scholarly journals Prospective aspects in the oncological treatment of prostate cancer

2020 ◽  
Author(s):  
Linda Varga
Keyword(s):  
Prostate Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Patient Positioning ◽  
Standard Of Care ◽  
Industrial Country ◽  
Image Guided Radiotherapy ◽  
Oncological Treatment ◽  
Safety Margins ◽  
Hormone Sensitive

Prostate cancer (PC) is the second most common malignancy worldwide; the incidence is growing in every industrial country. Depending on the stage, surgical therapy, radiotherapy, and hormonal therapy are the potential therapeutic options. The elevation of radiation dose significantly improves biochemical control and disease-free survival independently of the type of radiotherapy (RT). The short-term and long-term side-effects of therapy are very important as PC patients usually have long survival. Although RT is getting more targeted, tolerance of normal tissues limits dose escalation and increases acute and chronic gastrointestinal (GI) and urogenital (UG) morbidity, exacerbating the pre-existing urological, sexual, and psychological problems. Symptoms depend on the degree and extent of the tissue damage and have a significant adverse effect on the patient’s quality of life (QOL). In clinical practice, toxicity can be reduced by the use of modern radiotherapy techniques by decreasing the safety margins (e.g. intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT)), by advantageous patient positioning and with almost constant fullness of the rectum and the urinary bladder. During radiotherapy the supine position is the most frequently used laying method. Patients can be treated also in a prone position (with the use of belly board - BB). The use of BB is associated with lower dose burden of intestines in several clinical trials of pelvic cancers formerly in the 3DCRT and nowadays in the IMRT-IGRT era. Despite advances in loco-regional medical treatment, advanced or metastatic PC is still very serious problem. Systematic treatment of metastatic prostate cancer can be divided into hormone-sensitive (HS) and castration-resistant (CR) pathophysiological phases. For metastatic hormone-sensitive prostate cancer (mHSPC) until recently, androgen deprivation therapy (ADT) alone by surgical or medical castration was the standard-of-care. Although the histological classification of PC is well-known, the different molecular subtypes and variants may respond differently to certain therapies. In recent years, many retrospective studies have focused on identifying potential predictive factors for optimizing treatment decisions.

The evolution of the education module for men with metastatic prostate cancer (mPC) in the prostate cancer supportive care (PCSC) program.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 279-279
Author(s):  
Jennifer Marie Rauw ◽  
Sunil Parimi ◽  
Nikita Ivanov ◽  
Jessica Noble ◽  
Eugenia Wu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Options ◽  
Standard Of Care ◽  
Primary Therapy ◽  
Oncology Nurse ◽  
Castration Resistant ◽  
Medical Oncologists ◽  
Hormone Sensitive ◽  
Virtual Platform ◽  
Satisfaction Surveys

279 Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]

Treatments for metastatic hormone-sensitive prostate cancer: A systematic review.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 346-346
Author(s):  
Belal Firwana ◽  
Mohamad Bassam Sonbol ◽  
Fade A. Mahmoud ◽  
Konstantinos Arnaoutakis
Keyword(s):  
Prostate Cancer ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
P Value ◽  
Free Survival ◽  
Appropriate Treatment ◽  
Individual Trial ◽  
Efficacy Outcome ◽  
Significant Difference ◽  
Hormone Sensitive

346 Background: Over the past few years, the treatment of metastatic hormone sensitive prostate cancer (mHSPC) was revolutionized with the addition of docetaxel (DOC) or abiraterone (ABI) to the previous standard of care androgen deprivation treatment (ADT). Here, we sought to compare the effectiveness of docetaxel and abiraterone directly against ADT and indirectly to each other. Methods: We included randomized controlled trials (RCT) evaluating the efficacy of treatments in adults with newly diagnosed mHSPC. First-line treatments with DOC and ABI were considered. Efficacy outcome measures are overall survival (OS) and failure-free survival as (FFS) as defined by individual trial. If FFS was not reported, biochemical progression-free survival was considered FFS due to its specificity. The overall effect was pooled using the DerSimonian random effects model. Testing for subgroup difference was conducted using meta-regression method. Results: A total of five RCTs were included; three RCTs compared DOC+ADT versus ADT involving 2,992 participants, and two RCT compared ABI+ADT versus ADT involving 2,201 participants. The addition of DOC to ADT showed a significant improvement in OS compared to ADT monotherapy (HR 0.77, 95% CI 0.66 to 0.89) as well did the addition of ABI to ADT (HR 0.62, 95% CI 0.53 to 0.71). p-value for subgroup interaction was <0.05, suggesting a significant difference between pooled DOC and ABI effects, favoring the addition of ABI vs. DOC to ADT. Similar effects were found in significantly improving FFS when adding DOC (HR 0.64, 95% CI 0.58 to 0.70) or ABI (HR 0.30, 95% CI 0.27 to 0.34) to ADT compared to ADT monotherapy. p-value for interaction subgroup interaction was again significant <0.05 favoring the addition of ABI vs. DOC to ADT. Conclusions: The addition of either DOC or ABI to ADT showed significant improvement in OS and FFS when compared to ADT monotherapy in patients with mHSPC. Test for interaction suggests better outcome of ABI in comparison against DOC. Discussion with patients is encouraged to choose the appropriate treatment considering the adverse event profile for each. Further head-to-head comparison is needed to determine the effect.

scholarly journals Docetaxel vs. Novel Hormonal Agent for Upfront Management of De Novo Metastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Report of a Single-Center Experience

2021 ◽  
Author(s):  
Sunny Guin ◽  
Bobby K. Liaw ◽  
Tomi Jun ◽  
Kristin Ayers ◽  
Bonny Patel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Value ◽  
Proportional Hazards ◽  
De Novo ◽  
Standard Of Care ◽  
Cox Proportional Hazards ◽  
Post Treatment ◽  
Real World Data ◽  
Significant Difference ◽  
Hormone Sensitive

Abstract Background: Upfront docetaxel or novel hormonal agents (NHA) such as abiraterone and enzalutamide have become the standard of care for metastatic hormone sensitive prostate cancer (mHSPC). However, data comparing the efficacy of docetaxel and NHAs in this setting are limited.Patients and Methods: This was a retrospective cohort study of patients with de novo mHSPC treated with upfront docetaxel or an NHA between January 1, 2014 and April 30, 2019 within the Mount Sinai Health System. Clinical data were extracted from the medical record. The primary outcome was failure-free survival (FFS), defined as the time to next treatment. The primary predictor was treatment with docetaxel or NHA. FFS was compared between the two groups using the Kaplan Meier method and multivariable Cox proportional hazards models. We additionally assessed the prognostic value of post-treatment PSA.Results: We identified 94 de novo mHSPC patients; 52 and 42 treated with upfront docetaxel and NHAs, respectively. NHAs were associated with significantly longer FFS compared to docetaxel (20.7 vs. 10.1 months, p=0.023). In a multivariable model adjusting for demographics and clinical factors, docetaxel was independently associated with worse FFS compared to NHAs (HR 1.96, 95% CI 1.12−3.45, p=0.019). High metastasis burden patients had a significantly longer FFS with NHAs than docetaxel (25.12 vs. 9.63 months, p=0.014), while there was no significant difference in FFS among low metastasis burden patients (NHA 20.71 vs. Docetaxel 26.5 months, p=0.9). Regardless of treatment, lower post-treatment PSA levels were associated with improved FFS (58.95 vs. 11.57 vs. 9.4 months for PSA ≤0.2, 0.2-0.4, >0.4ng/ml, respectively; p<0.001) Conclusion: Comparative analysis of real-world data demonstrated longer FFS in de novo mHSPC treated with NHA compared to docetaxel. In addition, the depth of PSA response following combination treatment may hold prognostic value for mHSPC outcomes.

Volumetric modulated arctherapy (VMAT) compared with sliding window intensity-modulated radiotherapy (IMRT) for whole pelvis irradiation (WPI) of locally advanced prostate cancer (LAPC).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 171-171
Author(s):  
Olivier Riou ◽  
Pauline Regnault de la Mothe ◽  
David Azria ◽  
Sabine Vieillot ◽  
Norbert Ailleres ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Treatment Time ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Sliding Window ◽  
Standard Of Care ◽  
Locally Advanced Prostate Cancer ◽  
Integrated Boost ◽  
Set Up

171 Background: Concurrent radiotherapy to the pelvis plus a prostate boost with long term androgen deprivation is a standard of care for LAPC. IMRT has the ability to deliver highly conformal dose to the target while lowering the irradiation of critical organs around the prostate. However, delivery time is signicantly prolonged with static gantry IMRT. VMAT is able to reduce treatment time but results concerning organ sparing are controversial when compared to static gantry IMRT. Methods: 10 patients with locally advanced prostate cancer were included in this dosimetric study. The planning target volumes (PTV) 1 was defined as the pelvic lymph nodes, the prostate and the seminal vesicles plus set up margins. The PTV 2 consisted of the prostate with set up margins. The aimed dose to PTV1 was 54 Gy in 37 fractions and to PTV2, 74 Gy in 37 fractions, in a single plan using the integrated boost method, by means of a 7 coplanar static split fields IMRT, a one arc (RA1) and a two arc (RA2) Rapidarc planification. Results: All three techniques allow a very good coverage of both PTVs with an acceptable homogeneity. Static IMRT enables a better homogeneity for PTV 2 than Rapidarc techniques. Sliding-window IMRT and VMAT permitted to maintain doses to OAR within acceptable levels with a low risk of side-effects for each organ. Nevertheless, VMAT plans result in clinically and statistically significant reduction in doses to bladder (IMRT Vs RA2: Mean dose: 50.1 ± 4.6 Vs 47.1 ± 3.9 Gy, p = 0.037), rectum (Mean dose: 44 ± 4.5 Vs 41.6 ± 5.5 Gy, p = 0.006) and small bowel (V30: 76,47 ± 14,91% Vs. 47,49 ± 16,91%, p = 0.002). Conclusions: VMAT allows for better OAR sparing as compared to sliding-window IMRT while maintining PTV coverage into acceptable levels for WPI of LAPC.

Adjuvant docetaxel after definitive radiotherapy for high-risk prostate cancer: A meta-analysis of randomized clinical trials.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 374-374
Author(s):  
Ray Manneh Kopp ◽  
Mauricio Lema ◽  
Linda Ibatá
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Standard Of Care ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Disease Free

374 Background: In order to improve long term results for high-risk prostate cancer, several clinical trials have tested the addition of docetaxel chemotherapy. The outcomes of this trials have not led to clear conclusions. We conducted a meta-analysis of randomized phase 3 trials testing the efficacy of docetaxel after radiotherapy in high risk prostate cancer patients. Methods: A systematic review of PubMed (Medline), Embase and the Cochrane Library was conducted. We followed the PRISMA guidelines, three investigators independently selected the articles and verified inclusion criteria. We compared the overall survival and disease-free survival between the intervention group (adjuvant chemotherapy with docetaxel) and the control group (without adjuvant chemotherapy) by calculating the hazard ratio (HR) with 95% confidence intervals (CIs). Pooled effects were calculated using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: 382 publications were identified, four phase III trials (STAMPEDE, RTOG0521, SPCG-13, GETUG 12) comparing docetaxel vs standard of care after radiotherapy for high-risk prostate cancer fulfilled the inclusion criteria with data from 2034 patients (1135 in placebo group and 899 in adjuvant docetaxel group). Heterogeneity was not found between the included studies for OS (I 2 0%), but it was found between studies for disease-free survival (I2 60%). Adjuvant docetaxel chemotherapy showed overall survival benefit when compared to ADT alone (HR 0,72 95% CI 0,54-0,96). Adjuvant docetaxel also improved the disease-free survival when compared to ADT alone (HR 0,74 95% CI 0,64-0,86). No evidence of publication bias was observed. Conclusions: This meta-analysis shows that docetaxel after definitive radiotherapy in high-risk prostate cancer is likely to be more effective than standard of care in terms of overall survival and disease-free survival. Further prospective studies are needed in order to increase the sample that would lead to show a more robust data.

scholarly journals Testosterone monitoring for men with advanced prostate cancer: Review of current practices and a survey of Canadian physicians

2017 ◽  
Vol 11 (6) ◽  
pp. 204 ◽  
Author(s):  
Bobby Shayegan ◽  
Frédéric Pouliot ◽  
Alan So ◽  
John Fernandes ◽  
Joseph Macri
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Testosterone Level ◽  
Advanced Prostate Cancer ◽  
Standard Of Care ◽  
Androgen Deprivation ◽  
Testosterone Levels ◽  
Radiation Oncologists ◽  
Cancer Review ◽  
Hormone Sensitive

Androgen-deprivation therapy (ADT) is a standard of care in the treatment of advanced prostate cancer; however, testosterone monitoring practices for men undergoing ADT vary across Canada. Although a testosterone level of 1.7 nmol/L or lower has historically been defined as the accepted castrate level, newer assays with improved sensitivity have shown that both medical and surgical castration can suppress testosterone levels to below 0.7 nmol/L. This review explores the evidence supporting a redefinition of the castrate testosterone level as 0.7 nmol/L or lower, and presents results of a survey of testosterone monitoring practices among 153 Canadian urologists, uro-oncologists, and radiation oncologists who manage the treatment of men with hormone-sensitive prostate cancer.

scholarly journals Treatment of the Primary Tumor in Metastatic Hormone-sensitive Prostate Cancer: Not Yet Ready for Prime Time as the Standard of Care

2019 ◽  
Vol 76 (5) ◽  
pp. 543-545 ◽  
Author(s):  
Weranja K.B. Ranasinghe ◽  
Chad A. Reichard ◽  
Brian F. Chapin
Keyword(s):  
Prostate Cancer ◽  
Primary Tumor ◽  
Standard Of Care ◽  
Prime Time ◽  
Hormone Sensitive

scholarly journals Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data

2016 ◽  
Vol 17 (2) ◽  
pp. 243-256 ◽  
Author(s):  
Claire L Vale ◽  
Sarah Burdett ◽  
Larysa H M Rydzewska ◽  
Laurence Albiges ◽  
Noel W Clarke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Standard Of Care ◽  
Aggregate Data ◽  
Hormone Sensitive ◽  
Meta Analyses

scholarly journals Efficacy of enzalutamide in patients with metastatic hormone-sensitive and castration-refractory prostate cancer: authors’ experience

2021 ◽  
pp. 130-136
Author(s):  
T. V. Ustinova ◽  
L. V. Bolotina ◽  
A. A. Paichadze ◽  
A. A. Kachmazov ◽  
A. A. Fedenko ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Case ◽  
Treatment Options ◽  
Standard Of Care ◽  
Male Population ◽  
Castration Resistant ◽  
Age Of Diagnosis ◽  
Hormone Sensitive ◽  
New Treatment ◽  
New Generation

Prostate cancer is one of the most common neoplasms in men. It currently ranks second in Russian Federation amongst male population in overall number of cases after only lung cancer and third in cancer mortality. Prostate cancer is rarely diagnosed in patients younger than 40 years old, with overage age of diagnosis being between 50 and 70 years. A lot of different new treatment options were developed in the last decade for patients with metastatic prostate cancer (mPC). Despite androgen-deprivation remaining the standard of therapy, it has been proven that the addition of cytotoxic and hormonal drugs of new generation improves overall survival of patients with castration-sensitive and castration-resistant metastatic disease. Recently, enzalutamide became the new standard of care not only in castration-resistant mPC, but also in the setting of metastatic castration-sensitive prostate cancer, due to the data acquired in two large randomized trials ARCHES and ENZAMET. This article provides clinical examples demonstrating the effectiveness of enzalutamide in various forms of prostate cancer. In the first clinical case enzalutamide was used in the treatment of castration-sensitive mPC. Currently, patient continues to receive this therapy with progression-free interval exceeding 11  months. In  the  second clinical case, enzalutamide has shown its efficacy in  the  setting of  castration-resistant PC. Stable disease was achieved and as of  right now patient has shown no signs of  progression for 9 months, which is already a significantly better result in comparison with previous lines of treatment. 

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