scholarly journals Antagonizing GnRH receptors: A temporary ADT salvage maneuver for prostate cancer patients experiencing PSA failure with GnRH agonist

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Jehonathan Pinthus
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Gnrh Agonist ◽  
Gnrh Receptors ◽  
Psa Failure

Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

1997 ◽  
Vol 15 (4) ◽  
pp. 1465-1469 ◽  
Author(s):  
A V D'Amico ◽  
R Whittington ◽  
S B Malkowicz ◽  
D Schultz ◽  
J E Tomaszewski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Radical Retropubic Prostatectomy ◽  
Phase Iii ◽  
Psa Failure

PURPOSE A multivariable analysis to evaluate the potential clinical and pathologic factors that predict for early biochemical failure in patients with pathologically organ-confined and margin-negative disease was performed to define patients who may benefit from adjuvant therapy. PATIENTS AND METHODS Three hundred forty-one prostate cancer patients treated with a radical retropubic prostatectomy between January 1989 and June 1995 and found to have pathologically organ-confined and margin-negative disease comprised the study population. A logistic regression multivariable analysis to evaluate the predictive value of the preoperative prostate-specific antigen (PSA) level, pathologic (prostatectomy) Gleason score, and pathologic stage on PSA failure occurring during the first postoperative year was performed. RESULTS Predictors of PSA failure during the first postoperative year in patients with pathologically organ-confined disease included pathologic Gleason score > or = 7 (P = .0007) and preoperative PSA level greater than 10 (P < .0001). Corresponding 3-year freedom-from-PSA-failure rates for these pathologic organ-confined patients with both, one, or neither of these factors were 60%, 75% to 84%, and 95%, respectively (P < .0001). CONCLUSION Prostate cancer patients with pathologically organ-confined and margin-negative disease and a preoperative PSA level greater than 10 ng/mL or a pathologic Gleason score > or = 7 have significant decrements in short-term PSA-failure-free survival. Therefore, these patients should be considered for adjuvant therapy in the setting of a phase III clinical trial.

Urinary dysfunction appears to be the primary determinant of castration versus observation for prostate cancer patients with PSA failure

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14621-14621
Author(s):  
J. A. Zagory ◽  
C. Chang ◽  
S. Knight ◽  
E. A. Lyons ◽  
C. L. Bennett
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Watchful Waiting ◽  
Specific Antigen ◽  
Hormonal Treatment ◽  
Initial Therapy ◽  
Urinary Dysfunction ◽  
Definitive Treatment ◽  
Psa Failure ◽  
Decision Satisfaction

14621 Background: After undergoing definitive treatment for a primary localized disease, prostate cancer patients may experience a rise in their prostate specific antigen (PSA) levels. Treating PSA failure with hormonal treatment has many health related quality of life (HRQOL) implications, including urinary, bowel, sexual, and male hormonal problems. Predictors of choice between hormonal treatment versus watchful waiting have not been investigated. Methods: Patients were approached after consecutive rises in PSA levels (n = 31). Patients completed HRQOL and decision satisfaction questionnaires, and a literacy assessment. Results: Patients were between 56 and 85 years old; 55% were African American. 71% of African Americans and 50% of whites had low functional literacy. 58% of patients chose hormonal therapy to treat their PSA rise; 81% of patients reported urinary problems. All patients reported decision satisfaction (see Table). Factors associated with castration versus watchful waiting were primarily related to poor urologic function, and were not specifically prostate cancer related (dysuria, nocturia, urination frequency). Conclusions: Primary treatment of urinary dysfunction, rather than castration, should be evaluated as initial therapy for prostate cancer patients with PSA failure. [Table: see text] No significant financial relationships to disclose.

Quality of life and LhRH agonist therapy among prostate cancer patients who experience PSA failure

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9093-9093
Author(s):  
K. F. Kline ◽  
O. Sartor ◽  
N. A. Dandade ◽  
N. J. Nonzee ◽  
B. D. Vicuna ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Cancer Patients ◽  
Lhrh Agonist ◽  
Agonist Therapy ◽  
Psa Failure ◽  
Health Related Qol ◽  
Health Related ◽  
Lhrh Therapy

9093 Background: Growing numbers of prostate cancer patients survive for extended periods of time after initial diagnosis and treatment. Many experience a biochemical relapse (“PSA failure”) some time after prostatectomy or pelvic radiation. LhRH agonist therapy can reduce PSA levels, but its impact on survival time and quality of life (QOL) is unclear. We evaluated these concerns among Veterans who experienced PSA Failure. Methods: Eligibility criteria included: receipt of primary therapy for prostate cancer followed by a PSA nadir and subsequent PSA rise to at least 0.2 ng/ml. Data sources include patients (interviewer administered survey instruments on health-related QOL at baseline, 3 and 12 months) and medical records (clinical and laboratory findings). Results: 69 patients from the Jesse Brown VA Medical Center in Chicago have enrolled in the study to date. At their baseline interviews, 30 patients (43.5%) were receiving LhRH agonists (46.1% of 39 African-American patients and 48.0% of 25 White patients). LhRH agonist patients reported worse health-related QOL in domains relevant to prostate cancer than watchful waiting (WW) patients ( Table ), including increased frequency of urination, difficulty controlling urination, greater erectile dysfunction, and more limits on sexual activity. LhRH agonist and WW patients reported similar levels of sexual satisfaction. Conclusion: Of the PSA failure patients studied in this sample, those receiving LhRH agonist therapy experience more problems with urinary and sexual function than those who opted for WW. Longitudinal study will provide information about whether the LhRH therapy causes these side effects, or whether symptomatic patients are more likely to choose LhRH therapy than those with few prostate cancer symptoms. [Table: see text] No significant financial relationships to disclose.

Cardiovascular morbidity in a randomized trial comparing GnRH-agonist and antagonist among patients with advanced prostate cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5015-5015
Author(s):  
David Margel ◽  
Avivit Peer ◽  
Yaara Ber ◽  
Sivan Sela ◽  
Liat Shavit Grievink ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Cerebrovascular Event ◽  
Gnrh Agonists ◽  
Open Label ◽  
Gnrh Antagonists

5015 Background: Androgen-deprivation therapy (ADT) used in prostate-cancer may increase risk of cardiovascular disease (CVD). Limited preclinical and retrospective clinical data suggest that use of gonadotrophin-releasing hormone (GnRH)-antagonist may be associated with lower risk of CVD compared to GnRH-agonist. Methods: We conducted a randomized open-label study comparing the one year incidence of major cardiovascular and cerebrovascular event (MACCE) in prostate-cancer patients with pre-existing CVD commencing on GnRH-agonists or antagonists. Patients were followed every 3 months for the development of MACCE defined as either death, myocardial infarction (MI), cerebrovascular event (CVA), or percutaneous-coronary intervention (PCI). Serum levels of N-terminal pro-B-type natriuretic peptide (NTproBNP) were analyzed at baseline, 3, 6 and 12-months. Results: Eighty patients were enrolled (41 randomized to GnRH-antagonist, 39 to GnRH-agonist). Patients in both arms had similar age, baseline cardiovascular and prostate-cancer characteristics. During follow-up 15 patients developed a new cardiovascular event. Of these, nine patients developed MACCE (two deaths, one MI, two CVAs, and four PCI). Twenty percent (n = 8) of patients randomized to GnRH-agonists had a MACCE compared to 3% (n = 1) randomized to antagonists (log-rank p = 0.013). The absolute risk reduction for MACCE at 12 months using GnRH-antagonist was 18% (95%CI 5-31). Baseline levels of NTproBNP predicted events (AUC = 0.73 95%CI 0.54-0.91 p = 0.03) and increased over time only among patients with CV events. Conclusions: This is the first prospective study to test cardiovascular outcome among prostate-cancer patients receiving ADT. We demonstrated that in patients with pre-existing CVD, GnRH-antagonists was associated with development of fewer cardiovascular events compared to GnRH-agonists. Clinical trial information: NCT02475057.

434: Timing of LHRH Treatment After PSA Failure in Prostate Cancer Patients: A Survival Analysis from the Capsure Database

2004 ◽  
Vol 171 (4S) ◽  
pp. 114-115 ◽  
Author(s):  
Katrine L. Wallace ◽  
Eric P. Elkin ◽  
David M. Latini ◽  
Connie Chen ◽  
Peter R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Survival Analysis ◽  
Cancer Patients ◽  
Psa Failure

Quality-of-life and LhRH agonist therapy among prostate cancer patients following PSA failure

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16083-e16083
Author(s):  
N. Undevia-Yedavalli ◽  
N. Dandade ◽  
T. Luu ◽  
A. Samaras ◽  
O. Sartor ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Sexual Activity ◽  
Cancer Patients ◽  
Lhrh Agonist ◽  
Psa Failure ◽  
Health Related Qol ◽  
Health Related ◽  
Activity Report

e16083 Background: Growing numbers of prostate cancer patients experience biochemical relapse (PSA failure) after initial treatment. LhRH agonist (hormonal) therapy can reduce PSA levels, but there is no clear evidence that it slows disease progression or reduces mortality. Quality of Life (QoL) issues are essential when deciding between observation (OBS) versus hormonal castration following biochemical relapse. We evaluated health related quality of life and treatment satisfaction among prostate cancer patients who experience PSA failure. Methods: Eligibility criteria were receipt of primary therapy for prostate cancer followed by a PSA nadir and subsequent PSA rise to at least 0.2 ng/ml. Data sources include medical records and interviewer administered surveys on health- related QoL at baseline, 3 and 12 months. Results: Castrated versus observed patients who are satisfied with their sexual activity report similar health-related QoL, with the exception of higher rates of maintaining an erection (73.3% vs. 32.0%) and not having prostate cancer affect sexual activity (66.7% vs. 28.6%). Castrated and expectant management patients with low levels of satisfaction and sexual activity report similar health-related QoL. Conclusions: Among patients with PSA Failure, the only health-related QOL difference is reflected in sexual activity related to erectile dysfunction, but not sexual satisfaction among patients who all have a high level of treatment decision satisfaction and sexual activity. [Table: see text] [Table: see text]

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