scholarly journals Interdisciplinary consensus statement on indication and application of a hydrogel spacer for prostate radiotherapy based on experience in more than 250 patients

2016 ◽  
Vol 50 (3) ◽  
pp. 329-336 ◽  
Author(s):  
Arndt-Christian Müller ◽  
Johannes Mischinger ◽  
Theodor Klotz ◽  
Bernd Gagel ◽  
Gregor Habl ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Wall ◽  
Locally Advanced ◽  
Transrectal Ultrasound ◽  
Serious Adverse Event ◽  
Prostate Radiotherapy ◽  
Risk Prostate Cancer ◽  
Potential Benefits ◽  
Potential Risks ◽  
Current Experience

Abstract Background The aim of the study was to reach a consensus on indication and application of a hydrogel spacer based on multicentre experience and give new users important information to shorten the learning curve for this innovative technique. Methods The interdisciplinary meeting was attended by radiation oncologists and urologists, each with experience of 23 – 138 hydrogel injections (SpaceOAR®) in prostate cancer patients before dose-escalated radiotherapy. User experience was discussed and questions were defined to comprise practical information relevant for successful hydrogel injection and treatment. Answers to the defined key questions were generated. Hydrogel-associated side effects were collected to estimate the percentage, treatment and prognosis of potential risks. Results The main indication for hydrogel application was dose-escalated radiotherapy for histologically confirmed low or intermediate risk prostate cancer. It was not recommended in locally advanced prostate cancer. The injection or implantation was performed under transrectal ultrasound guidance via the transperineal approach after prior hydrodissection. The rate of injection-related G2-toxicity was 2% (n = 5) in a total of 258 hydrogel applications. The most frequent complication (n = 4) was rectal wall penetration, diagnosed at different intervals after hydrogel injection and treated conservatively. Conclusions A consensus was reached on the application of a hydrogel spacer. Current experience demonstrated feasibility, which could promote initiation of this method in more centres to reduce radiation-related gastrointestinal toxicity of dose-escalated IGRT. However, a very low rate of a potential serious adverse event could not be excluded. Therefore, the application should carefully be discussed with the patient and be balanced against potential benefits.

Management of late events after conventional radical prostate radiotherapy: against the odds of secondary tumours and recurrence of prostate cancer

2021 ◽  
Vol 14 (8) ◽  
pp. e242640
Author(s):  
Rodriguez-Perez AR ◽  
Montero-Feijoo M ◽  
Blanco-de-Córdoba LA ◽  
Luna-Tirado J
Keyword(s):  
Prostate Cancer ◽  
Medical Care ◽  
Locally Advanced ◽  
Iliac Vein ◽  
Base Case ◽  
Ureterovesical Junction ◽  
Prostate Radiotherapy ◽  
Prostate Cancer Relapse ◽  
Anatomic Locations ◽  
Old Men

We present two 85-year-old men, with a similar history of prostate cancer treated more than 10 years ago with radiotherapy, who were in remission, but sought medical care at a time, due to alarm sign and symptoms. Case 2 resulted in a locally advanced secondary radiation-induced sarcoma of the penile base. Case 1 suffered from a round, 2 cm soft-tissue lesion with spiculated borders at the ureterovesical junction responsible for ipsilateral iliac vein compression and urinary obstruction without proven biochemical prostate cancer relapse, raising concerns about recurrence or secondary tumour. Both patients followed an oncological geriatric assessment and were ‘vulnerable’ at their presentation. Hence, we describe the effort to perform medical care adequacy regarding patient’s frailty and the anatomic locations within the prior radiation field. In case 2, we got a pathological diagnose and followed sequential multimodal treatments without success. But in case 1, minimal intervention resulted in improvement.

scholarly journals Effectiveness of Androgen-Deprivation Therapy and Radiotherapy for Older Men With Locally Advanced Prostate Cancer

2015 ◽  
Vol 33 (7) ◽  
pp. 716-722 ◽  
Author(s):  
Justin E. Bekelman ◽  
Nandita Mitra ◽  
Elizabeth A. Handorf ◽  
Robert G. Uzzo ◽  
Stephen A. Hahn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Propensity Score ◽  
Advanced Prostate Cancer ◽  
Randomized Trials ◽  
Locally Advanced ◽  
The Elderly ◽  
Locally Advanced Prostate Cancer ◽  
High Risk Prostate Cancer ◽  
All Cause Mortality ◽  
Risk Prostate Cancer

Purpose We examined whether the survival advantage of androgen-deprivation therapy with radiotherapy (ADT plus RT) relative to ADT alone for men with locally advanced prostate cancer reported in two randomized trials holds in real-world clinical practice and extended the evidence to patients poorly represented in the trials. Methods We conducted nonrandomized effectiveness studies of ADT plus RT versus ADT in three groups of patients diagnosed between 1995 and 2007 and observed through 2009 in the SEER-Medicare data set: (1) the randomized clinical trial (RCT) cohort, which included men age 65 to 75 years and was most consistent with participants in the randomized trials; (2) the elderly cohort, which included men age > 75 years with locally advanced prostate cancer; and (3) the screen-detected cohort, which included men age ≥ 65 years with screen-detected high-risk prostate cancer. We evaluated cause-specific and all-cause mortality using propensity score, instrumental variable (IV), and sensitivity analyses. Results In the RCT cohort, ADT plus RT was associated with reduced cause-specific and all-cause mortality relative to ADT alone (cause-specific propensity score–adjusted hazard ratio [HR], 0.43; 95% CI, 0.37 to 0.49; all-cause propensity score–adjusted HR, 0.63; 95% CI, 0.59 to 0.67). Effectiveness estimates for the RCT cohort were not significantly different from those from randomized trials (P > .1). In the elderly and screen-detected cohorts, ADT plus RT was also associated with reduced cause-specific and all-cause mortality. IV analyses produced estimates similar to those from propensity score–adjusted methods. Conclusion Older men with locally advanced or screen-detected high-risk prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival.

scholarly journals Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy

2017 ◽  
Vol 58 (3) ◽  
Author(s):  
Carlos Gustavo Trujillo Ordoñez ◽  
Anamaria Ramos Hernández ◽  
Daniela Robledo Cárdenas ◽  
Ángela Marcela Mariño Álvarez ◽  
Juan Guillermo Cataño Cataño ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Locally Advanced ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Histological Findings ◽  
Risk Prostate Cancer ◽  
Locally Advanced Tumors ◽  
Clinical Records

<p><strong>Abstract</strong></p><p><strong>Objectives: </strong>To describe the histological findings in patients with prostate cancer (PCa) clinically classified as very low risk who underwent treatment with radical prostatectomy (RP). <strong>Material and methods: </strong>A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007-2015 who met Epstein criteria for very low risk disease were reviewed. Histological diagnosis was described and analyzed to determine if such criteria predicted very low risk. <strong>Results: </strong>A total of 609 records were reviewed; 83 (13.6%) met Epstein’s criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng/dl (IQR 4.3 – 6.8). Pathology showed a median tumor volume of 4% (IQR 1 – 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were reclassified to a greater score. Two (2.4%) patients were reclassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pT0. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. <strong>Conclusions: </strong>Up to one-third of the patients clinically classified with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein’s criteria seem to be adequate in predicting organ-confined disease. </p>

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