scholarly journals High-Grade Prostate Cancer: Favorable Results in the Modern Era Regardless of Initial Treatment

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Emma H. Ramahi ◽  
Gregory P. Swanson ◽  
Matthew W. Jackson ◽  
Fei Du ◽  
Joseph W. Basler
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Hormone Therapy ◽  
Specific Antigen ◽  
High Grade ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Modern Era

Purpose. We performed a retrospective study to determine the outcome of a modern cohort of patients with high-grade (Gleason score ≥ 8) prostate cancer treated with radical prostatectomy, radiation therapy, or hormone therapy. Methods. We identified 404 patients in the South Texas Veteran’s Healthcare System Tumor Registry diagnosed with high grade prostate cancer between 1998 and 2008. Mean follow-up was years. End points were biochemical failure-free survival, overall survival, metastasis-free survival, and cancer-specific survival. Results. 5-year overall survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 88.9%, 76.3%, and 58.9%, respectively. 5-year metastasis-free survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 96.8%, 96.6%, and 88.4%, respectively, and 5-year cancer-specific survival was 97.2%, 100%, and 89.9%, respectively. Patients with a Gleason score of 10 and pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year biochemical failure-free and cancer-specific survival. Patients with a pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year overall survival. Discussion. Even for patients with high-grade disease, the outcome is not as dire in the modern era regardless of primary treatment modality chosen. While there is room for improvement, we should not have a nihilistic impression of how these patients will respond to treatment.

High-grade prostate cancer with favorable results in the modern era.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 107-107
Author(s):  
E. Ramahi ◽  
G. P. Swanson ◽  
F. Du ◽  
J. Basler
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Gleason Score ◽  
Initial Treatment ◽  
Specific Antigen ◽  
Stage Migration ◽  
High Grade ◽  
Free Survival ◽  
Androgen Ablation ◽  
Modern Era

107 Background: Historically, patients with high-grade prostate cancer have the worst outcomes. With the advent of prostate- specific antigen (PSA) screening, diagnosing prostate cancer no longer depends on palpation of a bulky mass on digital rectal exam and prostate cancers are found at an earlier stage. Our aim is to determine the outcome of a modern cohort of high grade patients with the available treatment options. Methods: We reviewed the STVHS Tumor Registry and identified those patients diagnosed with prostate cancer between 2002 and 2008 capturing those patients with Gleason score >7 on biopsy. Details including all recorded PSA values, biopsy and surgical pathology results, primary, neoadjuvant and adjuvant treatment, as well as response to treatment were recorded and analyzed using Kaplan-Meier estimates, log-rank test, and multivariate analysis using Cox proportional hazards models. Results: We identified 297 patients with Gleason 8–10 cancer with a median follow up of 35 months. Initial treatment was surgery in 136, radiation in 52, and androgen ablation in 110; one patient has both surgery and androgen ablation. Five and 10 year biochemical-free survival (BFS), metastasis-free survival, and overall survival are shown in the Table . Overall, 5 year biochemical failure-free survival was 50% and metastasis free survival was 89%, resulting in an overall survival of 77%. Conclusions: Historically, patients with a Gleason score of 8–10 have done very poorly. However, in the modern era, regardless of the initial treatment, the outcome is not as dire. Possible reasons are less bulky tumors or other facets of stage migration. While there is room for improvement, we should not have a nihilistic impression of how these patients will respond to treatment. [Table: see text] No significant financial relationships to disclose.

scholarly journals Event-Free Survival, a Prostate-Specific Antigen–Based Composite End Point, Is Not a Surrogate for Overall Survival in Men With Localized Prostate Cancer Treated With Radiation

2020 ◽  
Vol 38 (26) ◽  
pp. 3032-3041 ◽  
Author(s):  
Wanling Xie ◽  
Meredith M. Regan ◽  
Marc Buyse ◽  
Susan Halabi ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Event Free Survival ◽  
Free Survival ◽  
Patient Level ◽  
End Point

PURPOSE Recently, we have shown that metastasis-free survival is a strong surrogate for overall survival (OS) in men with intermediate- and high-risk localized prostate cancer and can accelerate the evaluation of new (neo)adjuvant therapies. Event-free survival (EFS), an earlier prostate-specific antigen (PSA)–based composite end point, may further expedite trial completion. METHODS EFS was defined as the time from random assignment to the date of first evidence of disease recurrence, including biochemical failure, local or regional recurrence, distant metastasis, or death from any cause, or was censored at the date of last PSA assessment. Individual patient data from trials within the Intermediate Clinical Endpoints in Cancer of the Prostate–ICECaP–database with evaluable PSA and disease follow-up data were analyzed. We evaluated the surrogacy of EFS for OS using a 2-stage meta-analytic validation model by determining the correlation of EFS with OS (patient level) and the correlation of treatment effects (hazard ratios [HRs]) on both EFS and OS (trial level). A clinically relevant surrogacy was defined a priori as an R2 ≥ 0.7. RESULTS Data for 10,350 patients were analyzed from 15 radiation therapy–based trials enrolled from 1987 to 2011 with a median follow-up of 10 years. At the patient level, the correlation of EFS with OS was 0.43 (95% CI, 0.42 to 0.44) as measured by Kendall’s tau from a copula model. At the trial level, the R2 was 0.35 (95% CI, 0.01 to 0.60) from the weighted linear regression of log(HR)-OS on log(HR)-EFS. CONCLUSION EFS is a weak surrogate for OS and is not suitable for use as an intermediate clinical end point to substitute for OS to accelerate phase III (neo)adjuvant trials of prostate cancer therapies for primary radiation therapy–based trials.

Post-prostatectomy persisting PSA: Correlation with disease progression and survival in pT3 prostate cancer patients of the ARO 96-02 randomized phase III clinical trial—10 years' follow-up.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 32-32
Author(s):  
Thomas Wiegel ◽  
Detlef Bartkowiak ◽  
Dirk Bottke ◽  
Axel Hinke ◽  
Michael Stöckle ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Distant Metastases ◽  
Surgical Margins ◽  
Phase Iii ◽  
Clinical Relapse ◽  
Free Survival ◽  
Tumor Stages

32 Background: In the ARO 96-02 trial, patients with pT3 prostate cancer were randomly assigned before achieving an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP) to receive a wait and see policy (arm A) or adjuvant radiotherapy (RT) (arm B). If the undetectable PSA level was not achieved, patients were excluded by protocol and received RT with 66 Gy (arm C). Methods: Three hundred eighty eight patients with pT3-4 pN0 prostate cancer with positive or negative surgical margins were recruited; 78 retained a detectable PSA (median 0.6 ng/mL, range 0.05-5.6 ng/mL) after RP; 74 of them were irradiated with 66 Gy to the prostatic fossa. Radiotherapy was applied in median 86 days post-RP. Results: Compared to patients in arm A and B, the patients with persisting PSA after RP had higher preoperative PSA values (p<0.0001), higher tumor stages (p=0.0057), higher grades (more G3 tumors), higher Gleason scores (p=0.0013) and more positive surgical margins (p=0.033). For the 74 patients, the 10 years clinical relapse-free survival rate was 63%. Forty three men had hormonal therapy, 12 developed distant metastases; 23 patients died. Compared to patients who did achieve an undetectable PSA (arms A+B), arm-C patients fared significantly worse with a 10 year overall survival of 68% versus 84% (p=0.0019). The rate of developing distant metastases within 10 year post-RP was 2.5 fold higher (14.6 vs. 5.8%) for men with a persisting PSA compared with the patients in arm A (p=0.0079). Metastasis-free survival after 10 years was 67% in arm C versus 81% in arm B (p=0.01). Conclusions: A persisting PSA after prostatectomy seems to be an important prognosticator of clinical progression for pT3 tumors which should then prompt aggressive treatment. It correlates with a higher rate of distant metastases and with worse overall survival. The results underline the significance of achieving an undetectable PSA after radical prostatectomy.

Propensity score matched analysis of metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy or radical prostatectomy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 47-47
Author(s):  
Marshall Meeks ◽  
Stephanie Subasic Markovina ◽  
Joel Vetter ◽  
Alethea Paradis ◽  
Jeff M. Michalski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Specific Antigen ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

47 Background: National Comprehensive Cancer Network (NCCN) category 1 recommendation for localized high risk prostate cancer (HR-PCa) is definitive radiation therapy (RT) and androgen deprivation therapy (ADT). Radical prostatectomy (RP) is also an accepted treatment for patients with localized HR-PCa. Here we report a propensity score-matched analysis of institutional outcomes for patients with HR-PCa treated with RP or RT. Methods: Medical recor ds of patients with localized NCCN HR-PCa treated at our institution from 2002-2011 were reviewed. RT consisted of 73.8-77.4 Gray to the prostate and seminal vesicles; regional lymph nodes were treated for pre-treatment probability of involvement ≥15%. A combination of nearest neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 score [a validated comorbidity index], prostate specific antigen (PSA), biopsy Gleason, and clinical T-stage (cT) and exact matching on PSA, biopsy Gleason, and cT was performed. Multivariate cox-proportional hazards regression was used to compare metastasis-free survival (MFS) and overall survival (OS) (calculated from date of diagnosis). Results: 246 patients were identified (160 RP and 86 RT). Propensity score matching resulted in 62 matched pairs. For the RP group, minimally invasive surgery (70.9%) and lymph node dissection (100%) were common. ADT was administered to 37.1% and 80.6% of patients receiving RP and RT, respectively. Median follow-up was longer for the RT group (51.4 vs 41 months, p = 0.004). Five-year rates of metastasis for RT and RP were 8.9% and 33% (p = 0.003), and for death were 25.9% and 17.6%, respectively (p = 0.31). MFS was significantly better for patients treated with definitive RT compared to RP, while OS was not different (Table). Conclusions: In our cohort with HR-PCa, treatment with RT resulted in a MFS advantage over RP. This was not accompanied by an improvement in OS.The difference in MFS may possibly be related to the importance of early adjuvant ADT. [Table: see text]

Family history in primary hormone therapy for prostate cancer from a community-based multi-institutional Japan-wide database.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16549-e16549
Author(s):  
Masaki Shiota ◽  
Mizuki Onozawa ◽  
Shiro Hinotsu ◽  
Masatoshi Eto ◽  
Seiji Naito ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Family History ◽  
Hormone Therapy ◽  
Positive Family History ◽  
Progression Free Survival ◽  
Study Cohort ◽  
Community Based ◽  
Cancer Specific Survival ◽  
Free Survival

e16549 Background: Although a positive family history is known to increase the risk of morbidity of prostate cancer, little is known about the prognoses with hormone therapy of individuals with familial prostate cancer. Thus, in this study we aimed to determine the associations between hormone therapy and outcomes of a cohort of men with familial prostate cancer from a large community-based multi-institutional Japan-wide registry. Methods: Data of patients with prostate cancer who had received hormone therapy were extracted from a nationwide community-based database established by the Japan Study Group for Prostate Cancer. Family history of prostate cancer was available for 15,873 of these patients, who thus comprised the study cohort. Prognostic variables, including progression-free survival, cancer-specific survival, and overall survival, were compared between men with familial and men with sporadic prostate cancer. Results: A positive family history was identified in 247 patients (1.6%). Patients with a positive family history were younger than those without; however, other clinicopathological characteristics and prognoses were comparable. In subgroup analysis, family history was identified as a significant favorable prognostic factor for progression-free survival among patients treated by castration, as was overall survival among patients with PSA level at diagnosis less than 100 ng/mL and those with low or intermediate J-CAPRA risk. Conclusions: Our findings indicate that familial prostate cancer has an early-onset feature or is diagnosed earlier than sporadic prostate cancer. However, with hormone therapy the prognoses of individuals with familial prostate cancer are comparable to those of individuals with sporadic prostate cancer.

Overall survival outcomes with the use of adjuvant chemotherapy, radiation therapy and hormone therapy in high-risk, very-high-risk and node-positive prostate cancer post radical prostatectomy: A NCDB analysis.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 118-118
Author(s):  
Alina Basnet ◽  
Margaret K Formica ◽  
Poornima Ramadas ◽  
Sam Benjamin
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Radical Prostatectomy ◽  
Hormone Therapy ◽  
Group 2 ◽  
Very High ◽  
Group 1

118 Background: Phase III trials have not consistently demonstrated overall survival (OS) advantage of adjuvant radiation therapy (ART) in prostate cancer (PC) with high risk/very high risk features after radical prostatectomy (RP). Adjuvant hormone therapy (AHT) in PC after RP improved OS in patients with positive lymph nodes (pLNs). We report an observational study on the impact of AHT to ART in NCCN defined high-risk/very high risk (Group 1), and adjuvant chemotherapy (ACT) to AHT in pLNs (group 2) post RP on OS. Methods: We conducted a retrospective study of PC patients (group 1 and group 2) who underwent RP and/or pelvic lymph node dissection. OS was calculated using Kaplan Meier analysis. Group 1 compared ART+AHT vs ART and Group 2 AHT+ ACT vs AHT within 16 weeks of RP. Multivariate analysis was performed with Cox proportional hazard regression model to adjust for different variables. Results: Out of 1,390,357 PC patients reported in NCDB (2004-2015) 182,653 and 11,972 met our inclusion criteria for Group 1 and Group 2 respectively. 3.37% of Group 1 received ART and/or AHT. 19.81% of Group 2 received AHT and/or ACT. Patients who received ART + AHT were more likely to be older, Non-Hispanic white, more likely to have pT4, and have higher prostate specific antigen (PSA) and Gleason scores (GS). Patients who received AHT+ACT were more likely to be younger, with private insurance, and lower Charlson-Deyo Score (CDCC) score. Five and seven year OS with adjusted hazard ratio (aHR) among Group 1 and Group 2 are depicted in table. Conclusions: No statistically significant difference in OS was seen among respective treatment groups. Limitations that exist with this registry based study include lack of randomization, differences in surgical and radiation techniques, duration and choices of ACT and AHT.[Table: see text]

Biochemical Recurrence after Radical Prostatectomy

2018 ◽  
Author(s):  
Dunia Khaled ◽  
Scott Delacroix ◽  
Brian Chapin
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Lymph Node Dissection ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Node Dissection ◽  
Salvage Lymph Node Dissection

After receiving local treatment, many patients will develop a biochemical recurrence (BCR) in the absence of detectable distant disease (cM0) and comprise a significant proportion (20.1%) of prostate cancer disease states. The natural history of patients with BCR ranges from those with indolent, nonprogressive, slow prostate-specific antigen (PSA)-only progression to those ultimately destined to develop metastases and progress to a cancer-specific death. Pathologic predictors of BCR, clinical progression, and cancer-specific mortality are well established in the literature, although multiple novel predictors are emerging, which are highlighted. Traditional imaging cannot reliably distinguish local versus distant microscopic metastasis at the PSA levels that have been shown to confer survival advantage for salvage radiation therapy. We review past and present imaging standards and discuss novel imaging modalities, which may improve staging and offer opportunity for novel salvage therapies, including salvage lymph node dissection and stereotactic beam radiation therapy. With an emphasis on BCR after radical prostatectomy, both curative and palliative treatments are reviewed. This review contains 7 figures, 6 tables and 73 references Key words: biochemical recurrence, clinically undetectable metastases, molecular imaging, monitoring treatment response, prostate cancer, radical prostatectomy, rising prostate-specific antigen, salvage lymph node dissection, salvage radiation  

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