Follow-up Of Prostate Cancer Patients Research Articles

Rare Case of Testicular Metastasis of Prostate Carcinoma after 13 Years of Prostatectomy: A Case Report and Review of the Literature

Metastasis of prostate cancer to the testes is a rare phenomenon, often indicating advanced-stage disease. This case report details a 79-year-old man with a history of prostate cancer, who underwent endoscopic-extraperitoneal radical prostatectomy and bilateral pelvic lymph node dissection. The patient subsequently received radiation therapy for local recurrences. Thirteen years post-surgery, a testicular ultrasound revealed a cystic mass in the left testis, initially suspected to be a primary neoplasm. However, pathology with immunohistochemical analyses confirmed metastasis from prostate adenocarcinoma. Testicular metastasis of prostate cancer is uncommon, underscoring the aggressiveness and potential spread of the tumor. Clinically evident testicular metastases develop in only a small percentage of prostate cancer patients. This case report highlights the importance of considering metastatic disease in the differential diagnosis of testicular masses and the necessity of clinicopathologic correlation in such evaluations. Early detection and accurate diagnosis are crucial for managing testicular metastasis and improving patient outcomes. The case also emphasizes the significance of long-term follow-up in prostate cancer patients, as metastasis can occur many years post-initial treatment. Furthermore, it illustrates the critical role of advanced imaging techniques and thorough pathological assessments in identifying and managing metastatic spread. This report contributes to the limited but growing body of literature on testicular metastasis from prostate cancer, providing insights for clinicians in recognizing and managing this rare but serious complication. It underscores the need for ongoing research to better understand the mechanisms of metastatic spread and develop targeted therapeutic strategies.

Current status of PSMA-targeted imaging and therapy.

Currently, the incidence of prostate cancer is increasing, and it has become a great threat to men's health. The detection, staging, and follow-up of prostate cancer patients are inseparable from morphology or magnetic resonance imaging (MRI). However, these do not fully meet the needs of diagnosis and patient management. In particular, owing to the late diagnosis, metastatic castration-resistant prostate cancer (mCRPC) patients usually have poor survival and few options for further effective treatment. Prostate-specific membrane antigen (PSMA), because of its overexpression on prostate cancer cells, has gained interest due to its application in the imaging and theranostics field. Several PSMA radioligands have been developed for imaging and treating prostate cancer. Many clinical trials have assessed the efficacy and safety profiles of these radionuclide agents and show promise in patients who have exhausted other standard treatment options. To date, several small compounds for targeting PSMA have been developed, and 68Ga-PSMA-11 and 18F-DCFPyL have been approved by the United States (US) Food and Drug Administration (FDA) for imaging of prostate cancer. 111In- or 99mTc-labeled PSMA-ligand can guide surgeons searching for radioactive metastatic lymph nodes, and 177Lu- or 225Ac-labeled PSMA-ligand can be used for internal radiotherapy. Moreover, some molecules for therapeutic application are undergoing different stages of clinical trials. In this review, we present current perspectives on the use of PSMA-targeted imaging and theranostics in prostate cancer. As PSMA-targeted imaging and therapeutics are becoming the standard of care for prostate cancer patients, we emphasize the importance of integrating nuclear medicine physicians into multidisciplinary oncology teams.

MANAGEMENT OF PROSTATE CANCER IN KIDNEY TRANSPLANT RECIPIENTS.

Kidney transplantation is the treatment of choice in eligible patients with end-stage kidney disease. Prostate cancer (PC) is the second most common cancer in men worldwide. The prevalence of chronic kidney disease worldwide is 13.4%. The management of localized PC in these patients is challenging due to immunosuppressive therapy and pelvic graft localization. High graft and recipient survival rates have resulted in higher numbers of these patients in our everyday practice. A retrospective analysis of male patients who had undergone kidney transplantation at our center between 2002 and 2022 and were diagnosed and treated for PC was performed. We analyzed the incidence, treatment methods, and follow-up of PC patients in this population. A total of 1079 male patients were transplanted. PC was diagnosed in 12 patients (8 after and 4 before transplantation). The incidence of PC was 1.11%. Radical prostatectomy was performed in 11 patients, and one patient was treated with radical radiotherapy. Eleven patients had stable graft function; 1 graftectomy was performed, unrelated to PC. Three patients were indicated for salvage radiotherapy, one is in process for prostate-specific membrane antigen positron emission tomography (PSMA PET CT), and 7 patients are in follow-up and without recurrence. Radical prostatectomy is a safe treatment method for localized PC in kidney transplant recipients, which does not impair graft function and survival.

Preliminary results of the "DUO" observational study: Quality of life assessment and cross-sectional follow-up of prostate cancer patients treated with degarelix.

62 Background: The use of androgen deprivation therapy (ADT), has increased over time in the treatment of prostate cancer (PCa). ATD is accompanied by side effects, some of which may increase the cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of cardiovascular risks and quality of life at the initiation of degarelix, a GnRH antagonist, and 6 months later, in patients with advanced hormone-sensitive PCa. Methods: The DUO study is a PASS, pharmaco-epidemiologic, longitudinal, multicenter observational study. It prospectively enrolled PCa patients during the first 6 months of treatment with degarelix. cohort to describe the prevalence of real-life cardiovascular co-morbidities in. The study was carried out in 46 French urology centers. At D0 and M6, the prevalence of CV, osteoporotic, metabolic, mood disorder, geriatric and sexual morbidity and risk factors were recorded using validated tools and questionnaires. EQ-5D questionnaire measured quality of life. The evolution of the disease (PSA levels) and the tolerance of the treatments were also reported. Results: A total of 124 patients with advanced hormone-dependent PCa (of whom 26.6% were metastatic) were included. At D0 57.7% of patients had a CV morbidity and CV risk factors. Metabolic co-morbidities were also present in 60.6% of patients, osteoporotic risk factors in 34%, sexual disorders in 58%, and mood disorders in 36%. ONCO-G8 score ≤ 14 was observed in 45.6% of patients aged ≥ 70 years. The percentage of patients with CV co-morbidities remained stable (56.7%). The rates of osteoporotic, metabolic, sexual, and mood-related morbidity and risk factors also remained unaltered. Likewise, quality of life remained stable between D0 and M6 (Scores: 0.765 and 0.813 respectively). At the same time, the median PSA rate decreased by -98.4% from D0 (p < 0.001). 42 adverse events (AEs) were reported in 22 patients: degarelix-related AEs were reported in 4.4% of patients. Conclusions: The results of the DUO study showed high prevalence of CV co-morbidity and risk factors in patients with advanced PCa. It also showed no significant increase in CV co-morbidities and risk-factors during the first 6 months of treatment with degarelix as it was observed for osteoporotic, metabolic, sexual, and mood-related disorders. The GnRH antagonist was well tolerated without major impact on quality of life. Assessment of multiple co-morbidities at the initiation and during ADT is mandatory for the optimal management of patients.

Satisfaction with Nurse-led Follow-up in Prostate Cancer Patients—A Nationwide Population-based Study

BackgroundSatisfaction with nurse-led follow-up among men with prostate cancer is high. However, it is unclear whether all men are satisfied or whether there are men who would benefit from being followed by a urologist or a nurse. ObjectiveTo investigate the follow-up distribution between urologists and nurses, and whether the high self-reported satisfaction with nurse-led follow-up is independent of other factors such as age or comorbidity. Design, setting, and participantsAll Swedish men, ≤70 yr of age, with a low-risk prostate cancer diagnosis in 2008, answered a questionnaire 7 yr after diagnosis. The extensive questionnaire included a question on satisfaction with care, answered on a seven-point scale. Participants were divided based on whether they were followed up by a nurse, a urologist, or both. Outcome measurements and statistical analysisFactors that could influence the level of satisfaction were identified as age, education, comorbidity, treatment, disease progression, urinary bother, level of information, and participation in treatment decision. Likelihood ratio tests from ordinal regression were used to test the null hypothesis of similar satisfaction between groups. Results and limitationsOut of 1288 men, 1137 (88%) answered both the question on who performed the follow-up and the question regarding satisfaction. In all, 350 men reported that they were followed up by nurses (31%), 598 (52%) by urologists, and 189 (17%) by both. No differences in satisfaction where seen between the groups. Approximately 50% were satisfied completely, regardless of who performed the follow-up. Results were not affected by age, educational level, comorbidity, treatment, disease progression, urinary bother, information, or participation in treatment decision. Limitations include the nonrandomized, retrospective design and a potential recall bias. ConclusionsSatisfaction with nurse-led follow-up is high, regardless of factors such as age, level of education, comorbidity, and treatment. Patient summaryMen with prostate cancer can be offered nurse-led follow-up on a regular basis and still maintain their satisfaction with health care.

Development & Impact of a Virtual PSA Monitoring Clinic for Follow-up of Prostate Cancer Patients: An Efficient Model With Unique Benefits Relevant to COVID-19

To describe the development, clinical impact, financial impact, and patient satisfaction with a Virtual Prostate Cancer Clinic (VPCC) for follow up of patients treated for prostate cancer.In 2015, we developed an algorithm-based, nurse-practitioner led, VPCC with a digital health platform (DHP) infrastructure to take the place of routine in-person follow-ups for men who had completed definitive treatment with prostate cancer. Virtual monitoring consisted of PSA at an affiliated lab reporting directly into our EHR or a local lab, and patient-electronically submitted AUA and EPIC-CP questionnaires. The DHP analyzed PSA levels to indicate relapse or no relapse, and provided symptom scores based on questionnaire responses. Interaction was either by telephone, secure email, SMS, or messaging through the electronic health record portal. Post-treatment symptoms were managed virtually and patients with evidence of PSA recurrence were worked up with appropriate scanning per guidelines and discussed with the referring physician. We analyzed clinical volume, financial data, and surveyed patients on their satisfaction.From March 15, 2016, to July 31, 2020, a total of 1397 patients enrolled in the VPCC. 94.3% of patients were comfortable with this form of monitoring, with 3.4% neutral, and 2.3% uncomfortable. 92.4% saved time & 53.2% saved > 3 hours per visit. There were 702 in-person prostate cancer follow-up visits in FY15, but after the VPCC, this number was lower in each subsequent year by 13.5% (607) in FY16, 17.5% (579) in FY17, 21.0% (554) in FY18, and 24.0% (533) in FY19. Consults of all malignancy types conducted by radiation oncologists that treat GU malignancies on the main campus in FY15 were 534. Comparing pre-VPCC FY 15 to post-VPCC, we saw consult increases of 44.4% (771) in FY16, 45.5% (777) in FY17, 49.6% (799) in FY18, and 109.74% (1120) in FY19. GU new start volume in FY15 was 213, FY16 284, FY17 335, FY18 297, and FY19 382. Comparing pre-VPCC FY15 to post-VPCC, we observed increases of 33.3% in FY16, 57.3% in FY17, 39.4% in FY18, and 79.3 in FY19. There was no reimbursement for VPCC visits, but it increased physician availability for new patients and was associated with genitourinary radiation oncology revenue growth of 26.6%, 43.3%, 40.3%, and 74.4% for FY16, FY17, FY18, and FY19 compared to pre-VPCC FY15. Prior to Covid-19 (Oct-19: Feb-20), the FY20 monthly average was 26.4 referrals and 91.2 visits. During Covid-19 (Mar-20: Jul-20) dramatic increases in monthly referrals (59, +123%) and virtual visits (127, +39.3%) were observed.The VPCC is a novel method of delivering follow-up care virtually with a DHP infrastructure that led to high patient satisfaction, significant patient time-savings, significant revenue growth from provider availability for new patients, and finally, we found that during the COVID-19 era, this model allowed for very rapid switching of patients from in-person follow-ups to virtual monitoring.

Radiotherapy for prostate cancer: Effect of gold fiducial markers on diffusion-weighted magnetic resonance imaging.

There has been an increase in the use of gold fiducial markers to ensure precise radiotherapy delivery in prostate cancer patients. However, metal artifacts may affect the quality of subsequent imaging used to assess disease status following treatment. In this study, we evaluated the effect of gold fiducial markers on magnetic resonance imaging (MRI), particularly on diffusion-weighted imaging (DWI). Among 57 patients with prostate cancer, 21 patients in whom two gold markers were placed in the prostate tumor with abnormal signal intensity on DWI were evaluated. The effect of the markers on DWI was evaluated on a scale of 1-5, with a high score indicating clinical usefulness. Change inapparent diffusion coefficient (ADC; 10-3 mm2 /s) from before to after marker placement was also evaluated. The mean effect of the markers on DWI was 4.3 (standard deviation [SD] 1.3, range 2-5) points. The mean change in ADC was 0.045 (SD 0.041, range 0.025-0.089) × 10-3 mm2 /s. The gold fiducial markers demonstrated negligible effect on DWI quality. Therefore, gold markers do not affect MRI quality, particularly DWI, and may be used during follow-up in prostate cancer patients.

Toxicity and Quality of Life Results from a Randomized Phase II Trial of HDR Monotherapy for Low and Intermediate-Risk Prostate Cancer

To report health-related quality of life (HRQOL) and toxicity outcomes at 4-year follow-up in prostate cancer patients treated with high-dose rate (HDR) brachytherapy as monotherapy using single-fraction of 19 Gy or 2 fractions of 13.5 Gy (27 Gy/2 fractions one week apart).

PT074 - A prospective randomized trial of paper versus digital PROMS follow-up in prostate cancer patients after radiation therapy: Acceptance of digital follow-up by patients

PT074 - A prospective randomized trial of paper versus digital PROMS follow-up in prostate cancer patients after radiation therapy: Acceptance of digital follow-up by patients

EP-1596: Follow-up of prostate cancer patients receiving 68Ga-PSMA-PET guided dose escalation radiotherapy

EP-1596: Follow-up of prostate cancer patients receiving 68Ga-PSMA-PET guided dose escalation radiotherapy

PO-0827: Five year follow-up of prostate cancer patients treated with volumetric modulated arc therapy (VMAT)

PO-0827: Five year follow-up of prostate cancer patients treated with volumetric modulated arc therapy (VMAT)

The Trend of Uro-Oncologist About Blood Test and Imaging Studies for the Diagnosis of Biochemical Recurrence in Korea

Purpose The aim of this study is to investigate the criteria of biochemical recurrence (BCR) and follow-up periods and methods with and without blood and imaging test of urologic oncology before established guidelines of prostate cancer in Korea. Materials and Methods In December 2015, we sent the questionnaire to urologic oncologist in academic hospital and received the answer from 108 urologic oncologist (50%). Also, we analyzed the data of 1,141 patients underwent radical prostatectomy in 2005 from Korean Medical Insurance. Results In follow-up, 72 physicians (66.7%) performed blood test every 3 months, 51 physicians (47.2%) performed imaging study in case of BCR. Bone scan was the most common imaging study in the follow-up (74 physicians, 68.5%). But, bone scan was only performed in case of BCR (43 physicians, 39.8%). The criteria of BCR was PSA 0.2 ng/mL (75 physician, 69.4%), 76 physicians (70.4%) was performed different follow-up according to risk of patients. In Korean Medical Insurance data analysis, PSA were performed average 2 times every year and magnetic resonance imaging, computed tomography, Bone scan were performed average 0.1, 0.2, 0.1 times every year, respectively. Conclusions The criteria of BCR and the follow-up of prostate cancer patients in Korea were similar Korean prostate cancer guidelines. Blood and imaging test might be increased compared to 10 years ago, it is necessary to compare the Korean Medical Insurance data between 10 years ago and present. Key Words: Prostatic neoplasms; Recurrence; Prostate-specific antigen.

Multi-parametric magnetic resonance imaging monitoring patients in active surveillance for prostate cancer: a prospective cohort study

Objectives: To evaluate the use of multi-parametric magnetic resonance imaging (mpMRI) and mpMRI guided biopsies (MRGB) for monitoring an active surveillance (AS) prostate cancer cohort.Materials and methods: One year after initial diagnostic TRUS guided biopsy (TRUS-bx), baseline mpMRI, and enrolment in an AS program patients underwent a one year follow-up comprising the usual TRUS-bx and an mpMRI. Prostate MRI lesions were scored on the five-point PIRADS scale version 2. In cases without TRUS-bx progression, patients with PIRADS 4 or 5 lesions were scheduled for MRGB. Progression in TRUS-bx was defined as Gleason score (Gs) up-grades, >3 tumor positive cores or a maximal cancer core length (MCCL) > 50%. In MRGB, Gs upgrade or a MCCL ≥6 mm Gs 3 + 3 lesions were considered to reflect progression. PSA increase or progression in clinical T-classification alone was not considered clinical progression.Results: 50 patients were included in the study. In total 10 (20%) patients had per definition progression at one year follow-up. Seven patients (7/50 = 14%) had clinical progression based on TRUS-bx. mpMRI identified seven newly emerged PIRADS 4 lesions. Three patients with PIRADS 4 lesions had no sign of TRUS-bx progression, while MRGB revealed significant cancer (Gs 7 (3 + 4) and Gs 8 (3 + 5)). Consequently, seven patients underwent definitive treatment. Of these, six and four had a progression on MRI and TRUS-bx, respectively.Conclusions: Our study suggests that mpMRI is at least equal to TRUS-bx in detecting progression at one year follow-up in prostate cancer patients undergoing active surveillance.

Study protocol of an equivalence randomized controlled trial to evaluate the effectiveness of three different approaches to collecting Patient Reported Outcome Measures (PROMs) data using the Prostate Cancer Outcomes Registry-Victoria (PCOR-VIC)

BackgroundPatient-reported outcome measures (PROMs) are used by clinical quality registries to assess patients’ perspectives of care outcomes and quality of life. PROMs can be assessed through a self-administered survey or by a third party. Use of mixed mode approaches where PROMs are completed using a single or combination of administration method is emerging. The aim of this study is to identify the most cost-effective efficient approach to collecting PROMs among three modes (telephone, postal service/mail and email) in a population-based clinical quality registry monitoring survivorship after a diagnosis of prostate cancer. This is important to assist the registry in achieving representative PROMs capture using the most cost-effective technique and in developing cost projections for national scale-up.Methods/designThis study will adopt an equivalence randomised controlled design. Participants are men diagnosed with and/or treated for prostate cancer (PCa) participating in PCOR-VIC and meet the criteria for 12-month follow-up. Participants will be individually randomized to three independent groups: telephone, mail/postal, or email to complete the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) survey. It is estimated each group will have 229 respondents. We will compare the proportion of completed surveys across the three groups.The economic evaluation will be undertaken from the perspective of the data collection centre and consider all operating costs (personnel, supplies, training, operation and maintenance). Cost data will be captured using an Activity Based Costs method. To estimate the most cost-effective approach, we will calculate incremental cost-effectiveness ratios. A cost projection model will be developed based on most cost-effective approach for nationwide scale-up of the PROMs tool for follow-up of PCa patients in Australia.DiscussionThis study will identify the most cost-effective approach for collecting PROMs from men with PCa, and enable estimation of costs for national implementation of the PCa PROMs survey. The findings will be of interest to other registries embarking on PROMs data collection.Trial registrationACTRN12615001369516 (Registered on December 16, 2015)

SU-E-J-106: The Use of Deformable Image Registration with Cone-Beam CT for a Better Evaluation of Cumulative Dose to Organs

Purpose: The knowledge of dose accumulation in the patient tissues in radiotherapy helps in determining the treatment outcomes. This project aims at providing a workflow to map cumulative doses that takes into account interfraction organ motion without the need for manual re-contouring. Methods: Five prostate cancer patients were studied. Each patient had a planning CT (pCT) and 5 to 13 CBCT scans. On each series, a physician contoured the prostate, rectum, bladder, seminal vesicles and the intestine. First, a deformable image registration (DIR) of the pCTs onto the daily CBCTs yielded registered CTs (rCT) . This rCT combined the accurate CT numbers of the pCT with the daily anatomy of the CBCT. Second, the original plans (220 cGy per fraction for 25 fractions) were copied on the rCT for dose re-calculation. Third, the DIR software Elastix was used to find the inverse transform from the rCT to the pCT. This transformation was then applied to the rCT dose grid to map the dose voxels back to their pCT location. Finally, the sum of these deformed dose grids for each patient was applied on the pCT to calculate the actual dose delivered to organs. Results: The discrepancy between the planned D98more » and D2 and these indices re-calculated on the rCT, are, on average, of −1 ± 1 cGy and 1 ± 2 cGy per fraction, respectively. For fractions with large anatomical motion, the D98 discrepancy on the re-calculated dose grid mapped onto the pCT can raise to −17 ± 4 cGy. The obtained cumulative dose distributions illustrate the same behavior. Conclusion: This approach allowed the evaluation of cumulative doses to organs with the help of uncontoured daily CBCT scans. With this workflow, the easy evaluation of doses delivered for EBRT treatments could ultimately lead to a better follow-up of prostate cancer patients.« less

‘Carrying on the way we are is becoming shambolic’ – An interview study with prostate cancer specialists about their usual practice of follow-up

Aim: This study aims to clarify what practice for the follow-up of prostate cancer is occurring at present and to explain the reasons behind any variation. Background: Prostate cancer has been increasing in incidence in the UK for several years. It has been suggested that men with prostate cancer could be better managed, and that some aspects of care are duplicated by primary and secondary care professionals. Methods: This study aimed to interview the prostate cancer specialists identified as working within the district general hospitals of a large health board. The interviews used a qualitative semi-structured approach. Analysis was performed using The Framework method. Findings: Current practice for the follow-up of prostate cancer is variable both within and between hospitals. Patients are followed up in secondary care for longer than National Institute for Health and Care Excellence (NICE) recommends due to a lack of trust of general practitioners’ management. This inevitably impacts upon waiting lists, and many patients’ appointments are long overdue. A remote prostate-specific antigen (PSA) surveillance system may be beneficial. It is generally thought that change to the usual practice of follow-up of prostate cancer patients is required.

Radiation dosimetry of 18F-flurocholine PET/CT studies in prostate cancer patients

PurposeWe aimed to evaluate the Equivalent Doses (HTs) to highly exposed organs as well as the Effective Dose (ED) for 18F-fluorocholine PET/CT scan in the follow-up of prostate cancer patients. MethodsFifty patients were administered with 18F-fluorocholine. The activities in organs with the highest uptake were derived by region-of-interest (ROI) analysis. OLINDA/EXM1.0 and Impact software were used to assess ED for the administered 18F-fluorocholine and CT scan, respectively, and the 18F-fluorocholine and CT-scan EDs summed to yield the total ED for the PET/CT procedure. ResultsThe calculated 18F-fluorocholine and CT scans EDs based on ICRP Publication 103 were 5.2 mSv/300 MBq and 6.7 mSv, respectively. The 18F-fluorocholine HTs to the liver, kidneys, spleen and pancreas were about threefold higher than those from the CT, which contributed a greater proportion of the total ED than the 18F-fluorocholine did. ConclusionsFor 18F-fluorocholine PET/CT procedures, about 40% of the ED is contributed by administered 18F-fluorocholine and 60% by the CT scan. The kidneys and liver were the highly exposed organs. Considering the large number of diagnostic procedures oncology patients undergo, radiation dosimetry is important in relation to the stochastic risk of such procedures.

Cell-free plasma DNA as biochemical biomarker for the diagnosis and follow-up of prostate cancer patients

The aim of this study was to evaluate the diagnostic and potential prognostic value of cell-free plasma DNA (CF-pDNA) in patients with suspected or histologically proven prostate cancer (PCa). We included 133 men with a diagnosis of PCa and 33 controls. PCa patients had blood samples prospectively drawn every 3 months for 2 years. CF-pDNA was measured by spectrophotometry. Considering a cut-off value of 140 ng/mL of CF-pDNA the area under the curve was of 0.824(0.757-0.879 with a sensitivity = 66.2 % and a specificity = 87.9 %) and the positive and negative likelihood ratio were of 5.46 and 0.39, respectively. CF-pDNA tends to decrease slightly and return to baseline values in about a week after biopsy. There was no statistical significant correlation between CF-pDNA levels at study entry with PSA, Gleason score, stage and biochemical recurrence free survival (BRFS). However, with a mean follow-up of 13.5 months, we could observe a significant shorter BRFS for patients with at least one value above 140 ng/mL of CF-pDNA during follow-up (p = 0.048). CF-pDNA is a potentially valuable biomarker for PCa diagnosis and a potential tool for the follow-up of patients with PCa.

Cell-free plasma DNA for the diagnosis and follow-up of prostate cancer patients.

e16058 Background: Cell free plasma DNA (CF–pDNA) may have diagnostic and prognostic value in patients with Prostate Cancer (PCa). Methods: We included 133 men with PCa and 33 controls. PCa patients had blood drawn every 3 months for 2 years. CFpDNA was measured by spectrophotometry. Results: CF-pDNA had an area under the curve of 0.824 with a sensitivity of 66.2%, a specificity of 87.9% ,a positive and negative likelihood ratios of 5.46 and 0.39, respectively. There was no statistical significant correlation between CF-pDNA levels at study entry with PSA, Gleason score, stage and biochemical recurrence free survival(BRFS). However, with a mean follow up of 13.5 months, we observed significantly shorter BRFS for patients with at least one value above 140 ng/ mL of CF-pDNA during follow up (p= 0.048). Conclusions: CF-pDNA is a potentially valuable biomarker for PCa diagnosis and may have a prognostic role during follow-up of patients with PCa.

Long-term follow-up of prostate cancer patients treated with vaccine and definitive radiation therapy

Vaccine therapy in combination with radiation therapy may improve distant and/or local control in prostate cancer. We present long-term follow-up data on the secondary and exploratory endpoints of safety and biochemical failure, respectively, from patients with clinically localized prostate cancer treated definitively with a poxviral vector-based therapeutic vaccine combined with external beam radiation therapy (EBRT). Thirty-six prostate cancer patients received definitive EBRT plus vaccine. A total of 18 patients were treated with adjuvant standard-dose interleukin-2 (S-IL-2) (4 MIU m(-2)) and 18 were treated with very low-dose IL-2 (M-IL-2) (0.6 MIU m(-2)). Seven patients were treated with EBRT alone. Twenty-six patients treated with EBRT plus vaccine returned for follow-up, and we reviewed the most recent labs and clinical notes of the remaining patients. Median follow-up for the S-IL-2, M-IL-2 and EBRT-alone groups was 98, 76 and 79 months, respectively. Actuarial 5-year PSA failure-free probability was 78%, 82% and 86% (P=0.58 overall), respectively. There were no significant differences between the actuarial overall survival and the prostate cancer-specific survival between the two vaccine arms. Of the 26 patients who returned for follow-up, Radiation Therapy Oncology Group grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicity was seen in 19% and 8%, respectively, with no difference between the arms (P=1.00 and P=0.48 for grade ≥2 GU and GI toxicity, respectively). In all, 12 patients were evaluated for PSA-specific immune responses, and 1 demonstrated a response 66 months post-enrollment. We demonstrate that vaccine combined with EBRT does not appear to have significant differences with regard to PSA control or late-term toxicity compared with standard treatment. We also found limited evidence of long-term immune response following vaccine therapy.