scholarly journals Comparison of Clinical Outcomes of Radical Prostatectomy Versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5986
Author(s):  
Hung-Jen Shih ◽  
Shyh-Chyi Chang ◽  
Chia-Hao Hsu ◽  
Yi-Chu Lin ◽  
Chu-Hsuan Hung ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Outcomes ◽  
Young Patients ◽  
Biochemical Failure ◽  
Oncologic Outcomes ◽  
High Dose ◽  
Very High

That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥ 72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.

Long-term oncologic outcomes of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localized, high-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 153-153
Author(s):  
Jonathan L Silberstein ◽  
Stephen A Poon ◽  
Daniel Sjoberg ◽  
Andrew J. Vickers ◽  
Aaron Bernie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Oncologic Outcomes ◽  
Chemohormonal Therapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

153 Background: To determine long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemo-hormonal therapy for clinically localized, high-risk prostate cancer. Methods: In this phase II multicenter trial of patients with high-risk prostate cancer (prostate-specific antigen greater than 20ng/ml, Gleason greater than or equal to 8, or clinical stage greater than or equal to T3), androgen deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered prior to RP. We report the long-term oncologic outcomes of these patients and compared them to a contemporary cohort who met oncologic inclusion criteria but received RP only. Results: Thirty four patients were enrolled in this study and followed for a median of 13.1 years. Within 10 years most patients experienced biochemical recurrence (BCR-free probability= 22%; 95% CI 10%, 37%). However the probability of disease-specific survival at 10 years was 84% (95% CI 66%, 93%) and overall survival was 78% (95% CI 60%, 89%). The chemohormonal therapy group had higher-risk features than the comparison group (N=123 patients) with an almost doubled risk of calculated preoperative 5-year BCR (69% vs 36%, p<0.0001). After adjusting for these imbalances the CHT group had trends toward improvement in BCR (0.76, 95% CI 0.43, 1.34; p=0.3) and metastasis free survival (0.55, 95% CI 0.24, 1.29; p=.2) although these were not significant. Conclusions: Neoadjuvant chemohormonal therapy followed by RP was associated with lower observed rates of BCR and metastasis compared to a prostatectomy only group; however these results were not significant. Because this treatment strategy has known harms and unproven benefit, this strategy should only be instituted in the setting of a clinical trial.

13-year oncologic and functional outcomes and morbidity in men

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 121-121
Author(s):  
Daniel Shasha ◽  
Robert Salant ◽  
Ahalya Sivathayalan ◽  
Patrick Farrell ◽  
Philippa Cheetham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Young Patients ◽  
Androgen Deprivation ◽  
Oncologic Outcomes ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
External Beam Irradiation ◽  
Very High

121 Background: Young patients are most often recommended prostatectomy because few radiation series have reported long-term outcomes specifically for this age group. We now address that deficit by presenting single-institution 13-year oncologic outcomes and morbidity after I-125 prostate brachytherapy (BRT). Methods: Between 1998-2014, 227 patients < 55 years were prospectively followed after PCa treatment with BRT +/- external-beam irradiation +/- androgen deprivation. NCCN risk stratification identified 99 low-, 51 intermediate-, 77 high- + very-high-risk patients treated. Endpoints include Phoenix biochemical control (BC), prostate-cancer-specific survival (PCSS), overall survival (OS), and urinary, bowel, and sexual complications. Results: With a minimum and median follow-up of 26 and 72.3 months, respectively the 13-year actuarial rate of BC, PCSS, and OS for low-risk disease: 97.8%, 100%, 100%, respectively; for intermediate-risk disease: 94.0%, 100%, 88.1%, respectively and for high + very-high-risk disease 83.6%, 89.9%, 77.6%, respectively. Only 3 patients died of prostate cancer. Multivariate analysis demonstrated race, EBRT use, ADT use, PSA > 10, PSA > 20, GS > 7, T3a, T3b, smoking, diabetes as significant for BC and PCSS (p < 0.05). Permanent incontinence occurred only in the one patient who underwent TURP, 4 transient urethral strictures were all successfully dilated, and no other grade 3 intestinal or urinary complications were reported. In the 77.5 % potent at baseline, preservation was reported at 5 and 10-years overall in 75.8 % and 54.6 %, and with PDE5-I, 83.3% preserved potency at 10-years. Conclusions: Patients < 55 years achieve excellent and durable prostate cancer control at 13 years after I125 BRT, most notably in high-risk, with prostate cancer specific mortality uncommon in all but very-high-risk group. Significant urinary or bowel morbidity is uncommon, and potency preservation is expected with PDE5-I. We conclude age < 55 years should not be used to discriminate against LDRBT.

1116 RADICAL PROSTATECTOMY FOR VERY HIGH RISK T3B/4 PROSTATE CANCER – LONG TERM RESULTS OF A MULTIINSTITUTIONAL EXPERIENCE

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Martin Spahn ◽  
Paolo Gontero ◽  
Alberto Briganti ◽  
Burkhard Kneitz ◽  
Pia Bader ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Long Term Results ◽  
Very High

scholarly journals Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer

2016 ◽  
Vol 34 (5) ◽  
pp. 234.e13-234.e19 ◽  
Author(s):  
Paolo Dell׳Oglio ◽  
Robert Jeffrey Karnes ◽  
Steven Joniau ◽  
Martin Spahn ◽  
Paolo Gontero ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Young Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Survival Patterns
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