Radical Treatment For Prostate Cancer Research Articles

Triggers for transition from active surveillance to radical treatment of prostate cancer 2008-2020 - a case-control study.

To examine associations between objective signs of progression (triggers) and transition from active surveillance (AS) to radical treatment for prostate cancer (PC). This case-control study included men with low- or favourable intermediate-risk PC in the region of Halland, with data from The National Prostate Cancer Register (NPCR), Sweden, starting AS between 2008 and 2020. Cases were men who transitioned to radical treatment. For each case, 10 controls who remained in AS were selected without further matching. Triggers for transition to treatment were histopathological progression, magnetic resonance imaging (MRI) progression and increases in prostate-specific antigen (PSA) levels. We compared the probabilities for triggers between cases and controls, in 2008-2014 and 2015-2020, using logistic regression. Amongst 846 men, we identified 98 cases in 2008-2014 and 172 cases in 2015-2020. Histopathological progression was associated with transition, most strongly in the later period (2008-2014: odds ratios [OR] 6.88, 95% confidence interval [CI] 3.69-12.80; and 2015-2020: OR 75.29, 95% CI 39.60-143.17). MRI progression was associated with transition in 2015-2020 (OR 6.38, 95% CI 2.70-15.06), whereas an increase in PSA was weakly associated with transition in the early period. The absence of triggers was associated with no transition (2008-2014: OR 0.24, 95% CI 0.15-0.40, and 2015-2020: OR 0.09, 95% CI 0.06-0.14). The probability of no trigger was 27% in cases 2015-2020. The increase in association between histopathological trigger and transition to treatment indicates increased quality of AS. Still, amongst men treated from 2015 to 2020, 27% transitioned without any trigger.

Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis.

To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD -0.13; 95%CI, -0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD -0.45; 95%CI -0.84, -0.05; I2=93%; P=0.03). Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

Experience of robot-assisted radical prostatectomy after hemiablation of the prostate with high-intensity focused ultrasound using the Focal One robotic platform: clinical case

As new methods of focal treatment become more and more popular in the treatment of prostate cancer, cases of ineffective treatment are gradually revealed, which require correction in the volume of surgical or other method of treatment.The article describes experience of radical treatment of prostate cancer in case of local recurrence of the disease after ultrasound ablation of the prostate.A 58-year-old man who 1 year ago had undergone high-intensity focused ultrasound (HIFU) hemiablation of the left prostatic lobe using Focal One robotic platrform due to prostate adenocarcinoma was examined 1 year after the operation. Total prostate-specific antigen blood level was 5.45 ng/mL. The patient underwent a control transrectal biopsy of the prostate from 12 cores, which revealed recurrence of the disease in the contralateral (previously untreated) prostate lobe. The patient underwent robot-assisted radical prostatectomy. Operative time was 80 minutes. The patient was discharged from the hospital on the 7th day with no postoperative complications. The urethral catheter was removed on the 6th day after control CT cystography. Erectile function and urine retention were preserved. Total prostate-specific antigen level after 6 months of follow-up did not exceed 0.02 ng/mL.Robot-assisted radical prostatectomy is an effective and safe method of treatment in patients with recurrent prostatic adenocarcinoma after HIFU if performed by a surgeon with sufficient experience in robot-assisted surgery.

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Высокомощностная брахитерапия в монорежиме у пациентов с локализованным раком предстательной железы.

Introduction. Prostate cancer is the second most common cancer among men. In Russia the number of patients with stage I-II prostate cancer increased from 47,7% in 2010 to 60,7% in 2021. One of the main methods of treatment of localized prostate cancer is high-dose-rate brachytherapy, which today provides high accuracy of prostate dose coverage and minimizes the impact on nearby risk organs. Within ever-increasing publications, high-dose-rate brachytherapy is considered as a method of safe and effective radical treatment of prostate cancer. Materials and methods. Relevant publications were searched for in the PubMed and е-Library databases with the use of the keywords «brachytherapy», «highdose-rate brachytherapy», «brachytherapy as monotherapy». As a result of the search, 52 sources were selected and included in the given literature review. Results and discussion. The first report on the use of brachytherapy as monotherapy appeared in 2000 where published the results of treatment and demonstrated the safety and effectiveness of the method. Despite the large number of studies conducted all over the world with various options of dose delivery per fraction, the optimal dose and fractionation mode for high-dose-rate brachytherapy as monotherapy have not been determined yet. Conclusions. Currently high-dose-rate brachytherapy of localized prostate cancer as monotherapy has become widespread. However, the available modern data on fractionation modes require further study and research.

Which Patients with Prostate Cancer and Lymph Node Uptake at Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography/Computerized Tomography Scan Are at a Higher Risk of Prostate-specific Antigen Persistence After Radical Prostatectomy? Identifying Indicators of Systemic Disease by Integrating Clinical, Magnetic Resonance Imaging, and Functional Imaging Parameters

BackgroundThe role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. ObjectiveWe aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. Design, setting, and participantsWe identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). Outcome measurements and statistical analysisThe outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. Results and limitationsOverall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). ConclusionsOne out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2–3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. Patient summaryOur novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men's experiences.

Quality of life in prostate cancer survivorship is becoming increasingly important, with mental and social wellbeing recognised as key components. However, limited global evaluation of psychosocial challenges experienced after treatment exists. Therefore, we aimed to explore the lived experiences of men who underwent radical treatment, and its psychosocial impact. This qualitative study was conducted using 19 men who had undergone radical treatment (prostatectomy or radiotherapy) for their cancer. Semi-structured interviews were conducted exploring lived experiences of men after treatment. A Structured thematic analysis of collected data was undertaken, with an inductive co-construction of themes through the lens of the biopsychosocial model. Themes generated were considered within a psychological, social, and physical wellbeing framework. An initial knowledge gap meant mental wellbeing was strongly impacted initially leading to a 'Diagnostic Blow and the Search for Clarity'. Doubt over individuals' future resulted in 'An Uncertain Future' in many men. Once treatment was completed a 'Reflective journey' began, with men considering their outcomes and decisions made. Social wellbeing was also impacted with many identifying the 'Emotional Repercussions' on their relationships and the impact their diagnosis had on their partner and family. Many subsequently sought to increase their support through 'The Social Network and Advocacy', while physical changes led to an increased need for 'Social Planning'. Finally, physical wellbeing was highlighted by a continual acknowledgement of the 'Natural process of ageing' leading to a reluctancy to seek help, whilst simultaneously attempting to improve existing health via 'The Health Kick'. Radical treatments have a considerable impact on mental and social wellbeing of individuals. Anxiety after diagnosis and significant uncertainty over individual futures exist, with physical complications of treatment leading to social repercussions. Future research should aim to identify forms of support to improve quality of life of these men.

The impact of the time interval from diagnosis to radical prostatectomy on oncological outcomes in high-risk prostate cancer

Introduction. To date, the impact of the time interval from diagnostic prostate biopsy to radical prostatectomy on treatment outcomes remains a topical issue.Objective. To evaluate the effect of the timespan from diagnosis to radical treatment of prostate cancer (PCa) patients on tumor morphology and long-term oncological outcomes.Materials and methods. A retrospective analysis of the results of treatment of patients with high-risk PCa who underwent radical prostatectomy with extended lymphadenectomy from 2001 to 2019 in three St. Petersburg clinics was performed. The influence of the time interval from prostate biopsy to radical treatment on long-term outcomes was assessed.Results. An increase in the time interval before surgical treatment over three months did not affect the tumor morphology. Five-year biochemical relapse-free survival was 79.7%, 67.8% and 52.5% among patients with time interval from biopsy to surgical treatment less than 30 days, 30 – 90 days and more than 90 days, respectively. The time interval prior to radical treatment did not have any effect on overall and cancer-specific survival.Conclusion. The time interval from prostate biopsy to surgical intervention, not exceeding 3 months, is the most favorable with respect to long-term outcomes.

A Review of High-Intensity Focused Ultrasound in Urology.

Simple SummaryHigh intensity focused ultrasound is a novel and non invasive treatment for an increasing number of cancers and benign diseases. The principal is similar to focusing the sun’s rays with a magnifying glass, causing a burn at the focal point. This can be done with ultrasound if the usual diagnostic energy is increased 10,000 times. The ultrasound energy is generated under water and the energy passed noninvasively into the body to a sharp focus where it destroys tissue. The technology is rapidly evolving. In urology, trials have been done in a number of areas but the two which are most promising at the present time are for the treatment of renal and prostate cancers. Treatment of renal cancer is currently limited by the position of the kidneys due to the ribs and the presence of perinephric fat, but treatment for prostate cancer is becoming more established.This review provides an introduction to high-intensity focused ultrasound (HIFU) and reviews its historical and current use in urological surgery. Current and historical literature (1927–2020), including that describing trials and review articles in the medical and ultrasonic literature, has been reviewed, using Pub Med and Cochrane search engines. HIFU is currently one of a number of treatments for prostate cancer, both as a primary treatment that can be repeated, and as a salvage treatment post-radiotherapy. HIFU is not yet sufficiently mature to be a standard treatment for renal cancer or other urological diseases, although there has been some success in early clinical trials. As the technology improves, this situation is likely to change. HIFU has been understood as a concept for a century, and has been applied in experimental use for half that time. It is now an accepted treatment with low morbidity in many diseases outside the scope of this review. In urological surgery, prostate HIFU is accepted as a localised treatment in selected cases, with potentially fewer side effects than other localised therapies. Currently the treatment for renal cancer is hindered by the perinephric fat and the position of the kidneys behind the ribs; however, as the technology improves with image fusion, faster treatments, and the ability with phased array transducers and motion compensation to overcome the problems caused by the ribs and breathing, successful treatment of kidney tumours will become more of a reality. In due course, there will be a new generation of machines for treating prostate cancer. These devices will further minimise the side effects of radical treatment of prostate cancer.

SC279 - Additional value of 68GA-PSMA PET in patients who underwent choline-pet for biochemical recurrence after radical treatment for prostate cancer

SC279 - Additional value of 68GA-PSMA PET in patients who underwent choline-pet for biochemical recurrence after radical treatment for prostate cancer

Guidelines for radiotherapy of prostate cancer (2020 edition)

AbstractIn recent years, the incidence of prostate cancer in China has shown a trend of continuous growth. Prostate cancer has become a urinary malignant tumor that seriously affects the health of men in China. Radical surgery and precision radiotherapy are the main methods of radical treatment for prostate cancer. Standardized diagnosis and treatment via a multidisciplinary team should be the standard practice to improve cure rate. Rapid development in imaging, pathology and molecular gene diagnosis has significantly changed the management of prostate cancer. In radiation oncology, image‐guided intensity modulated radiotherapy has been widely adopted in the treatment of prostate cancer. The comprehensive approach centered with radiotherapy has achieved excellent curative effect while continuously reducing treatment‐related side effects.

Risk Stratification of Patients Candidate to Radical Prostatectomy Based on Clinical and Multiparametric Magnetic Resonance Imaging Parameters: Development and External Validation of Novel Risk Groups

BackgroundDespite the key importance of magnetic resonance imaging (MRI) parameters, risk classification systems for biochemical recurrence (BCR) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) are still based on clinical variables alone. ObjectiveWe aimed at developing and validating a novel classification integrating clinical and radiological parameters. Design, setting, and participantsA retrospective multicenter cohort study was conducted between 2014 and 2020 across seven academic international referral centers. A total of 2565 patients treated with RP for PCa were identified. Outcome measurements and statistical analysisEarly BCR was defined as two prostate-specific antigen (PSA) values of ≥0.2 ng/ml within 3 yr after RP. Kaplan-Meier and Cox regressions tested time and predictors of BCR. Development and validation cohorts were generated from the overall patient sample. A model predicting early BCR based on Cox-derived coefficients represented the basis for a nomogram that was validated externally. Predictors consisted of PSA, biopsy grade group, MRI stage, and the maximum diameter of lesion at MRI. Novel risk categories were then identified. The Harrel’s concordance index (c-index) compared the accuracy of our risk stratification with the European Association of Urology (EAU), Cancer of the Prostate Risk Assessment (CAPRA), and International Staging Collaboration for Cancer of the Prostate (STAR-CAP) risk groups in predicting early BCR. Results and limitationsOverall, 200 (8%), 1834 (71%), and 531 (21%) had low-, intermediate-, and high-risk disease according to the EAU risk groups. The 3-yr overall BCR-free survival rate was 84%. No differences were observed in the 3-yr BCR-free survival between EAU low- and intermediate-risk groups (88% vs 87%; p = 0.1). The novel nomogram depicted optimal discrimination at external validation (c-index 78%). Four new risk categories were identified based on the predictors included in the Cox-based nomogram. This new risk classification had higher accuracy in predicting early BCR (c-index 70%) than the EAU, CAPRA, and STAR-CAP risk classifications (c-index 64%, 63%, and 67%, respectively). ConclusionsWe developed and externally validated four novel categories based on clinical and radiological parameters to predict early BCR. This novel classification exhibited higher accuracy than the available tools. Patient summaryOur novel and straightforward risk classification outperformed currently available preoperative risk tools and should, therefore, assist physicians in preoperative counseling of men candidate to radical treatment for prostate cancer.

MSOR04 Presentation Time: 10:20 AM: Experimental Research on CD40/PI3K/AKT Signal Pathway Axis Regulated by MiR-503 and Its Biological Effects for Brachytherapy in Prostate Cancer

Purpose: Brachytherapy plays an important role in the radical treatment of prostate cancer, and its related biological effects and possible mechanisms have yet to be demonstrated. Based on the previous radiobiological study of tumor brachytherapy, this research intends to analyze the relationship between the radiosensitivity of prostate cancer and miR-503-CD40-PI3K/AKT signaling system, reveal the potential targets for improving brachytherapy sensitivity of prostate cancer.

Application of comprehensive rehabilitation programs after radical treatment of prostate cancer

Background. The main side effect of most of the methods of treating prostate cancer is incontinence of urine in varying degrees of severity. Although in most cases incontinence is a temporary phenomenon, this problem occurs in 3963% of patients during the first two years after treatment, and about 2456% of patients have to use urological pads or condoms. Incontinence of urine is also a serious psychological traumatic factor, which has аn extremely negative effect on patients quality of life.&#x0D; Aim: to substantiate the effectiveness of the use of complex rehabilitation programs in the correction of urinary incontinence in men who have undergone radical treatment for prostate cancer.&#x0D; Materials and methods. The study included patients with stage IIII prostate cancer, mean age 55 6 years, with complications after radical prostatectomy for at least 2 months without a tendency to improve in the form of moderate and severe urinary incontinence.&#x0D; Results. The combined technique of correction of urinary incontinence, modified by us, using neuromuscular stimulation, physiotherapy exercises and psychocorrectional exercises, has demonstrated its effectiveness in improving the quality of life in this group of patients.&#x0D; Conclusions. The combined technique of correction of an incontience of urine with use of neuromuscular stimulation, physiotherapy exercises and the psychocorrection of occupations is presented in this article, the assessment of efficiency of this comprehensive program of rehabilitation, and also improvement of quality of life of patients is carried out.

Supporting Patients With Untreated Prostate Cancer on Active Surveillance: What Causes an Increase in Anxiety During the First 10 Months?

BackgroundThe psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL).Materials and MethodsA total of 236 patients participated in the PCa Research International: AS (PRIAS) protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa (MAX-PC)], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety.ResultsThe median age was 64.4 years. Fifty-six patients (24%) reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio (OR) = 4.36], extraversion (OR = 1.9), and prostate-related symptoms (median OR = 0.46). Physical well-being was associated with a low PCa anxiety subscale (median OR = 0.15); neuroticism and functional well-being were associated with PSA anxiety (median OR = 7.05 and 0.73, respectively). Neuroticism and helplessness/hopelessness were associated with fear of progression (median OR = 18.1 and 5.8, respectively).ConclusionOnly a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors (i.e., anxious preoccupation, extraversion) for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being.

Quality of life evaluation of patients after radical treatment of prostate cancer

The article provides an overview of the current data on the quality of life in cancer patients, as well as the functional results of radical treatment of prostate cancer. The main goal was to evaluate the functional results in patients after radical prostatectomy, combined radiation therapy, and high dose-rate brachytherapy in 8 to 12 months after treatment. The study included 148 patients treated from 2017 to 2018. The life quality was assessed by specialized questionnaire. The obtained results indicate the better functional results and a higher level of the quality of life of patients after radiation therapy, compared with radical prostatectomy.

Work status and work ability after radical prostatectomy or active surveillance for prostate cancer

Objective: Being able to work is important for health-related quality of life (HRQoL), and little is known about work life after radical treatment for prostate cancer (PCa). The aim was to investigate work status (WS) and work ability (WA) after radical prostatectomy (RP) or active surveillance (AS) for PCa, and to identify factors associated with reduced WA.Materials and methods: This is a retrospective cross-sectional study of 606 men treated with RP (n = 442) or AS (n = 164) at two Norwegian general hospitals. In 2017, they were asked to complete questionnaires measuring adverse effects (AE), HRQoL, aspects of work life and psychological factors at a median of 4.1 (range 1.3–8.1) years after diagnosis. Clinical data were retrieved from medical records. WS was categorized into employed, unemployed or retired. WA was rated using the Work Ability Index. Regression analyses were performed to find factors associated with reduced WA.Results: WS was similar for the RP and AS groups at diagnosis and survey. There was a small reduction in WA from diagnosis to survey and the difference between the RP and AS groups was non-significant. Older age, poorer self-rated health, poorer incontinence score, more chronic fatigue, and increased anxiety and depressive symptoms were associated with reduced WA, while treatment method, urinary bother and use of pads were not.Conclusion: The impact of RP and AS on WS and WA was almost similar. Age and psychological variables were more strongly associated with reduced WA than cancer-related variables.

Comparison of Treatment-Related Toxicity With Hypofractionated or Conventionally Fractionated Radiation Therapy for Prostate Cancer: A National Population-Based Study

AimsRandomised controlled trials have shown comparable early oncological outcomes after hypofractionated and conventionally fractionated radiotherapy in the radical treatment of prostate cancer (PCa). The effect of hypofractionation on treatment-related gastrointestinal and genitourinary toxicity remains uncertain, especially in older men and those with locally advanced PCa. Materials and methodsA population-based study of all patients treated with radical conventionally fractionated radiotherapy (n = 9106) and hypofractionated radiotherapy (n = 3027) in all radiotherapy centres in the English National Health Service between 2014 and 2016 was carried out. We identified severe gastrointestinal and genitourinary toxicity using a validated coding framework and compared conventionally fractionated and hypofractionated radiotherapy using a competing-risks proportional hazards regression analysis. ResultsThe median age in our cohort was 72 years old and most patients had locally advanced disease (65%). There was no difference in gastrointestinal toxicity (conventionally fractionated radiotherapy: 5.0 events/100 person-years; hypofractionated radiotherapy: 5.2 events/100 person-years; adjusted subdistribution hazard ratio: 1.00, 95% confidence interval: 0.89–1.13; P = 0.95) or genitourinary toxicity (conventionally fractionated radiotherapy: 2.3 events/100 person-years; hypofractionated radiotherapy: 2.3 events/100 person-years; adjusted subdistribution hazard ratio: 0.92, 95% confidence interval: 0.77–1.10; P = 0.35) between patients who received conventionally fractionated radiotherapy and those who received hypofractionated radiotherapy. ConclusionsThis national cohort study has shown that the use of hypofractionated radiotherapy in the radical treatment of PCa does not increase rates of severe gastrointestinal or genitourinary toxicity. Our findings also support the use of hypofractionated radiotherapy in older men and those with locally advanced PCa.

Management of erectile dysfunction after prostate cancer treatment: cross-sectional surveys of the perceptions and experiences of patients and healthcare professionals in the UK

ObjectivesErectile dysfunction (ED) is known to be a common consequence of radical treatment for prostate cancer (PCa) but is often under-reported and undertreated. This study aimed to explore how ED...

Prediction nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for prostate cancer.

The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure. Seven hundred three (n= 703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced-stage PCa before second-line systemic therapies: group 4). First, we assessed 68Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive 68Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram's derived cutoff. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit. 68Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p< 0.001). At multivariable analyses, ISUP grade, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p≤ 0.04). A nomogram based on covariates included in the multivariate model demonstrated a bootstrap-corrected accuracy of 82%. The nomogram-derived best cutoff value was 40%. In DCA, the nomogram revealed clinical net benefit of > 10%. This novel nomogram proved its good accuracy in predicting a positive scan, with values ≥ 40% providing the most informative cutoff in counselling patients to 68Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.