and Outcomes of Deferred Treatment or Watchful Waiting Among Men With Prostate Cancer in a Nationwide Cohort

2009 ◽  
Vol 27 (30) ◽  
pp. 4980-4985 ◽  
Author(s):  
William V. Shappley ◽  
Stacey A. Kenfield ◽  
Julie L. Kasperzyk ◽  
Weiliang Qiu ◽  
Meir J. Stampfer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prospective Study ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Cox Proportional Hazards ◽  
Deferred Treatment ◽  
Cox Proportional Hazards Models ◽  
A Prospective Study

Purpose To examine consequences of deferred treatment (DT) as initial management of prostate cancer (PCa) in a contemporary, prospective cohort of American men diagnosed with PCa. Participants and Methods We evaluated deferred treatment for PCa in the Health Professionals Follow-up Study, a prospective study of 51,529 men. Cox proportional hazards models were used to calculate hazard ratios (HRs) for time to eventual treatment among men who deferred treatment for more than 1 year after diagnosis. HRs for time to metastasis or death as a result of PCa were compared between patients who deferred treatment and those who underwent immediate treatment within 1 year of diagnosis. Results From among 3,331 cohort participants diagnosed with PCa from 1986 to 2007, 342 (10.3%) initially deferred treatment. Of these, 174 (51%) remained untreated throughout follow-up (mean 7.7 years); the remainder were treated an average of 3.9 years after diagnosis. Factors associated with progression to treatment among DT patients included younger age, higher clinical stage, higher Gleason score, and higher prostate-specific antigen at diagnosis. We observed similar rates for development of metastases (n = 20 and n = 199; 7.2 v 8.1 per 1,000 person-years; P = .68) and death as a result of PCa (n = 8 and n = 80; 2.4 v 2.6 per 1,000 person-years; P = .99) for DT and immediate treatment, respectively. Conclusion In this nationwide cohort, more than half the men who opted for DT remained without treatment for 7.7 years after diagnosis. Older men and men with lesser cancer severity at diagnosis were more likely to remain untreated. PCa mortality did not differ between DT and active treatment patients.

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