scholarly journals A proof-of-concept study on the use of prostate artery embolization prior to definitive radiotherapy in prostate cancer

2020 ◽  
Author(s):  
Jeffrey Peacock ◽  
Dhiraj Sikaria ◽  
Laura Maun-Garcia ◽  
Khosrow Javedan ◽  
Kosj Yamoah ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Treatment ◽  
Organs At Risk ◽  
Statistical Significance ◽  
Volume Reduction ◽  
Proof Of Concept ◽  
Artery Embolization ◽  
Definitive Radiotherapy ◽  
Prostate Artery Embolization

Abstract Backgrounds: Prostatic artery embolization (PAE) has been well studied as a clinically effective therapy for alleviating lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). We demonstrate a proof of concept for PAE prior to definitive radiotherapy in patients with prostate cancer.Methods: From 12/2017 to 07/2019, 57 patients underwent PAE for LUTS and BPH. Nine of these patients had PAE for LUTS in the setting of localized prostate cancer prior to receiving radiation. Five of the nine patients received their entire radiotherapy course at our institution and had clinical follow up were included in the analysis. Median follow up was 18 months from the time of PAE. LUTS improvement quantified by IPSS was the primary endpoint and a two tail students T test was used to compare statistical significance. Side effects during radiation were quantified using the CTCAE scoring system. Pre- and post- PAE plans were compared in the five patients that by performing an isovolumetric expansion of the post PAE plan (treated plan) equivalent to the measured volume reduction after PAE. Patient 1 and 2 had prostate and seminal vesicle RT alone while patients 3-5 had prostate with elective nodal coverage. Mean doses to organs at risk were compared between the two plans.Results: The average IPSS score pre-PAE was 17.40 compared to post-PAE of 3.6 (p=0.02). The average IPSS score reduction after PAE was 13.8 (5-30). The average prostatic volume reduction after PAE was 23.14% (7.2% - 47.7%). There were no CTCAE grade 3 (severe) or higher during radiation treatment. Post-PAE plans in patient 1 and 2 had on average 16.7% and 39.8% decrease in mean dose across the bladder, rectum, and penile bulb compared to the pre-PAE plans. There were no appreciable differences in dosimetry in the patients 3-5 who had nodal coverage. There was no biochemical failure in any of the patients.Conclusion: We demonstrate a proof of concept that prostate artery embolization is useful as an adjunctive procedure to alleviate LUTS, achieve significant volume reduction prior to radiation therapy, and decrease radiation related toxicity in the treatment of prostate cancer.

scholarly journals Prostatic artery embolization (PAE) for prostatic origin bleeding in the context of prostate malignancy

2019 ◽  
Vol 8 (6) ◽  
pp. 205846011984606 ◽  
Author(s):  
Charles R Tapping ◽  
Jeremy Crew ◽  
Andrew Proteroe ◽  
Phil Boardman
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Benign Prostatic Hypertrophy ◽  
Artery Embolization ◽  
Prostatic Artery Embolization ◽  
Prostate Artery Embolization ◽  
Prostatic Artery

Prostate artery embolization (PAE) has been shown to be beneficial in treating men with benign prostatic hypertrophy (BPH). Here we describe treating four patients with prostate cancer (two with organ-confined and two with metastatic prostate cancer) with prostatic bleeding with PAE. Patients had other causes of hematuria excluded and were followed up at 3, 12, and 18 months after PAE. All four cases were technically successful and all cases of hematuria had resolved by the three-month follow-up (100%). There was one case of recurrence at 13 months after PAE which was successfully treated. PAE is useful for controlling significant prostatic bleeding in patients with prostate cancer and improves quality of life. Patients may, however, need repeated treatments to control the bleeding.

Radiation Treatment for Localized Prostate Cancer and the Risk of Developing Myelodysplastic Syndromes (MDS)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 120-120
Author(s):  
Sudipto Mukherjee ◽  
Chandana Reddy ◽  
Jay Ciezki ◽  
Ramon V. Tiu ◽  
Edward A. Copelan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Treatment ◽  
Previous History ◽  
World Health ◽  
Localized Prostate Cancer ◽  
Control Group ◽  
Surgery Group ◽  
Increased Risk ◽  
Secondary Mds

Abstract Abstract 120 Background: Both environmental radiation exposure and use of therapeutic radiation (XRT) in primary solid tumor malignancies increase the risk of secondary MDS. No data exist on the risk of developing secondary MDS in prostate cancer patients (pts) being treated with radiotherapy. Establishing this risk has important clinical implications, as prostate cancer is the leading cancer in men and radiation therapy has increasingly become the preferred modality for treatment of localized prostate cancer. Methods: We performed a prospective case control study of 11,015 pts with localized prostate adenocarcinoma newly diagnosed between 1986 and 2011 at Cleveland Clinic who underwent treatment with either radical prostatectomy (control group) or definitive radiotherapy (external beam radiotherapy [EBRT] or prostate interstitial brachytherapy [PI] – case group), to investigate the risk of radiation-related MDS. Data on demographics, surgery, radiation treatment, and follow-up were collected from merged prostate cancer and MDS databases. Cytogenetic risk groups were per International Prognostic Scoring System (IPSS) for MDS. Univariate and multivariate analyses were performed using the Fine and Gray competing risk model with MDS as a time-dependent endpoint (which incorporates differences in duration of follow-up) and death from any cause as the competing event, comparing radiotherapy groups to the surgical cohort as the reference group, controlling for age and follow-up frequency. Hazard ratios (HR) with 95% confidence intervals (CIs) are reported. Results: For all pts, median age was 64 years (yrs, range, 37 – 88) at the time of prostate cancer diagnosis: 69 yrs in EBRT, 67 yrs in PI, and 60 yrs in surgery pts, respectively (p<0.0001); 5119 (46%) were treated with XRT, 5896 (54%) with prostatectomy. None of the pts had a previous history of another malignancy. Among XRT pts, 2183 (43%) were treated with EBRT, 2936 (57%) with PI. Median follow-up was 3.0 yrs [(range, 0.0 – 25.2): 6.8 yrs in the EBRT group, 2.5 yrs in the PI group and 1.8 yrs in the surgery group, (p<0.0001)] following prostate intervention, longer (4.6 yrs) in pts treated since 1996, when PI was first performed [6.6 yrs in the EBRT group, 3.8 yrs in the PI group and 4.3 yrs in the surgery group, (p<0.0001)]. In the entire cohort, 30 pts developed MDS: 24 in the XRT group and 6 in the surgery group. MDS World Health Organization classification was: RA/RARS (n=12), RCMD (n=3), RAEB-1 (n=3), RAEB-2 (n=3), CMML (n=2), MDS-U (n=3) and unknown (n=4). IPSS cytogenetic risk classification was: good risk (n=17), intermediate risk (n=5), poor risk (n= 4) and unknown (n = 4). For MDS pts within the XRT group, median age at MDS diagnosis was 79 yrs (range, 74 – 89) for EBRT, 80 yrs (range, 64 – 100) for PI. The median time to develop MDS was 8.9 yrs (range, 0.9 – 20.2): 9.1 for EBRT, 8.2 for PI, and 13.0 for prostatectomy pts, respectively (p=0.05). In univariate analyses, older pts (HR=1.14; CI, 1.09 – 1.2; p<0.0001), and those treated with XRT (HR=3.3; CI, 1.35 – 8.08; p=0.009): EBRT (HR=2.6; CI, 1.0 – 6.9; p=0.05), PI (HR=5.87; CI, 2.1 – 16.3; p=0.0007) were significantly more likely to develop MDS. In multivariate analysis though, while advanced age (HR=1.13; CI, 1.0 – 1.2; p < 0.0001) remained significantly associated with MDS development, XRT did not (HR=1.56; CI, 0.56 – 4.38; p=0.4), though a trend remained for PI (HR=2.85; CI, 0.9 – 8.8; p = 0.07). Conclusions: Pts who underwent definitive radiation treatment for localized prostate cancer did not appear to have a significantly increased risk of subsequent MDS, in analyses that controlled for age and incorporated length of follow-up. A trend for MDS development was present for those undergoing XRT with PI. These findings are encouraging for both patients and providers who have concerns about the potential effects of XRT on development of MDS. Disclosures: Maciejewski: Celgene: Membership on an entity's Board of Directors or advisory committees. Sekeres:Celgene: Consultancy, Honoraria, Speakers Bureau.

Risk Of Acute and Chronic Leukemias Following Radiation Treatment For Locoregional Prostate Cancer In The United States Over 35-Years

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2652-2652
Author(s):  
Sudipto Mukherjee ◽  
Chandana A. Reddy ◽  
Jay P. Ciezki ◽  
Ramon V. Tiu ◽  
Anjali S. Advani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Radiation Treatment ◽  
The United States ◽  
Myelogenous Leukemia ◽  
Acute Leukemias ◽  
Prostate Cancer Diagnosis ◽  
Increased Risk ◽  
Secondary Leukemias

Abstract Background Prostate cancer is the most common cancer diagnosis in men, and one of the leading indications for radiation therapy. The risk of resultant secondary leukemias has not been consistently established. We investigated the risk of all leukemias in a population-based cohort of patients (pts) with locoregional prostate cancer definitively treated with radiotherapy. Methods We queried the Surveillance, Epidemiology, and End Results (SEER) 17 registries to identify a cohort of men >20 years old (n = 183,268) with locoregional prostate adenocarcinoma newly diagnosed between January 1973 and December 2008. Pts who underwent initial treatment with radical prostatectomy (RP) were compared to pts receiving RP with external beam radiotherapy (RP w/EBRT) to investigate the risk of radiation-induced leukemias. These cohorts tend to be well matched regarding age, medical comorbidities and disease characteristics. All new leukemias occurring as a second primary cancer at least one year after the first diagnosis of prostate cancer were identified in SEER using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) morphology codes. Secondary leukemias included acute myeloid leukemia (AML); chronic myelogenous leukemia (CML); acute and chronic lymphocytic leukemia (ALL & CLL) and other categories as reported in SEER. Pts were observed from date of prostate cancer diagnosis until leukemia occurrence, death, or last date of follow-up. Univariate and multivariate analyses were performed using the Fine and Gray competing risk regression analysis with leukemia as a time-dependent endpoint and death from any cause or the diagnosis of any other second cancer as competing events. RP w/ EBRT group was compared with the RP cohort as the reference group, controlling for age. Hazard ratios (HR) with 95% confidence intervals (CIs) are reported. Results Median age was 67 years (yrs, range 22 – 105) at prostate cancer diagnosis: 67 yrs in RP and 68 yrs in RP w/ EBRT pts (p<0.0001); 158,913 (86.7%) were treated with RP and 24,355 (13.3%) with RP w/EBRT. Median follow-up was 7.6 yrs [(range, 1 – 35.5): 7.5 yrs in the RP group and 8.3 yrs in the RP w/ EBRT group, (p<0.0001)]. In total, 949 (0.5%) leukemia cases were identified: 336 (0.2%) acute leukemias [266 (0.2%) in the RP group and 70 (0.3%) in the RP w/ EBRT]; 538 (0.3%) chronic leukemias [462 (0.3%) in the RP group and 76 (0.3%) in the RP w/ EBRT] and 75 (0.04%) of unspecified histology. Histologic subtypes (per ICD-O-3 codes) were: AML (n=249), acute monocytic leukemia (n=18), ALL (n=24), other acute leukemias (n=45), other myeloid/monocytic/lymphocytic leukemias (n=48), aleukemic/subleukemic/NOS (n=27), CML (n=131) and CLL (n=407). Median age at acute leukemia diagnosis was 77 yrs [(range, 50 – 101): 78 yrs in the RP group and 76 yrs in RP w/EBRT pts, (p=0.0271)] and for chronic leukemias was 76 yrs [(range, 47 – 101): 76 yrs in the RP group and 77 yrs in the RP w/EBRT pts, (p=0.50)].The median time to develop acute leukemias was 6.0 yrs [(range, 1 – 28.2): 6.1 yrs in the RP group and 5.7 yrs in the RP w/EBRT pts, (p=0.20)] and chronic leukemias was 6.9 yrs [(range, 1 – 29.8): 6.7 yrs in the RP group and 8.6 yrs in the RP w/EBRT pts, (p=0.0020)]. The cumulative incidence rate (CIR) at 20 years for acute leukemias was 0.24% for the RP pts vs. 0.32% for the RP w/EBRT pts (p=0.0196). The CIR at 20 years for chronic leukemias was 0.47% for the RP pts vs. 0.36% for the RP w/EBRT pts (p=0.10). In univariate analyses, age >70 yrs (HR=1.40; CI, 1.13 – 1.74; p=0.0023), and those who received RP w/ EBRT (HR=1.49; CI, 1.14 – 1.94; p=0.0033) were significantly more likely to develop acute leukemias. In multivariate analysis, both advanced age (HR=1.40; CI, 1.13 – 1.74; p = 0.0023) and RP w/ EBRT (HR=1.49; CI, 1.14 – 1.94; p=0.0032), remained significantly associated with increased risk of acute leukemias. Radiation treatment was not significantly associated with the risk of developing chronic leukemias among pts treated with RP w/EBRT vs. RP [HR=0.91; CI, 0.72 – 1.16; p=0.45). Conclusions Among the best matched prostate cancer treatment cohorts, those who underwent EBRT following RP had a 49% increased risk of subsequent acute leukemias, although the absolute number of cases was low. Risk assessment in this cohort spans a time frame where radiation technologies have rapidly advanced and hence treatment period effects need to be considered in interpretation of results Disclosures: No relevant conflicts of interest to declare.

Development of a PSA tracking system for patients wtih prostate cancer following definitive radiotherapy to enhance rural health.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Michael G. Chang ◽  
Kristine DeSotto ◽  
Paul Taibi ◽  
Sandra Troeschel
Keyword(s):  
Prostate Cancer ◽  
Detection System ◽  
Tracking System ◽  
Failure Detection ◽  
Phone Call ◽  
Therapeutic Window ◽  
Definitive Radiotherapy ◽  
Psa Testing ◽  
Query Tool

39 Background: Patients with prostate cancer (PC) may benefit from early intervention when they experience relapse/recur. About 50% of our PC patients are rural and experience barriers to care due to distance, cost, and convenience. We sought to create a PSA tracking system with the Veterans Administration’s (VA) Electronic Medical Record (EMR) that would provide a remote way to monitor disease progression after definitive radiotherapy (XRT) by annual PSA testing alone. Methods: Using VA’s EMR, we developed a query tool to identify all patients ever treated at our center with XRT for prostate cancer who were alive, had not been seen in our clinic in more than a year, did not have metastatic disease, and had a rising PSA of at least 0.5 ng/ml above nadir, or who had no PSA drawn within 15 months. Results: Among roughly 50,000 unique patients in the McGuire VAMC EMR, we found 1,858 patients treated with XRT for PC more than 5 years ago between 1997 and 2015. Of these 1,190 were still alive and 455 had not been seen by our clinic in 400 days or more. Of these 455 patients, 159 patients had not had a PSA drawn within 15 months and/or their most recent PSA was more than 0.5 ng/ml above nadir, triggering a chart review followed by either a phone call, repeat testing, in person follow up visit, or removal from follow up monitoring if clinically indicated. 296 patients were receiving appropriate care outside of our clinic and had no sign of significant rise in PSA. An analysis by the VA showed annual savings of $60,360 per year in fuel costs by avoiding unnecessary visits. Conclusions: The VA’s robust EMR and a new query tool can identify patients with prostate cancer who are lost to follow up or who needed intervention from among thousands of patients in the EMR, improving quality while reducing cost and unnecessary time and travel for rural and all patients. More importantly, our tool could be modified to improve survival for all VA patients with prostate cancer by creating a VA-wide PSA failure detection system. The system would alert providers to any patient who may benefit from early salvage radiotherapy or hormonal therapy before their disease progresses beyond the therapeutic window of benefit.

scholarly journals Clinical Validation and Treatment Plan Evaluation Based on Auto-Delineation of the Clinical Target Volume for Prostate Cancer Radiotherapy

2022 ◽  
Author(s):  
Jing Shen ◽  
Yinjie TAO ◽  
Hui GUAN ◽  
Hongnan ZHEN ◽  
Lei HE ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
At Risk ◽  
Organs At Risk ◽  
Treatment Plan ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Target Volume ◽  
Ct Scans ◽  
Dice Similarity Coefficient ◽  
Treatment Plans

Abstract Purpose Clinical target volumes (CTV) and organs at risk (OAR) could be auto-contoured to save workload. The goal of this study was to assess a convolutional neural network (CNN) for totally automatic and accurate CTV and OAR in prostate cancer, while also comparing anticipated treatment plans based on auto-contouring CTV to clinical plans. Methods From January 2013 to January 2019, 217 computed tomography (CT) scans of patients with locally advanced prostate cancer treated at our hospital were collected and analyzed. CTV and OAR were delineated with a deep learning based method, which named CUNet. The performance of this strategy was evaluated using the mean Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (95HD), and subjective evaluation. Treatment plans were graded using predetermined evaluation criteria, and % errors for clinical doses to the planned target volume (PTV) and organs at risk(OARs) were calculated. Results The defined CTVs had mean DSC and 95HD values of 0.84 and 5.04 mm, respectively. For one patient's CT scans, the average delineation time was less than 15 seconds. When CTV outlines from CUNetwere blindly chosen and compared to GT, the overall positive rate in clinicians A and B was 53.15% vs 46.85%, and 54.05% vs 45.95%, respectively (P>0.05), demonstrating that our deep machine learning model performed as good as or better than human demarcation Furthermore, 8 testing patients were chosen at random to design the predicted plan based on the auto-courtoring CTV and OAR, demonstrating acceptable agreement with the clinical plan: average absolute dose differences of D2, D50, D98, Dmean for PTV are within 0.74%, and average absolute volume differences of V45, V50 for OARs are within 3.4%. Without statistical significance (p>0.05), the projected findings are comparable to clinical truth. Conclusion The experimental results show that the CTV and OARs defined by CUNet for prostate cancer were quite close to the ground reality.CUNet has the potential to cut radiation oncologists' contouring time in half. When compared to clinical plans, the differences between estimated doses to CTV and OAR based on auto-courtoring were small, with no statistical significance, indicating that treatment planning for prostate cancer based on auto-courtoring has potential.

The impact of varying rectal contours on rectal dose in prostate cancer patients treated with hypofractionated radiation

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15598-15598
Author(s):  
B. B. Joshua ◽  
S. Faria ◽  
H. Patrocinio ◽  
F. DeBlois ◽  
M. Duclos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
At Risk ◽  
Radiation Treatment ◽  
Rectal Wall ◽  
Organs At Risk ◽  
Anal Verge ◽  
Rectal Toxicity ◽  
Rectal Dose ◽  
Organ At Risk ◽  
Definition Of

15598 Background: In curative radiation treatment of prostate cancer,the advent of 3DCRT has made a reduction in the incidence of normal tissue toxicities while optimizing tumor control. To optimize 3DCRT, the ICRU has published standard definitions of target volumes and organs at risk such that the tumor can receive the optimal dose with as little as possible dose to the organs at risk. However, the definition of the rectum as an organ at risk in radiation treatment of the prostate varies widely among institutions and so does the report of toxicities. We studied the effect of varying rectal contouring on rectal dose obtained from DVHs in a homogenous group of prostate cancer patients treated with hypo fractionationed radiation. Methods: 71 patients with favorable risk prostate cancer treated with a total of 66Gy in 3Gy/day fractionation.18 MV photons in a 5-field technique was used. None of the patients received hormonal therapy. Their treatment plans were archived and the rectum was re-contoured by a single investigator. 4 different contours were drawn to compare the rectal dose: i) the whole rectum from the anal verge to the recto sigmoid junction (WR); ii) the rectum from 1cm below the PTV to 1cm above (RPTV); iii) the rectal wall (i.e. the inner and outer rectal wall) from the anal verge to the recto sigmoid junction (RW); iv) the rectal wall from 1cm below the PTV to 1cm above (RWPTV) Results: There were significant differences in the median volume, minimum, mean rectal doses and dose to 50% of the volume, (p=0.0001). The whole rectum (WR) is having the lowest and the rectal wall with 1cm above and below the PTV (RWPTV) having the highest in all the parameters. The only parameter not significantly different among the 4 contours is the maximum rectal dose. Conclusion: the varied rectal contouring across different institutions is a possible reason for the broadly different reports of rectal toxicity after prostate irradiation. Our results suggest significant differences in rectal doses with varied contouring. Contouring the rectal wall only and limiting the volume to 1cm above and below the PTV confers the highest mean rectal dose. Comparison of rectal toxicity between institutions can only be meaningful if a consensual volume definition of the organ at risk is agreed upon. No significant financial relationships to disclose.

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