Outcome Changes after Diverse Radical Prostatectomy among Prostate Cancer Patients: Comparison of One and Five Years of Follow-Up

Objective: To determine the oncological outcome of adjuvant treatment between radiotherapy (RT) alone and combined radiotherapy with androgen deprivation therapy (ADT) in high risk prostate cancer patients after radical prostatectomy (RP). Materials and Methods: All medical records of high risk-prostate cancer patients (including PSA > 20 ng/ml, pT3-pT4 or Gleason score 8-10) who underwent RP in Siriraj Hospital between 2000 and 2016 were retrospectively reviewed. Demo-graphic data, pathological staging, types of adjuvant treatment, time to follow up and time to biochemical recurrence (BCR) were analyzed. Results: Undetectable PSA after RP was achieved in 1009 out of 1221 high risk prostate cancer patients who had been followed up at least 6 months after surgery. Pathological staging pT2, pT3, pT4 and N1 was 23.8%, 73%, 0.8% and 4.7%, respectively. Forty one percent received adjuvant treatment (41 adjuvant RT alone, 74 combined adjuvant RT and ADT, 303 ADT alone). Median follow up time in the adjuvant RT group and combined treatment group was 63.8 months (8.9 - 210.7). BCR rates were 22% (9 of 41) for adjuvant RT and 12.2% (9 of 74) for adjuvant combined treatment. 10-year BCR-free survival in the two groups was 70.2% and 83.8%, respectively. There was no statistical difference between adjuvant RT and adjuvant combined treatment in terms of survival benefit (Hazard Ratio 0.40; p = 0.057). Conclusion: Adjuvant radiotherapy after radical prostatectomy increases long term survival outcomes for high risk prostate cancer patients. This study shows that combined adjuvant RT and ADT may improve BCR-free survival.

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PSMA-Ligand Uptake Can Serve as a Novel Biomarker in Primary Prostate Cancer to Predict Outcome After Radical Prostatectomy

10.21203/rs.3.rs-603830/v1 ◽

2021 ◽

Author(s):

Hui Wang ◽

Thomas Amiel ◽

Christoph Würnschimmel ◽

Thomas Langbein ◽

Katja Steiger ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Pet Imaging ◽

Surgical Margin ◽

Disease Outcome ◽

Imaging Biomarker ◽

Psma Ligand ◽

Primary Prostate Cancer

Abstract BackgroundThe prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP).MethodsIn this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics were assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed. ResultsAt a median follow-up after RP of 38 months (interquartile range (IQR): 22-53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p=0.004) was detected. miT status (miT≥3a vs. miT<3, OR: 2.696, p=0.003) was identified as an independent predictor for Gleason score (GS)≥8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p=0.014), advanced GS (GS≥8 vs. GS<8, HR: 3.253, p<0.001) and miT status (miT≥3a vs. miT<3, HR: 1.941, p=0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p=0.022).ConclusionPreoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification. Prospective studies with larger cohort are necessary to fully determine its use including primary prostate cancer patients with different treatments and risk categories and late-stage patients.

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PD30-06 MORTALITY RISK FACTORS IN EUROPEAN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY. COMPETING RISK ANALYSIS WITH 15-YEARS FOLLOW UP

The Journal of Urology ◽

10.1016/j.juro.2015.02.1827 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Katharina Boehm ◽

Burkhard Beyer ◽

Alessandro Larcher ◽

Jonas Schiffmann ◽

Pierre Karakiewicz ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Radical Prostatectomy ◽

Risk Analysis ◽

Cancer Patients ◽

Mortality Risk ◽

Competing Risk ◽

Competing Risk Analysis

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Medically and economically appropriate follow-up schedule for prostate cancer patients after radical prostatectomy

International Journal of Urology ◽

10.1046/j.1442-2042.2002.00435.x ◽

2002 ◽

Vol 9 (3) ◽

pp. 134-140 ◽

Cited By ~ 4

Author(s):

MASASHI NIWAKAWA ◽

KEN-ICHI TOBISU ◽

HIROYUKI FUJIMOTO ◽

NAOKI MATSUOKA ◽

TADAO KAKIZOE

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients

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Clinical outcomes of salvage treatment in lymph node-positive prostate cancer patients after radical prostatectomy

PLoS ONE ◽

10.1371/journal.pone.0256778 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256778

Author(s):

Dowook Kim ◽

Dong-Yun Kim ◽

Jae-Sung Kim ◽

Sung Kyu Hong ◽

Seok-Soo Byun ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Clinical Outcomes ◽

Salvage Treatment ◽

Node Positive ◽

Psa Nadir ◽

Lymph Node Positive

Introduction The optimal salvage treatment strategies for lymph node-positive (LNP) patients after radical surgery have not been clearly defined in prostate cancer with biochemical recurrence or persistence of elevated prostate-specific antigen (PSA). In this study, we compared the clinical outcomes of two different salvage treatments, androgen deprivation therapy (ADT) alone versus ADT with radiotherapy (RT). We also investigated prognostic factors that could support the use of ADT with RT in LNP prostate cancer. Materials and methods We retrospectively reviewed 94 LNP prostate cancer patients who underwent radical prostatectomy (RP) followed by salvage treatment between 2004 and 2018. Salvage treatments involved either ADT alone or ADT with RT according to the clinical judgment of the physician. We analyzed clinicopathological and treatment factors related to 2nd biochemical failure (2nd BCF), clinical progression (CP), and progression-free survival (PFS). The cumulative failure after salvage treatment was defined as including both 2nd BCF and CP. Results The median duration of follow-up was 55 months (interquartile range, 35–97 months). Thirty-seven (39.4%) patients were treated with ADT alone, and 57 patients (60.6%) were treated with a combination of ADT with RT. During follow-up period, the incidence of failure after salvage treatment in the ADT alone group and the combined treatment group was 89.2% and 45.6%, respectively (HR, 22.4; 95% CI 5.43–92.1; P < 0.001). The combination of ADT with RT was associated with better 2nd BCF and PFS than ADT alone (P = 0.007 and P = 0.015, respectively). In multivariate analyses, number of positive LN ≥ 2 and PSA nadir ≥ 0.005 ng/ml after RP were associated with poor 2nd BCF, CP, and PFS after salvage treatment. Salvage by combined ADT plus RT showed better 2nd BCF and PFS than ADT alone. Specifically, patients with number of positive LN ≥ 2 or PSA nadir ≥ 0.005 ng/ml after RP showed better 2nd BCF (P = 0.004) or PFS (P = 0.011) when treated with ADT plus RT rather than ADT alone. Conclusions In patients with LNP prostate cancer, salvage ADT plus RT improved 2nd BCF and PFS compared to ADT alone. In particular, when the patients had more than two positive lymph nodes or PSA nadir ≥ 0.005 ng/ml after RP, ADT with RT seems to be a more beneficial salvage treatment resulting in better 2nd BCF and PFS.

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