scholarly journals Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer

2016 ◽  
Vol 6 ◽  
pp. 18 ◽  
Author(s):  
Daniel Corey Oppenheimer ◽  
Eric P Weinberg ◽  
Gary M Hollenberg ◽  
Steven P Meyers
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Treatment Options ◽  
Specific Antigen ◽  
Focal Therapy ◽  
External Beam Radiation ◽  
Common Disease ◽  
Recurrent Prostate Cancer ◽  
Beam Radiation ◽  
Contrast Enhanced

Multiparametric magnetic resonance (MR) imaging of the prostate combines both morphological and functional MR techniques by utilizing small field of view T1-weighted, T2-weighted, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy to accurately detect, localize, and stage primary and recurrent prostate cancer. Localizing the site of recurrence in patients with rising prostate-specific antigen following treatment affects decision making regarding treatment and can be accomplished with multiparametric prostate MR. Several different treatment options are available for prostate cancer including radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, or a number of focal therapy techniques. The findings of recurrent prostate cancer can be different depending on the treatment the patient has received, and the radiologist must be able to recognize the variety of imaging findings seen with this common disease. This review article will detail the findings of recurrent prostate cancer on multiparametric MR and describe common posttreatment changes which may create challenges to accurate interpretation.

scholarly journals Does the Presence of a Major Psychiatric Disorder Affect Tolerance and Outcomes in Men With Prostate Cancer Receiving Radiation Therapy?

2016 ◽  
Vol 11 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Joseph J. Safdieh ◽  
David Schwartz ◽  
Justin Rineer ◽  
Joseph P. Weiner ◽  
Andrew Wong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Specific Antigen ◽  
Delayed Diagnosis ◽  
External Beam Radiation ◽  
Definitive Treatment ◽  
Biochemical Control ◽  
Cancer Specific Survival ◽  
Beam Radiation ◽  
Propensity Score Adjustment

Prior studies have suggested that men with prostate cancer and psychiatric disorders (+Psy) have worse outcomes compared with those without (−Psy), particularly due to delayed diagnosis or reduced access to definitive treatment. In the current study, the toxicity and outcomes of men who were primarily diagnosed through prostate-specific antigen screening and who underwent definitive treatment with external beam radiation was investigated. The charts of 469 men diagnosed with prostate cancer from 2003 to 2010 were reviewed. The presence of +Psy was based on a Diagnostic and Statistical Manual of Mental Disorders–Fourth edition diagnosis of posttraumatic stress disorder, depression, schizophrenia, bipolar disorder, and/or generalized anxiety disorder. Kaplan–Meier analysis was used to analyze biochemical control, distant control, prostate cancer–specific survival, and overall survival. One hundred patients (21.3%) were identified as +Psy. At a median follow-up of 73 months, there were no differences regarding 6-year biochemical control (79.8% −Psy vs. 80.4% +Psy, p = .50) or 6-year distant metastatic-free survival (96.4% −Psy vs. 98.0% +Psy, p = .36). There were also no differences regarding the 6-year prostate cancer–specific survival (98.4% −Psy vs. 99.0% +Psy, p = .45) or 6-year overall survival (80.2% −Psy vs. 82.2% +Psy, p = .35). Short- and long-term genitourinary and gastrointestinal toxicities were similar between the groups. On multivariate analyses with propensity score adjustment, +Psy was not a significant predictor for toxicity, biochemical recurrence, or survival. The presence of +Psy was not associated with higher toxicity or worse clinical outcomes, suggesting that effective removal of screening and treatment barriers may reduce the survival disparities of these patients.

scholarly journals Focal Therapy, Differential Therapy, and Radiation Treatment for Prostate Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Anudh K. Jain ◽  
Ronald D. Ennis
Keyword(s):  
Prostate Cancer ◽  
Dose Rate ◽  
Radiation Treatment ◽  
Focal Therapy ◽  
High Dose Rate ◽  
External Beam Radiation ◽  
High Dose ◽  
Beam Radiation ◽  
Differential Therapy ◽  
Prostate Cancer Treatments

Focal and differential therapy represent an approach to improve the therapeutic ratio of prostate cancer treatments. This concept is a shift from treating the whole gland to intensely treating the portion of the gland that contains significant tumor. However, there are many challenges in the move towards focal approaches. Defining which patients are suitable candidates for focal therapy approaches is an area of significant controversy, and it is likely that additional data from imaging or detailed biopsy methods is needed in addition to traditional risk factors. A number of methods have been suggested, and imaging with multiparametric MRI and transperineal template mapping biopsy have shown promise. The approach of differential therapy where the entire prostate is treated to a lower intensity and the tumor areas to high intensity is also discussed in detail. Radiation therapy is a well suited modality for the delivery of differential therapy. Data in the literature using external beam radiation, high dose rate brachytherapy, and low-dose rate brachytherapy for differential therapy are reviewed. Preliminary results are encouraging, and larger studies and randomized controlled trials are needed to validate this approach.

Perceptions regarding prostate cancer (CaP) treatment options: Results from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6530-6530 ◽  
Author(s):  
Ronald C. Chen ◽  
Matthew Edward Nielsen ◽  
Bryce B. Reeve ◽  
Laura H. Hendrix ◽  
Robert P Agans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
Treatment Options ◽  
Population Based ◽  
Robotic Prostatectomy ◽  
External Beam Radiation ◽  
Radiation Oncologist ◽  
Beam Radiation ◽  
The North ◽  
Published Evidence

6530 Background: NC ProCESS is a population-based cohort of early (non-metastatic) CaP patients followed prospectively from diagnosis. Methods: Patients were identified through Rapid Case Ascertainment of the NC Cancer Registry from all NC counties in 2010-12. Phone survey assessed perceptions regarding treatment options and priorities in treatment selection. Results: 937 (59% of all eligible) completed this survey. Median age was 65; 72% were Caucasian. At time of survey, ~13 weeks from diagnosis, 98% had discussed options with a urologist, 49% with primary care, and 41% radiation oncologist. Many patients had concerns about potential effects of surgery and radiation on ability to perform daily activities, recovery time, and burden to family (Table). Open prostatectomy (ORP) and external beam radiation (RT) were deemed most likely to affect urinary and sexual function; fewer reported concern with robotic prostatectomy (RALP). Only 32% reported hormonal therapy would affect sexual function. Most reported surgery (especially RALP) had the best chance for cure, while 59% worried about recurrence with RT. In almost all questions, patients who consulted only with a urologist had significantly different perceptions about treatment options than those who also consulted with a radiation oncologist. In choosing treatment, 61% reported that cure was the highest priority, and 28% indicated preserving quality of life. Conclusions: Modern CaP patients often have misconceptions about treatment options inconsistent with published evidence, which are partially mitigated by multidisciplinary consultation. Most indicated cure as the highest priority, and surgery offers the best chance of cure. [Table: see text]

Hemi salvage HIFU in patients with radio recurrent prostate cancer: Early experience and results.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 99-99
Author(s):  
Gilles Pasticier ◽  
Eduard Baco ◽  
Olivier Rouviere ◽  
Sebastien Crouzet ◽  
Jean-Yves Chapelon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Treatment Options ◽  
Cancer Control ◽  
Artificial Urinary Sphincter ◽  
Androgen Deprivation ◽  
High Intensity Focused Ultrasound ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Salvage Hifu

99 Background: One third of patients treated with External beam radiation therapy (EBRT) for localized prostate cancer (PCa) experience local recurrence. Salvage treatment options include prostatectomy, cryoablation, and High Intensity Focused Ultrasound (HIFU). Whole gland treatment in these patients offers acceptable cancer control, but carries a risk of severe urinary incontinence in at least 20% of cases and reduction of Quality of Life (QoL). In patients with unilateral local relapse, focal HIFU is feasible. The aim of this prospective study was to evaluate the effect of Hemi HIFU in patients with unilateral recurrence after radiotherapy. Methods: Between 2009 and 2012, 48 patients were prospectively included in 2 centers. Inclusion criteria were positive MRI and biopsy in one lobe diagnosing unilateral cancer after EBRT (46 patients) and after brachytherapy (2 patients). Mean age was 68.8 ± 6 years, mean pre HIFU PSA was 5.2 ± 5.2 ng/mL and the repartition of Gleason score was ≤7: 28, ≥8: 18 and not determined: 2. Median follow-up was 16.3 months [range 3-43]. Treatments were performed with Ablatherm® HIFU device. Results: The mean PSA nadir value was 0.69 ± 0.83 (median: 0.4). Disease progression occured in 16 patients (35,5%). Local recurrence was found in 4 patients in the controlateral lobe, and in 4 patients in both lobes. Six patients developped metastases and 2 had rising PSA without local recurence or proven metastasis. Fifteen of these 16 patients received salvage treatments (3 re-HIFU, 11 androgen-deprivation, and 1 re-HIFU plus androgen-deprivation). Thirthy-six patients (75%) were pad-free. Seven patients (14.6 %) required 1 pad a day. Severe incontinence occured in 5 patients (10.4%). One of them received artificial urinary sphincter. Paired results indicated no significant change in QoL and IPSS scores: EORTC-QLC-30: (from 35.7 ± 8.7 to 36.8 ± 8.6, p=0.22) and IPSS: (from 7 ± 5.6 to 8.5 ± 5.1, p=0.13) Conclusions: Hemi-salvage HIFU is efficient in patients with unilateral radio-recurrent PCa with a preserved QoL offering comparable cancer control to whole gland treatment.

External beam radiation therapy or high intensity-focused ultrasound for localized prostate cancer: A matched pair analysis in the prostate-specific antigen era.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 109-109
Author(s):  
Gilles Pasticier ◽  
Sebastien Crouzet ◽  
Pascal Pommier ◽  
Christian Carrie ◽  
Olivier Rouviere ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Survival Rate ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Androgen Deprivation ◽  
High Intensity Focused Ultrasound ◽  
External Beam Radiation ◽  
Matched Pair ◽  
Beam Radiation ◽  
Free Survival

109 Background: In the absence of randomised study data institutional series have shown High Intensity Focused Ultrasound (HIFU) to produce excellent overall and cancer specific survival rates in patients with localized prostate cancer (LPCa) compared with alternative curative treatments. The aim of this study was to evaluate the oncologic outcome of patients treated with HIFU versus conformal external beam radiation therapy (C-EBRT) without previous or associated androgen deprivation(AD).This study was designed to overcome limitations of case series studies by using a matched pair design in patients treated contemporaneously with HIFU and C- EBRT in two institutions in the same town. Methods: 256 eligible patients with intermediate risk prostate cancer (d’Amico classification) treated between 2000 and 2005 were prospectively followed and matched to a 1:1 basis following know prognostic variables: prostate-specific antigen (PSA) level and Gleason score.190 perfect matches of patients (95 in each group) were further analysed. Progression free survival rate were the primary endpoint. Other endpoints were secondary used of salvage therapy, and survival rate without salvage palliative androgen deprivation therapy (S-ADT).The progression free survival rates were calculated with Kaplan-Meier estimate. For progression free calculation, failure was defined using the Phoenix definition (nadir + 2ng/ml) or at the time of a salvage treatment for local relapse evidenced by control biopsy. Results: The seven years progression free survival rate was not significantly different after HIFU than after C-EBRT (47% versus 52%, p: 0.311) . The palliative androgen deprivation free rate at seven years was significantly different after HIFU than after C-EBRT (85% versus 58%, p: 0.002). Conclusions: The progression free survival rate was not significantly different after HIFU use than after C-EBRT but the rate of patients who need palliative S-ADT was significantly different after HIFU or C-EBRT: Higher rate of S-ADT was associated with C-EBRT use than with HIFU use.

Sign in / Sign up

Export Citation Format

Share Document