Biochemical Progression-free Survival Research Articles

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).

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.

221 SALVAGE RADIOTHERAPY IN PATIENTS WITH PROSTATE CANCER AND BIOCHEMICAL RELAPSE AFTER RADICAL PROSTATECTOMY - LONG-TERM FOLLOW-UP OF A SINGLE CENTRE SURVEY

In patients with prostate cancer (PC) and biochemical relapse after radical prostatectomy, salvage radiotherapy (SRT) could improve PC-specific survival (PCSS) but the timing for initiation is still under discussion. We have demonstrated a low rate of biochemical relapses in a patient series with very low pre-SRT PSA levels after a median follow-up of 42 months. Here, we present an update of that study. Overall, 151 patients were analyzed. A biochemical relapse after SRT was diagnosed when the PSA exceeded the post-SRT nadir by 0.2 ng/ml with subsequent i ncrease. Parameters with significant impact on biochemical progression-free survival (BPFS), PCSS, and overall survival (OS) in univariate analysis were included in a multiple Cox regression analysis. After a median follow-up of 82 months, 18 patients (12 %) had died with 10 (6.6 %) deaths being PC-related. A biochemical progression was diagnosed in 83 patients (55 %). Univariate analysis revealed a significant impact of pre-SRT PSA level, Gleason score, and PSA doubling time (PSADT) on BPFS and for initial tumor stage and Gleason score on OS. Multivariate analysis confirmed the impact of pre-SRT PSA level, Gleason score, and PSADT on BPFS and tumor stage on OS. In this update, the rate of biochemical relapses increased compared with our previous data. Compared to similar studies, we found a remarkably low rate of PC-related deaths. Our data support early initiation of SRT. However, this treatment strategy, triggered by very low PSA levels, could carry the risk of overtreatment in at least a subset of patients.

Stereotactic body radiotherapy for low-risk prostate cancer: Five-year outcomes.

94 Background: Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Methods: Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35–36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed. Results: At a median follow-up of 5 years the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1–3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusions: Five-year results of SBRT for localized prostate cancer demonstrate the effectiveness and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are expected to further support this experience. [Table: see text]

PROGNOSTIC VALUE OF INITIAL PROSTATE-SPECIFIC ANTIGEN LEVELS AFTER SALVAGE CRYOABLATION FOR PROSTATE CANCER

OBJECTIVE To assess the prognostic value of initial prostate-specific antigen (PSA) levels after salvage cryoablation (SCA) for the long-term biochemical progression-free survival (bPFS) in patients with prostate cancer. PATIENTS AND METHODS In all, 455 hormone-naive patients from the Cryo On Line Data Registry, and treated with whole-gland SCA were assessed for PSA-based bPFS using the Phoenix criteria. The initial PSA level measured after SCA was considered the nadir. Kaplan-Meier plots of bPFS for initial PSA level of 5.0 ng/mL were constructed and plotted to 60 months. RESULTS In all, 280 patients had an initial PSA level of <0.6 ng/mL after SCA. At 12, 24 and 36 months 80%, 73.6%, and 67% of patients, respectively, were progression-free. For 118 patients with an initial PSA level after SCA of ≥0.6–≤5 ng/mL, 28% and 50% of these patients at 6 and 12 months, respectively, had PSA progression. Of 57 patients with an initial PSA level of ≥5 ng/mL, 64% progressed at 6 months. The PSA level before SCA and Gleason score correlated with bPFS by Spearman correlation (P < 0.001 and 0.002), respectively. CONCLUSION Curative therapy in prostate cancer not responding to radiotherapy is extremely challenging. There is no definition of success for cryosurgical treatment. The available data indicate that an initial PSA level of <0.6 ng/mL after SCA portends a favourable (67% at 36 months) bPFS. Individuals with initial PSA levels of ≥0.6 ng/mL after SCA are at risk of short-term biochemical progression (50% at 12 months).

Dose-escalated external beam radiotherapy in unresectable hepatocellular carcinoma.

267 Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Data regarding the use of external beam radiotherapy is limited in patients from populations without endemic viral hepatitis. We examine the outcomes for patients treated with external beam radiotherapy in the modern era at a single institution. Methods: A total of 29 patients with localized HCC treated from 2000 to 2009 were reviewed. Patients with metastatic disease at the time of radiation were excluded. Median radiation dose was 50 Gy (range 30-75 Gy) with a median biologically effective dose (BED) of 80.6 (range 60-138.6). Median tumor size at the time of radiation was 5.2 cm (range 2-25 cm). Results: Median residual tumor following radiation was 80% (range 27%-278%), with a median residual α-fetoprotein of 47% (range 0.8%-8240%). Estimated one-year overall survival (OS) and in-field progression-free survival (PFS) rates for the study population were 56% and 79%, respectively. One year OS in patients treated to a BED &lt;75 was 18% vs. 69% in patients treated to a BED ≥75 (p=0.002). One year in-field PFS rate (60% vs. 88%, p=0.023) and biochemical PFS duration (median 6.5 vs. 1.6 mos., p=0.001) were also significantly improved in patients treated to a BED ≥75. Grade 3 toxicity was seen in only 13.8% of patients. Conclusions: In a population without endemic viral hepatitis, unresectable HCC demonstrates significant response toexternal beam radiotherapy with minimal toxicity. Furthermore, our findings suggest that increased BED is associated with improved survival and local tumor control. No significant financial relationships to disclose.

Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer

To determine the impact of adjuvant androgen deprivation therapy (ADT) on survival in patients with seminal vesicle invasion (pT3b) at radical prostatectomy. We reviewed 12,115 patients who underwent radical prostatectomy between 1987 and 2002 to identify patients with pT3bN0 prostate cancer who received adjuvant ADT (n= 191). These patients were matched by clinical and pathological variables to a group of patients with pT3b prostate cancer who did not receive adjuvant ADT. Median postoperative follow-up was 10 years. Clinical endpoints included biochemical progression-free survival (BPFS), local recurrence-free survival (LRFS), systemic progression-free survival (SPFS), cancer-specific survival (CSS) and overall survival. Patients who underwent adjuvant ADT experienced improved 10-year BPFS (60% vs 16%, P < 0.001), LRFS (87% vs 76%, P= 0.002), SPFS (91% vs 78%, P= 0.004) and CSS (94% vs 87%, P= 0.037). Overall survival was not significantly different between groups (75% vs 69%, P= 0.12). Both luteinizing hormone-releasing hormone agonists (hazard ratio, 0.26; 95% CI, 0.15-0.46; P < 0.001) and bilateral orchiectomy (hazard ratio, 0.13; 95% CI, 0.06-0.31; P < 0.001) improved BPFS. When stratified by type of ADT (hormonal therapy vs orchiectomy), there was no difference in survival outcomes. Adjuvant ADT improves local, and systemic control after radical prostatectomy for pT3b prostate cancer. There is no difference in survival between patients receiving medical hormonal therapy vs patients undergoing orchiectomy. Given the lack of improvement in overall survival, continued investigation is needed to identify the cohort of pT3b patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach.

Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes

PurposeHypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT.Method and MaterialsBetween Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed.ResultsAt a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation.ConclusionFive-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

Outcome of surgery in locally advanced pT3a prostate cancer.

IntroductionThe aim of this study is to present the oncologic outcomes and to determine prognostic parameters of overall (OS), cancer specific survival (CSS), disease progression free survival (DPFS) and biochemical progression free survival (BPFS) after surgery for pT3a prostate cancer (PCa).Material and methodsBetween 2002 and 2007, a pT3a stage after radical prostatectomy was detected in 126 patients at our institution. Kaplan-Meier analysis was used to calculate OS, CSS, DPFS and BPFS. Cox regression was used to identify predictive factors of survival.ResultsFive-year OS, CSS, DPFS and BPFS rates were 96%, 98.7%, 97.3% and 60%, respectively. Among patients with prostate specific antigen (PSA) <10 ng/ml and PSA >20 ng/ml the 5-year OS was 98.8% and 80%, respectively, whereas 5-year BPFS was 66% and 16.6%, respectively. Survival was different when comparing surgery Gleason score ≤7 and ≥8. 5-year OS and BPFS were 98% vs. 80%, and 62.6% vs. 27.3%, respectively. Specimen Gleason score and preoperative PSA were significant predictors of BPFS. The risk of biochemical progression increased up to 2-fold when a Gleason score ≥8 was present at final pathology.ConclusionsIn locally advanced pT3 PCa, surgery can yield very good cancer control and survival rates especially in cases with PSA <10 ng/ml and Gleason score ≤7. PSA and Gleason score after surgery are the most significant predictors of outcomes after radical prostatectomy.

The correlation between annular treatment margins and biochemical failure in prostate brachytherapy patients with optimized intraprostatic dosimetry

Purpose To determine whether periprostatic treatment margins correlate with biochemical control in prostate brachytherapy patients with optimized intraprostatic dosimetry. Methods and Materials Nineteen biochemically failed brachytherapy patients were matched to 74 dosimetric and clinically equivalent nonfailures. The median followup time for the entire study population was 9.4 years. Eligibility requirements included a Day 0 intraprostatic D 90 of 100% or greater and V 100 of 90% or greater, absence of androgen deprivation therapy, and no evidence of distant metastasis in biochemically failed patients. A 5-mm annulus was constructed around the perimeter of each prostate. D 90 and V 100 at the anterior, posterior, superior, inferior, right lateral, and left lateral aspects of the annulus were evaluated for patients with biochemically controlled and failed disease. Biochemical progression-free survival (bPFS) was defined as a prostate-specific antigen level of 0.40 ng/mL or less after nadir. D 90 and V 100 parameters were compared between the controlled and failed groups using logistic regression. Predictors of biochemical failure were identified using Cox regression. Results No statistically significant differences in prostate-specific antigen level, Gleason score, percent positive biopsies, or intraprostatic dosimetry were observed between the controlled and failed patients. The D 90 and V 100 at the anterior, posterior, superior, inferior, right lateral, and left lateral aspects of the annulus were not statistically different between biochemically controlled and failed groups. Conclusion In this study, there was no relationship observed between annular dosimetry and biochemical control. It is unlikely that further radial dose intensification would have altered treatment outcome in this population of patients with optimized intraprostatic dosimetry.

Neoadjuvant radiotherapy for locally advanced and high-risk prostate cancer

Men presenting with high-risk or locally advanced prostate cancer may benefit from a combination of radiotherapy and surgery to maximize local control. Adjuvant radiotherapy following surgery has improved biochemical progression-free survival, metastasis-free survival, lengthened the time to hormone therapy use and improved overall survival in three randomized-phase III trials. One surprising result of the Southwest Oncology Group (SWOG) 8794 trial and the European Organisation for Research and Treatment of Cancer (EORTC) 22911 trial is that treatment failure was mainly a result of lack of local control. This finding has led to a new appreciation of local control as a determinant of survival and the role for combined modality approaches within a multidisciplinary team in the treatment of high-risk and locally advanced prostate cancer. One emerging novel approach is the use of preoperative or intraoperative radiotherapy in addition to best surgical and systemic treatments. Preliminary results from clinical trials indicate low rates of intraoperative toxic effects, an advantage of short treatment times and smaller image-guided radiotherapy treatment volumes when compared with postoperative radiotherapy. Potential disadvantages include over-treatment of patients and lack of data on long-term toxic effects. We present the published treatment approaches and rational for preoperative and intraoperative radiotherapy and compare these methods to the utility of postoperative radiotherapy.

Radiothérapie postopératoire du cancer de la prostate

More than one third of patients with localized prostate cancer at diagnosis who receive radical prostatectomy have histologically extraprostatic disease. Three randomized trials have demonstrated a significant benefit of postoperative radiotherapy for these patients in terms of biochemical progression-free survival, overall survival or metastasis-free survival in function of each study, at the cost of moderate acute and late toxicity. The technical developments of recent years have enabled the evolution of a three-dimensional conformal radiotherapy, with better adaptation of the dose distribution to the shape of target volumes to preserve organs at risk while delivering the required dose volume target. This requires a thorough knowledge of the prostate cancer radioanatomy, ballistics and dosimetry. Purpose of this work was to specify epidemiological and radioanatomy characteristics for this tumor type and conformal radiation modalities illustrated by a case report.

Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy

Introduction: Prostate cancer with a Gleason score (GS) of 8–10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort.Patients and Methods: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8–10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. Results: The median follow-up time was 88 months (18–168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. Conclusion: Management with aRT only in PSM was very effective, according to our retrospective study.

Transperineal prostate brachytherapy, using I-125 seed with or without adjuvant androgen deprivation, in patients with intermediate-risk prostate cancer: study protocol for a phase III, multicenter, randomized, controlled trial

BackgroundThe optimal protocol for 125I-transperineal prostatic brachytherapy (TPPB) in intermediate-risk prostate cancer (PCa) patients remains controversial. Data on the efficacy of combining androgen-deprivation therapy (ADT) with 125I-TPPB in this group remain limited and consequently the guidelines of the American Brachytherapy Society (ABS) provide no firm recommendations.Methods/DesignSeed and Hormone for Intermediate-risk Prostate Cancer (SHIP) 0804 is a phase III, multicenter, randomized, controlled study that will investigate the impact of adjuvant ADT following neoadjuvant ADT and 125I-TPPB. Prior to the end of March, 2011, a total of 420 patients with intermediate-risk, localized PCa will be enrolled and randomized to one of two treatment arms. These patients will be recruited from 20 institutions, all of which have broad experience of 125I-TPPB. Pathological slides will be centrally reviewed to confirm patient eligibility. The patients will initially undergo 3-month ADT prior to 125I-TPPB. Those randomly assigned to adjuvant therapy will subsequently undergo 9 months of adjuvant ADT. All participants will be assessed at baseline and at the following intervals: every 3 months for the first 24 months following 125I-TPPB, every 6 months during the 24- to 60-month post-125I-TPPB interval, annually between 60 and 84 months post-125I-TPPB, and on the 10th anniversary of treatment.The primary endpoint is biochemical progression-free survival (BPFS). Secondary endpoints are overall survival (OS), clinical progression-free survival, disease-specific survival, salvage therapy non-adaptive interval, acceptability (assessed using the international prostate symptom score [IPSS]), quality of life (QOL) evaluation, and adverse events. In the correlative study (SHIP36B), we also evaluate biopsy results at 36 months following treatment to examine the relationship between the results and the eventual recurrence after completion of radiotherapy.DiscussionThese two multicenter trials (SHIP0804 & SHIP36B) are expected to provide crucial data regarding the efficacy, acceptability and safety of adjuvant ADT. SHIP36B will also provide important information about the prognostic implications of PSA levels in intermediate-risk PCa patients treated with 125I-TPPB.Trial registrationNCT00664456, NCT00898326, JUSMH-BRI-GU05-01, JUSMH-TRIGU0709

High-Risk Prostate Cancer With Gleason Score 8–10 and PSA Level ≤15 ng/ mL Treated With Permanent Interstitial Brachytherapy

With widespread prostate-specific antigen (PSA) screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by a Gleason score (GS) ≥8 coupled with a relatively low PSA level. The optimal management of these patients has not been defined. Cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) were evaluated in brachytherapy patients with a GS ≥8 and a PSA level ≤15 ng/mL with or without androgen-deprivation therapy (ADT). From April 1995 to October 2005, 174 patients with GS ≥8 and a PSA level ≤15 ng/mL underwent permanent interstitial brachytherapy. Of the patients, 159 (91%) received supplemental external beam radiation, and 113 (64.9%) received ADT. The median follow-up was 6.6 years. The median postimplant Day 0 minimum percentage of the dose covering 90% of the target volume was 121.1% of prescription dose. Biochemical control was defined as a PSA level ≤0.40 ng/mL after nadir. Multiple parameters were evaluated for impact on survival. Ten-year outcomes for patients without and with ADT were 95.2% and 92.5%, respectively, for CSS (p = 0.562); 86.5% and 92.6%, respectively, for bPFS (p = 0.204); and 75.2% and 66.0%, respectively, for OS (p = 0.179). The median post-treatment PSA level for biochemically controlled patients was <0.02 ng/mL. Multivariate analysis failed to identify any predictors for CSS, whereas bPFS and OS were most closely related to patient age. Patients with GS ≥8 and PSA level ≤15 ng/mL have excellent bPFS and CSS after brachytherapy with supplemental external beam radiotherapy. The use of ADT did not significantly impact bPFS, CSS, or OS.

Response to Treatment for Prostate Cancer in Patients with Human Immunodeficiency Virus

To examine the clinicopathological characteristics and the outcome of HIV-infected patients treated for prostate cancer. We performed a retrospective chart review of all patients with prostate cancer treated at the Brooklyn Veterans Administration Medical Center. We recorded the immunological status at diagnosis, pathological data, treatment parameters, acute treatment-related toxicity, late treatment related toxicity, and biochemical failure. 16 prostate cancer patients treated between 1992 and 2008 were HIV-positive. Median age at diagnosis was 59 years. Median follow-up was 39 months. Ten patients were on highly active antiretroviral therapy (HAART) at prostate cancer diagnosis. Median CD4 count for all patients was 419. Median Gleason Score was 7. Median prostate-specific antigen was 6.3 ng/ml. Sixteen patients were treated with radiotherapy. 5-yr biochemical progression-free survival was 83%. Most patients experienced some gastrointestinal (GI) or genitourinary (GU) toxicity. In only five cases was acute GU toxicity clinically significant (grade ≥ 2). Four patients experienced clinically significant GI toxicity (grade ≥ 2). One of these patients developed late grade 3 GI toxicity. Five patients experienced clinically significant (grade ≥ 2) GU or GI late toxicity. In four of these patients late toxicity was limited to grade 2 GU symptoms. Prostate cancer therapy was well-tolerated in HIV-positive patients.

Clinical Impact of a PTV Reduction on Late Toxicity and Short-term Biochemical Progression-free Survival for Patients Treated with High Dose (78Gy) Daily On-line IG-IMRT for Prostate Cancer

Ultrasound (US)-based daily online IGRT is a user-friendly and noninvasive procedure. Comparisons between 2D-US and CT or fiducial marker-based strategies for interfraction localization have demonstrated that US was less accurate. We aimed to evaluate the clinical impact of a PTV margin reduction when delivering 3D-US-based daily online IG-IMRT.

Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

Standard prostate biopsy schemes underestimate Gleason score in a significant percentage of cases. Extended biopsy improves diagnostic accuracy and provides more reliable prognostic information. In this study, we tested the hypothesis that greater biopsy core number should result in improved treatment outcome through better tailoring of therapy. From April 1995 to May 2006, 1,613 prostate cancer patients were treated with permanent brachytherapy. Patients were divided into five groups stratified by the number of prostate biopsy cores (≤6, 7-9, 10-12, 13-20, and >20 cores). Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were evaluated as a function of core number. The median patient age was 66 years, and the median preimplant prostate-specific antigen was 6.5 ng/mL. The overall 10-year bPFS, CSS, and OS were 95.6%, 98.3%, and 78.6%, respectively. When bPFS was analyzed as a function of core number, the 10-year bPFS for patients with >20, 13-20, 10-12, 7-9 and ≤6 cores was 100%, 100%, 98.3%, 95.8%, and 93.0% (p < 0.001), respectively. When evaluated by treatment era (1995-2000 vs. 2001-2006), the number of biopsy cores remained a statistically significant predictor of bPFS. On multivariate analysis, the number of biopsy cores was predictive of bPFS but did not predict for CSS or OS. Greater biopsy core number was associated with a statistically significant improvement in bPFS. Comprehensive regional sampling of the prostate may enhance diagnostic accuracy compared to a standard biopsy scheme, resulting in better tailoring of therapy.

Prognostic value of initial prostate‐specific antigen levels after salvage cryoablation for prostate cancer

To assess the prognostic value of initial prostate-specific antigen (PSA) levels after salvage cryoablation (SCA) for the long-term biochemical progression-free survival (bPFS) in patients with prostate cancer. In all, 455 hormone-naïve patients from the Cryo On Line Data Registry, and treated with whole-gland SCA were assessed for PSA-based bPFS using the Phoenix criteria. The initial PSA level measured after SCA was considered the nadir. Kaplan-Meier plots of bPFS for initial PSA level of <0.6, ≥0.6-≤5.0 and >5.0 ng/mL were constructed and plotted to 60 months. In all, 280 patients had an initial PSA level of <0.6 ng/mL after SCA. At 12, 24 and 36 months 80%, 73.6%, and 67% of patients, respectively, were progression-free. For 118 patients with an initial PSA level after SCA of ≥0.6-≤5 ng/mL, 28% and 50% of these patients at 6 and 12 months, respectively, had PSA progression. Of 57 patients with an initial PSA level of ≥5 ng/mL, 64% progressed at 6 months. The PSA level before SCA and Gleason score correlated with bPFS by Spearman correlation (P < 0.001 and 0.002), respectively. Curative therapy in prostate cancer not responding to radiotherapy is extremely challenging. There is no definition of success for cryosurgical treatment. The available data indicate that an initial PSA level of <0.6 ng/mL after SCA portends a favourable (67% at 36 months) bPFS. Individuals with initial PSA levels of ≥0.6 ng/mL after SCA are at risk of short-term biochemical progression (50% at 12 months).

External validation of the cancer of the prostate risk assessment (CAPRA) score in a single-surgeon radical prostatectomy series

ObjectivesProstate cancer clinical staging has significant limitations in the ability to accurately risk-stratify patients for prompt treatment or expectant management. The University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF CAPRA) was recently described as a straightforward staging system that uses clinical variables to generate a score ranging from 0 to 10. Our objective was to perform an external validation of the CAPRA score as a predictor of 5-year progression-free survival (PFS) in a single-surgeon radical retropubic prostatectomy (RRP) series. Materials and methodsWe examined the performance characteristics of the preoperative CAPRA score (0–10) to predict biochemical progression-free survival (PFS) in 990 men who underwent RRP by a single surgeon from 2003 to 2009. ResultsCAPRA scores were significantly associated with the risk of early biochemical progression in our series. For example, 5-year PFS was markedly different for scores at the extremes of 0 to 1 vs. ≥7 (95% vs. 40%, respectively). The concordance index was 0.764 for the prediction of biochemical progression using CAPRA scores in this cohort, which compares favorably with the concordance index of 0.66 in the original CaPSURE dataset. ConclusionsOur results validate the UCSF-CAPRA score as a significant predictor of 5-year PFS in a single surgeon series. The CAPRA score is a simple preoperative tool that can be readily applied in clinical practice to help risk-stratify prostate cancer patients.

Efficacy and tolerance of salvage radiotherapy after radical prostatectomy, with emphasis on high-risk patients suited for adjuvant radiotherapy

Background and purpose Goals of this study are to report the outcomes and tolerance of salvage radiotherapy (SRT) after prostatectomy, to identify risk factors for failure after SRT and to evaluate how these results compare with published results of immediate post-operative adjuvant radiotherapy (ART). Material and methods Men receiving SRT for elevated PSA levels after radical prostatectomy (RP) were included. Biochemical progression-free survival (bPFS), overall survival (OS) and disease-specific survival (DSS) were estimated. Risk factors for biochemical failure and death were evaluated. Late toxicity and quality of life were evaluated. Secondary bPFS (defined as bPFS from prostatectomy until progression after radiotherapy) was calculated for high-risk patients (pT3 and/or positive surgical margins) in order to compare SRT outcomes with ART. Results 197 Men were included. Five-year bPFS after SRT was 59% (95% CI 49–69%). Five-year OS and DSS were 90% (85–96%) and 97% (93–100%), respectively. Capsular perforation (pT ⩾ T3), negative surgical margins and serum PSA > 1 ng/ml at the start of RT were significant predictors of lower bPFS. Patients without any negative factors had a 5-year bPFS of 89%. No severe late toxicity was reported. Five-year secondary bPFS for SRT in high-risk patients was 78% and comparable with published results for ART. Conclusions Salvage radiotherapy for patients with organ-confined prostate cancer was effective and well tolerated. SRT outcomes were comparable with published ART results for high-risk patients. Initially monitoring serum PSA and considering early SRT for these patients are not harmful and might be a valuable alternative for immediate ART.