scholarly journals Adjuvant radiotherapy versus observation alone, after radical prostatectomy in high risk prostate cancer

2015 ◽  
Vol 61 (4) ◽  
pp. 324-328 ◽  
Author(s):  
Andrea Petruzziello ◽  
Massakazu Kato ◽  
Lais Cristine Nienkotter ◽  
Luis Felipe Matiusso de Souza ◽  
Luiz Antônio Negrão Dias ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Progression Free Survival ◽  
Radiotherapy Group ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Biochemical Progression

SummaryObjectives:the authors compared biochemical and clinical outcomes of patients with resected high-risk prostate cancer, managed with adjuvant radiotherapy or observation alone.Methods:patients treated with radical prostatectomy (RP) between January 1995 and December 2005 at the authors’ department were evaluated. Patients with pT3, with or without positive surgical margins (PSM), were included for analysis. Demographic, clinical, pathologic and follow-up data were recorded. Comparison was made between adjuvant radiotherapy group (AR) and observation alone group (OA). Primary end-point was biochemical progression-free survival.Results:out of 739 patients treated with RP, 49 presented with pT3 with or without PSM. 39 received adjuvant radiotherapy and 10 were observed. Median follow- up was 6.2 years for AR and 7.3 years for OA. Biochemical progression occurred in 12.8%, in AR, and 70%, in OA (p=0.0008). Five-year biochemical progression-free survival was 87.1% in AR and 30% in OA (HR 0.12, 95% CI 0.03- 0.48 – p<0.0001). Rescue androgen deprivation therapy was needed in 2.6%, in AR, and 30%, in OA (p=0.023).Conclusions:adjuvant radiotherapy after radical prostatectomy in high-risk prostate cancer provided better biochemical outcomes. Whether this translates into better clinical progression, it is still unknown.

scholarly journals Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes and complications

2019 ◽  
Author(s):  
Young Suk Suk Kwon ◽  
Wei Wang ◽  
Arnav Srivast ◽  
Thomas L Jang ◽  
Singer A Eric ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Study Cohort ◽  
High Risk Prostate Cancer ◽  
Pathologic Features ◽  
Risk Prostate Cancer

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

Biochemical relapse in very high-risk prostate cancer after radical prostatectomy and DC-vaccine loaded with tumor RNA, hTERT, and survivin.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 324-324
Author(s):  
Wolfgang Lilleby ◽  
Anne Merete Tryggestad ◽  
Iris Bigalke ◽  
Bjørn Brennhovd ◽  
Karol Axcrona ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trial ◽  
Bone Marrow ◽  
Dendritic Cells ◽  
High Risk ◽  
Radical Prostatectomy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Biochemical Progression ◽  
Very High

324 Background: Patients with very high-risk prostate cancer (VHR-PC) features experience worse outcome after radical prostatectomy. This study was designed to assess biochemical failure and toxicity of adjuvant dendritic cells vaccine (DCV) in prostate cancer patients who are at greatest risk for cancer progression. Methods: Twenty patients with pathological stage pT2 - pT3b and Gleason score 7B-10, pN0, pN+ or pNx were enrolled into the approved study DC-005. The primary end point was clinical failure. Ten patients were tested for disseminated tumor cells (DTCs) to the bone marrow before inclusion to the study. Three patients out of 10 patients had positive DTCs detection in bone marrow. The mean age of the cohort was 63 years (SD 6.9 years), and three patients had postsurgical pN1 status. Eighteen patients had two or more high-risk factors (ISUP grade 5, T3- stage and or PSA > 20 ng/mL). Autologous dendritic cells were transfected with mRNA for hTERT, survivin and tumor mRNA. The DCV product was applied intradermally after curative intended surgery once per week the first months, then once per months the first year, thereafter every 3 months for two years or until biochemical progression (PSA relapse cut-off ≥ 0.3). Results: After 5 years follow-up (FU) 62% (12/20 patients) had not biochemically progressed and with a median FU of 69 months all patients included in the study are alive. Five patients were treated with salvage and one patient with adjuvant radiation treatment, three patients received limited ADT, and three patients are on first line ADT, none of those eight patients have experienced castration resistant prostate cancer. The toxicity was mild with no serious adverse event related to DCV. Conclusions: Adjuvant DCV mitigates the time to biochemical progression. These results appear favorably compared to historical controls in VHR-PC. The clinical outcomes of this study warrants a future enlarged clinical trial. Clinical trial information: NCT01197625.

1488 TESTOSTERONE REPLACEMENT THERAPY IN PATIENTS WITH HIGH RISK PROSTATE CANCER AFTER RADICAL PROSTATECTOMY LONG-TERM FOLLOW-UP

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Alexander W. Pastuszak ◽  
Amy M. Pearlman ◽  
Kumaran Sathyamoorthy ◽  
Joceline S. Liu ◽  
Larry I. Lipshultz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Replacement Therapy ◽  
Testosterone Replacement Therapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Long Term Follow Up
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