Treatment outcomes of radiotherapy versus prostatectomy for localized prostate cancer with Gleason 8 or more on biopsy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 120-120
Author(s):  
Christopher Baker ◽  
Andrew M. McDonald ◽  
Grant Clark ◽  
Caleb Dulaney ◽  
Eddy Shih-Hsin Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Initial Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Kaplan Meier ◽  
Initial Biopsy

120 Background: There have been no prospective randomized controlled trials comparing current treatment options for patients with high-risk localized prostate cancer. This study seeks to compare the biochemical and metastatic outcomes of patients that received definitive radiotherapy (dRT) or radical prostatectomy (RP) for localized prostate cancer with Gleason score ≥ 8 on initial biopsy. Methods: A total of 106 patients met the inclusion criteria of Gleason score ≥ 8 on initial biopsy and biochemical follow-up ≥ 1 year. Seventy-one patients were initially treated with dRT (96% also receiving androgen deprivation therapy) and 35 patients were initially treated with RP (with or without postoperative RT). Our primary endpoint was biochemical failure (BF). For dRT patients, BF was recorded according to the Phoenix Consensus or if extranodal metastasis was diagnosed. For surgical patients, BF was recorded according to American Urological Association guidelines or if extranodal metastasis occurred. If adjuvant/salvage RT was given postoperatively, BF was recorded if PSA ≥ 0.5 on two consecutive measures after completion of RT. Pretreatment characteristics were compared using Pearson Chi-square method and independent samples Mann-Whitney U test. Actuarial rates of BF and metastasis were calculated using the Kaplan-Meier method. Results: Median follow-up for all patients was 5.3 years. There was no statistical difference in clinical T-stage, initial PSA, or months of follow up between patients treated initially with radiotherapy vs. prostatectomy. Patients initially treated with dRT were significantly older than those treated with RP. The dRT group had a lower rate of BF compared to the RP group, p < 0.001. The Kaplan-Meier estimate of BF at 5 years was 7.6% in the dRT group compared to 34.5% in the RP group. Additionally, the Kaplan-Meier estimate of distant metastasis at 10 years was 22.7% in the dRT group compared to 55.9% of the RP group, p = 0.01. Conclusions: For our sample of patients with Gleason score ≥ 8 on initial biopsy, initial treatment with dRT was associated with lower rates of biochemical failure and extranodal metastasis when compared to initial treatment with prostatectomy.

How much does Gleason grade of follow-up biopsy differ from that of initial biopsy in untreated, Gleason score 4–7, clinically localized prostate cancer?

The Prostate ◽  
2007 ◽  
Vol 67 (15) ◽  
pp. 1614-1620 ◽  
Author(s):  
R. Choo ◽  
C. Danjoux ◽  
G. Morton ◽  
E. Szumacher ◽  
L. Sugar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Localized Prostate Cancer ◽  
Gleason Grade ◽  
Initial Biopsy

scholarly journals Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions

2016 ◽  
Vol 37 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Karen A. Scherr ◽  
Angela Fagerlin ◽  
Timothy Hofer ◽  
Laura D. Scherer ◽  
Margaret Holmes-Rovner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Active Treatment ◽  
Patient Preferences ◽  
Initial Treatment ◽  
Specific Antigen ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
Treatment Preference ◽  
Medical Factors

Objective. To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. Methods. We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients’ baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients’ interest in sex. Results. Patients’ initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists’ recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists’ recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients’ interest in sex (<15% of appointments). Conclusions. Patients’ treatment decisions were based largely on urologists’ recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients’ personal views of the relative pros and cons of treatment alternatives.

Preoperative Combined Nested Reverse Transcriptase Polymerase Chain Reaction for Prostate-Specific Antigen and Prostate-Specific Membrane Antigen Does Not Correlate With Pathologic Stage or Biochemical Failure in Patients With Localized Prostate Cancer Undergoing Radical Prostatectomy

2002 ◽  
Vol 20 (15) ◽  
pp. 3213-3218 ◽  
Author(s):  
John Thomas ◽  
Manjula Gupta ◽  
Ying Grasso ◽  
Chandana A. Reddy ◽  
Warren D. Heston ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Proportional Hazards ◽  
Specific Antigen ◽  
Cox Proportional Hazards ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Rt Pcr ◽  
Pathologic Stage ◽  
Kaplan Meier

PURPOSE: We report a prospective study examining the ability of preoperative nested reverse transcriptase polymerase chain reaction (RT-PCR) for prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSM) to predict pathologic stage and biochemical recurrence in patients with clinically localized prostate cancer treated with radical prostatectomy.PATIENTS AND METHODS: One hundred forty-one patients were entered onto the study. Preoperative evaluation included clinical T stage, serum PSA, biopsy Gleason score, and serum RT-PCR for PSA/PSM. Univariate and multivariate logistic regression models, Kaplan-Meier estimates, and Cox proportional hazards modeling were used to identify predictors of pathologic stage and biochemical failure.RESULTS: Seventy-three patients (51.8%) were RT-PCR positive for PSA, PSM, or both. In the multivariate logistic regression model, only initial PSA was an independent predictor of pathologic stage as defined by organ-confined disease (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.13; P = .026) or organ-/specimen-confined disease (OR, 1.09; 95% CI, 1.02 to 1.16; P = .009). Overall Kaplan-Meier biochemical relapse-free survival (bRFS) was 85% at 59 months. Multivariate analysis of predictors for bRFS with the Cox proportional hazards model indicated that only initial PSA (OR, 1.05; 95% CI, 1.02 to 1.09; P = .004) and biopsy Gleason score (OR, 3.57; 95% CI, 1.37 to 9.58; P = .009) were independent predictors of biochemical failure. RT-PCR status did not predict pathologic stage or biochemical failure. Repeat analysis excluding 27 patients who received preoperative androgen-deprivation therapy did not change the results.CONCLUSION: Combined nested RT-PCR for PSA and PSM is not an independent predictor of pathologic stage or biochemical failure in patients with localized prostate cancer undergoing radical prostatectomy. This assay has no clinical utility in this patient population.

Combined brachytherapy and external beam radiation for prostate cancer in a community setting

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16147-e16147
Author(s):  
G. J. Kubicek ◽  
G. J. Kubicek ◽  
S. Brown ◽  
S. Redfield
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Treatment Options ◽  
Community Setting ◽  
Late Toxicity ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.

A population-based study examining the impact of a multidisciplinary rapid access clinic on utilization of initial treatment options for patients with localized prostate cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 15-15
Author(s):  
Clement K. Ho ◽  
Joseph D. Ruether ◽  
Bryan J Donnelly ◽  
Marc Kerba
Keyword(s):  
Prostate Cancer ◽  
Initial Treatment ◽  
Treatment Options ◽  
Population Level ◽  
Treatment Decisions ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Rapid Access ◽  
Rapid Access Clinic ◽  
The Impact

15 Background: Treatment decisions in localized prostate cancer (LPCa) are complicated by the variety of available options. A rapid access cancer clinic (RAC) has been unique to Calgary, Alberta (AB) since 2007. RAC offers multidisciplinary prostate cancer care by a urologist, medical oncologist, and radiation oncologist. It is hypothesized that treatment utilization data from decisions taken at RAC may serve to benchmark the appropriateness of treatment decisions on a population level. Objectives: To compare utilization rates for initial treatment of LPCa between AB and RAC. Methods: Records of patients with clinically LPCa in AB between 2007-9 were reviewed with ethics approval. Records were linked to the AB cancer registry database. Clinical, treatment and health services characteristics pertaining to patients attending RAC were compared to those managed elsewhere in AB. The primary endpoints were utilization rates by initial treatment; prostatectomy (P), radiotherapy (RT), hormone therapy (H), active surveillance (A). A logistics regression model was constructed to examine the influence of RAC on initial treatment decisions, while controlling for interactions and factors of interest. Results: 2,660 patients were diagnosed with LPCa. 375 presented to RAC. Utilization rates among RAC patients: P-60.3% (95%CI: 55.3-65.2), A-16%(12.3-19.7), RT-11.7%(8.5-15.0) and H-8.0%(CI:5.2-10.8). This compares to AB rates of P-47.2%(45.9-48.3), A-6.1%(15.2-17.0), RT-18.8%(17.9-19.7), and H-14.5%(13.6-15.4). On multivariate analysis, RAC was associated with a trend towards receiving RT (OR 1.6, p=0.097). Conclusions: A specialized clinic for LPCa may be associated with a higher likelihood of receiving radiotherapy as initial treatment compared to the prostate cancer population in Alberta.

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.

Clinical recurrence post-biochemical failure of prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 195-195
Author(s):  
C. A. Reddy ◽  
J. P. Ciezki ◽  
E. A. Klein
Keyword(s):  
Prostate Cancer ◽  
Initial Treatment ◽  
Short Interval ◽  
Multivariable Analysis ◽  
Biochemical Failure ◽  
Early Initiation ◽  
Time Interval ◽  
Clinical Recurrence ◽  
Early Use

195 Background: The purpose of this study is to evaluate the role of salvage therapy (STx) after biochemical failure (bF) for prostate cancer (CaP) and to determine what factors are associated with the development of clinical recurrence (cR). Methods: From 1996-2009, 7,585 patients (pts) with CaP were treated with prostatectomy (RP), brachytherapy (PI), or external beam radiotherapy (RT). For RP patients (pts), bF was defined as a postoperative PSA >0.3 and for PI and RT pts the Phoenix definition was used. bF was documented in 927 pts. cR was defined as any image-based or pathological diagnosis of disease recurrence after bF. Cox proportional hazards regression was used to examine if the use of STx after bF, the time of bF, along with disease characteristics were associated with cR after bF. Results: The median follow-up after bF was 31months (mo; range: 0-131). Thirty percent of pts had a cR after bF, and the 5-year rate of cR free survival was 58%. STx within 1 year after bF (early) was given to 46% of pts, STx more than 1 year after bF (late) was given to 11% of pts, and 43% of pts did not receive STx. On univariate analysis, factors found to be significantly associated (p-value <0.05) with cR were a short interval between initial treatment and bF (bFTime), no use of STx, early initiation of STx, biopsy Gleason Score (bGS), clinical stage, older age at bF, the use of PI or RT, and increased frequency of PSA follow-up after bF (PSAfreq). In multivariable analysis, bFTime, no use of STx, early initiation of STx, bGS, the use of PI or RT, and PSAfreq remained significant. To better evaluate the effect the timing of initiation of STx had on the development of cR, a second analysis was preformed, limited to the 529 pts who did receive STx after bF. In multivariable analysis, early use of STx remained significant for cR (HR=2.09, 95%CI=1.24- 3.51). As a continuous variable, in a second multivariable analysis, delayed use of STx resulted in a reduced risk of developing cR (HR=0.98, 95%CI=0.96-1.00). Conclusions: This study suggests that while the use of STx after bF reduces the risk of subsequently developing cR, early use of STx after bF is not beneficial. Other factors such as the time interval between initial treatment and bF need to be evaluated when determining when to initiate STx after bF. No significant financial relationships to disclose.

Post-prostatectomy salvage radiation therapy in prostate cancer upon identification of biochemical failure.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 127-127
Author(s):  
Suneal Gopal Peddada ◽  
Craig Oliver ◽  
Angela Phelps ◽  
Steven H. Stokes ◽  
Jarrod Bartlett Adkison
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Salvage Radiotherapy ◽  
Failure Rates ◽  
Biochemical Control ◽  
Salvage Radiation Therapy

127 Background: Prostate Specific Antigen (PSA) values post-prostatectomy are used as an indication for salvage radiation therapy. It has been suggested that initiation of therapy at lower PSA values lead to better outcomes. This study investigates outcomes of salvage radiation therapy at specific PSA thresholds. Methods: One hundred two prostate cancer patients were treated with salvage radiotherapy at our institution with curative intent, 19 of whom had Gleason score ≤6, 52 of whom had Gleason 7, and 31 with Gleason ≥8. Median follow-up after radiotherapy was 51 months. The median PSA prior to salvage radiotherapy was 0.33 ng/mL, and the median time from prostatectomy to radiotherapy was 24.6 months. Positive margins were identified in 52 patients, and perineural invasion was positive in 83. The median dose delivered was 64.8 Gy. Results: The 5-year actuarial freedom from biochemical failure rates for NCCN low, intermediate, and high risk groups were 100%, 77%, and 62%, p=0.2449. The 5-year actuarial freedom from biochemical failure rates for Gleason score ≤6, Gleason 7, and Gleason ≥8 patients were 87%, 72%, and 49%, p=0.0187. Patients with pre-radiotherapy PSA ≤0.5 ng/mL had better 5-year biochemical control relative to patients with higher pre-radiotherapy PSA, 76% versus 51%, p=0.0211. The pathological margin status did not predict for biochemical control after salvage radiation across the different Gleason grades. Very few interval biochemical failures are observed after the 5-year point of follow-up. The 5-year overall survival for the entire cohort is 92%, with prostate cancer specific survival of 96%. Conclusions: Salvage radiotherapy demonstrated favorable efficacy with durable PSA control and few failures 5 years post radiation. Initiation of salvage radiotherapy for PSA ≤0.5 ng/mL demonstrated improved biochemical control, supporting the adoption of early referral to radiation oncology once post-prostatectomy biochemical failure is identified. [Table: see text]

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