Curative Treatment For Prostate Cancer Research Articles

Assessing the Impact of the Prostate Cancer Patient Empowerment Program (PC-PEP) on Relationship Satisfaction, Quality of Life, and Support Group Participation: A Randomized Clinical Trial.

Background/Objectives: The Prostate Cancer Patient Empowerment Program (PC-PEP) is a 6-month, home-based intervention aimed at enhancing mental health in men undergoing curative prostate cancer treatment. This exploratory secondary analysis evaluates PC-PEP's impact on relationship satisfaction, quality of life, and support group attendance among partnered participants. Methods: In a crossover randomized clinical trial ClinicalTrials.gov identifier: NCT03660085) of 128 men aged 50-82 scheduled for curative prostate cancer surgery or radiotherapy, 119 participants in relationships were included. Of these, 59 received the 6-month PC-PEP intervention, while 60 were randomized to a waitlist-control arm, receiving standard care for 6 months before starting PC-PEP. The intervention included daily emails with video instructions on mental and physical health, diet, social support, fitness, stress reduction, and intimacy. Outcomes were assessed using the Dyadic Adjustment Scale (DAS) and the Functional Assessment of Cancer Therapy-Prostate (FACT-P). Results: While relationship satisfaction remained stable, a significant improvement in emotional well-being was observed at 12 months in participants undergoing radiation therapy (p = 0.045). The PC-PEP intervention also led to significantly higher support group attendance at both 6 months (p = 0.001) and 12 months (p = 0.003), emphasizing its role in fostering social support and community engagement. Conclusions: The PC-PEP program effectively maintains relationship satisfaction and enhances emotional well-being, particularly in patients with fewer physical side effects. Its design promotes comprehensive care by integrating physical, psychological, and social support, making it a valuable resource for improving the quality of life in prostate cancer patients and potentially applicable to other cancer types.

Loss of miR-200c-3p promotes resistance to radiation therapy via the DNA repair pathway in prostate cancer

Radiotherapy represents a major curative treatment for prostate cancer (PCa), but some patients will develop radioresistance (RR) and relapse. The underlying mechanisms remain poorly understood, and miRNAs might be key players in the acquisition and maintenance of RR. Through their encapsulation in small extracellular vesicles (EVs), they can also be relevant biomarkers of radiation response. Using next-generation sequencing, we found that miR-200c-3p was downregulated in PCa RR cells and in their small EVs due to a gain of methylation on its promoter during RR acquisition. We next showed that its exogenous overexpression restores the radiosensitivity of RR cells by delaying DNA repair through the targeting of HP1α. Interestingly, we also observed downregulation of miR-200c-3p expression by DNA methylation in radiation-resistant lung and breast cancer cell lines. In summary, our study demonstrates that the downregulation of miR-200c-3p expression in PCa cells and in their small EVs could help distinguish radioresistant from sensitive tumor cells. This miRNA targets HP1α to delay DNA repair and promote cell death.

The use of focal therapy for the treatment of prostate cancer in Canada: Where are we, how did we get here, and where are we going?

Focal therapy is an emerging treatment for localized prostate cancer. The objectives of this review were to: 1) review how focal therapies are regulated and approved; 2) summarize the scope and quality of the literature regarding safety, efficacy, and side-effects; and 3) outline ongoing clinical trials of focal therapy in Canada. Using the PRISMA framework for scoping reviews, we searched PubMed, Embase, and Cochrane from 2021-2024, complementing Hopstaken et al's search up functional and oncologic outcomes. Additionally, we examined the FDA database for regulatory details and ongoing trials in Canada via ClinicalTrial.gov. FDA approval for prostate tissue ablation was granted to high-intensity focused ultrasound (HIFU) in 2015 via the de novo pathway; other therapies followed the 510(k) route, citing equivalence to predicate devices. Most studies are in early stages, primarily single-arm, prospective cohort designs. Oncologic outcomes like cancer detection and survival rates, alongside functional data, such as adverse events and erectile function, were assessed. Recurrence-free survival at 48 months ranged from 58-92%, pad-free rates were greater than 95%, and rates of new-onset erectile dysfunction were variable, ranging from no change to 50%. Rates of serious adverse events (SAEs) were low, ranging from 0-14%. Three Canadian clinical trials are actively enrolling participants, and five private clinics were found offering private HIFU, irreversible electroporation (IRE), or transurethral ultrasound ablation (TULSA). Focal therapy technologies have gained regulatory approval for prostate tissue ablation, and, aside from provincial support for cryoablation in Alberta, are available to Canadians through private payment or clinical trials. Many studies demonstrate promising cancer control and impressive functional outcomes but are limited by their short followup and lack of comparator group. Clinical trial or registry participation should be prioritized to ensure an evidence-based integration into current prostate cancer treatment approaches.

Image guided radiotherapy in curative treatment for prostate cancer. 5-year results from a randomized controlled trial (RIC-trial)

BackgroundBetween 2012 and 2015 we conducted a randomized controlled trial in prostate cancer patients comparing weekly 2-D portal imaging versus daily 3-D verification. AimTo evaluate the clinical outcomes of image guided radiotherapy by presenting rectal and urinary side effects, health related quality of life and progression free survival after 5-years follow up of a randomized controlled trial. MethodsWe randomized 260 men with intermediate or high-risk prostate cancer to weekly 2-D portal imaging with 15 mm margin from CTV to PTV (Arm A) or daily 3-D cone-beam computer tomography with 7 mm margins (Arm B). Prescribed doses were 78 Gy/39 fractions. All patients received hormonal therapy. Primary end point was patient reported bowel symptoms and secondary outcomes were patient reported urinary symptoms, health- related quality of life and progression free survival. ResultsOf the 216 patients available for analyses at 5 years more than 90 % completed patient reported outcome measures. There were no significant differences between study arms for any single items nor scales evaluating bowel symptoms. There were also no differences in self-reported urinary symptoms nor in health-related quality of life. Symptom scores were low in both study arms. Progression free survival was similar in Arm B as compared to arm A (Hazard ratio 1.01; 95 % CI 0.57 to 1.97). ConclusionsOur results support that both 2-D weekly and 3-D daily image guided radiotherapy are safe and efficient treatments for PC and emphasize the need to evaluate technological progress in clinical trials with long follow-up.

Pretreatment Patient-reported Overall Health: A Prognostic Factor for Early Overall Mortality After Primary Curative Treatment of Prostate Cancer

Background and objectiveRegistry-based studies for prostate cancer (PCa) document higher overall mortality (OM) after high-dose radiotherapy (RT) than after radical prostatectomy (RP). Our aim was to explore the association between pretreatment patient-reported health (“OverallHealth”: OH) and curative treatment type, and the impact on early OM. MethodsNew PCa patients registered between 2017 and 2019 in the Cancer Registry of Norway (n = 1949) completed the European Organisation for Research and Treatment of Cancer Quality-of-Life Core 30 (QLQ-C30) questionnaire before RP (n = 592) or RT (n = 610) or after allocation to active surveillance (AS; n = 747). We dichotomised the QLQ-C30 summary score to classify patients with un-impaired versus impaired OH. Standard univariable and multivariable analyses with treatment type or OM as the outcome were conducted. The mean observation time was 4.7 years (standard deviation 1.0). Statistical significance was set at p < 0.05. Key findings and limitationsImpaired OH was more frequent in the RT group (38%) than in the RP (25%) or AS (28%) group (p < 0.001). Higher age, higher risk group, and impaired OH increased the probability of undergoinRT rather than RP (p < 0.001). Impaired OH was associated with a twofold higher early OM rate in the RT group (16% vs 8%; p = 0.009) and fourfold higher OM rate in the AS group (13% vs 3%; p < 0.001). These findings remained significant in Cox regression analyses controlled for age and risk group. After RP, only locally advanced high-risk tumours were significantly associated with OM. Unknown psychometrics for the OH variable is the main study limitation. Conclusions and clinical implicationsPretreatment patient-reported impaired OH, measured as the QLQ-C30 summary score, was positively associated with allocation to RT or AS and is a prognostic factor for early OM. Before allocation to RT or AS, elderly patients with PCa should be screened and treated for health problems that can be remedied. Future studies should determine the psychometrics of the QLQ-C30 summary score in comparison to established frailty screening instruments. Patient summaryPatient-reported scores reflecting their overall health can help in choosing curative treatment for prostate cancer and are associated with survival during the first 5 years after treatment.

Abstract 805: Employment characteristics and work ability differences by race and income before undergoing curative treatment for prostate cancer (PCW WF-1802)

Abstract Background: African American (AA) men are, on average, diagnosed with prostate cancer at younger ages and more advanced stages than white men and therefore may be at greater risk of having cancer treatment negatively impact their work ability and job opportunities. This longitudinal, observational study aims to better identify whether race, household income (&amp;lt; or ≥ 300% the U.S. poverty line), or work-related factors may place some men with prostate cancer at greater risk for experiencing negative employment impacts from cancer treatment and its side effects. Here we report on individual and employment-related factors by race and income prior to treatment initiation. Methods: AA and white men who were expected to undergo primary curative treatment (prostatectomy or radiation therapy) in the near future for prostate cancer were recruited through the Wake Forest NCORP Research Base (UG1CA189824, NCT03963739) between 2019 and 2023. Participants were AA or white, recently employed, expecting to be working in 6 months, and willing to disclose income status. Participants answered questions prior to treatment initiation related to employment and working conditions, work ability, and demographic characteristics. Differences in outcomes by race and income were analyzed with Fisher's exact test or t-test. Results: The baseline questionnaire was completed by 244 men; 48% AA/52% white and 64% higher/36% lower Income. Most planned treatments included radiation therapy (60%) and/or prostatectomy (41%), with no statistical differences by income or race. Higher income men were significantly more likely than lower income men to be married, have attained higher education, have a management or professional job, work full-time, be a permanent employee, salaried, eligible to retain their job under FMLA, work in an office/home, have a psychologically demanding job, and less likely to hold a physically demanding job. AA men were significantly less likely than white men to be married, have attained higher education, have a management or professional job, or work in an office/home. AA men were more continuously hopeful about the future (69%) compared to white men (52%; p=0.0079). There were no significant differences across categories in age, perceived current work ability in relation to physical (69% very good) or mental (71% very good) demands, or number of jobs held. Prior to treatment, participants reported almost optimal current work ability (mean 9.0, SD 1.2) with a range of 0 to 10 with 10 as best possible work ability. Conclusion: In this study, income category is a greater predictor than race of job characteristics that may impact employment following definitive prostate cancer treatment. Citation Format: Joanne C. Sandberg, Emily V. Dressler, Louis S. Krane, Karen M. Winkfield, Lingyi Lu, Andrew M. Mayfield, Drew C. Monitto, J. Daniel Pennington, Deimante M. Tamkus, Glenn J. Lesser. Employment characteristics and work ability differences by race and income before undergoing curative treatment for prostate cancer (PCW WF-1802) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 805.

A Linear and Nonlinear QSAR Analysis of Benzimidazole Derivative XY123 in Prostate Cancer Treatment

Background: Metastatic Castration-Resistant Prostate Cancer (mCRPC) represents a critical challenge in current prostate cancer treatment. Benzimidazole Derivative XY123 has emerged as a novel inhibitor for its treatment. Objective: This study aims to establish a robust Quantitative Structure-Activity Relationship (QSAR) model for predicting the activity of Benzimidazole Derivative XY123 derivatives, aiding the development of novel anti-prostate cancer drugs. Methods: Utilizing CODESSA software, descriptors were computed based on various moieties of Benzimidazole Derivative XY123 derivatives. Multiple linear regression models were constructed, and both linear and nonlinear QSAR models were developed using heuristics and gene expression programming. Results: The linear model with two descriptors demonstrated the best predictive capacity for inhibitor activity, while the nonlinear model generated through Gene Expression Programming (GEP) exhibited correlation coefficients of 0.83 and 0.82 for the training and test sets, respectively. The average errors were 0.03 and 0.05, indicating the stability and the improved predictive ability of the nonlinear model. Conclusion: The QSAR linear model has an advantage over the nonlinear model in optimizing Benzimidazole Derivative XY123, providing a direction for the development of effective drugs for mCRPC treatment.

The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study.

We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects. This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014-2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment. Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min-max 44-84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] -0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance. In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study

BackgroundData on functional and psychological side effects following curative treatment for prostate cancer are lacking from large, contemporary, unselected, population-based cohorts. ObjectiveTo assess urinary symptoms, bowel disturbances, erectile dysfunction (ED), and quality of life (QoL) 12 mo after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) using patient-reported outcome measures in the Swedish prostate cancer database. Design, setting, and participantsThis was a nationwide, population-based, cohort study in Sweden of men who underwent primary RARP or RT between January 1, 2018 and December 31, 2020. Outcome measurements and statistical analysisAbsolute proportions and odds ratios (ORs) were calculated using multivariable logistic regression, with adjustment for clinical characteristics. Results and limitationsA total of 2557 men underwent RARP and 1741 received RT. Men who underwent RT were older (69 vs 65 yr) and had more comorbidities at baseline. After RARP, 13% of men experienced incontinence, compared to 6% after RT. The frequency of urinary bother was similar, at 18% after RARP and 18% after RT. Urgency to defecate was reported by 14% of men after RARP and 34% after RT. At 1 yr, 73% of men had ED after RARP, and 77% after RT. High QoL was reported by 85% of men after RARP and 78% of men after RT. On multivariable regression analysis, RT was associated with lower risks of urinary incontinence (OR 0.25, 95% confidence interval [CI] 0.19–0.33), urinary bother (OR 0.79, 95% CI 0.66–0.95), and ED (OR 0.54, 95% CI 0.46–0.65), but higher risk of bowel symptoms (OR 2.86, 95% CI 2.42–3.39). QoL was higher after RARP than after RT (OR 1.34, 95% CI 1.12–1.61). ConclusionsShort-term specific side effects after curative treatment for prostate cancer significantly differed between RARP and RT in this large and unselected cohort. Nevertheless, the risk of urinary bother was lower after RT, while higher QoL was common after RARP. Patient summaryIn our study of patients treated for prostate cancer, urinary bother and overall quality of life are comparable at 1 year after surgical removal of the prostate in comparison to radiotherapy, despite substantial differences in other side effects.

Therapeutic Approaches to Targeting Androgen Receptor Splice Variants.

Therapeutic options for advanced prostate cancer have vastly expanded over the last decade and will continue to expand in the future. Drugs targeting the androgen receptor (AR) signaling pathway, i.e., androgen receptor targeting agents (ARTAs), remain the mainstream treatments that are increasingly transforming the disease into one that can be controlled for an extended period of time. Prostate cancer is inherently addicted to AR. Under the treatment pressure of ARTA, molecular alterations occur, leading to the clonal expansion of resistant cells in a disease state broadly categorized as castration-resistant prostate cancer (CRPC). One castration resistance mechanism involves AR splice variants (AR-Vs) lacking the ligand-binding domain. Some AR-Vs have been identified as constitutively active, capable of activating AR signaling pathways without androgenic ligands. Among these variants, AR-V7 is the most extensively studied and may be measured non-invasively using validated circulating tumor cell (CTC) tests. In the context of the evolving prostate cancer treatment landscape, novel agents are developed and evaluated for their efficacy in targeting AR-V7. In patients with metastatic CRPC (mCRPC), the availability of the AR-V7 tests will make it possible to determine whether the treatments are effective for CTC AR-V7-positive disease, even though the treatments may not be specifically designed to target AR-V7. In this review, we will first outline the current prostate cancer treatment landscape, followed by an in-depth review of relatively newer prostate cancer therapeutics, focusing on AR-targeting agents under clinical development. These drugs are categorized from the standpoint of their activities against AR-V7 through direct or indirect mechanisms.

Stereotactic Body Radiation Therapy for the Curative Treatment of Prostate Cancer in Ultralarge (≥100 cc) Glands

PurposeHistorically, toxicity concerns have existed in patients with large prostate glands treated with radiotherapy (RT), particularly brachytherapy. There are questions whether this risk extends to stereotactic body radiation therapy (SBRT). In this retrospective review, we examine clinical outcomes of patients with prostate glands ≥100 cc treated curatively with SBRT. Methods and MaterialsWe retrospectively analyzed a large institutional database to identify patients with histologically confirmed localized prostate cancer in glands ≥100 cc, who were treated with definitive-robotic SBRT. Prostate volume (PV) was determined by treatment planning magnetic resonance imaging (MRI). Toxicity was measured using CTCAE version 5.0. Many patients received the Expanded Prostate Cancer Index Composite (EPIC) Quality of Life (QOL) questionnaires. Minimum follow-up (FU) was 2 years. ResultsSeventy-one patients were identified with PV ≥100 cc. Most had grade group (GG) 1 or 2 (41% and 37%, respectively) disease. All patients received a total dose of 3500-3625 cGy in 5 fractions. A minority (27%) received ADT, which was used for gland size downsizing in only 10% of cases. Nearly half (45%) were taking GU medications for urinary dysfunction prior to RT. Median toxicity FU was 4.0 years. Two-year rates of Grade 1+ genitourinary (GU), Grade 1+ gastrointestinal (GI), and Grade 2+ GU toxicity were 43.5%, 15.9%, and 30.4%, respectively. Total Grade 3 GU toxicities were very limited (2.8%). There were no Grade 3 GI toxicities. On logistic regression analysis, pretreatment use of GU medications was significantly associated with increased rate of Grade 2+ GU toxicity (OR = 3.19, p = 0.024). Furthermore, PV (analyzed as a continuous variable) did not have an effect on toxicity, QOL, or oncologic outcomes. ConclusionsWith early FU, ultra-large prostate glands do not portend increased risk of high-grade toxicity following SBRT but likely carry an elevated risk of low-grade GU toxicity.

Patient-reported outcomes after curative treatment for prostate cancer with prostatectomy, primary radiotherapy or salvage radiotherapy

Background Trials reporting adverse health outcomes (AHOs) in terms of patient-reported outcome measures (PROMs) after contemporary curative treatment of prostate cancer (PC) are hampered by study heterogeneity and lack of new treatment techniques. Particularly, the evidence regarding toxicities after radiotherapy (RT) with the volumetric arc therapy (VMAT) technique is limited, and comparisons between men treated with surgery, primary radiotherapy (PRT) and salvage radiotherapy (SRT) are lacking. The aim of the study was to evaluate change in PROMs 3 months after treatment with robotic-assisted laparoscopic prostatectomy (RALP), PRT and SRT administered with VMAT. Material and methods A prospective cohort study of men with PC who received curative treatment at the University Hospital of North Norway between 2012 and 2017 for RALP and between 2016 and 2021 for radiotherapy was conducted. A cohort of 787 men were included; 406 men treated with RALP, 265 received PRT and 116 received SRT. Patients completed the validated PROM instrument EPIC-26 before (pre-treatment) and 3 months after treatment. EPIC-26 domain summary scores (DSSs) were analysed, and changes from pre-treatment to 3 months reported. Changes were deemed clinically relevant if exceeding validated minimally clinically important differences (MCIDs). Results Men treated with RALP reported clinically relevant declining urinary incontinence DSS (−41.7 (SD 30.7)) and sexual DSS (−46.1 (SD 30.2)). Men who received PRT reported worsened urinary irritative DSS (−5.2 (SD 19.6)), bowel DSS (−8.2 (SD 15.1)) and hormonal DSS (−9.6 (SD 18.2)). Men treated with SRT experienced worsened urinary incontinence DSS (−7.3 (SD 18.2)), urinary irritative DSS (−7.5 (SD 14.0)), bowel DSS (−12.5 (SD 16.1)), sexual DSS (−14.9 (SD 18.9)) and hormonal DSS (−23.8 (SD 20.9)). Conclusion AHOs 3 months after contemporary curative treatment for PC varied according to treatment modality and worsened in all treatment groups, although most in SRT.

Re: A Comprehensive 6-mo Prostate Cancer Patient Empowerment Program Decreases Psychological Distress Among Men Undergoing Curative Prostate Cancer Treatment: A Randomized Clinical Trial

The Research Electronic Data Capture (REDCap) data management platform was developed in 2004 to address an institutional need at Vanderbilt University, then shared with a limited number of adopting sites beginning in 2006. Given bi-directional benefit in early sharing experiments, we created a broader consortium sharing and support model for any academic, non-profit, or government partner wishing to adopt the software. Our sharing framework and consortium-based support model have evolved over time along with the size of the consortium (currently more than 3200 REDCap partners across 128 countries). While the “REDCap Consortium” model represents only one example of how to build and disseminate a software platform, lessons learned from our approach may assist other research institutions seeking to build and disseminate innovative technologies.

PD27-09 PATIENT REPORTED OUTCOMES AFTER RADICAL PROSTATECTOMY OR RADIOTHERAPY FOR PROSTATE CANCER, A REGISTER-BASED NATIONWIDE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD27-09 PATIENT REPORTED OUTCOMES AFTER RADICAL PROSTATECTOMY OR RADIOTHERAPY FOR PROSTATE CANCER, A REGISTER-BASED NATIONWIDE STUDY Oskar Bergengren, Christian Corsini, Stefan Carlsson, Ingela Franck-Lissbrant, Hans Garmo, Marie Hjelm-Eriksson, Per Fransson, Jon Kindblom, David Robinson, Marcus Westerberg, Pär Stattin, and Sigrid Carlsson Oskar BergengrenOskar Bergengren More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Stefan CarlssonStefan Carlsson More articles by this author , Ingela Franck-LissbrantIngela Franck-Lissbrant More articles by this author , Hans GarmoHans Garmo More articles by this author , Marie Hjelm-ErikssonMarie Hjelm-Eriksson More articles by this author , Per FranssonPer Fransson More articles by this author , Jon KindblomJon Kindblom More articles by this author , David RobinsonDavid Robinson More articles by this author , Marcus WesterbergMarcus Westerberg More articles by this author , Pär StattinPär Stattin More articles by this author , and Sigrid CarlssonSigrid Carlsson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The two main alternatives for curative treatment of prostate cancer (PCa) are robot assisted radical prostatectomy (RARP) and radiotherapy (RT). We assessed outcomes after RARP and RT by use of Patient Reported Outcomes Measures (PROM) in a large, contemporary population. METHODS: The National Prostate Cancer Register of Sweden (NPCR) includes information on almost all Swedish men with PCa. The PCa Data Base Sweden (PCBaSe) links data to multiple national population-based registries. PROM are distributed to all men scheduled for curative treatment. 12 month PROM were used to evaluate the outcomes erectile dysfunction, urinary symptoms, bowel dysfunction, and quality of life (QoL). Data for all men who completed 12 month PROM in PCBaSe 5.0 aged <75 years, with clinical T1c-T3 or Tx, any Gleason score, preoperative PSA levels <l00 ng/mL, no metastases (N0, Nx. M0 or Mx) who underwent RARP or RT between 1 January 2018 and 31 December 2020 were analyzed (n=4298). Comorbidities were assessed by Charlson Comorbidity Index and a Drug Comorbidity Index. Adjusted odds ratios (OR) for each outcome comparing RT vs RARP (reference) were obtained using logistic regression, adjusting for confounders at date of treatment (age, comorbidities, educational level, civil status, PSA, prostate volume, biopsies with cancer, cT-stage and Gleason score). RESULTS: 2557 men underwent RARP and 1741 men received RT. On average, men who had undergone RT were 4 years older and had more comorbidities. The prevalence of erectile dysfunction was 80% among men who underwent RARP and 82% among RT. 13% of the men were incontinent one year after RARP while only 5% reported incontinence after RT. 17% of men treated with RT and 18% with RARP reported high urinary bother. 34% of men who underwent RT reported urgency to defecate compared to 14% of men treated with RARP. High QoL was reported by 85% of men who underwent RARP and 79% who underwent RT. RT was associated with lower risk of erectile dysfunction (OR 0.57, 95% CI 0.48-0.67), lower risk of urine incontinence (OR 0.24, 95% CI 0.19-0.32), lower urinary bother (OR 0.74, 95% CI 0.61-0.89) but higher risk of bowel related symptoms (OR 2.84 95%, CI: 2.40-3.37). RARP was associated with higher QoL (OR 1.33, 95% CI: 1.11-1.60). CONCLUSIONS: Results from this large, contemporary, and unselected population confirms previous reports on common side-effects after curative treatment for PCa. However, QoL is high regardless of treatment suggesting that factors other than side-effects are the main drivers of QoL. Source of Funding: National Institutes of Health/National Cancer Institute (K22 CA234400) to Dr. Carlsson and Hillevi Fries Research Foudation, Johanna Hagstrand and Sigfrid Linnérs Research Foundation, Nyströms America Scholarship, and the Swedish Society of Medicine to Dr. Bergengren © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e745 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oskar Bergengren More articles by this author Christian Corsini More articles by this author Stefan Carlsson More articles by this author Ingela Franck-Lissbrant More articles by this author Hans Garmo More articles by this author Marie Hjelm-Eriksson More articles by this author Per Fransson More articles by this author Jon Kindblom More articles by this author David Robinson More articles by this author Marcus Westerberg More articles by this author Pär Stattin More articles by this author Sigrid Carlsson More articles by this author Expand All Advertisement PDF downloadLoading ...

Cardiovascular outcomes after curative prostate cancer treatment: A population-based cohort study.

To investigate differences in cardiovascular disease (CVD) morbidity and mortality after radical prostatectomy or definitive radiotherapy with or without androgen deprivation therapy (ADT). We used population-based data from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Cause of Death Registry including 19 289 men ≤80 years diagnosed with non-metastatic prostate cancer during 2010-2019. Patients were treated with radical prostatectomy or definitive radiotherapy. We used competing risk models to compare morbidity from overall CVD, acute myocardial infarction (AMI), cerebral infarction, thromboembolism, and CVD-specific mortality for the overall cohort and stratified by prognostic risk groups. After a median follow-up time of 5.4 years (IQR 4.6 years), there were no differences in adjusted rates of AMI, cerebral infarction, and CVD-specific death between radical prostatectomy and definitive radiotherapy in any of the prognostic risk groups. Rates of overall CVD (0.82; 95% CI 0.76-0.89) and thromboembolism (0.30; 95% CI 0.20-0.44) were lower for definitive radiotherapy than radical prostatectomy during the first year of follow-up. After this overall CVD rates (1.19; 95% CI 1.11-1.28) were consistently higher across all risk groups in patients treated with definitive radiotherapy, but there were no differences regarding thromboembolism. During the first years after treatment, no differences were found in rates of AMI, cerebral infarction, and CVD-specific death between radiotherapy and radical prostatectomy in any of the prognostic risk groups. This suggests that ADT use in combination with radiotherapy may not increase the risks of these outcomes in a curative setting. The increased overall CVD rate for definitive radiotherapy after the first year indicates a possible relationship between definitive radiotherapy and other CVDs than AMI and cerebral infarction.

A Comprehensive 6-mo Prostate Cancer Patient Empowerment Program Decreases Psychological Distress Among Men Undergoing Curative Prostate Cancer Treatment: A Randomized Clinical Trial

BackgroundAlthough survival rates for newly diagnosed prostate cancer patients are very high, most of them will likely suffer significant treatment-related side effects, depression, or anxiety, affecting their quality of life. ObjectiveThe aim of this study was to examine the effects of a 6-mo online home-based physical, mental, and social support intervention, the Prostate Cancer Patient Empowerment Program (PC-PEP), on preventing psychological distress among men undergoing curative prostate cancer treatment. Design, setting, and participantsIn a crossover randomized clinical trial of 128 men aged 50–82 yr scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 received the 6-mo PC-PEP intervention and 62 were randomized to a waitlist-control arm and received the standard of care for 6 mo, and then PC-PEP to the end of the year. The PC-PEP intervention consisted of daily e-mails with video instructions providing education, patient activation, and empowerment on healthy living including physical and mental health, dietary recommendations, social support, physical and pelvic floor fitness, stress reduction using a biofeedback device, social connection and intimacy, and social support. Outcome measurements and statistical analysisThe primary outcome was nonspecific psychological distress (clinical cutoff ≥20) measured at baseline, and at 6 and 12 mo using the Kessler Psychological Distress Scale (K10). Results and limitationsAt 6 mo, patients in the waitlist-control group had 3.59 (95% confidence interval: 1.12–11.51) times higher odds for nonspecific psychological distress and need for psychological treatment than men who received the PC-PEP intervention. At 12 mo, the wait-list control group that received the intervention at 6 mo had higher psychological distress than the early group. ConclusionsPC-PEP delivered early following diagnosis significantly prevented the burden of psychological distress in men undergoing curative prostate cancer treatment compared with standard of care, or late (6 mo later) intervention. Patient summaryIn this report, we looked at the effectiveness of a program (Prostate Cancer Patient Empowerment Program: PC-PEP) developed with patients' engagement on the mental distress of patients awaiting curative treatment for their prostate cancer. The PC-PEP program lasted for 6 mo, and it prescribed, described, and demonstrated daily aerobic and strength training, kegels (pelvic floor training to help with urinary and sexual function), dietary changes that have been shown to be helpful in the prevention of prostate cancer and prostate cancer progression, stress reduction using a biofeedback device, as well as social and emotional support. All patients in the PC-PEP program were invited to a monthly video conference with the leads of the program who appeared in the 6 mo of daily videos prescribing the activities the patients were asked to watch and follow. The leads were a prostate cancer oncologist and a scientist in prostate cancer quality of life research. Half of the patients in this study received PC-PEP daily for the first 6 mo and were re-assessed at the end of the year. The other half received standard of care for 6 month and then received the intervention to the end of the year. The results of the study show that, at 6 mo, this intervention was effective at reducing the mental distress that accompanies a prostate cancer diagnosis and treatment compared with the standard of care. Mental distress was significantly reduced when the intervention was received early, compared with that received late (6 mo after scheduled curative treatment). We conclude that multi-faceted patient education and empowerment programming of this kind that is developed with patient engagement from the start is crucial to the care of patients diagnosed with prostate cancer and should be implemented in the standard of care. While treatment for prostate cancer is highly successful, side effects that accompany most treatments significantly affect the quality of life of patients. Here, we describe PC-PEP, a patient education and activation program that is cost effective, highly enforced by patients, and successful at reducing the impact of prostate cancer active treatment–related side effects on their psychological state. To learn more about this project, please visit www.pcpep.org. The program is now being tested in a phase 4 implementation trial throughout Canada and internationally (New Zealand), and is being expanded and tested for other types of cancer.

Systematic investigation of the mechanism of herbal medicines for the treatment of prostate cancer.

Due to various unpleasant side effects and general ineffectiveness of current treatments for prostate cancer (PCa), more and more people with PCa try to look for complementary and alternative medicine such as herbal medicine. However, since herbal medicine has multi-components, multi-targets and multi-pathways features, its underlying molecular mechanism of action is not yet known and still needs to be systematically explored. Presently, a comprehensive approach consisting of bibliometric analysis, pharmacokinetic assessment, target prediction and network construction is firstly performed to obtain PCa-related herbal medicines and their corresponding candidate compounds and potential targets. Subsequently, a total of 20 overlapping genes between DEGs in PCa patients and the target genes of the PCa-related herbs, as well as five hub genes, i.e., CCNA2, CDK2, CTH, DPP4 and SRC were determined employing bioinformatics analysis. Further, the roles of these hub genes in PCa were also investigated through survival analysis and tumour immunity analysis. Moreover, to validate the reliability of the C-T interactions and to further explore the binding modes between ingredients and their targets, the molecular dynamics (MD) simulations were carried out. Finally, based on the modularization of the biological network, four signaling pathways, i.e., PI3K-Akt, MAPK, p53 and cell cycle were integrated to further analyze the therapeutic mechanism of PCa-related herbal medicine. All the results show the mechanism of action of herbal medicines on treating PCa from the molecular to systematic levels, providing a reference for the treatment of complex diseases using TCM.

Preservation of Erectile Function after Stereotactic Radiosurgery with CyberKnife for Prostate Cancer

Prostate carcinoma is one of the most significant social oncological diseases among the male population. With the improvement of early diagnosis through PSA screening, new therapeutic options are open to patients. After the introduction of prostatectomy, it was clear the curative treatment for prostate cancer could have unpleasant effect on the erectile function and in this way to worsen the sexual health of men. The alternative of radical surgical treatment is radiotherapy. For that reason, the treatment by Stereotactic Body Radiation Therapy with Cyberknife for low- and intermediate-risk prostate cancer is gaining more and more popularity and scientific evidence. Even that the preservation of the erectile function after prostate radiation is still an ongoing challenge for the modern radiation oncology and the question of how to improve therapeutic techniques to achieve better results remains open

Exposure to statins post localized prostate cancer diagnosis and risk of metastasis among men who did not receive curative prostate cancer treatment.

Few studies have evaluated the effect of statin exposure on metastasis risk among prostate cancer patients not receiving curative treatment. We included men diagnosed with localized prostate cancer at an integrated health care system between 1997 and 2006 who did not receive curative treatment within 6 months of diagnosis. We followed these men until a metastatic event, disenrollment, death, or 12/31/2016. We collected all data from electronic health records supplemented by chart review. We used Cox regressions to examine the association between post-diagnostic statin exposure and metastasis, controlling for clinical characteristics and pre-diagnostic statin exposure. There were 4245 men included. Mean age of diagnosis was 68.02 years. 46.6% of men used statins after prostate cancer diagnosis. During follow-up, 192 men developed metastasis (cumulative incidence rate: 14.5%). In the adjusted Cox model, statin use post-prostate cancer diagnosis was not significantly associated with a metastatic event (HR=0.97, 95% CI=0.69, 1.36). Pre-diagnostic statin use was also not associated with development of metastasis (HR=0.76, 95% CI=0.53, 1.10). We did not observe a dose-response for the proportion of person-time at-risk post-prostate cancer diagnosis on statins (HR=0.98 per 10% increase in person-time exposed [95% CI=0.93, 1.03]). We did not find an inverse association between post-diagnosis statin exposure and metastasis development in localized prostate cancer patients who did not receive active treatment. Our results did not offer support to the chemopreventive potential of post-diagnostic statin use among men on active surveillance.

High levels of health-related quality of life five years after curative treatment of prostate cancer with HDR-brachytherapy and external beam radiation

Background and purpose The aim of this cross-sectional study was to investigate long-term health-related quality of life (HRQoL) in men with prostate cancer treated 2002–2008 with external beam radiotherapy (EBRT) combined with high dose-rate brachytherapy (HDRBT), Cohort A, and to compare these data with age-adjusted normative data. In addition, differences in HRQoL following adjustments of the brachytherapy technique in 2001 were investigated by comparing Cohort A with men treated at the same clinic from 1998-2000, Cohort B. Methods and material Cohort A: 1495 men treated with EBRT 2 Gy to 50 Gy and 2 fractions of 10 Gy HDRBT at a single centre, 2002–2008, still alive at five years. As part of routine follow-up, the patients responded to the EORTC QLQ-C30 and PR-25 questionnaires. Cohort B: HRQoL data was retrieved from an earlier study from the original article. Results In Cohort A, 1046 (70%) men completed the questionnaires at five years, median age 66 years. In general, HRQoL mean scores were high and similar to Swedish age-matched normative data. Concerning disease-specific HRQoL, low levels of bowel and urinary problems were reported, in contrast to a substantial effect on sexual functioning. ‘No’ or ‘A little’ problems with faecal incontinence and urinary incontinence were reported by 98% and 93% of patients, respectively. The corresponding figure for sexual functioning was 39%. A difference in the frequency of nocturia in favour of Cohort A was the only statistically significant difference between Cohort A and B found in general and disease-specific HRQOL (p = 0.03), despite modifications in the brachytherapy procedure introduced in 2001. Conclusion Long-term general HRQoL was rated high and comparable to an aged-matched reference population five years after treatment with combined radiotherapy. Disease-specific HRQoL was still affected, foremost in the sexual domain.