Hypofractionated radiation therapy in low-risk prostate cancer: Outcome, toxicity, and sexual function.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16575-e16575
Author(s):  
Luca Marinelli ◽  
Chiara Reverberi ◽  
Mattia Falchetto Osti ◽  
Vitaliana De Sanctis ◽  
Manuela Giuliani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
Clinical Stage ◽  
Low Risk ◽  
Long Term Results ◽  
Chi Square ◽  
Gu Toxicity ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

e16575 Background: To evaluate efficacy, toxicity of image-guided hypofractionated radiotherapy (HFRT) in patients with low-risk prostate cancer. Methods: Eighty-five low-risk prostate cancer patients (Gleason score ≤6, clinical stage T1/T2a-b N0 M0, and PSA ≤10 ng/mL) were treated with HFRT from March 2007 to November 2015. All patients were staged with multi-parametric contrast-enhanced MRI. Clinical target volume (CTV) encompassed prostate with proximal seminal vescicles. Margin from CTV to PTV was 5 mm in all directions. Patients received a total dose of 60 Gy in 20 fractions with 3D-CRT. Daily cone beam CT (IGRT) was executed. RTOG/EORTC morbidity Scoring Scale was used for evaluate toxicities. Results: Median follow-up was 54 months (range 11-116 months). The actuarial 8-years Overall Survival was 97.1%. Eight-years Cancer Specific Survival was 100%, 8-years Biochemical Relapse Free Survival was 98.8%, no patients presented clinical local recurrence. Median of PSA at diagnosis was 3.27 ng/mL (range 1.69-9.98 ng/mL) and at the last follow-up was 0.39 ng/mL (range 0.01-2.26 ng/mL). Acute grade 1-2 gastrointestinal (GI) toxicity occurred in 13 patients (15.3%), grade 1-2 genitourinary (GU) toxicity in 33 cases (38.8%). Grade 3 GU toxicity occurred in 2 patients (2.4%). Grade 1-2 GI and GU late toxicities were observed in 4 (4.7 %) and 25 (29.4 %) patients, respectively. Sexual functionality was qualitatively evaluated, scoring 0 for absence, 1 for presence of erection but insufficient for intercourse, 2 for a sufficient one. Before RT, 4.7 % had score 0, 47.1% had score 1 and 48.2% had score 2. After RT, 34.1% of patients presented score 0, 51.8% score 1 and 14.1% score 2 (Chi-square p = 0,004). After treatment, patients with < 70 years presented score 0 in 4.7% of patients, score 1 in 20% and score 2 in 8.2%. Those with > 70 years, 29.4% presented score 0, 31.8% score 1 and 5.9% score 2 (Chi square p = 0.011). Conclusions: Long-term results of our study demonstrated that HFRT in low-risk prostate cancer is efficacy and well tolerated. HFRT significantly worsened sexual function, even if patients with age < 70 years had a higher probability to maintain any form of sexual function after therapy.

Active surveillance for low-risk prostate cancer: Practice across Europe.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 217-217 ◽  
Author(s):  
Aini Azmi ◽  
Ruth Dillon ◽  
Laure Marignol ◽  
Simona Borghesi ◽  
Mary Dunne ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Online Survey ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Evidence Based Guideline

217 Background: Active surveillance (AS) is a recognized treatment option for patients with low-risk prostate cancer (PCa). We carried out a web-based survey to evaluate how AS is practiced by European urologists and to review criteria for patient selection, follow up and indications for intervention. Methods: 2959 potential participants were identified via various European urological association databases and invited via email to complete an online survey consisting of 19 questions. Only urologists practising in an EU country were eligible to participate. Results: 226 urologists participated in the survey corresponding to a response rate of 8%. None of the 19 questions were answered by all urologists, therefore results exclude the missing data. 220 (97%) urologists offer AS. 48% (n=103/216) and 24% (n=53/216) urologists offer AS within the context of an official protocol or clinical trial respectively. The most used factors in selecting patients are Gleeson score (GS) ≤3+3=6 (n=174/202, 86%) and PSA ≤10ng/ml (n=171/200, 85%). 48% (n=96/201) only include patients with ≤2 cores positive while 18% (n=37/201) include those with <50% positive biopsy cores. 41% urologists (n=82/202) only include patients with a clinical stage ≤T1cN0M0. MRI pelvis is performed as a baseline investigation by only 28% (n=57/200). All responding urologists (n=194) use serial PSA to follow up their patients. 89% (n=172/194) carry out serial DRE while 83% (n=161/194) perform repeated prostate biopsy. Re-biopsy is performed within the first year of AS by 77% of urologists (n=131/171). Only 8% (n=15/193) use serial MRI pelvis to monitor their patients. The follow up intensity also varies widely. GS progression was the most frequently cited trigger for intervention (n=168/192, 87%) followed by PSA doubling time of ≤3 years (n=115/192, 60%). Conclusions: Several internationally published guidelines on PCa treatment have recommended AS as a therapeutic option for patients with low-risk PCa. However presently there is a lack of consensus on an optimal AS protocol. This survey shows the wide variation in the practice of AS across Europe and highlights the need for patients to be included in clinical trials to enable an evidence-based guideline to be established.

Outcomes following immediate versus delayed radical prostatectomy among men on active surveillance for prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 40-40
Author(s):  
Christopher James Welty ◽  
Pauline Fillipou ◽  
Janet E. Cowan ◽  
Peter Carroll
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
San Francisco ◽  
Active Surveillance ◽  
Clinical Stage ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Pre Treatment

40 Background: Little is known about the risk of delaying radical prostatectomy (RP) until biopsy progression following active surveillance (AS) for prostate cancer. This study examines the pathological outcomes associated with surgery following AS compared to immediate treatment of prostate cancer with similar grades. Methods: Men who underwent RP between 1997-2013 at University of California San Francisco were included. The first comparison consisted of men who met strict AS inclusion criteria (Gleason Score ≤ 6, PSA ≤ 10, clinical stage <T3, ≤ 33% biopsy cores positive, and <= 50% of any single core positive) at diagnosis and underwent AS prior to RP (AS+RP) compared to men who met strict AS criteria and underwent RP within 6 monts (immediate RP). The second comparison consisted of men who met strict AS criteria and were upgraded on follow-up biopsy compared to a cohort of men matched on the basis pre-treatment biopsy pathology. Logistic regression was used to determine associations of RP group with adverse pathology (stage ≥pT3/N1, positive margins, and/or upgrade to Gleason >=4+3), adjusting for clinical and demographic factors. Results: We identified 241 men who underwent RP after a period of AS, 157 of whom initially met strict AS criteria. The median time to RP was 20 months (IQR 14-36). Men who met strict criteria and underwent immediate RP were less likely to have unfavorable pathology than those who underwent AS+RP (OR 0.39, 95% CI 0.24-0.62). Fifty-four of the men who underwent AS+RP did so have upgrading to Gleason 3+4 disease. These patients were matched with 154 men based on their pre-treatment biopsy features. After appropriate matching, the timing of RP was not associated with adverse pathology (OR 1.27, 9% CI 0.65-2.49). Conclusions: Men who undergo surgery following AS are a selected subset of men with low risk prostate cancer. The surgical pathology features of these patients are more similar to men undergo surgery after diagnosis with intermediate risk prostate cancer than those diagnosed with very low risk disease. Additional follow-up of this and other cohorts is needed to assess long term clinical outcomes following delayed RP.

583 Definition of mid-term MRI follow-up after focal therapy for clinically localized low risk prostate cancer

2013 ◽  
Vol 12 (1) ◽  
pp. e583-e584
Author(s):  
F. Mistretta ◽  
A. Losa ◽  
G. Cardone ◽  
M. Lazzeri ◽  
G.M. Gadda ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Focal Therapy ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Definition Of

scholarly journals MP48-17 DO PROGRESSION RATES ON FOLLOW UP BIOPSY OVER TIME DIFFER BETWEEN MEN WITH VERY LOW RISK AND LOW RISK PROSTATE CANCER ON ACTIVE SURVEILLANCE?

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Srinath Kotamarti* ◽  
Andrew Wood ◽  
Alyssa Yee ◽  
Daniel Rabinowitz ◽  
Allison Marziliano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Over Time

Long-term experience with 181 patients who received transperineal I-125 implants for prostate cancer: Efficacy and urinary toxicity

2011 ◽  
Vol 11 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Eliahu Gez ◽  
Joshua Genesin ◽  
Daniel Shahar ◽  
Valeriya Semenisty ◽  
Tanya Mashiac ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hormonal Therapy ◽  
Treatment Plan ◽  
Prostate Gland ◽  
Target Volume ◽  
Low Risk ◽  
Prostate Brachytherapy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

AbstractBackground: In low-risk prostate cancer, the target volume for radiotherapy is the prostate gland only and prostate brachytherapy with an I-125 implant provides the most conformal radiotherapy.Methods: Patients underwent a pre-implant prostate volume study from which a treatment plan was developed 2 weeks prior to implant. A dosimetric study was performed 1 month following the implant. The prescription dose was 145 Gy with the 95% isodose line covering the entire target volume. The maximal dose to the urethra was less than 210 Gy. Follow-up included serum PSA and IPSS evaluation every 3 months during the first year and then every 6 months beginning in the second year.Results: During December 2000–March 2009, 181 patients with early prostate cancer underwent I-125 implant. The median post-implant PSA value of the entire cohort was 0.7 ng/ml. No patient developed clinical failure. In the follow-up, nine patients had biochemical failure according to the RTOG-ASTRO Phoenix definition (Nadir + 2.0 ng/ml). Of these, one patient refused hormonal therapy desiring to preserve sexual potency, and eight patients received hormonal therapy with a decreased serum PSA to 0.0 ng/ml. The treatment side effects were primarily urinary disturbances.Conclusion: An I-125 implant is an effective and well-tolerated treatment and should be recommended for patients with low-risk prostate cancer.

scholarly journals Clinical Significance of Multiparametric Magnetic Resonance Imaging as a Preoperative Predictor of Oncologic Outcome in Very Low‐Risk Prostate Cancer

2019 ◽  
Vol 8 (4) ◽  
pp. 542
Author(s):  
Doo Yong Chung ◽  
Min Seok Kim ◽  
Jong Soo Lee ◽  
Hyeok Jun Goh ◽  
Dong Hoon Koh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Low Risk ◽  
P Value ◽  
Resonance Imaging ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Currently, multiparametric magnetic resonance imaging (mpMRI) is not an indication for patients with very low-risk prostate cancer. In this study, we aimed to evaluate the usefulness of mpMRI as a diagnostic tool in these patients. We retrospectively analyzed the clinical and pathological data of individuals with very low-risk prostate cancer, according to the NCCN guidelines, who underwent mpMRI before radical prostatectomy at our institution between 2010 and 2016. Patients who did not undergo pre-evaluation with mpMRI were excluded. We analyzed the factors associated with biochemical recurrence (BCR) using Cox regression model, logistic regression analysis, and Kaplan–Meier curve. Of 253 very low-risk prostate cancer patients, we observed 26 (10.3%) with BCR during the follow-up period in this study. The median follow-up from radical prostatectomy was 53 months (IQR 33–74). The multivariate Cox regression analyses demonstrated that the only factor associated with BCR in very low-risk patients was increase in the pathologic Gleason score (GS) (HR: 2.185, p-value 0.048). In addition, multivariate logistic analyses identified prostate specific antigen (PSA) (OR: 1.353, p-value 0.010), PSA density (OR: 1.160, p-value 0.013), and suspicious lesion on mpMRI (OR: 1.995, p-value 0.019) as the independent preoperative predictors associated with the pathologic GS upgrade. In our study, the pathologic GS upgrade after radical prostatectomy in very low-risk prostate cancer patients demonstrated a negative impact on BCR and mpMRI is a good prognostic tool to predict the pathologic GS upgrade. We believe that the implementation of mpMRI would be beneficial to determine the treatment strategy for these patients.

Role of 5-alpha-reductase inhibitors in active surveillance of patients with low-risk prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 14-14
Author(s):  
Andrew Szehsun Chiang ◽  
D. Andrew Loblaw ◽  
Vibhuti Jethava ◽  
Perakaa Sethukavalan ◽  
Liying Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Doubling Time ◽  
Low Risk ◽  
Reductase Inhibitors ◽  
Psa Doubling Time ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
5 Alpha Reductase Inhibitors ◽  
Doubling Times

14 Background: Active surveillance (AS) is a recognized management option for low-risk prostate cancer. Many institutions use serial PSA values to determine when to reclassify patients into higher risk categories. The impact of 5-alpha-reductase inhibitors (5-ARIs) in this setting has not been well studied. The purpose of this retrospective review was to compare PSA doubling time prior to the initiation of a 5-ARI (pre-5-ARI) to that after the PSA nadir (post-nadir) has been reached. Methods: Between 1996 and 2010, a total of 100 patients with a history of 5-ARI use were captured from our AS database. Of these, twenty-nine had a sufficient number of PSA values to determine both pre-5-ARI and post-nadir doubling times. The majority had stage T1c disease (89.7%) and Gleason scores of six or lower (93.1%). The average PSA at presentation was 6.93 µg/L. More patients were prescribed dutasteride (79.3%) than finasteride (20.7%). PSA doubling time was calculated using the general linear mixed-model method. Statistical analysis was performed using the non-parametric sign test. Results: Median follow-up was 69.5 months (mo). For the twenty-nine patients analyzed, the median pre-5-ARI PSA doubling time was 55.8 mo (6-556.8 mo), while that for the post-nadir values was 25.2 mo (6-231 mo) (p=0.0081). Six patients were ultimately reclassified after an average of 67.7 mo (59-95 mo), due to progression in either PSA doubling time (n=2) or Gleason score (n=4). The median pre-5-ARI and post-nadir doubling times for this group were 48.2 mo (32.4-91.1 mo) and 23.3 mo (6-44.3 mo), respectively. Five of the patients underwent radical prostatectomy, while one underwent radiotherapy with androgen deprivation. Of the six patients, one had biochemical failure after an average post-treatment follow-up of 21.3 mo (0-52 mo). Conclusions: In AS for low-risk prostate cancer, it was found that 5-ARIs significantly decreased PSA doubling time. This effect may be related to preferential suppression of benign prostatic tissue, thereby providing a more accurate depiction of the true cancer-related doubling time. If validated with a larger cohort, 5-ARIs may enhance the utility of PSA doubling time as a biomarker of disease progression in AS.

Value of multimodality MRI and MR-guided biopsy at inclusion in an active surveillance protocol for prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 105-105
Author(s):  
Diederik Meindert Somford ◽  
Caroline M. Hoeks ◽  
Roderick C. van den Bergh ◽  
Henk Vergunst ◽  
Inge M van Oort ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Prostate Carcinoma ◽  
Clinical Stage ◽  
Low Risk ◽  
Definitive Treatment ◽  
Guided Biopsy ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Surveillance Protocol

105 Background: To prevent overtreatment of insignificant and/or low-risk prostate carcinoma in the PSA screening era, active surveillance is emerging as a treatment strategy for selected patients. In our series we aim to establish whether MRI could aid in correct risk assessment for these patients within the framework of the Prostate Cancer Research International Active Surveillance (PRIAS) study. Methods: We included patients in our protocol based on contemporary criteria for active surveillance: - Diagnosis of prostate cancer by TRUS-guided biopsy. - PSA ≤10 ng/mL, PSA density <0.2 ng/mL/mL - Clinical stage ≤ T2 - Gleason score (GS) ≤3+3=6 - ≤ 2 biopsy cores with cancer All patients underwent multimodality MRI of the prostate, including T2-weighted, diffusion-weighted and dynamic contrast-enhanced MR sequences. When a tumor-suspicious region (TSR) could be identified a targeted MR-guided biopsy (MRGB) was performed to obtain pathology. Patients were referred for definitive treatment in case of GS > 3+3=6 upon MRGB or T3 stage at MRI. Results: In 48 of 49 included patients at least one TSR was identified, with a median of 2 TSRs (range1-4) per patient. MRGB was obtained from every TSR, with a median of 4 MRGBs taken per patient. Five patients had a GS >3+3=6 upon MRGB and were excluded. Three patients were excluded due to suspicion of T3 stage on MRI. Five patient were excluded upon physician’s discretion due to multifocal prostate cancer upon MRGB. Combined multimodality MRI/MRGB in our active surveillance cohort thus excluded 27% (13/49) of patients who were incorrectly stratified as low-risk prostate carcinoma by contemporary criteria. Conclusions: Application of multimodality MRI and MRGB in an active surveillance protocol improves risk stratification, adding onto contemporary PSA and TRUS-guided biopsy criteria for low-risk prostate cancer. This approach might increase safety and reliability of active surveillance for prostate cancer and deserves ongoing prospective evaluation.

Perspectives of health care professionals on active surveillance for the management of prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 81-81
Author(s):  
Fred Saad ◽  
Kittie Pang ◽  
Margaret Fitch ◽  
Veronique Ouellet ◽  
Simone Chevalier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Active Surveillance ◽  
Health Care Providers ◽  
Low Risk ◽  
Care Providers ◽  
Radiation Oncologists ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

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