Five-Year Outcomes of Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer-The Largest Experience in China

2021 ◽  
Author(s):  
Xianzhi Zhao ◽  
Yusheng Ye ◽  
Haiyan Yu ◽  
Lingong Jiang ◽  
Chao Cheng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Cox Regression Analysis ◽  
Gu Toxicity ◽  
Biochemical Progression ◽  
Grade 3 ◽  
Very High

Abstract Objective To evaluate the efficacy and toxicity of SBRT for localized prostate cancer (PCa). Moreover, it is the largest-to-date pilot study to report 5-year outcomes of SBRT for localized PCa from China. Methods In this retrospective study, 133 PCa patients in our center were treated by SBRT with CyberKnife (Accuray) from October 2012 to July 2019. Follow-up was performed every 3 months for evaluations of efficacy and toxicity. Biochemical progression-free survival (bPFS) and toxicities were assessed using the Phoenix definition and the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0 respectively. Factors predictive of bPFS were identified with COX regression analysis. Results 133 patients (10 low-, 21 favorable intermediate-, 31 unfavorable intermediate-, 45 high-, and 26 very high risk cases on the basis of the NCCN risk classification) with a median age of 76 years (range: 54–87 years) received SBRT. The median dose was 36.25Gy (range: 34-37.5Gy) in 5 fractions. Median follow-up time was 57.7 months (3.5–97.2 months). The overall 5-year bPFS rate was 83.6% for all patients. The 5-year bPFS rate of patients with low-, favorable intermediate-, unfavorable intermediate-, high-, and very high risk PCa was 87.5%, 95.2%, 90.5%, 86.3%, and 61.6% respectively. Urinary symptoms were all alleviated after SBRT. All the patients tolerated SBRT with only 1 (0.8%) and 1 (0.8%) patient reporting grade-3 acute and late genitourinary (GU) toxicity, respectively. There were no grade 4 toxicities. Gleason score (P < 0.001, HR = 7.483, 95%CI: 2.686–20.846) was the independent predictor of bPFS rate after multivariate analysis Conclusion SBRT is an efficient and safe treatment modality for localized PCa with high 5-year bPFS rates and acceptable toxicities.

scholarly journals Five-year outcomes of stereotactic body radiation therapy (SBRT) for prostate cancer: the largest experience in China

2021 ◽  
Author(s):  
Xianzhi Zhao ◽  
Yusheng Ye ◽  
Haiyan Yu ◽  
Lingong Jiang ◽  
Chao Cheng ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Patient Reporting ◽  
Cox Regression Analysis ◽  
Gu Toxicity ◽  
Grade 3 ◽  
Very High

Abstract Objective To evaluate the efficacy and safety of SBRT for localized prostate cancer (PCa) with CyberKnife in China. Moreover, it is the largest-to-date pilot study to report 5-year outcomes of SBRT for localized PCa from China. Methods In this retrospective study, 133 PCa patients in our center were treated by SBRT with CyberKnife (Accuray Inc., Sunnyvale, USA) from October 2012 to July 2019. Follow-up was performed every 3 months for efficacy and toxicity evaluation. Biochemical progression-free survival (bPFS) and toxicities were assessed using the Phoenix definition and the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0, respectively. Factors predictive of bPFS were identified with COX regression analysis. Results 133 patients (10 low-, 21 favorable intermediate-, 31 unfavorable intermediate-, 45 high-, and 26 very high risk cases on the basis of NCCN risk classification) with a median age of 76 years (range 54–87 years) received SBRT. The median dose was 36.25 Gy (range 34–37.5 Gy) in 5 fractions. Median follow-up time was 57.7 months (3.5–97.2 months). The overall 5-year bPFS rate was 83.6% for all patients. The 5-year bPFS rate of patients with low-, favorable intermediate-, unfavorable intermediate-, high-, and very high risk PCa was 87.5%, 95.2%, 90.5%, 86.3%, and 61.6%, respectively. Urinary symptoms were all alleviated after SBRT. All patients tolerated SBRT with 1 (0.8%) patient reporting grade-3 acute and 1 (0.8%) patient reporting grade-3 late genitourinary (GU) toxicity, respectively. There were no grade 4 toxicities. Gleason score (P < 0.001, HR = 7.483, 95%CI: 2.686–20.846) was the independent predictor of bPFS rate after multivariate analysis. Conclusion SBRT is an efficient and safe treatment modality for localized PCa with high 5-year bPFS rates and acceptable toxicities.

Toxicity and efficacy of salvage paclitaxel chemotherapy in Royal Marsden (RM) oesophagogastric adenocarcinoma (OGA) patients (pts).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 188-188
Author(s):  
NOELIA TARAZONA ◽  
Elizabeth Catherine Smyth ◽  
Clare Peckitt ◽  
Ian Chau ◽  
David J. Watkins ◽  
...  
Keyword(s):  
Cox Regression ◽  
Prognostic Score ◽  
Significant Proportion ◽  
Progression Free Survival ◽  
Response Duration ◽  
Hematological Toxicity ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Grade 3

188 Background: Paclitaxel is a standard global salvage therapy for pts with advanced refractory OGA. Western pts may differ from Asian pts with respect to chemotherapy metabolism and cancer behaviour, and the benefits associated with paclitaxel in this setting have not been assessed outside of Asia. We examined the efficacy and toxicity associated with salvage paclitaxel for advanced OGA at RM over a 3 year period. Methods: This was a retrospective observational study. We identified all pts with OGA treated with salvage weekly paclitaxel from 01/06/2011 to 21/02/2014 from the electronic pt record at RM. The following data was collected: demographics, metastatic sites, resection status, response/duration of response to prior chemotherapy, ECOG PS, haemoglobin, albumin, alkaline phosphatase (ALP), neutrophil/lymphocyte ratio, CEA, CA19.9, RM prognostic score, CT response and date of progression, death or last follow up. Toxicity was collected as per NCI Common Toxicity Criteria (v4.0). Overall and progression free survival (OS/PFS) were estimated using the Kaplan-Meier method. Multivariate Cox regression analysis examined the association between clinical and laboratory variables with survival. Results: 57 pts were identified. Pts were 74% male; median age 64y; 66% PS 0-1; 91% 2nd line. Median number cycles 3 (range 1-8). Median follow up 13.6m. Response rate was 18.4% in evaluable pts. OS and PFS were 5.8m (95% CI: 4.8 – 6.8m) and 2.6m (95% CI: 1.9 – 3.2m). 2y and 3y survival from start of 1st line treatment were 26% and 13%. In multivariate analyses PS ≥2 [HR 2.28, p = 0.018], and ALP ≥100 U/L, [HR=2.01, p= 0.033] were independent negative prognostic factors for OS. ≥ Grade 3 nausea, diarrhea and neuropathy were uncommon (<2% each), rate of ≥ grade 3 fatigue was 11%. Grade 3-4 neutropenia, leucopenia and thrombocytopenia occurred in 12%, 11% and 2% pts. Conclusions: Advanced OGA pts treated at RM with salvage paclitaxel have an OS equivalent to pts in clinical trials with less hematological toxicity than seen in Asian patients. This may be due to regional pharmacogenetic profiles. As a significant proportion of pts now survive 2-3y with limited toxicity, therapeutic nihilism is unwarranted.

scholarly journals Prostate Cancer Survival By Risk of Progression and Other Prognostic Factors in Mallorca, Spain

2021 ◽  
Author(s):  
Juan-José Montaño ◽  
Antoni Barceló ◽  
Paula Franch ◽  
Jaume Galceran ◽  
Alberto Ameijide ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Survival ◽  
Cox Regression ◽  
Strong Relationship ◽  
Low Risk ◽  
Medium Risk ◽  
Risk Of Progression ◽  
Very High

Abstract Objectives: 1) to find out the distribution of prostate cancer by risk of progression; 2) to determine the cause-specific survival by risk of progression in prostate cancer; 3) to identify the factors associated with the risk of dying from this cancer.Methods: Incident prostate cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: invasive cases with code C61.9 and any histology. Cases identified exclusively through death certificate were excluded. We collected: age; date and method of diagnosis; date of follow-up or death; T, N, M and stage according to the TNM 7th edition; Gleason score; PSA; histology according to the ICD-O 3rd edition 6 ; comorbidities and treatments. We calculated risk in 4 categories: low, medium, high and very high. End point of follow-up was 31 December 2014. Multiple imputation (MI) was performed to estimate cases with unknown risk of progression. Survival analysis was performed using the actuarial and Kaplan-Meier methods, as well as the Cox regression model.Results: We identified 2921 cases. After MI, 9.5% had low risk, 24.9% medium risk, 42.7% high risk and 22.9% very high risk. Five years after diagnosis, survival after MI was 89% globally, that being 100% for low risk cases, 96% for medium risk, 93% for high risk and 69% for very high risk. Cases with histology other than adenocarcinoma, with high and, especially, very high risk of progression, as well as with systemic, mixed and observation/unspecified treatments have worse prognosis. Treatment showed a strong relationship with age and life expectancy.Conclusions: Risk of progression and treatment were the main variables associated to survival in prostate cancer.

scholarly journals Comparison of the oncological and functional outcomes of brachytherapy and radical prostatectomy for localized prostate cancer

2019 ◽  
Author(s):  
Fei Wang ◽  
Xue fei Ding ◽  
Yang Luan ◽  
Yao-zong Xu ◽  
Cheng-hao Guo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Group Versus ◽  
Bowel Function ◽  
Cox Regression Analysis ◽  
High Risk Disease ◽  
Lower Hrqol

Abstract Objective:To compare the oncological and functional outcomes of brachytherapy(BT) and radical prostatectomy(RP) in patients with localized prostate cancer(PCa).Methods:We retrospectively analyzed data from 415 patients with localized PCa who were treated with RP (n= 280) or BT (n=135) at Northern Jiangsu People's Hospital between November 2012 and April 2019. Biochemical relapse-free survival(bRFS) and cancer-specific survival (CSS) were compared. Multivariate Cox regression analysis was used to evaluate bRFS. Health-related quality of life(HRQoL) was measured using the Expanded Prostate Cancer Index Composite(EPIC) questionnaire.Results:The BT group was older, had a higher initial PSA, and had a higher proportion of high-risk patients. The median follow-up time was 38.6 months. The 3-year bRFS was 77.3% in the RP group versus 84.0% in the BT group(P=0.246). For the RP group, the 3-year bRFS for patients presenting with low-, intermediate-, and high-risk disease was 90.3%, 79.6% and 71.3%, respectively, compared with 90.9%, 93.8% and 80.7% in the BT group(P=0.948,0.213,0.263, respectively). The 3-year CSS was 96.1% in the RP group versus 94.5% in the BT group(P=0.948). For the RP group, the 3-year CSS for patients presenting with low-, intermediate-, and high-risk disease was 100%, 100% and 92.8%, respectively, compared with 100%, 100% and 92.4%, for the BT group(P=0.620). Based on multivariate Cox regression analysis, clinical T stage ≥ T2b was the main independent prognostic factor for bRFS. Regarding the quality of life, compared with the baseline, both treatments produced a significant decrease in different aspects of HRQoL at 3, 6 and 12 months after treatment. Patients in the BT group had lower HRQoL with regard to urinary irritation/obstruction and bowel function or bother, while patients in the RP group had lower HRQoL concerning urinary incontinence and sexual function or bother. There was no significant difference in HRQOL aspects between the two groups after follow-up for 2 years compared with the baseline.Conclusion:BT provides equivalent oncological control outcomes for patients with localized PCa compared with RP. Clinical T stage ≥ T2b was the independent prognostic factor for bRFS. BT had better HRQoL compared with RP, except for urinary irritation/obstruction and bowel function or bother, but returned to baseline after 2 years.

Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiotherapy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 47-47
Author(s):  
Sergio Faria ◽  
Russel RUO ◽  
Fabio Cury ◽  
Marie Duclos ◽  
Luis Souhami
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Target Volume ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Risk Prostate Cancer

47 Background: Two recent large randomized trials confirm that 60Gy in 20 fractions is an effective regimen compared to conventionally fractionated escalated doses in localized prostate cancer. However, in these two trials the prostate was the only target volume irradiated. The purpose of this study is to report acute and late toxicity in patients with high-risk prostate cancer treated with the same moderate hypofractionated radiotherapy (HypoRT) to two target volumes at the same time: prostate and pelvic nodes. Methods: High-risk prostate cancer patients received 60Gy/20 fractions (4 weeks) to the prostate while the pelvic-nodes received 44Gy delivered with intensity modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) during the same 20 fractions. ADT started 2-3 months before HypoRT. Acute and late toxicity were prospectively assessed according to CTCAE.v3. Results: 105 patients treated between September/2010 and November/2013 were reviewed. Median follow up is 41 months. Median ADT duration was 18 months. Acute grade > 2 gastrointestinal (GI) or genitourinary (GU) toxicity was seen in 17% and 17% respectively, with only 1 and 3 patients experiencing GI and GU acute grade 3 toxicity, respectively. The worst grade > 2 late GI and GU toxicity was seen in 7% and 8% of patients, respectively. There was no grade 4-5 toxicity. At the last follow-up, the rates of grade = 2 GI and GU toxicity were 5% and 3%, respectively with no residual grade > 3 toxicity. The 48-month actuarial progression free survival is 82%. We found only 8 publications on this topic, all delivered the HypoRT in 25-28 fractions, but only one has long-term toxicity. Conclusions: ADT with HypoRT delivered with IMRT and SIB to the prostate (60Gy) and pelvic nodes (44Gy) in 20 fractions is feasible and well tolerated after 41months of median follow-up. Our approach shortens treatment duration, is convenient and its results support a needed randomized trial. Clinical trial information: NCT02107287.

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 Hypofractionated helical intensity-modulated radiotherapy (75 Gy at 2.5 Gy/fraction) for intermediate- and high-risk prostate cancer: Assessment of toxicity

2011 ◽  
Vol 11 (3) ◽  
pp. 145-154
Author(s):  
Moonkyoo Kong ◽  
Seong Eon Hong ◽  
Jinhyun Choi ◽  
Sung-Goo Chang
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radiation Therapy Oncology Group ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
High Risk Prostate Cancer ◽  
Gu Toxicity ◽  
Risk Prostate Cancer ◽  
Grade 3

AbstractPurpose: To evaluate the toxicity of hypofractionated helical intensity-modulated radiotherapy (IMRT) for men with intermediate- and high-risk prostate cancer.Methods and Materials: A retrospective toxicity analysis was performed in 22 patients treated definitively with hypofractionated helical IMRT. The helical IMRT were designed to deliver 75 Gy in 2.5 Gy/fraction to the prostate gland, 63 Gy in 2.1 Gy/fraction to seminal vesicle, and 54 Gy in 1.8 Gy/fraction to pelvic lymph nodes. No patient received hormonal therapy. Toxicity was graded by the Radiation Therapy Oncology Group (RTOG) scales.Results: All patients tolerated the treatment well without treatment interruption, and there was no Grade 3 or more acute toxicity. With a median follow-up of 24.5 months, there was no Grade 3 or more late toxicity. The late Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity for total 22 patients were 9.1% and 18.2%, respectively, and the late Grade 1 GI and GU toxicity were 18.2% and 50%, respectively. Late GU toxicity was associated with greater bladder volume irradiated ≥70 Gy. Late GI toxicity did not correlate with any of the dosimetric parameters.Conclusions: This study demonstrate that hypofractionated helical IMRT with high biologic effective dose (BED) is well tolerated with favourable toxicity rate. If longer follow-up periods and larger cohorts confirm the favourable biochemical control rate and our favourable toxicity assessment results, the hypofractionated IMRT (total 75 Gy, 2.5 Gy/fraction) might be implemented in clinical field for treatment of prostate cancer.

scholarly journals Stereotactic body radiotherapy for low-risk prostate cancer: Five-year outcomes.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 94-94
Author(s):  
D. Freeman ◽  
C. R. King
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Progression Free Survival ◽  
Low Risk ◽  
Free Survival ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Biochemical Progression ◽  
Grade 3

94 Background: Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Methods: Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35–36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed. Results: At a median follow-up of 5 years the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1–3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusions: Five-year results of SBRT for localized prostate cancer demonstrate the effectiveness and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are expected to further support this experience. [Table: see text]

scholarly journals Myocardial Metabolic Response Predicts Chemotherapy Curative Potential on Hodgkin Lymphoma: A Proof-of-Concept Study

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 971
Author(s):  
Cecilia Marini ◽  
Matteo Bauckneht ◽  
Anna Borra ◽  
Rita Lai ◽  
Maria Isabella Donegani ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cox Regression ◽  
Metabolic Response ◽  
Progression Free Survival ◽  
Disease Relapse ◽  
Cox Regression Analysis ◽  
Normal Tissues ◽  
Pet Ct ◽  
Genome Sharing

Genome sharing between cancer and normal tissues might imply a similar susceptibility to chemotherapy toxicity. The present study aimed to investigate whether curative potential of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is predicted by the metabolic response of normal tissues in patients with Hodgkin lymphoma (HL). METHODS: According to current guidelines, 86 patients with advanced-stage (IIB-IVB) HL, prospectively enrolled in the HD0607 trial (NCT00795613), underwent 18 F-fluorodeoyglucose PET/CT imaging at diagnosis and, at interim, after two ABVD courses, to decide regimen maintenance or its escalation. In both scans, myocardial FDG uptake was binarized according to its median value. Death and disease relapse were recorded to estimate progression-free survival (PFS) during a follow-up with median duration of 43.8 months (range 6.97–60). RESULTS: Four patients (4.6%) died, while six experienced disease relapse (7%). Complete switch-off of cancer lesions and cardiac lighting predicted a favorable outcome at Kaplan–Mayer analyses. The independent nature and additive predictive value of their risk prediction were confirmed by the multivariate Cox regression analysis. CONCLUSION: Susceptibility of HL lesions to chemotherapy is at least partially determined by factors featuring the host who developed it.

scholarly journals A novel predictor of clinical progression in patients on active surveillance for prostate cancer

2019 ◽  
Vol 13 (8) ◽  
Author(s):  
Guan Hee Tan ◽  
Antonio Finelli ◽  
Ardalan Ahmad ◽  
Marian Wettstein ◽  
Alexandre Zlotta ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Roc Curves ◽  
Standard Of Care ◽  
Low Risk ◽  
Clinical Progression

Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PC). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP).     Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years follow-up. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo / prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival curves between TCLo density groups. Test characteristics of TCLo were explored with receiver operating characteristic (ROC) curves.     Results: We included 181 patients who had CBx between 2012-2015, and met inclusion criteria. The mean age of patients was 62.58 years (SD=7.13) and median follow-up was 60.9 months (IQR=23.4). A high TCLo density score (>0.05) was independently associated with time to CP (HR 4.70, 95% CI: 2.62-8.42, p<0.001), and GP (HR 3.85, 95% CI: 1.91-7.73, p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.     Conclusion: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PC.

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