Primary Radiotherapy For Prostate Cancer Research Articles

Patient-reported lower limb edema after primary radiotherapy for prostate cancer

Background Secondary lymphedema is a known side effect to radiotherapy (RT), but limited information regarding prevalence and risk factors for lower limb edema (LLE) after curative radiotherapy in patients with prostate cancer (PCa) is available. This study provides a descriptive analysis of patient-reported LLE with analysis of risk factors in a cohort of patients with PCa treated with curative RT. Material and methods A total of 302 patients with PCa with prospective registration of patient-reported LLE (EORTC QLQ-PR25 (Question 46)) were included. Analysis of LLE was done with the calculation of prevalence rates and Kaplan-Meier statistics. Risk factors for LLE were analyzed multivariate with Cox regression analysis. Results At a median follow-up of 15 (3–51) months, the overall crude incidence of patients reporting ‘quite a bit’ or ‘a lot’ of LLE was 49 (16.2%) and 21 (7.0%), respectively. The baseline prevalence rate of ‘quite a bit’ and ‘a lot’ of LLE was 5.0% and 0.8%, respectively. During follow-up the prevalence rate for ‘quite a bit’ or ‘a lot’ of LLE increased significantly and remained constant from 6 months where 11.5% (±1.7%) reported ‘quite a bit’ and 2.9% (±0.5%) reported ‘very much’ LLE (p < 0.001), respectively. Significant risk factors (p < 0.10) for LLE in univariate analysis included lymph node irradiation (HR:2.325), baseline Body Mass Index (BMI) (HR:1.100), Charlson Comorbidity Index (HR:1.227), Androgen Deprivation Therapy (HR:2,979), and Performance Status (HR:0.594). Only high BMI (HR:1.091) remained significant in multivariate analysis with a three-fold increase in LLE in patients with BMI ≥ 30 compared to normal weight patients. Conclusion Severe patient-reported LLE after curative RT for PCa is rare. Significantly more patients with a high BMI report ‘quite a bit’ or ‘very much’ LLE compared to patients with a normal BMI. Obese PCa patients could be offered a rehabilitation program for early detection and management of LLE.

OC-0592 Patient reported quality of life during and after primary radiotherapy for prostate cancer

OC-0592 Patient reported quality of life during and after primary radiotherapy for prostate cancer

MP73-06 OUTCOMES OF SALVAGE CRYOTHERAPY FOR BIOCHEMICAL RECURRENCE FOLLOWING PRIMARY RADIOTHERAPY IN THE MANAGEMENT OF PROSTATE CANCER - 14-YEARS SINGLE INSTITUTION EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP73-06 OUTCOMES OF SALVAGE CRYOTHERAPY FOR BIOCHEMICAL RECURRENCE FOLLOWING PRIMARY RADIOTHERAPY IN THE MANAGEMENT OF PROSTATE CANCER - 14-YEARS SINGLE INSTITUTION EXPERIENCE Gregory Mansour, Andrew Wang, and Robert Given Gregory MansourGregory Mansour More articles by this author , Andrew WangAndrew Wang More articles by this author , and Robert GivenRobert Given More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage cryotherapy of the prostate remains a treatment option for biochemical recurrence (BCR) following either radiotherapy or other local ablative therapies of prostate cancer. Previous studies have assessed long-term oncologic results to include overall disease survival in addition to freedom from starting ADT. We aim to assess oncologic outcomes in addition to de novo stricture, fistula, urinary incontinence, and erectile dysfunction rates. METHODS: We retrospectively reviewed all men who underwent salvage cryotherapy following external beam radiation therapy (EBRT), proton beam therapy, primary cryotherapy, and brachytherapy at our institution from 2005 through 2019. Functional and oncologic outcomes were assessed. Biochemical recurrence-free survival was defined based on a combination of the Phoenix and Astro criteria and analyzed using Kaplan-Meier statistics. RESULTS: Of the total 85 patients included, 71 had primary EBRT, 9 had brachytherapy, 3 had combined EBRT and brachytherapy, and 2 had proton beam therapy. All patients had negative staging workups prior to salvage therapy. Recto-urethral fistulas occurred in 2 patients (2.3%), 21 patients (24.4%) developed urethral strictures, and 23 patients (26.7%) reported de novo incontinence requiring pads. 5- year overall biochemical free survival was 49%. A total of 53% of subjects had biochemical recurrence with a mean time of 39 months after salvage treatment. Overall cancer specific survival was 86% and metastasis free survival was 77.9%. There was not a statistically significant correlation identified between pretreatment PSA and timing to BCR R2=0.05 p=0.129. One patient did not have a PSA response after salvage cryotherapy and went on to develop metastatic disease. CONCLUSIONS: Salvage cryotherapy remains one of the few potentially curative interventions following primary radiotherapy for prostate cancer. This study highlights the necessity for patient counseling given the side effect profile. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1036 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Mansour More articles by this author Andrew Wang More articles by this author Robert Given More articles by this author Expand All Advertisement PDF downloadLoading ...

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

BackgroundThe rates of local failure after curative radiotherapy for prostate cancer (PC) remain high despite more accurate locoregional treatments available, with one third of patients experiencing biochemical failure and clinical relapse occurring in 30–47% of cases. Today, androgen deprivation therapy (ADT) is the treatment of choice in this setting, but with not negligible toxicity and low effects on local disease. Therefore, the treatment of intraprostatic PC recurrence represents a challenge for radiation oncologists. Prostate reirradiation (Re-I) might be a therapeutic possibility. We present our series of patients treated with salvage stereotactic Re‑I for intraprostatic recurrence of PC after radical radiotherapy, with the aim of evaluating feasibility and safety of linac-based prostate Re‑I.Materials and methodsWe retrospectively evaluated toxicities and outcomes of patients who underwent salvage reirradiation using volumetric modulated arc therapy (VMAT) for intraprostatic PC recurrence. Inclusion criteria were age ≥ 18 years, histologically proven diagnosis of PC, salvage Re‑I for intraprostatic recurrence after primary radiotherapy for PC with curative intent, concurrent/adjuvant ADT with stereotactic body radiation therapy (SBRT) allowed, performance status ECOG 0–2, restaging choline/PSMA-PET/TC and prostate MRI after biochemical recurrence, and signed informed consent.ResultsFrom January 2019 to April 2022, 20 patients were recruited. Median follow-up was 26.7 months (range 7–50). After SBRT, no patients were lost at follow-up and all are still alive. One- and 2‑year progression free survival (PFS) was 100% and 81.5%, respectively, while 2‑year biochemical progression-free survival (bFFS) was 88.9%. Four patients (20%) experienced locoregional lymph node progression and were treated with a further course of SBRT. Prostate reirradiation allowed the ADT start to be postponed for 12–39 months. Re‑I was well tolerated by all patients and none discontinued the treatment. No cases of ≥ G3 genitourinary (GU) or gastrointestinal (GI) toxicity were reported. Seven (35%) and 2 (10%) patients experienced acute G1 and G2 GU toxicity, respectively. Late GU toxicity was recorded in 10 (50%) patients, including 8 (40%) G1 and 2 (10%) G2. ADT-related side effects were found in 7 patients (hot flashes and asthenia).ConclusionLinac-based SBRT is a safe technique for performing Re‑I for intraprostatic recurrence after primary curative radiotherapy for PC. Future prospective, randomized studies are desirable to better understand the effectiveness of reirradiation and the still open questions in this field.

Outcomes of Sterotactic Body Radiotherapy (SBRT) for pelvic lymph node recurrences after adjuvant or primary radiotherapy for prostate cancer.

There is a paucity of data on the management of recurrent lymph nodes after primary or adjuvant radiotherapy (RT) for prostate cancer (PCa). In this study, we report our tertiary cancer center experience with stereotactic body radiotherapy (SBRT) for the management of pelvic lymph node recurrences after adjuvant or primary RT for PCa. Patients who underwent SBRT for pelvic lymph node metastases from PCa between 2013 and 2019 were retrospectively assessed for local control (LC), androgen deprivation treatment-free survival (ADT-FS), and toxicity outcomes. The primary endpoint was LC and ADT-FS. The secondary endpoint was late treatment toxicity. Twenty-two lesions of 18 patients receiving SBRT for pelvic lymph node recurrences for PCa between February 2013 and March 2019 were evaluated. At a median follow-up duration of 29.5 months (range: 9-54 months), LC was 95.5% vs. 90.2% at 1 and 2 years, respectively. Ten patients received palliative ADT following SBRT after a median period of 14.5 months (range: 6-31 months). ADT-FS was 72.2% and 54.3% at 1 and 2 years, respectively. Comparative analysis of biologically effective dose (BED) values revealed that higher BED10 values were associated with higher ADT-FS (P = 0.008). ADT-FS was 55.6% and 88.9% for BED10 <50 Gy and for BED10 >50 Gy, respectively (P = 0.008). Assessment of late toxicity outcomes revealed that the most common toxicity was urinary toxicity and fatigue; however, no patient had ≥ grade 3 toxicity. Our tertiary cancer center experience confirms the safety and efficacy of SBRT for the management of pelvic lymph node recurrences from PCa.

Can quantitative analysis of multi-parametric MRI independently predict failure of focal salvage HIFU therapy in men with radio-recurrent prostate cancer?

ObjectivesFocal salvage HIFU is a feasible therapeutic option in some men who have recurrence after primary radiotherapy for prostate cancer. We aimed to determine if multi-parametric quantitative parameters, in addition to clinical factors, might have a role in independently predicting focal salvage HIFU outcomes. MethodsA retrospective registry analysis included 150 consecutive men who underwent focal salvage HIFU (Sonablate500) (2006-2015); 89 had mpMRI available. Metastatic disease was excluded by nodal assessment on pelvic MRI, a radioisotope bone-scan and/or choline or FDG PET/CT scan. All men had mpMRI and either transperineal template prostate mapping biopsy or targeted and systematic TRUS-biopsy. mpMRI included T2‐weighted, diffusion‐weighted and dynamic contrast‐enhancement. Pre-HIFU quantitative mpMRI data was obtained using Horos DICOM Viewer v3.3.5 for general MRI parameters and IB DCE v2.0 plug-in. Progression-free survival (PFS) was defined by biochemical failure and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer‐specific death. Potential predictors of PFS were analyzed by univariable and multivariable Cox-regression. ResultsMedian age at focal salvage HIFU was 71 years (interquartile range [IQR] 65–74.5) and median PSA pre-focal salvage treatment was 5.8ng/ml (3.8-8). Median follow-up was 35 months (23-47) and median time to failure was 15 months (7.8–24.3). D-Amico low, intermediate and high-risk disease was present in 1% (1/89), 40% (36/89) and 43% (38/89) prior to focal salvage HIFU (16% missing data). 56% (50/89) failed by the composite outcome. A total of 22 factors were evaluated on univariable and 8 factors on multivariable analysis. The following quantitative parameters were included: Ktrans, Kep, Ve, Vp, IS, rTTP and TTP. On univariable analysis, PSA, prostate volume at time of radiotherapy failure and Ve (median) value were predictors for failure. Ve represents extracellular fraction of the whole tissue volume. On multivariable analysis, only Ve (median) value remained as an independent predictor. ConclusionsOne pharmacokinetic quantitative parameter based on DCE sequences seems to independently predict failure following focal salvage HIFU for radio-recurrent prostate cancer. This likely relates to the tumor microenvironment producing heat-sinks which counter the heating effect of HIFU. Further validation in larger datasets and evaluating mechanisms to reduce heat-sinks are required.

68 Ga-PSMA-PET/CT helps to select patients for salvage radical prostatectomy with local recurrence after primary radiotherapy for prostate cancer.

To investigate the diagnostic performance of gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) in patients with recurrent prostate cancer with regard to the presence of lymph node metastases (LNM) and local recurrences after primary radiotherapy. We retrospectively reviewed 142 patients following salvage radical prostatectomy (sRP), 50 of which had a 68 Ga-PSMA PET/CT performed as a preoperative staging module. Predictive clinical parameters were analysed in a multivariate Cox regression analysis. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and the accuracy of 68 Ga-PSMA PET/CT were analysed with regard to LNM and local recurrence. In all, 613 lymph nodes were resected in 40 patients and 23 lymph nodes had metastatic deposits in 14 patients. In all patients local recurrence could have been found with 68 Ga-PSMA PET/CT. Sensitivity, specificity, PPV and NPV and accuracy on a per lymph node basis were 34.78% (16.38-57.2%), 100% (99.38-100%), 100%, 97.52% (96.69-98.15%) and 97.55% (96.00-98.62%). For detecting local recurrence, the sensitivity and PPV were both 100% with an accuracy of 100% (92.89-100%). 68 Ga-PSMA PET/CT should be the standard imaging in biochemical recurrent prostate cancer. With this imaging module one detects first local recurrence and can detect locoregional and distant metastases more precisely than standard CT and bone scan.

931 - Does salvage whole gland ablation therapy confer survival advantage to patients who failed primary radiotherapy for prostate cancer?

931 - Does salvage whole gland ablation therapy confer survival advantage to patients who failed primary radiotherapy for prostate cancer?

Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives.

Over the last decades, primary prostate cancer radiotherapy saw improving developments, such as more conformal dose administration and hypofractionated treatment regimens. Still, prostate cancer recurrences after whole-gland radiotherapy remain common, especially in patients with intermediate- to high-risk disease. The vast majority of these patients are treated palliatively with androgen deprivation therapy (ADT), which exposes them to harmful side-effects and is only effective for a limited amount of time. For patients with a localized recurrent tumor and no signs of metastatic disease, local treatment with curative intent seems more rational. However, whole-gland salvage treatments such as salvage radiotherapy or salvage prostatectomy are associated with significant toxicity and are, therefore, uncommonly performed. Treatments that are solely aimed at the recurrent tumor itself, thereby better sparing the surrounding organs at risk, potentially provide a safer salvage treatment option in terms of toxicity. To achieve such tumor-targeted treatment, imaging developments have made it possible to better exclude metastatic disease and accurately discriminate the tumor. Currently, focal salvage treatment is being performed with different modalities, including brachytherapy, cryotherapy, high-intensity focused ultrasound (HIFU), and stereotactic body radiation therapy (SBRT). Oncologic outcomes seem comparable to whole-gland salvage series, but with much lower toxicity rates. In terms of oncologic control, these results will improve further with better understanding of patient selection. Other developments, such as high-field diagnostic MRI and live adaptive MRI-guided radiotherapy, will further improve precision of the treatment.

Single-institution comparative study on the outcomes of salvage cryotherapy versus salvage robotic prostatectomy for radio-resistant prostate cancer.

BackgroundAlthough primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments.MethodsFrom January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists.Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment.ResultsPatients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy.ConclusionWhile recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity.

Objective consensus from decision trees.

BackgroundConsensus-based approaches provide an alternative to evidence-based decision making, especially in situations where high-level evidence is limited. Our aim was to demonstrate a novel source of information, objective consensus based on recommendations in decision tree format from multiple sources.MethodsBased on nine sample recommendations in decision tree format a representative analysis was performed. The most common (mode) recommendations for each eventuality (each permutation of parameters) were determined. The same procedure was applied to real clinical recommendations for primary radiotherapy for prostate cancer. Data was collected from 16 radiation oncology centres, converted into decision tree format and analyzed in order to determine the objective consensus.ResultsBased on information from multiple sources in decision tree format, treatment recommendations can be assessed for every parameter combination. An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties. In the clinical example involving prostate cancer therapy, three parameters were used with two cut-off values each (Gleason score, PSA, T-stage) resulting in a total of 27 possible combinations per decision tree. Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters.ConclusionRecommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

VMAT technique enables concomitant radiotherapy of prostate cancer and pelvic bone metastases

Background. Prostate cancer (PCa) patients with metastatic disease often suffer from skeletal pain and urinary retention impairing their quality of life. Prophylactic radiotherapy to bone metastases planned concomitantly with primary PCa radiotherapy could enable more precise control of combined dose in healthy tissues when compared to sequential palliative treatment.Materials and methods. Volumetric modulated arc therapy (VMAT) was planned for 14 PCa patients with primary bone metastases. The bone planning target volume (PTVbone) was contoured together with the PTVs of prostate (pr), pelvic lymph nodes (ln) and seminal vesicles (sv). Another virtual plan was calculated excluding PTVbone for dose volume histogram (DVH) comparison. DVHs were additionally compared to a set of actual VMAT treatment plans of a control cohort of 13 high risk PCa patients treated with PTVpr, PTVsv and PTVln. The prescribed doses varied between 42 and 76 Gy for PTVbone.Results. Recommended healthy tissue tolerances (Quantec) were not exceeded except for one patient's rectum V50Gy value. Rectum doses did not increase significantly due to the inclusion of PTVbone. For bladder, there was a slight increase for V65Gy and V50Gy (2.7% and 7.4%). The DVHs of metastatic and non-metastatic patients were comparable. There were no differences in the PTVpr DVH parameters, while mean PTVln dose increased by 3.7 Gy–4.4 Gy due to the increased treatment volume related to PTVbone. All side effects were < grade 3 during the mean follow-up duration of 25 months.Conclusions. VMAT offers a good optimization tool for adding extra PTVs to the radiotherapy plan. Radiotherapy of bone metastases concomitantly with irradiation of the primary prostate tumor is a safe and well-tolerated approach and deserves to be studied in a randomized setting.

Effects of angiotensin-converting enzyme (ACE) inhibitors on the outcomes of patients receiving primary radiotherapy for prostate cancer (PC).

e16016 Background: ACE inhibitors have been linked with an increased incidence of prostate, breast and lung cancer as well as increased recurrence rates in breast cancer. However the effects of ACE inhibitors on patients receiving primary radiation therapy for PC are unknown. Methods: We conducted a retrospective medication review of a prospective cohort of 1956 men who received primary radiotherapy (RT) for PC at the Peter McCallum Cancer Institute, Melbourne, Australia from 2003 -07. A competing risks model was developed for statistical analysis of the data. Results: 56% of patients who received RT also had concurrent salvage androgen deprivation therapy (sADT). A total 502 men had subsequent biochemical failure, 314 had initiated sADT and 125 had died of prostate cancer. Median follow up after RT was 71 months and 41 months after initiation of sADT. Of the 603 men who were on ACE-inhibitors, 160 received sADT. After adjusting for patient age, initial tumor stage, Gleason Score and PSA, along with planned ADT usage and ACE27 co-morbidity score, there were significant association between ACE-inhibitors and PC-specific mortality both from the time of RT and sADT (p= 0.035 and 0.01 respectively), with a strong increase in hazard (HR 1.58 [95%CI 1.03-2.42) and 2.02 [95%CI 1.16-2.90]). No significant association was seen with time to metastasis development, suggesting the impact of ACE inhibitors may be in the post-metastasis phase of the disease. Conclusions: ACE inhibitors may increase the rates of PC-specific mortality in men receiving primary RT for PC. However these results need to be further validated by randomized controlled studies and the mechanisms need to be investigated.

Utilization of local salvage therapy after primary radiotherapy for prostate cancer.

231 Background: Early biochemical detection and subsequent slow progression of recurrent prostate cancer after primary radiotherapy permit the delivery of potentially curative local salvage therapy (LST). Several LST options are available, including cryotherapy, brachytherapy (BT), and radical prostatectomy (RP). We studied the rates at which patients are offered, and receive LST after failure of primary radiotherapy. Methods: Patients with localized prostate cancer who received primary radiotherapy with curative intent between 1999-2000 were identified in the British Columbia radiotherapy database. Data on clinicopathologic features, primary therapy, PSA kinetics, and salvage therapy were collected retrospectively. We excluded patients with T4 tumors, PSA &gt;40, or age &gt;72 years at time of primary therapy. Biochemical recurrence (BCR) was defined by the Phoenix criteria. Patients were also deemed radiation failures if salvage therapy was started without meeting criteria for BCR. Results: Out of 1785 patients treated with radiation, 1067 met the inclusion criteria. Of these, 257 experienced BCR. Five patients received LST (3 RP, 2 BT). LST was considered in 11 other patients, but 2 were not referred for urologic opinion, and 9 declined intervention. 60 patients were considered ineligible for LST: 43 due to suspected metastasis and 17 due to other comorbidities. LST was unlikely to be offered to 80 patients due to age &gt;75 at time of BCR. 59 additional patients appeared to be eligible for LST but there was no evidence that it was considered in the medical record. ADT was started within 12 months of BCR in 118 patients, and after at least one year of observation in another 66. Conclusions: Few patients were considered for LST in the study period, and only 5 received it. This review of practice patterns reveals a lack of uniform monitoring and treatment strategies in this challenging patient population, and indicates a need for more collaboration between all treating physicians, as well as with tertiary care centers.

A population-based study on the utilisation rate of primary radiotherapy for prostate cancer in 4 regions in the Netherlands, 1997–2008

Aim The purpose was to study variations in utilisation rates of external beam radiotherapy (EBRT) and brachytherapy (BT) for prostate cancer patients. Materials and methods We calculated the proportion and number of EBRT and BT given or planned within 6 months of diagnosis in 4 Dutch regions, according to stage and age in a population-based setting including 47,259 prostate cancer patients diagnosed from 1997 until 2008. Results During this study period, the overall utilisation rate of EBRT remained stable at around 25%, while the rate of BT for non-metastasized patients increased from 1% (95% CI:0–1%) to 12% (11–13%) in 2006 and slightly decreased towards 10% (9–11%) in 2008. From 2001 on, the overall utilisation rate of EBRT decreased significantly in one region ( p < 0.05). In this region, a sharp rise in the utilisation rate of BT for non-metastatic patients was noted to 17% (14–20%) in 2008 after a peak of 24% (21–27%) in 2006. For localised disease, BT was used more often at the expense of EBRT while for locally advanced disease the utilisation rate of EBRT increased. In the multivariate analysis, regional differences in the utilisation rate of EBRT persisted with odds ratios ranging from 0.7 to 0.9 compared to the reference region. Moreover, low rates of EBRT were associated with high BT rates. The regional differences could not be explained by differences in risk profiles. Conclusions The utilisation rate of EBRT remained stable with limited variation between regions while BT was used increasingly with clear regional differences. To cope with this and in view of the increasing incidence of prostate cancer, adequate resources have to be planned for the optimal care of these patients.

78 INTENSITY-MODULATED RADIOTHERAPY REPLACES 3-DIMENSIONAL EXTERNAL BEAM AS THE PREFERRED RADIOTHERAPY MODALITY IN PROSTATE CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201178 INTENSITY-MODULATED RADIOTHERAPY REPLACES 3-DIMENSIONAL EXTERNAL BEAM AS THE PREFERRED RADIOTHERAPY MODALITY IN PROSTATE CANCER Matthew J. O'Shaughnessy, Stephanie L. Jarosek, Beth A. Virnig, Badrinath R. Konety, and Sean P. Elliott Matthew J. O'ShaughnessyMatthew J. O'Shaughnessy Minneapolis, MN More articles by this author , Stephanie L. JarosekStephanie L. Jarosek Minneapolis, MN More articles by this author , Beth A. VirnigBeth A. Virnig Minneapolis, MN More articles by this author , Badrinath R. KonetyBadrinath R. Konety Minneapolis, MN More articles by this author , and Sean P. ElliottSean P. Elliott Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.142AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intensity-modulated radiotherapy (IMRT) has been shown to improve local disease control while minimizing adverse effects, compared to 3-dimensional external beam radiotherapy (3-D EBRT). The uptake of IMRT in common clinical practice has not been previously described. Our objectives were to use the Surveillance, Epidemiology, and End Results– Medicare (SEER- Medicare) dataset to (1) analyze time trends in the type of radiotherapy (RT) used for primary local treatment for prostate cancer and (2) identify disease characteristics associated with trends in the type of RT used. METHODS From the linked SEER-Medicare dataset (inclusive of years 2000-2005), we identified cases of incident non-metastatic prostate cancer managed with radiation within 12 months of diagnosis. Medicare claims for IMRT, 3-D EBRT, brachytherapy (BT) and any combination thereof were identified. The frequency of each RT strategy was documented over time and then stratified by patient demographic and tumor characteristics and compared by chi-square. Tumor characteristics were categorized as low risk (T1, WHO grade 1 or 2), intermediate risk (T2, WHO grade 1 or 2) and high risk (≥T3 or WHO grade 3). RESULTS 42,151 patients who received primary radiotherapy for prostate cancer were identified. The rate of IMRT use significantly increased from 0 to 46.4% (P<0.0001) of all patients undergoing RT, whereas EBRT use declined from 55.1% to 9.2% (P<0.0001) over the same interval. BT + EBRT combination therapy decreased from 21.7% to 6.3% (P<0.0001) whereas BT + IMRT combination increased from 0% to 12.9% (P<0.0001). BT use as monotherapy peaked in 2002 at 43.5% but decreased over the subsequent three years to 25.2%. When the results were stratified by tumor risk, similar trends were seen. BT is more common for low and intermediate risk prostate cancer. CONCLUSIONS Our population-based study using SEER-Medicare data shows that IMRT has largely replaced EBRT as the preferred radiotherapy for localized prostate cancer, regardless of risk category. Factors contributing to the increased use of IMRT include the possibility of delivering higher doses of radiation more safely and more favorable reimbursement. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e34 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew J. O'Shaughnessy Minneapolis, MN More articles by this author Stephanie L. Jarosek Minneapolis, MN More articles by this author Beth A. Virnig Minneapolis, MN More articles by this author Badrinath R. Konety Minneapolis, MN More articles by this author Sean P. Elliott Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patient-reported quality of life after salvage brachytherapy for radio-recurrent prostate cancer: A prospective Phase II study

Background Patient-reported quality of life (QOL) after salvage brachytherapy for radiorecurrent prostate cancer has not been well-characterized prospectively. Methods We examined 25 men who recurred after primary radiotherapy for prostate cancer and received MRI-guided salvage brachytherapy as part of a prospective Phase II study. These patients received prospectively a validated patient-reported QOL questionnaire to fill out at baseline, as well as 3, 15, and 27 months after re-irradiation to determine the degree of sexual, bowel, and urinary dysfunction (maximum dysfunction score = 100). Results On average, sexual function continued to decline with time, and patients had significantly worse sexual function scores at 27 months than baseline ( p = 0.01). Although bowel and urinary symptoms worsened acutely at 3 or 15 months, they showed on average some improvement by 27 months, and there were no significant differences between baseline and 27-month urinary or bowel scores. An interval to re-irradiation less than 4.5 years and prior brachytherapy were each associated significantly with the largest decrements in bowel function ( p = 0.035). Conclusion Similar to the patterns seen in the de novo setting, patients who receive salvage brachytherapy report a worsening of bowel and urinary symptoms followed by some improvement by 27 months, while sexual function steadily declines over time. Interval to re-irradiation and type of prior radiation received may be used to counsel and optimize selection of men for salvage brachytherapy with regard to QOL endpoints.

Increase of hepcidin plasma and urine levels is associated with acute proctitis and changes in hemoglobin levels in primary radiotherapy for prostate cancer

To analyse hepcidin serum and urine levels during radiotherapy for prostate cancer. In 18 patients undergoing radiotherapy for prostate cancer, blood, plasma, and urine samples were taken before and during radiotherapy. Complete blood cell count, pro-hepcidin-, ferritin-, transferrin-, IL-1beta-, IL-6-, and TNF-alpha concentration was determined. Pro-hepcidin concentration was additionally measured in urine samples. Toxicity was evaluated weekly. Differences among tested factors were tested by Wilcoxon rank sign test for paired data. In ten patients developing acute radiation-induced proctitis, a significant increase in pro-hepcidin, IL-6, and TNF-alpha plasma levels (p < 0.05) was detected. Pro-hepcidin urine levels also showed a strong trend towards increase (p = 0.06). Concurrently, hemoglobin, and leucocytes were significantly decreased in the patients with acute proctitis (p < 0.05). In eight patients showing no symptoms of proctitis, solely a significant decrease for leucocytes was detected. Additive, these patients showed a significant increase of ferritin, and a decrease of transferrin levels (p < 0.05). Hepcidin levels are increased and hemoglobin is decreased during radiotherapy for prostate cancer in patients who develop acute proctitis. Radiation-induced expression of cytokines may be responsible for increased hepcidin expression in the liver. Regulation of iron metabolism by hepcidin may be an underestimated response in radiotherapy.