scholarly journals Choice of treatment options for metastatic hormone-sensitive prostate cancer

2020 ◽  
pp. 90-99
Author(s):  
R. A. Gafanov ◽  
A. G. Dzidzaria ◽  
I. B. Kravtsov ◽  
S. V. Fastovets
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Treatment Options ◽  
Standard Of Care ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
The Past ◽  
Choice Of Treatment ◽  
Hormone Sensitive ◽  
The Impact

The arsenal of available treatments and treatments for metastatic hormone-sensitive prostate cancer (mHRPC) has increased significantly over the past 5 years. Although androgen-preferential therapy (ADT) remains the mainstay of treatment, the addition of docetaxel, abiraterone, enzalutamide, apalutamide, or local external beam radiation therapy improves the outcome of patients with mHRPC and becomes the standard of care. Choosing a therapy to improve treatment outcomes for patients with mHRPC is becoming increasingly challenging as there are different options for this stage of the disease. This article provides an overview of clinical trials that included ADT in combination with chemotherapy, new hormonal therapy, and radiation therapy. We will also consider recent advances in the choice of treatment for men diagnosed with mHPCR and the impact of previous therapy on the subsequent biology of the disease. Options include chemohormone therapy, androgen receptor (AR) targeted therapy in addition to ADT or, less commonly, ADT alone. The choice of treatment should be based on a consideration of the clinical characteristics and characteristics of the disease, as well as taking into account the patient’s preferences, territorial constraints and financial resources.

Calculated prostate cancer volume greater than 4.0 cm3 identifies patients with localized prostate cancer who have a poor prognosis following radical prostatectomy or external-beam radiation therapy.

1998 ◽  
Vol 16 (9) ◽  
pp. 3094-3100 ◽  
Author(s):  
A V D'Amico ◽  
R Whittington ◽  
S B Malkowicz ◽  
D Schultz ◽  
I Kaplan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Clinical Staging ◽  
External Beam ◽  
Beam Radiation ◽  
Psa Failure ◽  
The Impact

PURPOSE Patients with palpable extraprostatic disease (T3) have a poor prostate-specific antigen (PSA) failure-free (bNED) survival rate after radical prostatectomy (RP) or external-beam radiation therapy (RT). This study was performed to validate or refute the prognostic value of the previously defined calculated prostate cancer volume (cV(Ca)). PATIENTS AND METHODS For patients with clinically localized disease (T1c,2), a Cox regression multivariable analysis was used to assess the ability of the cV(Ca) value to predict time to posttherapy PSA failure following RP or RT. RESULTS The cV(Ca) value was a significant predictor (P < or = .0005) of time to posttherapy PSA failure in both an RP and RT data set independent of the one used to derive the cV(Ca)-based clinical staging system. In both RP- and RT-managed patients, estimates of 3-year bNED survival were not statistically different for patients with either T1c,2 disease and a cV(Ca) greater than 4.0 cm3 (RP, 27%; RT, 18%) or T3 disease (RP, 37%; RT, 34%). Despite pathologic T2 disease, the 3-year estimate of bNED survival was at most 51% in RP-managed patients with T1c,2 disease and cV(Ca) greater than 4.0 cm3. CONCLUSION A cV(Ca) greater than 4.0 cm3 identified patients with T1c.2 disease whose bNED survival was poor after RT or RP despite pathologic T2 disease that suggests the presence of occult micrometastatic disease in many of these patients. Prospective randomized trials to evaluate the impact on survival of adjuvant systemic therapy in these high-risk patients are justified.

scholarly journals Hypofractionation in Prostate Cancer: Radiobiological Basis and Clinical Appliance

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
M. Mangoni ◽  
I. Desideri ◽  
B. Detti ◽  
P. Bonomo ◽  
D. Greto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Standard Of Care ◽  
External Beam Radiation ◽  
High Dose ◽  
Clinical Experiences ◽  
Beam Radiation ◽  
Conventional Fractionation ◽  
Time Period ◽  
Biologically Equivalent Dose

External beam radiation therapy with conventional fractionation to a total dose of 76–80 Gy represents the most adopted treatment modality for prostate cancer. Dose escalation in this setting has been demonstrated to improve biochemical control with acceptable toxicity using contemporary radiotherapy techniques. Hypofractionated radiotherapy and stereotactic body radiation therapy have gained an increasing interest in recent years and they have the potential to become the standard of care even if long-term data about their efficacy and safety are not well established. Strong radiobiological basis supports the use of high dose for fraction in prostate cancer, due to the demonstrated exceptionally low values ofα/β. Clinical experiences with hypofractionated and stereotactic radiotherapy (with an adequate biologically equivalent dose) demonstrated good tolerance, a PSA control comparable to conventional fractionation, and the advantage of shorter time period of treatment. This paper reviews the radiobiological findings that have led to the increasing use of hypofractionation in the management of prostate cancer and briefly analyzes the clinical experience in this setting.

Gleason pattern 5 as a pathologic predictor of recurrence, development of metastasis, and prostate cancer-specific death for patients receiving salvage radiation therapy following radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 151-151
Author(s):  
William C. Jackson ◽  
Skyler B. Johnson ◽  
Corey Foster ◽  
Darren Li ◽  
Benjamin Foster ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Risk Stratification ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Beam Radiation ◽  
Gleason Pattern ◽  
The Impact

151 Background: The presence of primary, secondary, and tertiary Gleason pattern 5 (GP5) in prostate cancer has been shown to predict outcomes and improve risk stratification following radical prostatectomy (RP) and external beam radiation therapy (EBRT). However, the predictive value of GP5 has not been assessed in salvage EBRT (SRT) for a rising PSA after RP. We sought to assess the prognostic capability of the presence of GP5 in this setting. Methods: 575 patients who received SRT at a single institution for biochemical recurrence after RP were retrospectively reviewed in an IRB approved analysis. We assessed the impact of GP5 on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and Cox Proportional Hazards models. Results: Median follow up was 56.7 months post SRT. On pathologic evaluation, 563 patients had a documented Gleason score (GS). 60 patients (10.7%) had primary, secondary, or tertiary GP5. GP5 was the strongest pathologic predictor of DM (p<0.01 HR: 1.9 [95%CI: 1.3-2.9]) and PCSM (p<0.01 HR: 4.0 [95%CI: 2.1-7.7]) on univariate analysis. The presence of GP5 was a better predictor of BF, DM, PCSM, and OS than stratification by GS8-10. Patients with GP5 had clinically worse outcomes than GS8 patients without GP5. There was no difference in outcome between primary, secondary, and tertiary GP5. On multivariate analysis, GP5 was the strongest pathologic predictor of BF (p<0.01 HR: 2.7 [95%CI: 1.6-4.5]), DM (p<0.01 HR: 11.2 [95%CI: 3.9-32.2]), and PCSM (p<0.01 HR: 6.0 [95%CI: 1.8-19.6]). Conclusions: In SRT, where pathologic factors including extra-capsular extension, seminal vesicle invasion, and margin status are known, the presence of GP5 is the strongest pathologic predictor of BF, DM, and PCSM. Traditional GS risk stratification fails to fully utilize the prognostic capabilities of individual GP’s for SRT patients following RP. Intensification of treatment regimens, such as early use of androgen deprivation therapy or adjuvant radiation, may be appropriate for patients with GP5 in this setting.

scholarly journals Comparison of Survival Between Hypofractionated and Conventional Radiotherapy in Clinically Localized Prostate Cancer: A Single-Center Retrospective Cohort

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Afshin Rakhsha ◽  
Bahram Mofid ◽  
Amir Shahram Yousefi Kashi ◽  
Farzad Taghizadeh-Hesary ◽  
Massumeh Sajjadi rad
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
External Beam Radiation ◽  
Consecutive Series ◽  
Clinical Relapse ◽  
Beam Radiation ◽  
Fractionation Schedule ◽  
The Mean ◽  
The Impact

Background: Prostate cancer (pCa) is the most frequently diagnosed visceral cancer among men. The main role of radical prostatectomy and external-beam radiation therapy (EBRT) in the management of patients with localized pCa has been established. Objectives: This study aims at comparing the clinical outcomes of hypofractionated versus conventional EBRT in the definitive management of patients with localized pCa. Methods: From 2013 to 2019, a consecutive series of patients with localized pCa was treated with conventional (74 Gy at 2 Gy fractions) or hypofractionated (70.2 Gy at 2.7 Gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), respectively. The impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-RFS) and overall survival (OS) was assessed. Results: The median follow-up was 42 months (range: 8 - 81 months). Among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. The patient characteristics between groups were comparable. The mean bc-RFS of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (CI) 95%: 34.5 - 35.7, P = 0.25). Accordingly, the mean OS of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (CI 95%: 37.3 - 38.6, P = 0.04). The sub-analysis showed that the OS benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (CI 95%: 0.02 - 1.46, P = 0.054). Conclusions: Hypofractionation had OS benefit over the conventional schedule for definitive radiotherapy of localized pCa. This benefit was limited to patients with intermediate- and high-risk pCa.

Maximum tumor diameter as a predictor for outcome following salvage radiation for prostate cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 78-78
Author(s):  
Skyler B. Johnson ◽  
William C. Jackson ◽  
Yeohan Song ◽  
Benjamin Foster ◽  
Darren Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Continuous Variable ◽  
Assessment Tools ◽  
External Beam Radiation ◽  
Tumor Diameter ◽  
Beam Radiation ◽  
Maximum Tumor Diameter ◽  
The Impact

78 Background: While maximum tumor diameter (MTD), as identified on radical prostatectomy (RP) specimens, has been associated with prostate cancer recurrence, the prognostic significance of this variable is unknown in the context of salvage external beam radiation therapy (EBRT) following a rising PSA after RP. Here, we investigate associations between MTD and outcomes in this setting. Methods: From an IRB approved retrospective single-institutional cohort, 575 patients treated with salvage radiation therapy (SRT) were identified, with MTD data available on 173. ANOVA and chi-square were utilized to compare prognostic variables with MTD. The impact of MTD on biochemical failure (BF), metastasis (Mets), prostate cancer-specific mortality (PCSM) and overall survival (OS) was assessed on univariate and multivariate analysis using Kaplan-Meier and Cox-proportional hazards regression. Results: Median follow up was 76.5 months (IQR, 46.5-104.0) and median MTD was 18 mm (IQR, 13-22). Median RT dose was 68.4 Gy (IQR, 64.8-68.4). MTD size correlated with pT-stage, Gleason score, and presence of seminal vesicle invasion or lymph node invasion. Receiver operator characteristic (ROC) curve analysis was used to correlate MTD with clinical end-points and identified 14 mm as the most prognostic cut-point. A MTD >14 mm was associated with a 1.8, 4.0 and 8-fold increase in the risk of BF (p<0.02), Mets (p<0.002), and PCSM (p<0.02), respectively. As a continuous variable, on multivariate analysis, MTD was shown to be a marginally significant predictor of OS (p=0.056, HR [95%] 1.6 [1.0-2.5]), and a significant predictor of PCSM (p<0.03, HR [95%] 2.0 [1.1-3.8]) and Mets (p=0.01, HR [95%] 1.7 [1.1-2.6) but not BF. In this model, for every 10 mm increase in MTD, there is a 1.7, 2.0, and 1.6 fold risk of metastasis, prostate cancer death and overall death, respectively. Conclusions: As a categorical and continuous variable, MTD is a significant predictor of prostate cancer outcomes following SRT and should be used in clinical decision making in this population and in future clinical risk assessment tools.

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