scholarly journals Comparative Oncological Outcomes Following Radical Prostatectomy or External Beam Radiation Therapy Plus Androgen Deprivation Therapy in Men with Clinical T3b Prostate Cancer

2021 ◽  
Author(s):  
Wonchul Lee ◽  
Bumjin Lim ◽  
Yoon Soo Kyung ◽  
Choung-Soo Kim
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Androgen Deprivation ◽  
External Beam Radiation ◽  
Oncological Outcomes ◽  
Biopsy Gleason Score

Abstract Purpose To compare oncological outcomes in men with clinical T3b prostate cancer who underwent radical prostatectomy (RP) or a combination of radiation therapy plus androgen deprivation therapy (HT + RT).Materials and Methods Men with clinical T3b prostate cancer who underwent RP or HT + RT between 2007 and 2014 were evaluated. All patients were relatively healthy, with Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 without nodal or distant metastasis. Cancer-specific survival (CSS) was analyzed. Age, biopsy Gleason score, and initial prostate specific antigen (PSA) concentration were adjusted by propensity score matching. Cox proportional hazard model was used to assess factors prognostic of CSS.Results Of the 152 patients with clinical T3b prostate cancer, 45 underwent RP and 107 underwent HT + RT between 2007 and 2014. Mean CSS was significantly longer in the RP than in the HT + RT group (p = 0.029). Age, biopsy Gleason score, and pretreatment PSA concentration were significantly higher in the HT + RT group. In the propensity score matched population of 34 patients each, CSS remained significantly longer in the RP than in the HT + RT group (125.21 ± 5.10 months vs. 107.73 ± 9.01 months, p = 0.041). Multivariate analysis showed that undergoing HT + RT was the only significant poor prognostic factor for CSS (hazard ratio = 2.849; 95% confidence interval, 1.086–7.473, p = 0.033).Conclusion CSS was significantly longer in men with clinical T3b prostate cancer who underwent RP than HT + RT, suggesting that RP should be the initial treatment of choice for these patients.

scholarly journals Clinical Outcomes in Locally Advanced Prostate Cancer Between Radical Prostatectomy and Radiotherapy With Androgen Deprivation Therapy: A Propensity Score-matched Analysis

2021 ◽  
Author(s):  
Yu-Cheng Lu ◽  
Chao-Yuan Huang ◽  
Chia-Hsien Cheng ◽  
Kuo-How Huang ◽  
Yu-Chuan Lu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Locally Advanced Prostate Cancer

Abstract To compare clinical outcomes between the use of robotic-assisted laparoscopic radical prostatectomy (RP) and radiotherapy (RT) with long-term androgen deprivation therapy (ADT) in locally advanced prostate cancer (PC), we enrolled 315 patients with locally advanced PC (clinical T-stage 3/4). Propensity score-matching at a 1:1 ratio was performed. The median follow-up period was 59.2 months (IQR: 39.8-87.4). There were 117 (37.1%) patients in the RP group and 198 (62.9%) patients in the RT group. RT patients were older and had higher PSA at diagnosis, higher Gleason score grade group and more advanced T-stage (all p<0.001). After propensity score-matching, there were 68 patients in each group. Among locally advanced PC patients, treatment with RP had a higher risk of biochemical recurrence compared to the RT group. In multivariate Cox regression analysis, treatment with RT plus ADT significantly decreased the risk of biochemical failure (HR: 0.162, p<0.001), but there was no significant difference in local recurrence, distant metastasis and overall survival (p=0.470, p=0.268 and p=0.509, respectively). This information may provide insight for clinicians and patients for decision-making regarding their preference for either treatment strategy.

Cancer-specific survival following radical prostatectomy or radiation therapy and short course hormonal therapy in men with localized, unfavorable-risk prostate cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4572-4572
Author(s):  
H. K. Tsai ◽  
M. Chen ◽  
D. G. McLeod ◽  
P. R. Carroll ◽  
J. P. Richie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Initial Therapy ◽  
External Beam Radiation ◽  
Short Course ◽  
Psa Failure ◽  
Risk Prostate Cancer

4572 Background: We estimated prostate cancer-specific mortality (PCSM) rates following radical prostatectomy (RP) or external beam radiation therapy (RT) and 6 months of androgen suppression therapy (AST) in men with unfavorable-risk prostate cancer. Methods: Between 1981 and 2002, 3,240 men with intermediate- (T2b or Gleason score 7 or prostate-specific antigen (PSA) > 10 to 20 ng/mL) or high-risk (T2c or Gleason score 8 to 10 or PSA > 20 ng/mL) prostate cancer were treated with RP (n = 2,690) or RT+AST (n = 550) and comprised the study cohort. If PSA failure occurred, defined by a postoperative PSA level > 0.2 ng/mL and rising or by the ASTRO definition following RT+AST, then men received salvage RT or life-long AST, respectively. Life-long AST was initiated if PSA failure occurred after salvage RT. Imaging of the pelvis and skeleton was negative for metastases at the time of any salvage therapy. Gray’s formulation was used to compare the cumulative incidence estimates of PCSM and to calculate the adjusted hazard ratios (HR) and associated 95% confidence intervals for initial treatment and known prognostic factors. Results: After a median follow-up time for living patients of 4.5 and 4.2 years for the RP and RT+AST cohorts, respectively, there were no significant differences in the estimates of PCSM following RP or RT+AST in men with intermediate- (p = 0.44) or high-risk (p = 0.26) disease. As shown in the Table , after adjusting for PSA level, Gleason score, and T-category, initial therapy was not significantly associated with PCSM for men with intermediate- (HR: 1.2 [95% CI: 0.3, 4.3]; p = 0.78) or high-risk (HR: 1.2 [95% CI: 0.5, 2.8]; p = 0.62) disease. Conclusion: Men with localized, unfavorable-risk prostate cancer who receive RT and short course AST as initial therapy appear to have similar PCSM rates as men who undergo initial RP followed by salvage RT and life-long AST after first and second PSA failure, respectively. [Table: see text] No significant financial relationships to disclose.

The risk of death from prostate cancer in men with Gleason Score 3+4 prostate cancer treated using brachytherapy with or without a short course of androgen deprivation therapy.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 330-330
Author(s):  
David Dewei Yang ◽  
Ming-Hui Chen ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
Anthony Victor D'Amico
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Risk Of Death ◽  
Short Course ◽  
Increased Risk ◽  
Adenocarcinoma Of The Prostate ◽  
Biopsy Gleason Score

330 Background: We evaluated whether the intermediate-risk factors of percentage of positive biopsies (PPB), clinical tumor category, and prostate-specific antigen (PSA) level, in addition to age, were associated with the risk of prostate cancer-specific mortality (PCSM) among men with Gleason 3+4 prostate cancer treated with brachytherapy (BT) alone or BT and a short course of androgen deprivation therapy (ADT). Methods: We conducted a prospective cohort study of 1920 consecutively treated men with Gleason 3+4 adenocarcinoma of the prostate who received BT or BT and a median of 4 months of ADT between 10/14/1997 and 5/28/2013. Separate multivariable Fine and Gray competing risks regression models among men treated with BT or BT and ADT were used to assess whether PPB, cT2b-T2c, and PSA of 10.1-20.0 ng/ml, in addition to age greater than the median of 70 years, were associated with the risk of PCSM after adjustment for comorbidity. Results: After a median follow-up of 7.8 years (interquartile range 5.2-10.4 years), 284 men (14.8%) had died, including 31 (10.9% of deaths) from PC of which 18 (58.1%) and 13 (41.9%) occurred in men treated with BT or BT and ADT, respectively. For men treated with BT alone, increasing PPB, PSA of 10.1-20.0 vs 4.0-10.0 ng/mL, and age >70 vs ≤70 years were significantly associated with an increased risk of PCSM (adjusted hazard ratio [AHR] 1.015 95% confidence interval [CI] 1.000-1.031, P=0.048; AHR 5.55, 95% CI 2.01-15.29, P<0.001; and AHR 3.66, 95% CI 1.16-11.56, P=0.03, respectively). The respective results for men treated with BT and ADT were AHR 1.009, 95% CI 0.987-1.031, P=0.44; AHR 4.17, 95% CI 1.29-13.50, P=0.02; and AHR 3.74, 95% CI 0.87-16.05, P=0.08. The clinical tumor category was not significantly associated with the risk of PCSM. Conclusions: Among men with biopsy Gleason score 3+4 PC, both age >70 years and PSA of 10.1-20.0 ng/ml were significantly associated with an increased risk of PCSM following BT, and adding 4 months of ADT may not be sufficient to mitigate this risk. Advanced imaging and targeted biopsy of suspicious areas should be considered to personalize treatment in order to minimize the risk of PCSM in these men.

PSA levels, PSA doubling time, Gleason score and prior therapy cannot predict measured uptake of [68Ga]PSMA-HBED-CC lesion uptake in recurrent/metastatic prostate cancer

2017 ◽  
Vol 56 (06) ◽  
pp. 225-232 ◽  
Author(s):  
David Pfister ◽  
Natascha Drude ◽  
Felix Mottaghy ◽  
Florian Behrendt ◽  
Frederik Verburg
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Doubling Time ◽  
Lesion Size ◽  
Tracer Uptake ◽  
Androgen Deprivation ◽  
Pet Ct

SummaryAim: To assess whether clinical prostate cancer (PCA) related factors and therapy status can predict the degree of tracer uptake on [68Ga]PSMA-HBED-CC PET/CT.Materials & methods: We retrospectively studied 124 patients with recurrent an/or metastatic PCA who underwent [68Ga]PSMAHBED-CC PET/CT. The maximum standardized uptake value (SUVmax) was determined in the prostate bed as well as in three size categories (≤ 5 mm, > 5–15 mm, > 15 mm) in pelvic lymph node, extrapelvic lymph node, bone and visceral metastases.Results: Significant positive correlations between lesion size and SUVmax were found in pelvic lymph node metastases > 5 -≤15 mm (Spearmans rho = 0.502, p = 0.002) as well as in extrapelvic lymph node metastases5 mm (rho = 0.314, p = 0.033) and > 5 ≤-15 mm (rho = 0.614, p < 0.001). SUVmax tended to be higher in the largest diameter category in each anatomic station than in the middle and lower categories. We were unable to find evidence for a relationship between SUVmax and PSA, PSAdt, Gleason score, androgen deprivation therapy, radiation therapy or chemotherapy status.Conclusion: Measured tracer uptake in [68Ga]PSMA-HBED-CC PET/CT in patients with recurrent/metastasized prostate cancer is significantly influenced by lesion size as a result of partial volume effects in the very small lesions. Clinical indicators of aggressive prostate cancer behaviour such as PSA levels, PSA doubling time or the Gleason score of the primary tumour, as well as the androgen deprivation therapy, radiation therapy or chemotherapy status are not related to measured tracer uptake.

scholarly journals Evolving Paradigm of Radiotherapy for High-Risk Prostate Cancer: Current Consensus and Continuing Controversies

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Aditya Juloori ◽  
Chirag Shah ◽  
Kevin Stephans ◽  
Andrew Vassil ◽  
Rahul Tendulkar
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Androgen Deprivation Therapy ◽  
Randomized Trials ◽  
Androgen Deprivation ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

High-risk prostate cancer is an aggressive form of the disease with an increased risk of distant metastasis and subsequent mortality. Multiple randomized trials have established that the combination of radiation therapy and long-term androgen deprivation therapy improves overall survival compared to either treatment alone. Standard of care for men with high-risk prostate cancer in the modern setting is dose-escalated radiotherapy along with 2-3 years of androgen deprivation therapy (ADT). There are research efforts directed towards assessing the efficacy of shorter ADT duration. Current research has been focused on assessing hypofractionated and stereotactic body radiation therapy (SBRT) techniques. Ongoing randomized trials will help assess the utility of pelvic lymph node irradiation. Research is also focused on multimodality therapy with addition of a brachytherapy boost to external beam radiation to help improve outcomes in men with high-risk prostate cancer.

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