What is the optimal management of Gleason score 7 (GS7) prostate cancer (PC) at biopsy? A comparison of disease control for prostatectomy (RP) versus radiation therapy (RT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 250-250
Author(s):  
John Morgan Watkins ◽  
Patricia L. Watkins ◽  
Tarek A. Dufan ◽  
Nadim Koleilat
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Disease Control ◽  
Gleason Score ◽  
Tumor Staging ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
External Beam ◽  
Disease Free

250 Background: Optimal therapy for Gleason score 7 (GS7) prostate cancer (PC) remains to be defined, with consensus guidelines identifying both prostatectomy (RP) and radiation therapy (RT) as acceptable. The present investigation seeks to compare outcomes between these treatment approaches. Methods: Patients were retrospectively identified for inclusion by clinically localized disease, GS7, and a prostate-specific antigen (PSA) less than 30 at diagnosis. Comparison of demographic, tumor, staging, and outcome variables was performed. Disease recurrence was defined as per contemporary society guidelines. Kaplan-Meier method employed for disease control estimates. Results: Between 2003 and 2010, 267 patients were diagnosed with GS7 prostate cancer, of whom 207 were eligible for the current analysis (120 RP/87 RT). Excepting older age for RT patients (median age 73 vs. 62), the groups were well-balanced. For RP patients, 82 patients (60%) had at least one high-risk feature, of whom only four (5%) received adjuvant RT. For RT patients, 71 of patients (82%) received hormone therapy (median duration 6 months), and 48% (42) underwent external beam RT alone, 41% (36) brachytherapy (BT) alone, and 10% (9) external beam RT plus BT boost. At a median follow-up of 62.2 months (range, 13.1-136.6; with no difference between treatment groups), 64 patients had PSA relapse (51 RP/13 RT) and 15 had died (five of or with disease). Five-year disease-free and disease-specific survivals for RP versus RT were 55.4% versus 82.6% (p<0.0001) and 97.6% versus 98.8% (p=NS), respectively. Conclusions: For GS7 prostate cancer patients, RT is associated with superior disease-free survival at 5 years when compared with RP alone. Whether this difference remains in the setting of appropriately employed adjuvant RT remains to be determined. No difference in survival endpoints was detected, though there were few events at 5 years.

Long-term results of salvage cryotherapy for prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
A. Williams ◽  
C. Martinez ◽  
V. Chalasani ◽  
C. Lu ◽  
C. Ng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Free Survival ◽  
Salvage Cryotherapy ◽  
Disease Free

108 Background: The optimum treatment of Prostate cancer recurrence following external bean radiation therapy (EBRT) remains a controversial topic. The primary problem with comparing salvage techniques following EBRT is the lack of long term data. We reviewed the long- term overall survival, disease-specific survival and disease free survival of patients who have undergone salvage cryotherapy to the prostate gland. Methods: A retrospective analysis was performed on all patients undergoing salvage cryotherapy for locally recurrent prostate cancer after EBRT by a single surgeon at a single institution from 1995-2004. Patients preoperative, perioperative and postoperative data was reviewed and recorded. Should a patient no longer be followed by the urology service the Patients and the patient's primary care physician or urologist were contacted. Mortality data, PSA results, bone scan results and any details of hormone therapy were recorded for this study. Results: 187 patients were included in the current study from which 176 patients had records available for follow up giving a follow up rate of 94%. Mean follow up was 7.46 years (1-14 years). 52 patients were followed for greater than 10 years. Average time to prostate cancer recurrence in patients who developed recurred was 2.3 years and average time to hormone therapy in these patients was 2.8 years. Overall survival at 10 years was high at 87%. Risk factors for recurrence of tumour identified were presalvage PSA, preradiation and presalvage gleason score. Preradiation gleason score had little impact on survival. PSA nadir of >1.0ng/mL was highly predictive of early recurrence. Disease-free survival rates of between 39 and 64% depending on risk factors. Conclusions: Cryotherapy has a definite role in the management of prostate cancer, representing a minimally invasive salvage treatment with acceptable 10 year disease free survival (DFS) of upwards of 39% and specific groups attaining 10 year DFS of 64%. Presalvage PSA and Gleason score are the best predictors of disease recurrence, whilst preradiation gleason score did not correlate with risk of disease recurrence. A PSA Nadir greater than 1 ng/mL indicates a poor prognosis in which early ADT should be strongly considered. No significant financial relationships to disclose.

Prostate-specific antigen nadir: the optimum level after irradiation for prostate cancer.

1996 ◽  
Vol 14 (11) ◽  
pp. 2893-2900 ◽  
Author(s):  
F A Critz ◽  
A K Levinson ◽  
W H Williams ◽  
D A Holladay
Keyword(s):  
Prostate Cancer ◽  
Survival Rate ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Free Survival ◽  
Psa Nadir ◽  
Disease Free Survival Rate ◽  
Disease Free

PURPOSE The prostate-specific antigen (PSA) nadir that reflects potential cure of prostate cancer by irradiation has not been established. This report attempts to demonstrate the PSA nadir goal for radiotherapy. MATERIALS AND METHODS From January 1984 through April 1994, 536 stage T1T2NO prostate cancer patients were treated with radioactive iodine 125 (125I) prostate implants followed by external-beam radiation. All were staged node-negative: 68% by pelvic node dissection and the remainder by computed tomographic (CT) scan. The mean pretreatment PSA level was 12.4 ng/mL (median, 8.4 ng/mL; range, 0.3 to 188 ng/mL). The median follow-up duration is 40 months (range, 12 to 138). An increasing posttreatment PSA level defined recurrence. RESULTS Patients who achieved a PSA nadir < or = 0.5 ng/mL had a 95% (+/- 4%) 5-year and an 84% (+/- 12%) 10-year disease-free survival rate, compared with a 5-year disease-free survival rate of 29% (+/- 30%) for those who reached a nadir of 0.6 to 1.0 ng/mL (P = .0001). All patients with a nadir greater than 1.0 ng/mL ultimately failed. Eighty percent of all 536 patients are projected to achieve a nadir < or = 0.5 ng/mL and 90% of patients who achieve this PSA level do so within 48 months of treatment (median, 18 months). Compared with pretreatment PSA level and histologic grade, the PSA nadir is the most significant factor associated with disease-free survival. CONCLUSION For most patients to be successfully treated for prostate cancer with radiotherapy, at least with this combination technique, the PSA nadir should become undetectable (< or = 0.5 ng/mL), similar to that after radical prostatectomy. A PSA nadir of < or = 0.5 ng/mL after radiotherapy for prostate cancer may be used as a reasonable indicator of 10-year disease-free survival.

La progressione di malattia dopo prostatectomia radicale: Quale strategia terapeutica?

1995 ◽  
Vol 62 (4) ◽  
pp. 558-561
Author(s):  
R. Bertè ◽  
P. Guaitoli ◽  
S. Callari ◽  
L. Zappalà ◽  
G. Mazza
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cancer Progression ◽  
Disease Free Survival ◽  
Hormonal Treatment ◽  
Clinical Aspects ◽  
Pathological Features ◽  
Free Survival ◽  
Controversial Subject ◽  
Disease Free

Cancer progression, following radical prostatectomy, is distinguished by its biological or clinical aspects and is a controversial subject. As adjuvant therapy there is hormonal treatment and radiation therapy or a combination of both. The lack of standardization of the main pathological features of prostate cancer does not allow an accurate valuation of the results from the most important studies. A real efficacy in local or distant control seems to be certain, while the influence on disease-free survival is more uncertain. After a review of the most common options of treatment, the Authors present their results from 107 radical prostatectomies carried out between 1989 and 1994.

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
pp. 536-541 ◽  
Author(s):  
CHARLES J. ROSSER ◽  
RAMSAY CHICHAKLI ◽  
LAWRENCE B. LEVY ◽  
DEBORAH A. KUBAN ◽  
LEWIS G. SMITH ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
Vol 168 (2) ◽  
pp. 536-541 ◽  
Author(s):  
Charles J. Rosser ◽  
Ramsay Chichakli ◽  
Lawrence B. Levy ◽  
Deborah A. Kuban ◽  
Lewis G. Smith ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

Prognostic Significance of Pathologic Features in Localized Prostate Cancer Treated With Radical Prostatectomy: Implications for Staging Systems and Predictive Models

2001 ◽  
Vol 19 (16) ◽  
pp. 3692-3705 ◽  
Author(s):  
David I. Quinn ◽  
Susan M. Henshall ◽  
Anne-Maree Haynes ◽  
Phillip C. Brenner ◽  
Raji Kooner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Free Survival ◽  
Pathologic Stage ◽  
Preoperative Serum ◽  
Staging Systems ◽  
Disease Free

PURPOSE: Although predicting outcome for men with clinically localized prostate cancer (PC) has improved, the staging system and nomograms used to do this are based on results from the North American health system. To be internationally applicable, these models require testing in cohorts from a variety of different health systems based on the predominant PC case identification methods used. PATIENTS AND METHODS: We studied 732 men with localized PC treated with radical prostatectomy and no preoperative therapy between 1986 and 1999 at one Australian institution to determine the effect of clinicopathologic features on disease-free survival. RESULTS: Preoperative serum prostate-specific antigen (PSA) concentration, Gleason score, pathologic stage, and year of surgery were independent predictors of outcome. Although margin status demonstrated only a trend toward significance in multivariate modeling overall, it proved to be independent in subgroups based on later year of surgery (1986 to 1994 v 1995 to 1998), preoperative PSA of less than 10 ng/mL, and Gleason score ≥ 7. Adjuvant radiation therapy improved disease-free survival rates in patients with multiple surgical margin involvement. CONCLUSION: This work confirms the prognostic significance of pathologic stage, Gleason score, and preoperative serum PSA. In the context of a contemporaneous screening effect in Australia, these findings may have implications for methods that predict outcome following surgery as screening becomes more prevalent in a population. The independent prognostic effect of margin status may alter with an increase in the proportion of screening-identified PCs. Staging systems and nomograms that predict outcome following surgery require validation in cohorts with different health practices before being universally applied.

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