scholarly journals Isolated peritoneal carcinomatosis in prostate cancer: from a successful hormonal management to a review of the literature

2021 ◽  
pp. FSO707
Author(s):  
Emilie Delchambre ◽  
Stéphane Rysselinck ◽  
Géraldine Pairet ◽  
Caterina Confente ◽  
Emmanuel Seront
Keyword(s):  
Prostate Cancer ◽  
Peritoneal Carcinomatosis ◽  
Complete Response ◽  
Abiraterone Acetate ◽  
Review Of The Literature ◽  
Metastatic Lesions ◽  
Psma Pet ◽  
Visceral Metastases ◽  
History Of ◽  
Late Stages

Metastases from prostate cancer involve mainly the bone compartment. However, visceral metastases are found in up to 49% of metastatic patients, occurring mainly in late stages of the disease, and are correlated with poor outcome. Peritoneal carcinomatosis is rarely described in literature, particularly when not associated with other distant metastatic lesions. We present the management of a patient with prostate cancer progressing on androgen deprivation therapy with description of omental involvement on 68Ga PSMA-PET. There was no ascite or other distant lesion, reflecting thus a specific tropism of the cancer in this patient who had no history of prostate surgery. Abiraterone acetate resulted in a long-lasting complete response. We also present a review focusing on this entity.

ARTO trial (NCT03449719), a randomized phase II trial enrolling oligometastatic castration-resistant prostate cancer patients treated with first-line abiraterone acetate with or without stereotactic body radiation therapy: Preliminary results comprehensive of biochemical outcomes and circulating tumor cells analysis.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 118-118
Author(s):  
Giulio Francolini ◽  
Pietro Garlatti ◽  
Mauro Loi ◽  
Beatrice Detti ◽  
Michele Aquilano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Androgen Receptor ◽  
Adverse Events ◽  
Phase Ii Trial ◽  
Abiraterone Acetate ◽  
Metastatic Lesions ◽  
Randomized Phase Ii ◽  
And Control ◽  
Psma Expression

118 Background: Androgen Receptor Targeted Agents (ARTA) represent one of the main treatment options for metastatic castrate resistant prostate cancer (mCRPC). Addition of stereotactic radiation therapy (SBRT) to ablate metastatic foci may improve clinical outcomes in oligometastatic setting. ARTO trial (NCT03449719) is a randomized phase II trial testing the benefit of upfront SBRT on all sites of metastatic disease in oligo-mCRPC patients undergoing I line therapy with Abiraterone Acetate (AA). In this preliminary analysis, we report results after 6 months of follow up, together with an exploratory analysis of androgen receptor splice variants (ARV7/ARFL) Prostate Specific Antigen (PSA) and Prostate Specific Membrane Antigen (PSMA) expression on Circulating Tumor Cells (CTCs) detected in this cohort of patients. Methods: 31 patients affected by oligo-mCRPC (defined as < 3 non-visceral metastatic lesions) were randomized to receive I line AA therapy with or without SBRT on all metastatic sites. Baseline blood samples to detect CTCs and evaluate their ARV7, ARFL, PSA and PSMA expression were taken before AA treatment start. Assessments comprehensive of clinical examination and serum PSA were performed every three months. Toxicity was assessed by the Common Terminology Criteria for Adverse Events toxicity scale (CTCAE v.4.03). Results: Thirteen and 18 patients were enrolled in the treatment and control arm, respectively. Nineteen metastatic lesions were treated with SBRT in the treatment arm. At 6 months, complete response (defined as a serum PSA level < 0.2 ng/dl) and biochemical response (defined as a PSA reduction > 50% if compared to baseline) were achieved in 6 vs 4 and in 10 vs 8 patients in the treatment vs control arm, respectively. One patient in the treatment arm died for other causes, 1 biochemical progression occurred in the control arm. No adverse events occurred in both arms of treatment. CTCs analysis was available for 10 patients, out of whom 4 were found positive for CTCs (1 and 3 from the treatment and control arm, respectively). ARV7 and ARFL were expressed in 1 patient from the control arm, PSMA was expressed in all CTC positive patients, PSA was expressed in 2 patients from the control and one from the treatment arm. Conclusions: SBRT+AA in oligo-mCRPC patients was safe and yielded promising biochemical results. CTCs detection in this selected cohort of oligo-mCRPC was lower if compared to historical data of unselected mCRPC patients. Data about ARV7, ARFL, PSA and PSMA expression represent an interesting snapshot of biomarker arrangement in this setting. Clinical trial information: NCT03449719.

Prevalence of oligoprogressive, metastatic castration-resistant prostate cancer (mCRPC) amenable to stereotactic ablative radiotherapy (SABR) in men undergoing abiraterone acetate (AA) therapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16509-e16509
Author(s):  
Erica McDonald ◽  
Sierra Cheng ◽  
Vanessa Sarah Arciero ◽  
Ronak Saluja ◽  
Katherine A. Zukotynski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
De Novo ◽  
Metastatic Tumor ◽  
Clinical Situation ◽  
Abiraterone Acetate ◽  
Stereotactic Ablative Radiotherapy ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Metastatic Lesions

e16509 Background: SABR is increasingly used for treating men with oligometastatic prostate cancer, a state between loco-regional and widespread metastatic disease that exists de novo, presents as oligorecurrence, is treatment-induced, or occurs as oligoprogression. The latter is a clinical situation where a limited number of metastatic tumor sites progress (usually defined as ≤3-5), while all other metastases are controlled by a given systemic therapy. The frequency of oligoprogression amenable to SABR is unknown. Methods: Thus, in a retrospective chart analysis we studied the progression pattern of 35 men with chemotherapy-naïve mCRPC undergoing AA therapy, and of 20 men undergoing AA therapy after docetaxel chemotherapy. Applying RECIST1.1 and/or PCWG2 criteria, patients (pts) were considered SABR candidates if they radiologically progressed in ≤5 distinct metastatic locations, while all other sites were stable or responding. Results: In chemotherapy-naïve men, pre-AA metastatic lesions were located in bone (94%), lymph nodes (49%), lungs (17%) and liver (3%), whereas progression during AA therapy occurred in bone (89%), lymph nodes (49%), lungs (14%) and liver (9%). 12 pts (34%) met the criteria of oligoprogression with a median of 2 progressive lesions/pt (range 1-5). 8 pts presented with bone progression only, 3 with nodal progression, and 1 pt with combined bone/nodal progression. Post-docetaxel pts had pre-AA metastatic lesions located in bone (75%), lymph nodes (35%), lungs (5%) and liver (5%). Progression during AA therapy occurred in bone (80%), lymph nodes (75%), lungs (20%) and liver (5%). Only 1 pt met oligoprogression criteria with a single progressive bone metastasis. Conclusions: A sizeable number of men with chemotherapy-naïve mCRPC progressing during AA therapy might be considered for SABR. By contrast, progression of post-docetaxel mCRPC treated with AA is typically widespread. Further efforts are needed to identify criteria for oligoprogressive pts most suitable for SABR with sustained benefit versus men that may progress rapidly with widespread metastases following radiotherapy.

scholarly journals 18F-DCFPyL (PSMA) PET in the Management of Men with Biochemical Failure after Primary Therapy: Initial Clinical Experience of an Academic Cancer Center

2021 ◽  
Vol 28 (5) ◽  
pp. 3251-3258
Author(s):  
Ur Metser ◽  
Claudia Ortega ◽  
Douglas Hussey ◽  
Rosanna Chan ◽  
Alejandro Berlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Complete Response ◽  
Biochemical Failure ◽  
Biochemical Response ◽  
Cancer Center ◽  
Primary Therapy ◽  
Ablative Therapies ◽  
Academic Center ◽  
Psma Pet ◽  
Psa Response

Purpose: To describe the initial experience of an academic center using 18F-DCFPyL PET in managing men with recurrent prostate cancer. Materials & Methods: This prospective, single-arm IRB-approved study included men with biochemical failure after primary therapy for prostate cancer and negative/equivocal CT and bone scintigraphy who were candidates for salvage therapy, as determined by a multidisciplinary panel of experts. 18F-DCFPyL PET was assessed for the presence and extent of recurrence: local, oligometastatic (≤4), or extensive. Post-PET management and clinical outcome, including PSA response, was documented. For patients who received PET-directed ablative therapies, response was categorized as “complete” if PSA became undetectable or “favorable” if PSA decreased ≥50%. Results: Forty-seven men with biochemical failure after radical prostatectomy (n = 29), primary radiotherapy (n = 15) or focal tumor ablation (n = 3) were included. PET was positive in (43/47) 91.5%, including local recurrence in (9/47) 19.2%; oligometastatic disease in (16/47) 34%; and extensive metastatic disease in (18/47) 38.3%. PET-directed focal ablative therapies without systemic therapy were given to (13/29) 44.8% of patients without extensive metastases on PET with a mean PSA response of 69% (median, 74.5%; range: 35–100). Favorable biochemical response was observed in (10/13) 76.9% of patients with limited recurrence on PET, and in 23.1% (3/13), there was complete response. Conclusion: 18F-DCFPyL PET was positive in >90% of patients with biochemical failure. For those with limited recurrence, PSMA PET-directed local ablative therapies resulted in favorable outcome in more than 3 in 4 patients, and in nearly a quarter of them, there was complete biochemical response.

scholarly journals Highlighting the Place of Metastasis-Directed Therapy in Isolated Liver Metastases in Prostate Cancer: A Case Report

2021 ◽  
Vol 11 ◽  
Author(s):  
Anne-Emmanuella Yeo ◽  
Aurore Hendrix ◽  
Caterina Confente ◽  
Nicolas Christian ◽  
Baudouin Mansvelt ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Liver Metastases ◽  
Poor Prognosis ◽  
Prostate Cancer Patient ◽  
Abiraterone Acetate ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Visceral Metastases ◽  
Isolated Liver

Metastatic prostate cancer remains a challenge for clinicians. Metastases involve mainly the bone compartment and can manifest as oligometastatic disease. In this setting, the role of metastasis-directed therapies (MDT) including surgery and/or stereotactic body radiotherapy is currently evaluated. Visceral metastases are less common and have very poor prognosis in mPC. Whether treating isolated visceral metastases such as liver metastases with MDT could increase the prognosis remains unknown. We report the management of a prostate cancer patient who progressed on androgen deprivation therapy with apparition of two liver metastases. We describe the feasibility of combining MDT with abiraterone acetate and prednisone in a patient with metastatic castration-resistant prostate cancer. MDT allowed the interruption of abiraterone acetate, preventing cumulative toxicity of this agent.

scholarly journals Machine learning for differentiating metastatic and completely responded sclerotic bone lesion in prostate cancer: a retrospective radiomics study

2019 ◽  
Vol 92 (1101) ◽  
pp. 20190286 ◽  
Author(s):  
Emine Acar ◽  
Asım Leblebici ◽  
Berat Ender Ellidokuz ◽  
Yasemin Başbınar ◽  
Gamze Çapa Kaya
Keyword(s):  
Prostate Cancer ◽  
Machine Learning ◽  
Texture Analysis ◽  
Area Under The Curve ◽  
Ct Images ◽  
Metastatic Lesions ◽  
Psma Pet ◽  
Pet Ct ◽  
Sclerotic Lesions ◽  
Psma Expression

Objective:Using CT texture analysis and machine learning methods, this study aims to distinguish the lesions imaged via 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/CT as metastatic and completely responded in patients with known bone metastasis and who were previously treated.Methods:We retrospectively reviewed the 68Ga-PSMA PET/CT images of 75 patients after treatment, who were previously diagnosed with prostate cancer and had known bone metastasis. A texture analysis was performed on the metastatic lesions showing PSMA expression and completely responded sclerotic lesions without PSMA expression through CT images. Textural features were compared in two groups. Thus, the distinction of metastasis/completely responded lesions and the most effective parameters in this issue were determined by using various methods [decision tree, discriminant analysis, support vector machine (SVM), k-nearest neighbor (KNN), ensemble classifier] in machine learning.Results:In 28 of the 35 texture analysis findings, there was a statistically significant difference between the two groups. The Weighted KNN method had the highest accuracy and area under the curve, has been chosen as the best model. The weighted KNN algorithm was succeeded to differentiate sclerotic lesion from metastasis or completely responded lesions with 0.76 area under the curve. GLZLM_SZHGE and histogram-based kurtosis were found to be the most important parameters in differentiating metastatic and completely responded sclerotic lesions.Conclusions:Metastatic lesions and completely responded sclerosis areas in CT images, as determined by 68Ga-PSMA PET, could be distinguished with good accuracy using texture analysis and machine learning (Weighted KNN algorithm) in prostate cancer.Advances in knowledge:Our findings suggest that, with the use of newly emerging software, CT imaging can contribute to identifying the metastatic lesions in prostate cancer.

Abiraterone acetate treatment in patients with castration-resistant prostate cancer with visceral metastases

2019 ◽  
Vol 30 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Gaetano Facchini ◽  
Carla Cavaliere ◽  
Carmine D’Aniello ◽  
Gelsomina Iovane ◽  
Sabrina Rossetti
Keyword(s):  
Prostate Cancer ◽  
Abiraterone Acetate ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Visceral Metastases

Response to abiraterone acetate in the postchemotherapy setting in patients with castration-resistant prostate cancer whose disease progresses early on docetaxel.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 17-17 ◽  
Author(s):  
Deborah Mukherji ◽  
Carmel Jo Pezaro ◽  
Diletta Bianchini ◽  
Andrea Zivi ◽  
Johann Sebastian De Bono
Keyword(s):  
Prostate Cancer ◽  
Antitumor Activity ◽  
Abiraterone Acetate ◽  
Cross Resistance ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Progression Of Disease ◽  
Psa Response ◽  
Visceral Metastases ◽  
Radiological Response

17 Background: Abiraterone acetate (AA) has recently been approved for men with metastatic castration-resistant prostate cancer (CRPC) following docetaxel chemotherapy. AA inhibits CYP17, reducing androgen production and thereby impacting androgen receptor (AR) signalling. Recent evidence suggests taxanes also impact AR signalling, raising concerns about potential cross-resistance. We have previously shown that docetaxel has no antitumor activity in AA refractory patients. We have now evaluated the antitumor activity of AA post-docetaxel to determine the activity of AA in docetaxel refractory patients. Methods: Forty four men with CRPC treated with docetaxel (75 mg/m2 every 21 days) followed by post-chemotherapy AA at the Royal Marsden Hospital were identified. Radiological response by RECIST, PSA response by PSAWG2 criteria and symptomatic benefit were evaluated. Results: An average of 9 cycles of docetaxel were given (range 3-17); 7 patients discontinued chemotherapy due to progression of disease and 10 for toxicity. Of 40 patients with PSA data available, 26 (65%) had a PSA decline of at least 50%. At commencement of AA, median age was 68 years. Bone, nodal and visceral metastases were present in 38 (86%), 23 (52%) and 6 (14%) of the cohort respectively. An average of 5 months of treatment were delivered and 23 patients continue on AA. Of the 44, 7 (16%) patients had a 50% or greater PSA decline on AA. None of the 7 patients who were docetaxel refractory had a subsequent PSA, radiological or clinical response to AA. Of the 6 patients who received less than 5 cycles of docetaxel due to toxicity, 2 had subsequent PSA response on AA. There was no relationship between length of time on LHRH agonist and PSA response to AA. Conclusions: Our data suggest that patients who are refractory to docetaxel do not respond to AA. Overall, in conjunction with our other evidence that in AA-refractory patients docetaxel has no antitumor activity, these data provide further evidence for cross-resistance between these two agents.

scholarly journals Erratum to: ‘Clinical impact of PSMA PET in biochemically recurrent prostate cancer; a review of the literature’

2020 ◽  
Vol 10 (6-7) ◽  
pp. 122-123
Author(s):  
Maurits Wondergem ◽  
Friso M. van der Zant ◽  
Wouter A. M. Broos ◽  
Remco J. J. Knol
Keyword(s):  
Prostate Cancer ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Recurrent Prostate Cancer ◽  
Tijdschrift Voor ◽  
Psma Pet

In the article ‘Clinical impact of PSMA PET in biochemically recurrent prostate cancer; a review of the literature’ (Tijdschrift voor Urologie, October 2020), the column headings of Tab. 3 are missing. The complete table is presented …

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