scholarly journals Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?

2020 ◽  
Vol 15 (4) ◽  
Author(s):  
Shiva Madhwan Nair ◽  
Andrew Warner ◽  
Arnon Lavi ◽  
George Rodrigues ◽  
Joseph Chin
Keyword(s):  
Prostate Cancer ◽  
Propensity Score ◽  
Local Treatment ◽  
Prostate Cancer Risk ◽  
High Intensity Focused Ultrasound ◽  
Recurrent Prostate Cancer ◽  
Cancer Specific Survival ◽  
Ablation Therapy ◽  
Systemic Treatments ◽  
The Impact

Introduction: Some men who experience prostate cancer recurrence post-radiotherapy may be candidates for local salvage therapy, avoiding and delaying systemic treatments. Our aim was to assess the impact of clinical outcomes of adding salvage local treatment in prostate cancer patients who have failed radiation therapy. Methods: Following radiation biochemical failure, salvage transperineal cryotherapy (sCT, n=186), transrectal high intensity focused ultrasound ablation (sHIFU, n=113) or no salvage treatment (NST, identified from the pan-Canadian Prostate Cancer Risk Stratification [ProCaRS] database [n=982]) were compared with propensity-score matching. Primary endpoints were cancer-specific survival (CSS) and overall survival (OS). Results: Median followup was 11.6, 25.1, and 14.3 years following NST, sCT, and sHIFU, respectively. Two propensity-score matched analyses were performed: 1) 196 NST vs. 98 sCT; and 2) 177 NST vs. 59 sHIFU. In the first comparison, there were 78 deaths and 49 prostate cancer deaths for NST vs. 80 deaths and 24 prostate cancer deaths for sCT. There were significant benefits in CSS (p<0.001) and OS (p<0.001) favoring sCT. In the second comparison, there were 52 deaths (31 from prostate cancer) for NST vs. 18 deaths (nine from prostate cancer) for sHIFU. There were no significant differences in CSS or OS possibility attributed to reduced sample size and shorter followup of sHIFU cohort. Conclusions: In select men with recurrent prostate cancer post-radiation, further local treatment may lead to benefits in CSS. These hypothesis-generating findings should ideally be validated in a prospective clinical trial setting.

scholarly journals Radiotherapy in nodal oligorecurrent prostate cancer

2021 ◽  
Author(s):  
Michael Pinkawa ◽  
Daniel M. Aebersold ◽  
Dirk Böhmer ◽  
Michael Flentje ◽  
Pirus Ghadjar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Literature Review ◽  
Survival Rates ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Nodal Metastasis ◽  
Stereotactic Ablative Radiotherapy ◽  
Current Standard ◽  
Free Survival ◽  
Systemic Treatments

Abstract Objective The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer. Materials and methods A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurrence patterns after local nodal treatment was performed. The DEGRO Prostate Cancer Expert Panel discussed the results and developed treatment recommendations. Results Metastasis-directed radiotherapy results in high local control (often > 90% within a follow-up of 1–2 years) and can be used to improve progression-free survival or defer androgen deprivation therapy (ADT) according to prospective randomized phase II data. Distant progression after involved-node SABR only occurs within a few months in the majority of patients. ENRT improves metastases-free survival rates with increased toxicity in comparison to SABR according to retrospective comparative studies. The majority of nodal recurrences after initial local treatment of pelvic nodal metastasis are detected within the true pelvis and common iliac vessels. Conclusion ENRT with or without a boost should be preferred to SABR in pelvic nodal recurrences. In oligometastatic prostate cancer with distant (extrapelvic) nodal recurrences, SABR alone can be performed in selected cases. Application of additional systemic treatments should be based on current guidelines, with ADT as first-line treatment for hormone-sensitive prostate cancer. Only in carefully selected patients can radiotherapy be initially used without additional ADT outside of the current standard recommendations. Results of (randomized) prospective studies are needed for definitive recommendations.

Prostate cancer risk calculators for healthy population: A systematic review (Preprint)

2021 ◽  
Author(s):  
Antonio Bandala-Jacques ◽  
Kevin Daniel Castellanos Esquivel ◽  
Fernanda Pérez-Hurtado ◽  
Cristobal Hernández-Silva ◽  
Nancy Reynoso-Noverón
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
Cancer Risk ◽  
Digital Rectal Examination ◽  
Prostate Cancer Risk ◽  
Individual Risk ◽  
Healthy Population ◽  
Risk Of Cancer ◽  
The Impact

BACKGROUND Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to a better discrimination of patients in need of invasive diagnostic procedures and for optimized allocation of healthcare resources OBJECTIVE To systematically review available literature on current prostate cancer risk calculators’ performance in healthy population, by comparing the impact factor of individual items on different cohorts, and the models’ overall performance. METHODS We performed a systematic review of available prostate cancer risk calculators targeted at healthy population. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, the analyzed calculators, the population for which it was calibrated, the included risk factors, and the model’s overall accuracy. RESULTS We included a total of 18 calculators across 53 different manuscripts. The most commonly analyzed ones were they PCPT and ERSPC risk calculators, developed from North American and European cohorts, respectively. Both calculators provided high precision for the diagnosis of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations, which reached diagnostic precisions as high as 0.938. The most commonly included risk factors in the calculators were age, PSA levels and digital rectal examination findings. Additional calculators included race and detailed personal and family history CONCLUSIONS Both the PCPR and the ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic accuracy. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which was has been calibrated for its intended population and can be easily reproduced and implemented CLINICALTRIAL CRD42021242110

Severe-COVID-19 and mortality among patients (pts) with prostate cancer (PCa) receiving androgen deprivation therapy (ADT).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 39-39
Author(s):  
Matthew D Tucker ◽  
Andrew Lachlan Schmidt ◽  
Chih-Yuan Hsu ◽  
Yu Shyr ◽  
Andrew J. Armstrong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Mortality Rate ◽  
Propensity Score ◽  
Viral Entry ◽  
Primary Diagnosis ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Retrospective Nature ◽  
Ecog Ps ◽  
The Impact

39 Background: The presence of progressing cancer, male sex and advanced age have been shown to increase the severity of coronavirus disease 2019 (COVID-19). Given that the androgen regulated gene TMPRSS2 has been implicated in SARS-CoV-2 viral entry, we hypothesized that ADT may improve COVID-19 outcomes. This analysis evaluated clinical outcomes of pts with PCa with concurrent SARS-CoV-2 infection and investigated the impact of ADT on occurrence of severe-COVID-19 and mortality. Methods: Data was obtained via the COVID-19 and Cancer Consortium (CCC19), a multicenter registry including >120 cancer centers with de-identified data from pts with COVID-19 and cancer. Men with confirmed SARS-CoV-2 infection and a primary diagnosis of prostate cancer were included: data cutoff of July 31, 2020. The primary endpoint was the development of severe-COVID-19 (death, ICU admission, or mechanical ventilation) among pts on ADT vs. those not on ADT at time of COVID-19 infection. Secondary endpoints included 30-day mortality based on ADT use. Mortality and development of severe-COVID-19 were assessed in Pts grouped by therapy: 1st generation androgen receptor inhibitor (ARI-1), 2nd generation ARI (darolutamide, enzalutamide, apalutamide, ARI-2), abiraterone/prednisone, and chemotherapy. Propensity score matching was utilized. Logistic regression was utilized to adjust for age, ECOG PS, comorbidities, and race. Results: 589 pts were included; median follow-up was 42 days (IQR 25-90) and 62% (363/589) were hospitalized. Severe-COVID-19 developed in 28% of pts and the all-cause 30-day mortality rate was 19%. There was no significant difference in the development of severe-COVID-19 or 30-day mortality between Pts on ADT vs not on ADT, whether using descriptive statistics with the entire population or using the propensity score matched population (Table). Among the descriptive population, the numerical rates of severe-COVID-19 and mortality were lowest in Pts receiving ARI-2, but sample size was low. Conclusions: The overall 30-day mortality rate and percentage developing severe-COVID-19 were high. There was no statistical difference in the development of severe-COVID-19 or mortality based on receipt of ADT; however, this analysis is limited by the retrospective nature and small N after propensity-matching. [Table: see text]

Management of Biochemically Recurrent Prostate Cancer: Ensuring the Right Treatment of the Right Patient at the Right Time

2018 ◽  
pp. 355-362 ◽  
Author(s):  
Daniel E. Spratt ◽  
Deaglan J. McHugh ◽  
Michael J. Morris ◽  
Alicia K. Morgans
Keyword(s):  
Prostate Cancer ◽  
New Technologies ◽  
Postoperative Radiotherapy ◽  
The United States ◽  
Common Disease ◽  
Recurrent Prostate Cancer ◽  
Systemic Treatments ◽  
Effect Of Therapy ◽  
New Gene ◽  
The Right

Biochemically recurrent prostate cancer is an increasingly common disease state, with more than 25,000 cases occurring annually in the United States. Fortunately, progress continues to be made to more effectively identify metastatic disease, optimize existing therapies, and develop new technologies and therapeutic strategies for the timing and delivery of systemic treatments to improve outcomes. This review covers three topics related to the diagnosis and treatment of men with biochemical recurrence (BCR). First, we provide an update on the state of the rapidly evolving field of molecular imaging and its place in practice. Second, we describe validated clinicopathologic methods to risk stratify patients with biochemically recurrent disease, including new gene expression classifiers, to personalize postoperative radiotherapy (RT) timing. Last, we define our approach to optimal management with systemic therapy, including identifying the patients who may benefit most and balancing the duration and timing of treatment with consideration of the effect of therapy on quality of life (QOL) and medical complications associated with treatment.

Immediate or Deferred Androgen Deprivation for Patients With Prostate Cancer Not Suitable for Local Treatment With Curative Intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891

2006 ◽  
Vol 24 (12) ◽  
pp. 1868-1876 ◽  
Author(s):  
Urs E. Studer ◽  
Peter Whelan ◽  
Walter Albrecht ◽  
Jacques Casselman ◽  
Theo de Reijke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Local Treatment ◽  
Androgen Deprivation ◽  
Cancer Specific Survival ◽  
Deferred Treatment ◽  
Symptomatic Disease ◽  
Androgen Ablation ◽  
Number Of Patients ◽  
Significant Difference

Purpose This study (EORTC 30891) attempted to demonstrate equivalent overall survival in patients with localized prostate cancer not suitable for local curative treatment treated with immediate or deferred androgen ablation. Patients and Methods We randomly assigned 985 patients with newly diagnosed prostate cancer T0-4 N0-2 M0 to receive androgen deprivation either immediately (n = 493) or on symptomatic disease progression or occurrence of serious complications (n = 492). Results Baseline characteristics were well balanced in the two groups. Median age was 73 years (range, 52 to 81). At a median follow-up of 7.8 years, 541 of 985 patients had died, mostly of prostate cancer (n = 193) or cardiovascular disease (n = 185). The overall survival hazard ratio was 1.25 (95% CI, 1.05 to 1.48; noninferiority P > .1) favoring immediate treatment, seemingly due to fewer deaths of nonprostatic cancer causes (P = .06). The time from randomization to progression of hormone refractory disease did not differ significantly, nor did prostate-cancer specific survival. The median time to the start of deferred treatment after study entry was 7 years. In this group 126 patients (25.6%) died without ever needing treatment (44% of the deaths in this arm). Conclusion Immediate androgen deprivation resulted in a modest but statistically significant increase in overall survival but no significant difference in prostate cancer mortality or symptom-free survival. This must be weighed on an individual basis against the adverse effects of life-long androgen deprivation, which may be avoided in a substantial number of patients with a deferred treatment policy.

scholarly journals Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU): Overview of Emerging Applications (Part 2)

2019 ◽  
Vol 191 (06) ◽  
pp. 531-539 ◽  
Author(s):  
Florian Siedek ◽  
Sin Yuin Yeo ◽  
Edwin Heijman ◽  
Olga Grinstein ◽  
Grischa Bratke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
High Intensity ◽  
Focused Ultrasound ◽  
Treatment Options ◽  
Local Treatment ◽  
Review Literature ◽  
High Intensity Focused Ultrasound ◽  
Malignant Tissue ◽  
Safe Alternative

Background High-intensity focused ultrasound (HIFU) allows noninvasive heating of deep-seated tissues. Guidance under magnetic resonance imaging (MR-HIFU) offers spatial targeting based on anatomical MR images as well as MR-based near-real-time temperature maps. Temperature feedback allows delivery of a well-defined thermal dose enabling new applications such as the ablation of malignant tissue. Methods Peer-reviewed publications on MR-HIFU were studied and are summarized in this review. Literature was restricted to applications in oncology. Results Several MR-HIFU-based applications for the treatment of malignant diseases are currently part of clinical trials or translational research. Recent trials regarding the treatment of prostate cancer with MR-HIFU have already shown this to be a safe and patient-friendly method. For the treatment of breast cancer and malignancies within abdominal organs, MR-HIFU has been applied so far only in proof of concept studies. Conclusion MR-HIFU is currently being investigated for the ablative treatment of malignant tissue in a variety of oncological applications. For example, the transrectal as well as transurethral ablation of prostate cancer using MR-HIFU was shown to be a patient-friendly, safe alternative to other local treatment options with low side effects. Key points:  Citation Format

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