Association of salvage cryoablation with decreased utilization of androgen deprivation therapy for recurrent prostate cancer after radiotherapy.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 358-358
Author(s):  
J Kellogg Parsons ◽  
Brittney Cotta ◽  
Brent Rose ◽  
James Don Murphy ◽  
Stephen T. Ryan
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Biochemical Recurrence ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Case Series ◽  
Androgen Deprivation ◽  
Initial Diagnosis ◽  
Recurrent Prostate Cancer ◽  
Primary Radiotherapy

358 Background: Cryoablation is an established treatment for recurrent prostate cancer after primary radiotherapy, but outcomes data are mostly limited to uncontrolled case series. We assessed salvage cryoablation efficacy with a comparative analysis in a large national cohort. Methods: Patients with clinically localized prostate cancer treated with primary radiotherapy from 2000 to 2015 were identified in the Veterans Affairs Informatics and Computing Infrastructure (VINCI) dataset. Prostate-specific antigen (PSA) recurrence was defined as nadir + 2 ng/mL. Inclusion criteria included availability of serial PSA measures for ≥ 3 years after completion of radiotherapy and PSA < 10 ng/mL at recurrence. Salvage cryotherapy was identified with procedure- and fee-based billing codes. Chi square and Wilcoxon analysis was utilized for descriptive statistics; and Kaplan Meier analyses for time to androgen deprivation therapy (ADT). Results: Among 35,502 patients who underwent primary radiotherapy, 4,391 (12.3%) developed biochemical recurrence a median (IQR) of 4.5 (2.7, 6.9) years after treatment. Of these, 3889 (88.9%) had PSA < 10 ng/mL at time of recurrence, of whom 95 (2.4%) underwent salvage cryoablation. Cryoablation patients were younger at initial diagnosis (60 years versus 65 years, p < 0.01); had a lower pre-treatment PSA (6.6 ng/mL versus 7.8 ng/mL, p < 0.01); and had a lower PSA nadir (0.04 ng/mL versus 0.19 ng/mL, p<0.01). There were no between-group differences for clinical stage at initial diagnosis (p = 0.22) or African American prevalence (34.7% versus 29%, p =0.27). After recurrence, median (IQR) follow-up for those who did and did not receive cryoablation was 9.1 (7.2, 9.11) and 8.1 (5.4, 10.9) years, respectively. Cryoablation patients were less likely to receive ADT (40% versus 55%, p < 0.01); and, among those who did, time to ADT from recurrence was significantly longer compared to those who did not receive cryoablation (15.5 months versus 5.8 months, p<0.01). Conclusions: Salvage cryoablation is associated with decreased utilization of ADT in patients with biochemical recurrence after radiation.

scholarly journals ETS-related gene(ERG) expression as a predictor of oncological outcomes in patients with high-grade prostate cancer treated with primary androgen deprivation therapy: a cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025161
Author(s):  
Mark Rezk ◽  
Ashish Chandra ◽  
Daniel Addis ◽  
Henrik Møller ◽  
Mina Youssef ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Prostate Specific Antigen ◽  
Outcome Measures ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Related Gene

ObjectivesTo determine whetherETS-related gene(ERG) expression can be used as a biomarker to predict biochemical recurrence and prostate cancer-specific death in patients with high Gleason grade prostate cancer treated with androgen deprivation therapy (ADT) as monotherapy.MethodsA multicentre retrospective cohort study identifying 149 patients treated with primary ADT for metastatic or non-metastatic prostate cancer with Gleason score 8–10 between 1999 and 2006. Patients planned for adjuvant radiotherapy at diagnosis were excluded. Age at diagnosis, ethnicity, prostate-specific antigen and Charlson-comorbidity score were recorded. Prostatic tissue acquired at biopsy or transurethral resection surgery was assessed for immunohistochemical expression ofERG. Failure of ADT defined as prostate specific antigen nadir +2. Vital status and death certification data determined using the UK National Cancer Registry. Primary outcome measures were overall survival (OS) and prostate cancer specific survival (CSS). Secondary outcome was biochemical recurrence-free survival (BRFS).ResultsThe median OS of our cohort was 60.2 months (CI 52.0 to 68.3).ERGexpression observed in 51/149 cases (34%). Multivariate Cox proportional hazards analysis showed no significant association betweenERGexpression and OS (p=0.41), CSS (p=0.92) and BRFS (p=0.31). Cox regression analysis showed Gleason score (p=0.003) and metastatic status (p<1×10-5) to be the only significant predictors of prostate CSS.ConclusionsNo significant association was found betweenERGstatus and any of our outcome measures. Despite a limited sample size, our results suggest thatERGdoes not appear to be a useful biomarker in predicting response to ADT in patients with high risk prostate cancer.

Association of metastasis-free survival (MFS) with overall survival (OS) in men with PSA-recurrent prostate cancer treated with deferred androgen-deprivation therapy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 109-109 ◽  
Author(s):  
Michael Thomas Schweizer ◽  
Xian C. Zhou ◽  
Hao Wang ◽  
Ting Yang ◽  
Farah Shaukat ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Median Time ◽  
Androgen Deprivation Therapy ◽  
Biochemical Recurrence ◽  
Cox Regression ◽  
Performance Status ◽  
Androgen Deprivation ◽  
Clinical Event ◽  
Recurrent Prostate Cancer ◽  
Ecog Performance Status

109 Background: To support the hypothesis that metastases are a significant clinical event, we aimed to explore the association between MFS with OS in men with biochemically-recurrent prostate cancer. Methods: This is a retrospective analysis of 450 men treated at a single institution between July 1981 and July 2010 with biochemical recurrence following prostatectomy, of which 140 (31%) developed subsequent metastases. In all patients, androgen deprivation therapy was deferred until after the development of radiographic metastases. Univariate and multivariable Cox regression models were developed to investigate factors influencing OS. Results: The median time from biochemical recurrence to metastasis (i.e. MFS) was 10.2 y (95% CI, 7.6–14.0 y), and the median time from first metastasis to death (i.e. OS) was 6.6 y (95% CI, 5.8–8.4 y). Using multivariable Cox regressions, we identified 4 variables that were independently prognostic for OS (Table): MFS (≤3 vs >3 y; P=0.009), number of metastases (≤3 vs ≥4; P=0.001), painful metastases (present vs absent; P<0.001), and ECOG performance status (0 vs ≥1; P=0.001). The concordance index reflecting the association between MFS and OS was 0.67. Conclusions: After adjusting for other prognostic variables, MFS was independently associated with OS in men with biochemically-recurrent prostate cancer. While this observation requires prospective validation, it suggests that MFS may be a reasonable endpoint in future clinical trials. [Table: see text]

The Role of Chromogranin A (CgA) in Monitoring Patients with Prostate Cancer Under Androgen Deprivation Therapy: Comparison with Prostatic Specific Antigen (PSA)

2008 ◽  
Vol 1 (2) ◽  
pp. 115-119
Author(s):  
Athanasios Bantis ◽  
Petros Sountoulides ◽  
Athanasios Zissimopoulos ◽  
Christos Kalaitzis ◽  
Stilianos Giannakopoulos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Chromogranin A ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Prostatic Specific Antigen

scholarly journals Effect of Salvage Radiotherapy and Endocrine Therapy on Patients with Biochemical Recurrence After Prostate Cancer Operation— a Meta‑Analysis

2021 ◽  
Vol 15 (3) ◽  
pp. 155798832110248
Author(s):  
Yong Yuan ◽  
Qiang Zhang ◽  
Chaofan Xie ◽  
Tao Wu
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Endocrine Therapy ◽  
Androgen Deprivation Therapy ◽  
Biochemical Recurrence ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Androgen Deprivation ◽  
Salvage Radiotherapy ◽  
End Point

Context: Several studies reported the application of androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. Objective: To perform a systematic review and meta-analysis evaluating of endocrine therapy and radiotherapy in patients with biochemical recurrence after prostate cancer surgery. The primary end point was biochemical progression-free survival (bPFS). Secondary end point was overall survival (OS). Methods: A systematic review of PubMed/Medline, Embase, and Cochrane databases to identify relevant studies published in English up to March 2020. Twelve studies were selected for inclusion. Results: There were 11 studies included in the present study. Including two randomized controlled trials and nine cohort studies. The meta-analysis shows a significant bPFS benefit from androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. (hazard ratio [HR]: 0.57; 95% confidence interval CI, 0.52–0.63; p < .001). For patients with GS < 7 and low-risk patients, combined treatment can have a benefit for BPFs (HR: 0.53; 95% CI, 0.37–0.76; HR: 0.58; 95% CI, 0.36–0.93). Androgen deprivation therapy and radiotherapy in patients with biochemical recurrence was associated with a slightly OS improvement (HR: 0.73; 95% CI, 0.57–0.93; p = 0.01). Conclusions: Compared with salvage radiotherapy alone, This meta-analysis shows a significant bPFS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence after prostate cancer operation. And benefit more for high-risk groups. However, there was no significant benefit in group GS ≥ 8. It shows a slightly OS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence.

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