scholarly journals Active surveillance before radiotherapy — outcome and predictive factors for multiple biopsies before treatment

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Alexandre Alcaidinho ◽  
Guila Delouya ◽  
Jean-Paul Bahary ◽  
Fred Saad ◽  
Daniel Taussky
Keyword(s):  
Active Surveillance ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Repeat Biopsy ◽  
External Beam Radiation ◽  
Gleason Grade ◽  
Beam Radiation ◽  
Cox Regression Analysis ◽  
Multiple Biopsies ◽  
Grade Progression

Introduction: We aimed to investigate whether patients on active surveillance (AS) had worse outcomes than patients who received immediate treatment with radiotherapy and whether a Gleason grade progression on repeat biopsy influenced outcome. Methods: From our institutional database, we identified 2001 patients treated between 2005 and 2019 with primary external beam radiation therapy or brachytherapy. Biochemical recurrence (BCR) was analyzed in relation to clinical factors such as a Gleason grade progression or having multiple biopsies vs. only one biopsy. Patients on AS were identified as those who had undergone ≥2 biopsies. We used log-rank tests for univariate analysis (UVA) and Cox regression analysis for multivariable analysis (MVA). Results: Of 2001 patients, 374 (19%) patients had ≥2 biopsies before treatment, of which 48% presented with a Gleason grade progression of mostly to Gleason 3+4 (36%); 32% had a cancer volume increase on biopsy and 16% had no significant change on biopsy. For patients with ≥2 biopsies, median time from first biopsy to treatment was 22.0 months (interquartile range [IQR] 14.7–36.1). By UVA, patients with Gleason grade progression (n=105) had a worse BCR-free rate (p=0.02) than patients who had no grade progression on repeat biopsy or only one biopsy. On MVA, this effect was lost. Having ≥2 biopsies was not a significant negative prognostic factor on UVA (p=0.2) or MVA. Conclusions: In our experience, radiotherapy after a period of AS, even with Gleason grade progression, did not lead to worse outcomes compared to patients who had radiotherapy after only one biopsy.

Bilateral disease and risk of prostate cancer progression in an active surveillance cohort.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 207-207
Author(s):  
Nabila Khondakar ◽  
Luke P. O'Connor ◽  
Cheyenne Williams ◽  
Michael Daneshvar ◽  
Jillian Egan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Progression ◽  
Median Time ◽  
Active Surveillance ◽  
Multivariable Analysis ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Cox Regression Analysis ◽  
Bilateral Disease ◽  
Systematic Biopsy

207 Background: Active surveillance (AS) is considered the standard of care for managing patients with low-risk prostate cancer. Identifying risk factors for disease progression on AS can improve risk stratification. As previously described, the presence of bilateral disease may affect disease progression. Current systematic biopsy techniques inadequately predict presence of bilateral disease. We hypothesize that combined mpMRI-guided fusion biopsy and systematic biopsy will improve detection of bilateral disease. Methods: Our institutional database of patients referred for AS from 2007-2020 was queried. All AS patients received combined 12-core systematic biopsy and mpMRI-Fusion biopsy (Cbx), and those with Gleason Grade group 1 (GG1) on confirmatory Cbx were included. Cox regression analysis identified baseline characteristics associated with AS progression, defined as progression to GG ≥ 2. The distributions of GG and National Comprehensive Cancer Network (NCCN) risk categories were also compared. Results: 103 patients with prostate cancer and at least one follow-up biopsy at our institution were included in the analysis. 30% (31/103) had bilateral disease and 70% (72/103) had unilateral disease. On univariable and multivariable analysis, both PSAD (univariable HR = 1.6; 95% CI: 1.1-2.2; multivariable HR = 1.7; CI: 1.2-2.5) and presence of bilateral disease (univariable HR = 2.2; 95% CI: 1.3-4.0; multivariable HR = 2.2; 95% CI: 1.2-4.0) at time of confirmatory biopsy were significantly associated with AS progression. On Kaplan-Meier analysis, median time from Cbx to AS progression ≥ GG2 for the whole cohort was 52 months (95% CI: 44 - 68). The median time to progression for patients with unilateral and bilateral disease was 68 months and 52 months, respectively (log-rank test, p = 0.0055). Bilateral disease was marginally associated with receiving an NCCN score of high or very high on upgraded biopsy (RR: 3.16, 95% CI: 1.004-9.932). NCCN score at time of confirmatory biopsy was not associated with progression. However, NCCNs scores and GG at time of progression were higher among patients with bilateral disease (p = 0.015 and p = 0.024). Ultimately, use of combined biopsy resulted in 16.1% more bilateral cancers detected when compared to systematic biopsy. Conclusions: Detection of bilateral disease using combined biopsy was significantly associated with disease progression in patients on AS. Notably, combined biopsy resulted in greater detection of bilateral disease than systematic biopsy alone. Identifying presence of bilateral disease using combined biopsy could ultimately contribute to management decisions in patients on AS.

The prognostic value of percent positive biopsies in intermediate to high risk prostate cancer treated with brachytherapy and supplemental beam radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4645-4645
Author(s):  
R. D. Nurani ◽  
K. E. Wallner ◽  
G. S. Merrick ◽  
P. Orio ◽  
J. Virgin ◽  
...  
Keyword(s):  
High Risk ◽  
Gleason Score ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Biochemical Failure ◽  
Gleason Grade ◽  
Beam Radiation ◽  
Cox Regression Analysis ◽  
Biological Variables

4645 Background: Percent biopsy core positivity (%BCP) has been correlated with tumor volume, extraprostatic disease and biochemical progression free survival (bPFS) in surgical series. In an external beam series, it can predict time to progression in a subset of patients. Methods: The percentage of biopsy cores involved with cancer was determined from original pathology reports of 566 patients with clinical stage T1c-T2a, Gleason grade 7–10 and/or PSA 10–20 CaP. These patients had previously been treated on a prospective study that randomized between 20 or 44 Gy of supplemental beam radiation therapy followed by Pd-103 brachytherapy. bPFS was defined as having a serum PSA ≤0.5 ng/ml at last follow-up. Patients were censored at last follow-up if their serum PSA was still decreasing. Results: 5 year bPFS was 79% for the entire group of 566 patients and 84% for the sub-group of 333 patients with %BCP quantified. On Cox regression analysis, biological variables analyzed included PSA, PSA < or ≥ 10, Gleason score, Gleason score < or ≥8, %BCP divided into two different grouping schemes (<34, 34 through 50 and ≥50) and < or ≥50. Treatment related variables analyzed included V100, V100 < or ≥90%, D 90, D 90 < or ≥80%, supplemental beam dose of 20 or 40 Gy. On univariate analysis, significant factors were limited to: %BCP < vs. ≥50 (p = 0.004), %BCP <34 Vs. ≥50% (p = 0.006), PSA, PSA < or ≥10, Gleason score, V100 < or ≥90%, D 90. On multivariate analysis, %BCP was the only significant determinant (p = 0.006) irregardless of which stratification scheme was utilized. For %BCP ≥50%, the hazard ratio for biochemical failure was 3.6 (95% confidence interval 1.4 to 8.8). On Kaplan-Meier analysis, 5 year bPFS was 90% and 79% for patients with <50% and ≥50% cores involved respectively (p = 0.002). Conclusions: With implementation of implant techniques that uniformly meet optimal dosimetric criteria in patients felt to be at intermediate to high risk of failure based on Gleason and PSA, the percent of biopsy cores positive with malignancy emerges as the single most important factor in predicting biochemical failure. There is a statistically significant reduction in bPFS in patients with ≥50% of their core needle biopsies involved with malignancy. No significant financial relationships to disclose.

Significant interaction between testosterone recovery (TR) and biochemical progression-free survival (BPFS) in intermediate- and high-risk patients with prostate cancer treated with radiation therapy (RT) and androgen deprivation therapy (ADT).

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 202-202
Author(s):  
D. Shasha ◽  
T. Nabhani ◽  
S. J. Rauth ◽  
R. Salant ◽  
L. B. Harrison
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

202 Background: To examine the interaction testosterone-recovery-free survival (TRFS) and BPFS in patients with intermediate and high-risk prostate cancer treated with combined external beam radiation therapy (EBRT), prostate implant (PI), and ADT. Methods: We prospectively collected data between 1998 and 2010 from 1,564 patients with clinically localized prostate cancer treated by a single physician (DS). 294 patients with NCCN intermediate or high-risk prostate cancer were treated with EBRT, PI, and ADT. 60% of these patients had intermediate-risk disease. Initial prostate-specifc antigen (PSA), Gleason Score (GS), AJCC tumor stage (TStage), and RT parameters were recorded. PSA, and testosterone (T) were measured at each follow-up visit. BPFS was scored using the Phoenix definition. Testosterone recovery occurred when the serum T level rose above 150ng/ml. TR was dichotomized at 2 years. Survival was evaluated using Cox-regression analysis. Results: Median age was 66 yrs-old, intraquartile range (IQR) was 60-71. Median ADT duration (ADTD) was 1.31 years (IQR 0.25-2.35). Testosterone recovery (TR) was seen in 73% of patients. Median TRFS was 3.1 years (IQR 1.94-4.12). Median BPFS was 4.96 years (IQR 3.39-9.12). Overall BPFS was 90% in this patient population. Three patients experienced metastatic failure. There were no prostate cancer deaths. On univariate analysis ADTD (p=0.05), TRFS (p=0.04), GS (p=0.02), and PSA (p=0.05) were significantly associated with BPFS. On multivariable analysis TRFS (p=0.009), TStage (p=0.02), GS (p=0.02), and PSA (p=0.04) were significantly associated with BPFS. Conclusions: Prolonged testosterone suppression after combination EBRT/PI/ADT is strongly associated with improved BPFS. The physiological implications of this finding warrant further study. No significant financial relationships to disclose.

Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment

The Prostate ◽  
2017 ◽  
Vol 77 (6) ◽  
pp. 686-693 ◽  
Author(s):  
Raisa S. Pompe ◽  
Helen Davis-Bondarenko ◽  
Emanuele Zaffuto ◽  
Zhe Tian ◽  
Shahrokh F. Shariat ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Local Treatment ◽  
Population Based ◽  
External Beam Radiation ◽  
Gleason Grade ◽  
External Beam ◽  
Beam Radiation ◽  
Grade Groups

scholarly journals Diet quality and Gleason grade progression among localised prostate cancer patients on active surveillance

2019 ◽  
Vol 120 (4) ◽  
pp. 466-471 ◽  
Author(s):  
Justin R. Gregg ◽  
Jiali Zheng ◽  
David S. Lopez ◽  
Chad Reichard ◽  
Gladys Browman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Diet Quality ◽  
Gleason Grade ◽  
Grade Progression

scholarly journals Stereotactic body radiotherapy versus conventional/moderate fractionated radiation therapy with androgen deprivation therapy for unfavorable risk prostate cancer

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Sagar A. Patel ◽  
Jeffrey M. Switchenko ◽  
Ben Fischer-Valuck ◽  
Chao Zhang ◽  
Brent S. Rose ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Stereotactic Body Radiotherapy ◽  
Multivariable Analysis ◽  
Androgen Deprivation ◽  
Sensitivity Analyses ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Risk Of Death ◽  
Risk Prostate Cancer

Abstract Background Ultrahypofractionation using stereotactic body radiotherapy (SBRT) is an increasingly utilized technique for men with prostate cancer (PC). The comparative efficacy of SBRT plus androgen deprivation therapy (ADT) compared to fractionated radiotherapy (EBRT) plus ADT in higher-risk prostate cancer is unknown. Methods Men > 40 years old with localized PC treated with external beam radiation and concomitant ADT for curative intent between 2004 and 2016 were analyzed from the National Cancer Database. Patients who lacked ADT or risk stratification data were excluded. 558 men treated with SBRT versus 40,797 men treated with conventional or moderately hypofractionated EBRT were included. Patients were stratified by unfavorable intermediate (UIR) and high (HR) risk using NCCN criteria. Kaplan Meier and Cox proportional hazards were used to compare overall survival (OS) between RT modality, adjusting for age, race, and comorbidity index. Results With a median follow up of 74 months, there was no difference in estimated 6-year OS between men treated with SBRT versus EBRT regardless of risk group. On multivariable analysis, there was no difference in risk of death for men treated with SBRT compared to EBRT (UIR: adjusted HR 1.09, 95% CI 0.68–1.74, p = .72; HR: adjusted HR 0.93, 95% CI 0.76–1.14, p = .51). On sensitivity analyses, when confining the cohort to men treated with NCCN-preferred dose fractionations, with no comorbidities, or < 65 years old, there remained no survival difference between treatment groups for both UIR and HR. Conclusion Within study limitations, we found no difference in survival between SBRT+ADT and standard of care EBRT+ADT for UIR or HR PC. These results support recent NCCN guideline updates, which include SBRT as a non-preferred option for higher risk men. Prospective validation would further strengthen the evidence basis behind these recommendations.

Correlation of percent of core biopsies positive for prostate cancer and biochemical outcome following I-125 prostate brachytherapy or external beam radiation.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 40-40
Author(s):  
R. D. Tendulkar ◽  
K. L. Stephans ◽  
C. A. Reddy ◽  
K. Martires ◽  
A. R. Patel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Gleason Score ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Prostate Brachytherapy ◽  
Beam Radiation ◽  
T Stage ◽  
Psa Testing ◽  
Biopsy Gleason Score

40 Background: The percentage of positive cores (PPC) on biopsy for prostate cancer has been identified as a predictor of outcome following definitive local treatment. We aim to identify whether this observation holds true for a modern cohort of patients (pts) treated at Cleveland Clinic with permanent prostate brachytherapy (PB) or external beam radiation therapy (EBRT). Methods: We retrospectively reviewed pathology reports of pts treated with either PB or EBRT from our IRB-approved prospective prostate cancer registry. No pts underwent both PB and EBRT. The number of biopsy cores sampled, number of cores positive for prostate cancer, and maximum length of any core positive for prostate cancer were collected. Cox proportional hazards regression was used to analyze biochemical relapse free survival (bRFS) using the nadir + 2 ng/ml definition. Results: We identified 1253 PB and 879 EBRT pts with complete pathology and clinical information. Among PB pts, 46% were low risk, 40% intermediate risk, and 14% high risk, while 78% had <50% PPC, and 22% had >=50% PPC. The 5-year bRFS for PB was 92.0% for <50% PPC, vs. 83.1% for >=50% PPC (HR 2.1, p=0.0005). For PB pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following PB. Among EBRT pts, 11% were low risk, 36% intermediate risk, and 53% high risk, while 55% had <50% PPC, and 45% had >=50% PPC. The 5-year bRFS for EBRT was 85.6% for <50% PPC, vs. 77.1% for >=50% PPC (HR 1.8, p<0.0001). For EBRT pts, significant predictors of bRFS on univariate analysis included: PPC, clinical T stage, PSA, biopsy Gleason score, androgen deprivation, EBRT dose, and frequency of PSA testing. On multivariate analysis, only PPC, biopsy Gleason score, and PSA frequency remained significant predictors following EBRT. Conclusions: Following PB or EBRT, the percent of positive cores for prostate cancer was a significant predictor of bRFS on multivariate analysis, more so than conventional predictors such as T stage and PSA. No significant financial relationships to disclose.

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