Recurrence In Prostate Cancer Patients Research Articles

Galectin-3: a possible complementary marker to the PSA blood test.

The prostate-specific antigen (PSA) test has served as a blood marker of prostate cancer (PCa), and for monitoring recurrence/metastasis in patients after therapeutic intervention. However, the applicability/reliability of the PSA test was recently questioned as it is not without challenges, in particular in men who have PCa without an elevated PSA (false negative), or in men who are disease-free with elevated levels of PSA (false positive). Galectin-3 is a tumor-associated protein; present in the seminal fluid and is a substrate for the PSA enzyme e.g., a chymotrypsin-like serine protease. We hypothesized that the cleavage status and level of galectin-3 in the prostate tissue and sera are associated with PCa. Thus, we compared galectin-3 levels obtained from sera of non-cancer urology patients to those of metastatic PCa patients. The data were confirmed by analyzing PCa tissue arrays. Here, we report that galectin-3 levels in the sera of patients with metastatic PCa were uniformly higher as compared to the non-cancer patient controls. The data suggest that galectin-3 serum level may be a useful serum complementary marker to the PSA blood test to be used for initial and follow-up PSA complimentary diagnostic/prognostic tool for recurrence in PCa patients.

High-Dose-Rate Brachytherapy as a Salvage Reirradiation for Recurrent Prostate Cancer Patients

High-Dose-Rate Brachytherapy as a Salvage Reirradiation for Recurrent Prostate Cancer Patients

PO-0701: Toxicity and outcome of recurrent prostate cancer patients treated with 11-C Choline PET/CT-guided tomotherapy

PO-0701: Toxicity and outcome of recurrent prostate cancer patients treated with 11-C Choline PET/CT-guided tomotherapy

Statin therapy is not associated with prostate cancer recurrence among patients who underwent radiation therapy

We investigated whether statin use is associated with reduced risk of recurrence in prostate cancer patients who undergo radiotherapy. A retrospective cohort of 774 patients from a California health plan was followed for 5years. Statin use prior to, during and after radiotherapy was not associated with prostate cancer recurrence [hazard ratio=0.99 (0.70–1.39), 0.87 (0.62–1.22) and 0.78 (0.55–1.09), respectively] in multivariable Cox models. No clear dose–response relationship was observed for average daily statin dose or duration of statin use. Our findings do not support a preventive benefit of statins in prostate cancer recurrence after radiotherapy.

Development and Clinical Validation of a Real-Time PCR Assay for PITX2 DNA Methylation to Predict Prostate-Specific Antigen Recurrence in Prostate Cancer Patients Following Radical Prostatectomy

Prostate cancer is the most common cancer among men. The prospective discrimination of aggressive and clinically insignificant tumors still poses a significant and, as yet, unsolved problem. PITX2 DNA methylation is a strong prognostic biomarker in prostate cancer. Recently, a diagnostic microarray for prostate cancer prognosis based on PITX2 methylation has been developed and validated. Because this microarray requires nonstandard laboratory equipment, its use in a diagnostic setting is limited. This study aimed to develop and validate an alternative quantitative real-time PCR assay for measuring PITX2 methylation that can easily be established in clinical laboratories, thereby facilitating the implementation of this biomarker in clinical practice. A methylation cut-off for patient stratification was established in a training cohort (n = 157) and validated in an independent test set (n = 523) of men treated with radical prostatectomy. In univariate Cox proportional hazards analysis, PITX2 hypermethylation was a significant predictor for biochemical recurrence (P < 0.001, hazard ratio = 2.614). Moreover, PITX2 hypermethylation added significant prognostic information (P = 0.003, hazard ratio = 1.814) to the Gleason score, pathological T stage, prostate-specific antigen, and surgical margins in a multivariate analysis. The clinical performance was particularly high in patients at intermediate risk (Gleason score of 7) and in samples containing high tumor cell content. This assay might aid in risk stratification and support the decision-making process when determining whether a patient might benefit from adjuvant treatment after radical prostatectomy.

11C]Choline Positron Emission Tomography/Computerized Tomography for Early Detection of Prostate Cancer Recurrence in Patients with Low Increasing Prostate Specific Antigen

The effectiveness of salvage therapy in prostate cancer is greater for low prostate specific antigen values. Therefore, early detection of tumor recurrence is warranted. [(11)C]choline positron emission tomography/computerized tomography has the potential of early restaging of prostate cancer with low prostate specific antigen, but the selection of patients at high risk for positive [(11)C]choline positron emission tomography/computerized tomography is desirable to optimize salvage therapy. This retrospective study included 75 patients with prostate cancer with an increasing prostate specific antigen less than 1.5 ng/ml after radical prostatectomy who never received antiandrogen deprivation therapy or salvage radiotherapy who underwent [(11)C]choline positron emission tomography/computerized tomography for the restaging of disease. Binary logistic regression was used to assess predictive factors of positive [(11)C]choline positron emission tomography/computerized tomography. Included variables were trigger prostate specific antigen, prostate specific antigen doubling time, age, pathological stage and Gleason score. Median prostate specific antigen was 0.61 ng/ml. [(11)C]choline positron emission tomography/computerized tomography was positive in 16 of 75 patients (21%). On univariate analysis prostate specific antigen doubling time less than 6 months was the only factor significantly associated with an increased risk of positive [(11)C]choline positron emission tomography/computerized tomography (OR 7.77, 95% CI 2.34-25.80, p = 0.001). In patients with prostate specific antigen doubling time less than 6 months, the positive detection rate of [(11)C]choline positron emission tomography/computerized tomography increased to 50%. In patients with prostate cancer with biochemical failure after radical prostatectomy and prostate specific antigen less than 1.5 ng/ml, prostate specific antigen doubling time less than 6 months predicts positive [(11)C]choline positron emission tomography/computerized tomography. In these patients [(11)C]choline positron emission tomography/computerized tomography may reduce by 50% the number in whom salvage therapy is initiated empirically without knowing the disease location.

Levels of a subpopulation of platelets, but not circulating endothelial cells, predict early treatment failure in prostate cancer patients after prostatectomy

Background:Angiogenesis is one of the hallmarks of cancer driving tumour growth and ultimately metastasis. Circulating endothelial cells (CECs) and circulating endothelial progenitor (CEPs) cells have been reported as candidate surrogate markers for tumour vascularisation. Our aim was to investigate the potential use of these circulating cells levels as predictors of prostate cancer treatment failure and metastasis.Methods:We examined the levels of CD31+CD45− cells (CECs) and CD31+CD45−CD117+ (CEPs) in s.c. and orthotopic models of human prostate cancers and correlated measurements with tumour size, volume and microvessel density (MVD). We then performed a prospective cohort study in 164 men with localised prostate cancer undergoing prostatectomy. The CD31+CD45−, CD31+CD45−CD146+ (CECs) and CD31+CD45intermediateCD133+ (CEPs) populations were quantified and subsequently enriched for further characterisation.Results:In preclinical models, levels of CD31+CD45− cells, but not CEPs, were significantly elevated in tumour-bearing mice and correlated with tumour size, volume and MVD. In our human prospective cohort study, the levels of CD31+CD45− cells were significantly higher in men who experienced treatment failure within the first year, and on logistic regression analysis were an independent predictor of treatment failure, whereas neither levels of CECs or CEPs had any prognostic utility. Characterisation of the isolated CD31+CD45− cell population revealed an essentially homogenous population of large, immature platelets representing <0.1% of circulating platelets.Conclusion:Elevated levels of a distinct subpopulation of circulating platelets were an independent predictor for early biochemical recurrence in prostate cancer patients within the first year from prostatectomy.

Diffusion-weighted imaging of local recurrent prostate cancer after radiation therapy: comparison with 22-core three-dimensional prostate mapping biopsy

Accurate localization of local recurrence within the prostate gland is important to perform focal salvage therapy effectively with minimal complications. The purpose of this study was to evaluate the usefulness of diffusion-weighted imaging (DWI) in the detection and localization of prostate cancer recurrence in patients with biochemical failure after definitive radiation therapy using 22-core three-dimensional prostate mapping biopsy (3D-PMB) as a standard reference. Ten patients who underwent magnetic resonance imaging and 22-core 3D-PMB were retrospectively analyzed. For visual assessment of DWI, the prostate was divided into 22 regions corresponding to 3D-PMB. Two diagnostic radiologists determined the presence of abnormal high signal intensity in each region on DWI, and the results of DWI were compared with those of 3D-PMB. Of the 220 regions, 16 regions in six patients were positive for cancer on 3D-PMB, and 30 regions in six patients were judged as positive on DWI. On a patient-by-patient basis, sensitivity and specificity were 100% (6/6) and 100% (4/4), respectively. On a region-by-region basis, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 69% (11/16), 91% (185/204), 37% (11/30), 97% (185/190) and 89% (196/220), respectively. For discrepant localization between DWI and pathology, DWI-positive and pathology-positive regions tended to be adjacent to each other. In conclusion, DWI is a useful tool for the detection and localization of recurrent prostate cancer in patients with biochemical failure after radiation therapy and may be helpful in the planning of focal salvage therapy.

Plasma hTERT mRNA discriminates between clinically localized and locally advanced disease and is a predictor of recurrence in prostate cancer patients

Introduction: Since the introduction of prostate-specific antigen (PSA) testing, new prostate cancer (PCa) patients are diagnosed earlier and most have localized and locally advanced disease. Current diagnosis methods lack specificity and sensitivity, leading to overdiagnosis and overtreatment of patients with low-risk organ-confined localized disease. Therefore, new non-invasive molecular tools are needed to discriminate between localized and locally advanced disease.Methods: Plasma telomerase reverse transcriptase (hTERT) mRNA levels were determined by qRT-PCR in 49 patients with localized and locally advanced PCa. Diagnostic accuracy and efficacy as a prognostic factor of biochemical recurrence of plasma hTERT mRNA were determined using univariate and multivariate analyses and compared with conventional tumor markers.Results: Patients with locally advanced disease had significantly (p < 0.05) higher plasma hTERT mRNA and serum PSA levels than those with localized disease. Plasma hTERT mRNA test showed lower sensitivity (83% vs. 100%), higher specificity (73% vs. 43%), AUC ROC curve (0.911 vs. 0.757), and positive likelihood ratios (6.17 vs. 1.76) than the PSA assay in discriminating between localized and locally advanced disease. At multivariate analysis, plasma hTERT mRNA levels and age but not PSA showed a positive trend (p = 0.05) in the risk of locally advanced PCa. On univariate analysis, plasma hTERT mRNA and serum PSA were identified as significant prognostic factors of biochemical recurrence. Using ROC curves and the appropriate cutoff, both tests showed high sensitivity (85%) and specificity (72%). Kaplan–Meier curves confirmed the significant differences between the groups and patients with higher levels than the cutoff value showed diminished recurrence-free survival (p < 0.05). At multivariate analysis, Gleason score and PSA were the strongest factors associated with biochemical recurrence (p < 0.05), whereas hTERT mRNA did not reach statistical significance, although a positive trend was observed (p = 0.09).Conclusion: Plasma hTERT mRNA quantification can be both a useful non-invasive tumor marker for discriminating between localized and locally advanced PCa, as well as a prognostic factor of recurrence at the molecular level.

Abstract 647: Use of statin and risk of prostate cancer recurrence among patients who received radical prostatectomy

Abstract Background: HMG-CoA reductase inhibitors (“statins”) have shown broad-spectrum anti-cancer properties in laboratory studies. In epidemiologic studies, statin use has been linked to reduced risk of advanced prostate cancer (PCa). We investigated whether statin use is associated with reduced risk of recurrence in PCa patients who received radical prostatectomy. Methods: All men with incident PCa diagnosed between 2004-2005 who subsequently underwent radical prostatectomy in Kaiser Permanente Southern California (KPSC) health plan were identified using KPSC's accredited cancer registry. Exclusion criteria included &amp;lt;24 months prior KPSC membership, use of neoadjuvant therapy, and stage 4 disease. Subjects were followed for 5 years after prostatectomy for: (1) Biochemical recurrence, defined as a single PSA measurement &amp;gt;0.2 ng/ml; and (2) clinical disease progression, defined as diagnosis of metastatic disease (identified using ICD-9 codes) or PCa-related death (i.e., PCa as primary cause of death). Information on statin use, demographics, co-morbid conditions, pathoclinical prognostic factors, e.g., stage and Gleason score, and outcomes were obtained from cancer registry and electronic medical records. The effects of statin use prior to and after prostatectomy were both examined using bivariate and multivariable Cox models, adjusting for known prognostic factors. For post-operative statin exposure, a time-dependent Cox model was used. Results: A total of 1192 men were included; 38% had pre-operative and 55% had post-operative statin use. Neither pre- nor post-operative statin use was associated with risk of any outcome, as there was no evidence of a clear dose-response relationship (Table). Conclusion: These data suggest that despite statin's protective effect in developing PCa, statin use may not prevent PCa progression. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 647. doi:1538-7445.AM2012-647

Does hormone therapy reduce disease recurrence in prostate cancer patients receiving dose-escalated radiation therapy? An analysis of Radiation Therapy Oncology Group 94-06

Does hormone therapy reduce disease recurrence in prostate cancer patients receiving dose-escalated radiation therapy? An analysis of Radiation Therapy Oncology Group 94-06

Tumor Volume Associated with Recurrence in Prostate Cancer Patients with Seminal Vesicle Invasion

Objectives: To examine predictors of progression-free survival in men with seminal vesicle invasion (SVI) following radical prostatectomy (RP) for clinically localized prostate cancer. Methods and Materials: Between 1999 and 2009, 1383 men underwent RP at Indiana University. Among them, 115 men were identified with SVI. Disease progression was defined by a rise in PSA ≥ 0.2 ng/ml, receipt of salvage therapy, progression to metastatic disease, or death. After excluding 13 patients for receiving adjuvant therapy, 102 were stratified according to surgical margin (SM) and lymph node (LN) status for Kaplan-Meier analysis of disease progression. Cox proportional hazards analyses of biochemical progression-free survival were undertaken with respect to margin status, pre-operative prostate specific antigen (PSA), tumor volume, age, and post-operative Gleason sum. Stem and leaf plot was undertaken for tumor volume by biochemical PFS. Results: Mean age was 61 years, median Gleason sum was 7, mean tumor volume was 9.7 ml, and mean pre-operative PSA was 13.6 ng/ml. Mean time to disease progression was 17 months. Mean follow-up was 37 months. Kaplan-Meier analysis revealed statistically insignificant differences in progression-free survival stratified by SM and LN status (p = 0.12). Cox univariate analyses revealed tumor volume to be a statistically significant predictor of progression free survival (p = 0.02). Stem and Leaf plot revealed tumor volume to be statistically significantly larger in patients who experienced biochemical recurrence, compared to those who did not. Conclusion: Tumor volume was associated progression-free survival in this cohort of SVI patients, while pathologic Gleason sum, PSA, margin and nodal status were not.

Vaccine-Derived Poliomyelitis 12 Years after Infection

1. Valicenti R, Lu J, Pilepich M, Asbell S, Grignon D. Survival advantage from higher-dose radiation therapy for clinically localized prostate cancer treated on the Radiation Therapy Oncology Group trials. J Clin Oncol 2000;18:2740-6. 2. Valicenti RK, Bae K, Michalski J, et al. Does hormone therapy reduce disease recurrence in prostate cancer patients receiving dose-escalated radiation therapy? An analysis of Radiation Therapy Oncology Group 94-06. Int J Radiat Oncol Biol Phys 2011;79:1323-9.

Smoking and Prostate Cancer Survival and Recurrence

Studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients are limited, with few prostate cancer-specific outcomes. To assess the relation of cigarette smoking and smoking cessation with overall, prostate cancer-specific, and cardiovascular disease (CVD) mortality and biochemical recurrence among men with prostate cancer. Prospective observational study of 5366 men diagnosed with prostate cancer between 1986 and 2006 in the Health Professionals Follow-Up Study. Hazard ratios (HRs) for overall, prostate cancer-specific, and CVD mortality, and biochemical recurrence, defined by an increase in prostate-specific antigen (PSA) levels. There were 1630 deaths, 524 (32%) due to prostate cancer and 416 (26%) to CVD, and 878 biochemical recurrences. Absolute crude rates for prostate cancer-specific death for never vs current smokers were 9.6 vs 15.3 per 1000 person-years; for all-cause mortality, the corresponding rates were 27.3 and 53.0 per 1000 person-years. In multivariable analysis, current vs never smokers had an increased risk of prostate cancer mortality (HR, 1.61; 95% confidence interval [CI], 1.11-2.32), as did current smokers with clinical stage T1 through T3 (HR, 1.80; 95% CI, 1.04-3.12). Current smokers also had increased risk of biochemical recurrence (HR, 1.61; 95% CI, 1.16-2.22), total mortality (HR, 2.28; 95% CI, 1.87-2.80), and CVD mortality (HR, 2.13; 95% CI, 1.39-3.26). After adjusting for clinical stage and grade (likely intermediates of the relation of smoking with prostate cancer recurrence and survival), current smokers had increased risk of prostate cancer mortality (HR, 1.38; 95% CI, 0.94-2.03), as did current smokers with clinical stage T1 through T3 (HR, 1.41; 95% CI, 0.80-2.49); they also had an increased risk of biochemical recurrence (HR, 1.47; 95% CI, 1.06-2.04). Greater number of pack-years was associated with significantly increased risk of prostate cancer mortality but not biochemical recurrence. Current smokers of 40 or more pack-years vs never smokers had increased prostate cancer mortality (HR, 1.82; 95% CI, 1.03-3.20) and biochemical recurrence (HR, 1.48; 95% CI, 0.88-2.48). Compared with current smokers, those who had quit smoking for 10 or more years (HR, 0.60; 95% CI, 0.42-0.87) or who have quit for less than 10 years but smoked less than 20 pack-years (HR, 0.64; 95% CI, 0.28-1.45) had prostate cancer mortality risks similar to never smokers (HR, 0.61; 95% CI, 0.42-0.88). Smoking at the time of prostate cancer diagnosis is associated with increased overall and CVD mortality and prostate cancer-specific mortality and recurrence. Men who have quit for at least 10 years have prostate cancer-specific mortality risks similar to those who have never smoked.

Abstract 4557: A novel approach of disrupting androgen-receptor signaling for prostate cancer intervention

Abstract The development of castration-resistant prostate cancer after androgen deprivation therapy remains the major challenge in the treatment of advanced prostate cancer. Current androgen deprivation therapy targets the action of androgen receptor by reducing circulating androgen level through castration or by disrupting the binding of androgens to the receptor with anti-androgen. Despite the initial efficacy of androgen deprivation therapy, relapse with incurable castration-resistant prostate cancer invariably occurs, constituting the major cause of prostate cancer mortality. Although castration-resistant prostate cancer is no longer responsive to androgen deprivation, the expression and signaling of androgen receptor are maintained. Agents such as abiraterone are effective in prolonging survival in patients with castration-resistant prostate cancer, but even this potent and irreversible CYP17 inhibitor has a relatively short time to disease progression in these patients. One potential mechanism is the prevalent upregulation of the constitutively-active, ligand-binding-domain-truncated androgen receptor splice variants, which have been shown to contribute to castration-resistant tumor growth. Thus, developing effective strategies attacking the androgen receptor itself to reduce its availability is urgently needed in the battle against prostate cancer recurrence during androgen deprivation therapy. Our data show that two potent second-generation selenium-containing drugs, methylseleninic acid (MSA) and methylselenocysteine (MSC), are very effective in decreasing the abundance of both the full-length and the truncated androgen receptor. They not only enhance the efficacy of anti-androgen in both androgen-dependent and castration-resistant prostate cancer cells, but also inhibit prostate tumor relapse after castration in a xenograft model. Our results also show that combination of these agents with anti-androgen produces a robust downregulation of an androgen receptor target, telomerase and its catalytic subunit, telomere reverse transcriptase (hTERT). The combination efficacy is significantly mitigated when hTERT/telomerase expression is restored. In addition, their inhibition of prostate tumor relapse after castration is also accompanied by a pronounced decrease of hTERT. The importance of the findings on hTERT/telomerase lies not only in its key role in regulating cell growth and survival, but also in the association of high hTERT expression with biochemical recurrence in prostate cancer patients undergoing radical prostatectomy and neoadjuvant androgen deprivation therapy. Taken together, our findings provide strong justification and lay the groundwork for an effective therapeutic modality that capitalizes on a new approach of disrupting androgen-receptor-mediated growth response important for the development of castration resistance. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4557. doi:10.1158/1538-7445.AM2011-4557

Body Mass Index, Prostate Cancer–Specific Mortality, and Biochemical Recurrence: a Systematic Review and Meta-analysis

Increasing evidence suggested obesity, measured by body mass index (BMI), was associated with prostate cancer-specific mortality, and its impact on biochemical recurrence was also inconclusive. We systematically searched MEDLINE, EMBASE, and bibliographies of retrieved studies up to January 5, 2010. We used random-effects meta-analysis to assess the relative risks (RR) of prostate cancer-specific mortality and biochemical recurrence associated with a 5 kg/m(2) increase in BMI. Among the six population-based cohort studies in 1,263,483 initially cancer-free men, 6,817 prostate cancer deaths occurred; a 5 kg/m(2) increase in BMI was associated with 15% (RR: 1.15, 95% confidence interval (CI): 1.06-1.25, P < 0.01) higher risk of dying of prostate cancer. In the six postdiagnosis survival studies on 18,203 patients with 932 prostate cancer deaths, a 5 kg/m(2) increase in BMI was associated with 20% higher prostate cancer-specific mortality (RR: 1.20, 95% CI: 0.99-1.46, P = 0.06). In the sixteen studies which followed 26,479 prostate cancer patients after primary treatment, a 5 kg/m(2) increase in BMI was significantly associated with 21% increased risk of biochemical recurrence (RR: 1.21, 95% CI: 1.11-1.31 P < 0.01). Elevated BMI is associated with risk of prostate cancer-specific mortality in prospective cohort studies and biochemical recurrence in prostate cancer patients. Its association with prostate cancer-specific mortality in diagnosed patients needs to be further evaluated.

Does Hormone Therapy Reduce Disease Recurrence in Prostate Cancer Patients Receiving Dose-Escalated Radiation Therapy? An Analysis of Radiation Therapy Oncology Group 94-06

The purpose of this study was to evaluate the effect on freedom from biochemical failure (bNED) or disease-free survival (DFS) by adding hormone therapy (HT) to dose-escalated radiation therapy (HDRT). We used 883 analyzable prostate cancer patients who enrolled on Radiation Therapy Oncology Group (RTOG) 94-06, a Phase I/II dose escalation trial, and whose mean planning target volume dose exceeded 73.8 Gy (mean, 78.5 Gy; maximum, 84.3 Gy). We defined biochemical failure according to the Phoenix definition. A total of 259 men started HT 2 to 3 months before HDRT, but not longer than 6 months, and 66 men with high-risk prostate cancer received HT for a longer duration. At 5 years, the biochemical failure rates after HDRT alone were 12%, 18%, and 29% for low-, intermediate-, and high-risk patients, respectively (p < 0.0001). Cox proportional hazards regression analysis adjusted for covariates revealed that pretreatment PSA level was a significant factor, whereas risk group, Gleason score, T-stage, and age were not. When the patients were stratified by risk groups, the Cox proportion hazards regression model (after adjusting for pretreatment PSA, biopsy Gleason score, and T stage) did not reveal a significant effect on bNED or DFS by adding HT to HDRT CONCLUSION: The addition of HT did not significantly improve bNED survival or DFS in all prostate cancer patients receiving HDRT, but did approach significance in high-risk patient subgroup. The result of this study is hypothesis generating and requires testing in a prospective randomized trial.

Long-term results of salvage cryotherapy for prostate cancer.

108 Background: The optimum treatment of Prostate cancer recurrence following external bean radiation therapy (EBRT) remains a controversial topic. The primary problem with comparing salvage techniques following EBRT is the lack of long term data. We reviewed the long- term overall survival, disease-specific survival and disease free survival of patients who have undergone salvage cryotherapy to the prostate gland. Methods: A retrospective analysis was performed on all patients undergoing salvage cryotherapy for locally recurrent prostate cancer after EBRT by a single surgeon at a single institution from 1995-2004. Patients preoperative, perioperative and postoperative data was reviewed and recorded. Should a patient no longer be followed by the urology service the Patients and the patient's primary care physician or urologist were contacted. Mortality data, PSA results, bone scan results and any details of hormone therapy were recorded for this study. Results: 187 patients were included in the current study from which 176 patients had records available for follow up giving a follow up rate of 94%. Mean follow up was 7.46 years (1-14 years). 52 patients were followed for greater than 10 years. Average time to prostate cancer recurrence in patients who developed recurred was 2.3 years and average time to hormone therapy in these patients was 2.8 years. Overall survival at 10 years was high at 87%. Risk factors for recurrence of tumour identified were presalvage PSA, preradiation and presalvage gleason score. Preradiation gleason score had little impact on survival. PSA nadir of &gt;1.0ng/mL was highly predictive of early recurrence. Disease-free survival rates of between 39 and 64% depending on risk factors. Conclusions: Cryotherapy has a definite role in the management of prostate cancer, representing a minimally invasive salvage treatment with acceptable 10 year disease free survival (DFS) of upwards of 39% and specific groups attaining 10 year DFS of 64%. Presalvage PSA and Gleason score are the best predictors of disease recurrence, whilst preradiation gleason score did not correlate with risk of disease recurrence. A PSA Nadir greater than 1 ng/mL indicates a poor prognosis in which early ADT should be strongly considered. No significant financial relationships to disclose.

Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F]choline PET/CT in the detection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP)

This study compares proton magnetic resonancespectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined techniques at 3T magnet versus [(18)F]choline PET/computed tomography (CT) in the detection of local prostate cancer recurrence in patients with biochemical progression after radical retropubic prostatectomy (RRP). 84 consecutive patients at high risk of local recurrence underwent combined 1HMRSI-DCEMR and 18-Fcholine- PET/CT. MR scan protocol included turbo spin echo (TSE) T2-weighted sequences in the axial, sagittal and coronal planes; three-dimensional (3D) chemical shift imaging (CSI) sequences with spectral/spatial pulses optimized for quantitative detection of choline and citrate; dynamic contrast enhanced gradient-echo (GRE) T1-weighted sequence. The population was divided into two groups. Group A included 28 patients with a lesion size ranging between 5.00mm and 7.2mm and PSA reduction following radiation therapy. Group B included 56 patients with a lesion size between 7.6mm and 19.4mm. Sensitivity, specificity, positive predictive value (PPV) and accuracy were evaluated and receiver operating characteristic (ROC) curves were performed. In Group A combined 1H-MRSI and DCE-MRI showed a sensitivity of 92%, a specificity of 75% (PPV 96%) while PET-CT examination showed a sensitivity of 62% and a specificity of 50% (PPV 88%) in identifying local recurrence. The accuracy of MRI was 89% while PET-CT showed an accuracy of 60%. Areas under the ROC curve (AUC) values for MR and PET-CT were 0.833 and 0.562, respectively. In Group B combined 1H-MRSI and DCEMR showed a sensitivity of 94% and a specificity of 100% (PPV 100%) with accuracy of 94%. PET-CT had a sensitivity of 92% and a specificity of 33% (PPV 98%) with accuracy of 91%. The AUCs for MR and PET-CT values were 0.971 and 0.837, respectively. The diagnostic accuracy of combined 1HMRSI-DCEMR was higher than PET/CT to identify local prostate cancer recurrence, mostly in patients with low biochemical progression after RRP (0.2-2ng/mL).

669 AN EVALUATION OF THE OUTCOMES OF ADMINISTERING A SECOND-LINE LHRH ANALOGUE FOLLOWING PSA RECURRENCE IN PROSTATE CANCER PATIENTS UNDERGOING ANDROGEN DEPRIVATION THERAPY WITH AN LHRH ANALOGUE

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2010669 AN EVALUATION OF THE OUTCOMES OF ADMINISTERING A SECOND-LINE LHRH ANALOGUE FOLLOWING PSA RECURRENCE IN PROSTATE CANCER PATIENTS UNDERGOING ANDROGEN DEPRIVATION THERAPY WITH AN LHRH ANALOGUE Nathan Lawrentschuk, Kimberley Fernandes, Karen Hersey, and Neil E. Fleshner Nathan LawrentschukNathan Lawrentschuk More articles by this author , Kimberley FernandesKimberley Fernandes More articles by this author , Karen HerseyKaren Hersey More articles by this author , and Neil E. FleshnerNeil E. Fleshner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1056AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with hormone refractory prostate cancer (PC) have few management options. LHRH antagonists, although in the same class, are slightly different in their pharmacology. Our aim was to determine if re-challenging PC patients who are receiving an LHRH analogue but are progressing, with a different LHRH analogue (Zoladex[Z]or Lupron[L]) will result in a PSA response. The secondary objectives were to calculate PSA response and whether the PSA reduction from switching the regimens changes depending on whether patients switch from L to Z, or vice versa. METHODS A retrospective ethics approved review of PC patients at multiple institutions who were receiving an LHRH analogue (Z or L) who started progressing as measured by two consecutive PSA rises and were then re-challenged with the other LHRH analogue (Z or L). PSA data, testosterone data and clinical data was obtained. Statistical analysis was undertaken. RESULTS 39 individuals were included in the analysis. 27 (69%) had a reduced PSA after three months of switching regimens as compared to the PSA immediately prior to switching regimens. The median change in PSA is -1.5 ng/ml (IQR -10.0-0.8), indicating a statistically significant reduction using the sign rank test (p value = 0.01). This proportion of patients who experienced a reduction in PSA is statistically significantly different from 50% (p value 0.02; 95%CI 0.52-0.83), indicating an overall reduction of PSA when comparing the two time points. The median % change for those switching from L to Z was -69.3% (-81.5-26.2%), and the median percent change from those switching from Z to L was -6.4% (-61.7-21.8%; p=0.05). The median time until people experienced a higher PSA level was 5.16 months (95% CI 3.5-17.4). CONCLUSIONS From this study there is evidence that a reduction in PSA levels occurred after switching therapies, and that the reduction was higher for the group switching from L to Z than from Z to L. The duration of response upon switching was around 5 months. The study is limited by being retrospective. However, the data is hypotheses generating for a future prospective clinical trial. Figure 1. Distribution of PSA before after switching therapies, by therapy order(Z=Zoladez, L=Lucrin). Toronto, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e261-e262 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Lawrentschuk More articles by this author Kimberley Fernandes More articles by this author Karen Hersey More articles by this author Neil E. Fleshner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...