Therapy For Localized Prostate Cancer Research Articles

Prostate-specific antigen vs. magnetic resonance imaging parameters for assessing oncological outcomes after high intensity–focused ultrasound focal therapy for localized prostate cancer

IntroductionFocal therapy for localized prostate cancer has the potential for oncological control without the side effects of radical therapies. However, there is currently no validated method for monitoring treatment success. We assessed the diagnostic performance of prostate-specific antigen (PSA) parameters and MRI compared to histological outcomes following focal therapy. Patients and methodsPatients from 3 Ethics Review Board approved prospective studies of focal high intensity–focused ultrasound (HIFU) (Sonablate 500) for localized prostate cancer (T1c–T3a, Gleason grade≤4+3, and PSA≤20). Post-HIFU PSA nadir, 6-month PSA, PSA density, and early (<3wk) and late (6mo) MRI (T2-weighted, dynamic contrast-enhanced±diffusion-weighted) was assessed for predictive accuracy of cancer on postoperative biopsy, using receiver operating characteristic (ROC) analysis and sensitivity, specificity, and positive and negative predictive estimates. ROC areas for MRI and PSA were compared. Calculations for statistical significance (P≤0.05) were obtained in a subset of patients comparing area under ROC for 6-month MRI and PSA criteria, across 4 different histological definitions of disease significance. ResultsOf 118 men, 111 underwent at least 1 postoperative biopsy (median 6 cores), with an overall positive biopsy rate of 37% (41/118), over a mean follow-up period of 716 days post-HIFU. Areas under ROC for early and late MRI were (depending on definition of significant disease) 0.65 to 0.76 and 0.77 to 0.85, respectively, with sensitivity, specificity, and negative predictive values of 68% to 91%, 52% to 55%, and 85% to 98% (early MRI), and 63% to 80%, 67% to 73%, and 86% to 97% (late MRI). The area under the ROC curve was statistically significantly higher for late MRI than 6 months and nadir PSA for residual disease >3mm or any Gleason 4 tumor. ConclusionsEarly and late MRI performed better than PSA measurements in the detection of residual tumor after focal therapy.

CT Measures of Bone Mineral Density and Muscle Mass Can Be Used to Predict Noncancer Death in Men with Prostate Cancer.

Purpose To determine if computed tomographic (CT) metrics of bone mineral density and muscle mass can improve the prediction of noncancer death in men with localized prostate cancer. Materials and Methods Institutional review board approval was obtained, with waiver of informed consent. All patients who underwent radiation therapy for localized prostate cancer between 2001 and 2012 with height, weight, and past medical history documented and who underwent CT that included the L4-5 vertebral interspace were included. On a single axial CT section obtained at the mid-L5 level, the mean CT attenuation of the trabecular bone of the L5 vertebral body (L5HU) was measured. The height-normalized psoas cross-sectional area (PsoasL4-5) was measured on a single CT section obtained at the L4-5 vertebral interface. Multivariable Cox proportional hazards models were used to assess effects on noncancer death. By using parameter estimates from an adjusted model, a prognostic index for prediction of noncancer death was generated and compared with age-adjusted Charlson Comorbidity Index (CCI) by using the Harrell c statistic. Results Six hundred fifty-three men met the inclusion criteria. Prostate cancer risk grouping, androgen deprivation, race, age-adjusted CCI, L5HU, and PsoasL4-5 were included in a multivariable model. Age-adjusted CCI (hazard ratio [HR] = 1.36, P < .001), L5HU (HR = 2.88 for L5HU < 105 HU, HR = 1.42 for 105 HU ≤ L5HU ≤ 150 HU, P < .001), PsoasL4-5 (HR = 1.95 for PsoasL4-5 < 7.5 cm2/m2, P = .003), and race (HR = 1.68 for African American race, HR = 1.77 for other nonwhite race, P = .019) were independent predictors of noncancer death. The prognostic index yielded a c value of 0.747 for the prediction of noncancer death versus 0.718 for age-adjusted CCI alone. Conclusion L5HU and PsoasL4-5, which are surrogates for bone mineral density and muscle mass, respectively, were independent predictors of noncancer death. The prognostic index that incorporated these measures with the CCI was associated with improved accuracy for prediction of noncancer death. © RSNA, 2016 Online supplemental material is available for this article.

MRI evaluation following partial HIFU therapy for localized prostate cancer: A single-center study

To evaluate the value of MRI for surveillance of primary hemi-HIFU therapy for localized PCa in a single-center. Patients with localized prostate cancer were treated with hemi-HIFU from October 2009 to March 2014. All patients performed MRI before focal therapy, the reader was blinded to the treatment. Oncological failure was defined as positive biopsy or biochemical recurrence (Phoenix). Twenty-five patients were treated with hemi-HIFU in one center. The median nadir PSA was 1.45±1.4ng/mL. Prostate volume decreased from 45cc to 25cc on MRI findings. At 20 months, none of the patients had histological recurrence. Biochemical-free survival rate was 88%. MRI evaluation had a negative predictive value of 100% on the treated area and 81% on the untreated area. PSAd≥0.1ng/mL(2) was a predictive factor for cancer on untreated area (P=0.042). MRI control at 6 months is a potentially effective evaluation of treated area after hemi-HIFU and may replace randomized biopsies if PSAd<0.1ng/mL(2) during follow-up. 4.

07 - Oncologic outcomes after hemiablation therapy for localized prostate cancer

07 - Oncologic outcomes after hemiablation therapy for localized prostate cancer

Neoadjvant hormone therapy for localized prostate cancer: Initial experiences in intermittent-and high-risk patients in the robotic surgery ERA

Neoadjvant hormone therapy for localized prostate cancer: Initial experiences in intermittent-and high-risk patients in the robotic surgery ERA

Use, complications, and costs of stereotactic body radiotherapy for localized prostate cancer

Stereotactic body radiotherapy (SBRT) for localized prostate cancer has potential advantages over traditional radiotherapies. Herein, the authors compared national trends in use, complications, and costs of SBRT with those of traditional radiotherapies. The authors identified men who underwent SBRT, intensity-modulated radiotherapy (IMRT), brachytherapy, and proton beam therapy as primary treatment of prostate cancer between 2004 and 2011 from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare linked data. Temporal trend of therapy use was assessed using the Cochran-Armitage test. Two-year outcomes were compared using the chi-square test. Median treatment costs were compared using the Kruskal-Wallis test. A total of 542 men received SBRT, 9647 received brachytherapy, 23,408 received IMRT, and 800 men were treated with proton beam therapy. There was a significant increase in the use of SBRT and proton beam therapy (P<.001), whereas brachytherapy use decreased (P<.001). A higher percentage of patients treated with SBRT and brachytherapy had low-grade cancer (Gleason score ≤ 6 vs ≥ 7) compared with individuals treated with IMRT and proton beam therapy (54.0% and 64.2% vs 35.2% and 49.6%, respectively; P<.001). SBRT compared with brachytherapy and IMRT was associated with equivalent gastrointestinal toxicity but more erectile dysfunction at 2-year follow-up (P<.001). SBRT was associated with more urinary incontinence compared with IMRT and proton beam therapy but less compared with brachytherapy (P<.001, respectively). The median cost of SBRT was $27,145 compared with $17,183 for brachytherapy, $37,090 for IMRT, and $54,706 for proton beam therapy (P<.001). The use of SBRT and proton beam therapy for localized prostate cancer has increased over time. Despite men of lower disease stage undergoing SBRT, SBRT was found to be associated with greater toxicity but lower health care costs compared with IMRT and proton beam therapy. Cancer 2016;122:2496-504. © 2016 American Cancer Society.

Acute Urinary Morbidity Following Stereotactic Body Radiation Therapy for Prostate Cancer with Prophylactic Alpha-Adrenergic Antagonist and Urethral Dose Reduction.

Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to the adjacent critical organs. Large fraction sizes may increase urinary morbidity due to unavoidable treatment of the prostatic urethra. This study reports rates of acute urinary morbidity following SBRT for localized prostate cancer with prophylactic alpha-adrenergic antagonist utilization and urethral dose reduction (UDR). From April 2013 to September 2014, 102 patients with clinically localized prostate cancer were treated with robotic SBRT to a total dose of 35-36.25 Gy in five fractions. UDR was employed to limit the maximum point dose of the prostatic urethra to 40 Gy. Prophylactic alpha-adrenergic antagonists were initiated 5 days prior to SBRT and continued until resolution of urinary symptoms. Quality of life (QoL) was assessed before and after treatment using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite-26 (EPIC-26). Clinical significance was assessed using a minimally important difference (MID) of one half SD change from baseline. One hundred two patients underwent definitive prostate SBRT with UDR and were followed for 3 months. No patient experienced acute urinary retention requiring catheterization. A mean baseline AUA symptom score of 9.06 significantly increased to 11.83 1-week post-SBRT (p = 0.0024) and 11.84 1-month post-SBRT (p = 0.0023) but returned to baseline by 3 months. A mean baseline EPIC-26 irritative/obstructive score of 87.7 decreased to 74.1 1-week post-SBRT (p < 0.0001) and 77.8 1-month post-SBRT (p < 0.0001) but returned to baseline at 3 months. EPIC-26 irritative/obstructive score changes were clinically significant, exceeding the MID of 6.0. At baseline, 8.9% of men described their urinary function as a moderate to big problem, and that proportion increased to 37.6% 1 week following completion of SBRT before returning to baseline by 3 months. Stereotactic body radiation therapy for localized prostate cancer with utilization of prophylactic alpha-adrenergic antagonist and UDR was well tolerated as determined by acute urinary function and bother, and symptoms were comparable to those observed following conventionally fractionated external beam radiation therapy (EBRT). Longer follow-up is required to assess long-term toxicity and efficacy following SBRT with UDR.

The Devastated Bladder Outlet in Cancer Survivors After Local Therapy for Prostate Cancer

Prostate cancer is common; this combined with the long life expectancy after treatment has sparked a growing emphasis on prostate cancer survivorship care. An important goal of such care is preserving quality of life through ameliorating the side effects of therapy. Posterior urethral stenosis (PUS) can occur as a complication of radical prostatectomy (RP) and radiation therapy (RT). Evaluation includes a history, physical exam, uroflowmetry, lab tests, cystoscopy, and radiological studies. PUS is initially managed with endoscopic techniques such as dilation or internal urethrotomy. Patients who fail such therapies can be offered surgical reconstruction. Continence is an important factor in the management of PUS. In some cases, particularly after radiotherapy, the outlet may not be salvageable, and a permanent indwelling catheter or urinary diversion may be the only options. We review the evaluation of patients with the devastated bladder outlet: those undergoing repeat endoscopic treatments, surgical reconstruction, or urinary diversion.

PD43-08 PROSPECTIVE LONGITUDINAL COMPARATIVE STUDY OF LONG-TERM URINARY AND SEXUAL FUNCTION AFTER PRIMARY SURGICAL TREATMENT FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-08 PROSPECTIVE LONGITUDINAL COMPARATIVE STUDY OF LONG-TERM URINARY AND SEXUAL FUNCTION AFTER PRIMARY SURGICAL TREATMENT FOR LOCALIZED PROSTATE CANCER Homayoun Zargar, Daniel Moon, Anthony Costello, Mark Frydenberg, and Mari Botti Homayoun ZargarHomayoun Zargar More articles by this author , Daniel MoonDaniel Moon More articles by this author , Anthony CostelloAnthony Costello More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , and Mari BottiMari Botti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1786AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to prospectively and independently assess real world outcomes of Australian men’s urinary and sexual function following retropubic (RRP), laparoscopic (LRP) and robotic assisted (RARP) radical prostatectomy surgery for localized prostate cancer METHODS From 2009 to 2012 men with localized prostate cancer undergoing surgery by one of fourteen study urologists working across eight private-sector sites were included in the study. Patients were consented for the study and data was collected by self-reported questionnaires prospectively at 3,6,12,18 and 24 months by researchers independent of treating urologists. Urinary and sexual function data were obtained using EPIC, SHIM and IPSS questionnaires. RESULTS Overall 1005 men were recruited with the study participation rate of 79.2%, with 836 men having completed surveys at each follow-up (Table 1). At 24 months follow up the median EPIC urinary and sexual summary scores were at 95.6 and 47.4% of baseline respectively. The rate of erectile function preservation at 24 months in men with good erectile function preoperatively (SHIM≥ 20) was 27% for the entire cohort. On multivariable cox regression model (including age, Gleason score, prostate volume, preoperative SHIM score, surgical modality), age (OR 0.94 95% CI (0.91-0.97); p=0.001), preoperative erectile function (OR 1.26 95% CI (1.14-.41); p<0.001) and laparoscopic approach (OR 0.23 95% CI (0.09-0.60); p=0.002) were predictors of good erectile function at 24 months. CONCLUSIONS Surgical therapy for localized prostate cancer provides excellent long-term urinary function as measured by EPIC urinary summary score in our series. Long-term sexual function was less preserved as demonstrated by 24 months EPIC sexual summary score. The rate of sexual function preservation for men with good preexisting sexual function treated by surgical therapy in this real world prospective independently collected community based study is far lower than previously reported by tertiary referral centres. Preexisting erectile function, age and modality of surgery impact the final long-term sexual function. The impact of surgeon’s training and experience are likely to be important determiners of long-term sexual function and will be addressed in future studies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e995 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Homayoun Zargar More articles by this author Daniel Moon More articles by this author Anthony Costello More articles by this author Mark Frydenberg More articles by this author Mari Botti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment trends for clinically localized prostate cancer. National population analysis: GESCAP group

ObjectivesTo describe the established therapies for localized prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines. Patients and methodsThis was an epidemiological, observational, prospective and multicentre study. Of the 3918 patients diagnosed with PC during 2010, only those patients with localized PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D’Amico risk stratification criteria (localized [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score. ResultsBy applying the D’Amico criteria, we included 3641 (92.93%) patients. Based on the UAE recommendations: (1) 68.87% of the patients at low-intermediate risk aged ≤65 years underwent radical prostatectomy; (2) 34.51% of the patients >65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; (3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; (4) 15.20% of the patients at low risk were only treated with brachytherapy; (5) active surveillance or observation was selected for 2.44% of the patients aged ≤65 years and for 10.63% of the patients at low-intermediate risk who were >65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments. ConclusionsThis is the first national European study to evaluate the therapeutic management of localized PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localized PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localized tumors, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).

The role of salvage extended lymph node dissection (LND) in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.

242 Background: According to the risk constellation recurrence rate of prostate cancer following local therapy is up to 60%. Early salvage radiotherapy already showed a benefit in progression-free survival. We analyzed the impact of salvage extended lymph node dissection on cancer control in patients with rising PSA and nodal recurrence in PET/CT scan. Methods: Between 2003 and 2015 we performed a salvage extended lymph node dissection in 95 patients with rising PSA and nodal recurrence in PET/CT scan after previous local therapy for prostate cancer. The extent of resection field was adjusted to the pre-operative imaging. Results: We identified 95 patients with rising PSA and nodal recurrence in PET/CT scan with a mean age of 66 years (55-76 years). There were no significant intraoperative complications. Postoperatively, 12% had Clavien/Dindo grade 3 complications. Complete PSA response, defined as a postoperative PSA level &lt; 0.2 ng/ml, was diagnosed in 36% of patients. With a median follow-up of 19 months (1-101 months) cancer-specific mortality rate was less than 1%. Median progression-free survival was 7 months (1-43 months). The interval until the initiation of systemic treatment was 12 months (1-43 months). Conclusions: Salvage LND can be performed without significant complications. Immediate complete PSA response can be achieved in one third of patients and systemic therapy can be delayed by one year. For a general treatment recommendation individual predictive markers are currently still missing.

Urethral strictures after radiation therapy for prostate cancer.

Urethral stricture after radiation therapy for localized prostate cancer is a delicate problem as the decreased availability of tissue healing and the close relation to the sphincter complicates any surgical approach. We here review the pathophysiology, dosimetry, and the disease specific aspects of urethral strictures after radiotherapy. Moreover we discuss different treatment option such as direct vision internal urethrotomy as well as techniques for open reconstruction with and without tissue transfer.

Tendencias de tratamiento en el cáncer de próstata clínicamente localizado. Análisis poblacional a nivel nacional: grupo GESCAP

ObjectivesTo describe the established therapies for localised prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines. Patients and methodsThis was an epidemiological, observational, prospective and multicentre study. Of the 3,918 patients diagnosed with PC during 2010, only those patients with localised PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3,713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D’Amico risk stratification criteria (localised [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score. ResultsBy applying the D’Amico criteria, we included 3,641 (92.93%) patients. Based on the UAE recommendations: 1) 68.87% of the patients at low-intermediate risk aged≤65 years underwent radical prostatectomy; 2) 34.51% of the patients>65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; 3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; 4) 15.20% of the patients at low risk were only treated with brachytherapy; 5) active surveillance or observation was selected for 2.44% of the patients aged≤65 years and for 10.63% of the patients at low-intermediate risk who were>65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments. ConclusionsThis is the first national European study to evaluate the therapeutic management of localised PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localised PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localised tumours, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).

Evolution of a CDC Public Health Research Agenda for Low-Risk Prostate Cancer.

Men with prostate cancer face difficult choices when selecting a therapy for localized prostate cancer. Comparative data from controlled studies are lacking and clinical opinions diverge about the benefits and harms of treatment options. Consequently, there is limited guidance for patients regarding the impact of treatment decisions on quality of life. There are opportunities for public health to intervene at several decision-making points. Information on typical quality of life outcomes associated with specific prostate cancer treatments could help patients select treatment options. From 2003 to present, the Division of Cancer Prevention and Control at CDC has supported projects to explore patient information-seeking behavior post-diagnosis, caregiver and provider involvement in treatment decision making, and patient quality of life following prostate cancer treatment. CDC's work also includes research that explores barriers and facilitators to the presentation of active surveillance as a viable treatment option and promotes equal access to information for men and their caregivers. This article provides an overview of the literature and considerations that initiated establishing a prospective public health research agenda around treatment decision making. Insights gathered from CDC-supported studies are poised to enhance understanding of the process of shared decision making and the influence of patient, caregiver, and provider preferences on the selection of treatment choices. These findings provide guidance about attributes that maximize patient experiences in survivorship, including optimal quality of life and patient and caregiver satisfaction with information, treatment decisions, and subsequent care.

Impact of the use of an endorectal balloon on rectal dosimetry during stereotactic body radiation therapy for localized prostate cancer

PurposeEndorectal balloons may be of benefit during stereotactic body radiation therapy of the prostate to limit intrafraction prostatic motion and potentially minimize rectal toxicity. We evaluated the effect of the endorectal balloon (ERB) on rectal dosimetry, specifically the absolute volume of rectum receiving high dose. Methods and materialsEleven patients with localized prostate cancer underwent stereotactic body radiation therapy planning with computed tomography simulation with and without a RadiaDyne ERB inflated with 60 mL of water. Prescription dose was 3625 cGy in 5 fractions of 725 cGy. The V3600 (volume receiving 3600 cGy), V3440 (volume receiving 3440 cGy), and volume receiving 50% of the prescription dose were calculated for both the rectum and rectal wall. Repeat plans were generated using smaller planning target volume margins (reduced to 1 mm from 3 mm posteriorly) and after virtually replacing the water-filled ERB with air equivalent density. Comparisons were made using the Wilcoxon signed-rank test. ResultsThe rectal V3600 and V3440 were significantly lower without ERB than with water-filled ERB using standard 3-mm posterior margin (P = .003 for both V3600/V3440), water-filled ERB using reduced 1-mm posterior margin (P = .016 and .003), or air-filled ERB (P = .003 and .004). Regarding the rectal wall, V3600 and V3440 were also significantly lower without ERB than with any ERB, except when using the water-filled ERB with reduced posterior margin (P = .328). The volumes of rectum and rectal wall receiving lower dose (volume receiving 50% of the prescription dose) were not significantly greater without the ERB. ConclusionWe found an increase in the volume of rectum and rectal wall receiving high dose radiation utilizing an ERB. Consideration in using an ERB should account for potential increased rectal dose and subsequent toxicity.

Detection of Core2 β-1,6-N-Acetylglucosaminyltransferase in Post-Digital Rectal Examination Urine Is a Reliable Indicator for Extracapsular Extension of Prostate Cancer.

To identify appropriate candidates for aggressive treatment such as radical prostatectomy or radiation therapy of localized prostate cancer (PCa), novel predictive biomarkers of PCa aggressiveness are essential. Core2 β-1,6-N-acetylglucosaminyltransferase-1 (GCNT1) is a key enzyme that forms core 2-branched O-glycans. Its expression is associated with the progression of several cancers. We established a mouse IgG monoclonal antibody (mAb) against GCNT1 and examined the relationship of GCNT1 expression to the clinicopathological status of PCa. Paraffin-embedded PCa specimens were analyzed by immunohistochemistry for GCNT1 expression using a newly established mouse anti-GCNT1 mAb by ourselves. GCNT1-positive tumor showed significantly higher Gleason score and larger tumor volume. The number of GCNT1-positive cases was significantly lower in cases of organ-confined disease than in cases of extracapsular extension. GCNT1-negative tumors were associated with significantly better prostate-specific antigen (PSA)-free survival compared with GCNT1-positive tumors. Multivariate analysis revealed that detection of GCNT1 expression was an independent risk factor for PSA recurrence. We established new methods for GCNT1 detection from PCa specimens. Immunoblotting was used to examine post-digital rectal examination (DRE) urine from PCa patients. Over 90% of GCNT1-positive PCa patients with high concentrations of PSA showed extracapsular extension. In conclusion, GCNT1 expression closely associates with the aggressive potential of PCa. Further research aims to develop GCNT1 detection in post-DRE urine as a marker for PCa aggressiveness.

Automatic Substitute Computed Tomography Generation and Contouring for Magnetic Resonance Imaging (MRI)-Alone External Beam Radiation Therapy From Standard MRI Sequences.

To validate automatic substitute computed tomography CT (sCT) scans generated from standard T2-weighted (T2w) magnetic resonance (MR) pelvic scans for MR-Sim prostate treatment planning. A Siemens Skyra 3T MR imaging (MRI) scanner with laser bridge, flat couch, and pelvic coil mounts was used to scan 39 patients scheduled for external beam radiation therapy for localized prostate cancer. For sCT generation a whole-pelvis MRI scan (1.6 mm 3-dimensional isotropic T2w SPACE [Sampling Perfection with Application optimized Contrasts using different flip angle Evolution] sequence) was acquired. Three additional small field of view scans were acquired: T2w, T2*w, and T1w flip angle 80° for gold fiducials. Patients received a routine planning CT scan. Manual contouring of the prostate, rectum, bladder, and bones was performed independently on the CT and MR scans. Three experienced observers contoured each organ on MRI, allowing interobserver quantification. To generate a training database, each patient CT scan was coregistered to their whole-pelvis T2w using symmetric rigid registration and structure-guided deformable registration. A new multi-atlas local weighted voting method was used to generate automatic contours and sCT results. The mean error in Hounsfield units between the sCT and corresponding patient CT (within the body contour) was 0.6 ± 14.7 (mean ± 1 SD), with a mean absolute error of 40.5 ± 8.2 Hounsfield units. Automatic contouring results were very close to the expert interobserver level (Dice similarity coefficient): prostate 0.80 ± 0.08, bladder 0.86 ± 0.12, rectum 0.84 ± 0.06, bones 0.91 ± 0.03, and body 1.00 ± 0.003. The change in monitor units between the sCT-based plans relative to the gold standard CT plan for the same dose prescription was found to be 0.3% ± 0.8%. The 3-dimensional γ pass rate was 1.00 ± 0.00 (2 mm/2%). The MR-Sim setup and automatic sCT generation methods using standard MR sequences generates realistic contours and electron densities for prostate cancer radiation therapy dose planning and digitally reconstructed radiograph generation.

Postoperative Leukocytosis After Robotic-Assisted Radical Prostatectomy Is Not Associated with Perioperative Outcome and Histopathological Findings.

Recently a retrospective study has been published describing a significant correlation of immediate postoperative leukocytosis (IPLC) and a favorable pathological Gleason score (pGS) in patients undergoing robotic-assisted radical prostatectomy (RARP). The aim of the present study was to prospectively validate these results on an external dataset. In total, 346 patients undergoing RARP as first-line therapy for localized prostate cancer were included. Clinical and histopathological parameters, criteria of IPLC, and pGS were recorded prospectively. Potential association between IPLC and pGS was evaluated by univariate and multivariate analyses. IPLC was found in 77.2% (n = 267) of all patients with a median leukocyte blood count (LBC) of 12.5 × 10(9)/L (interquartile range, 10.2-15 × 10(9)/L). Of these, in 255 patients IPLC was found within the range of 10-20 × 10(9)/L, whereas an IPLC of >20 × 10(9)/L was found in only 12 patients. Of the patients, 49.1%, 40.5%, and 10.4% presented with a pGS6, pGS7, and pGS8-10 tumor, respectively. There was neither a univariate nor a multivariate correlation between IPLC and pGS. Furthermore, no significant correlation could be detected between IPLC and other clinical, intraoperative, or histopathological criteria. In 175 (66%) patients with IPLC normal LBC levels were measured on postoperative Day 4. IPLC was not associated with more favorable tumor biology (lower pGS, better tumor stage) and not influenced by patient conditions (age, body mass index, American Society of Anesthesiologists score, smoking) or intraoperative parameters (blood loss, operating time, surgeon). In addition, there was no significant correlation with serious complications (Clavien-Dindo Grade 3a/b) within a period of 90 days.

Urethra-sparing high-intensity focused ultrasound for localized prostate cancer: Functional and oncological outcomes.

To evaluate longitudinal changes in urinary function and quality of life, and the oncological outcomes of patients treated with urethra-sparing high-intensity focused ultrasound for localized prostate cancer. Patients with negative findings in the urethra and the anterior urethral zone using transrectal ultrasound-guided targeted biopsies, and magnetic resonance imaging, received urethra-sparing or whole-gland high-intensity focused ultrasound as the primary therapy for localized prostate cancer without transurethral resection of the prostate. Longitudinal changes in urinary function and quality of life, and the oncological outcomes of the patients were analyzed retrospectively. The median follow-up times for urethra-sparing and whole-gland high-intensity focused ultrasound were 36 and 30 months, respectively. Comparing the patients treated with urethra-sparing high-intensity focused ultrasound (n = 45) with those treated with whole-gland high-intensity focused ultrasound (n = 65), there were significant differences in the International Prostate Symptom Score (P = 0.014) at 3 months, International Prostate Symptom Score quality of life (P = 0.033) at 3 months, maximum urinary flow rate (mL/s; at 3 months, P = 0.010; at 6 months, P = 0.038) and residual urine volume (mL; at 3 months, P < 0.0001; at 6 months, P = 0.016; at 12 months, P = 0.028). For quality of life, there were significant differences in Functional Assessment of Cancer Therapy - General (at 3 months, P = 0.022) and Functional Assessment of Cancer Therapy - Prostate (at 3 months, P = 0.028; at 6 months, P = 0.034). There were no significant differences in oncological outcomes regarding negative biopsy rates on follow up (91% vs 92%; P = 0.8) or biochemical disease-free survival rates (86.7% vs 89.2%; P = 0.7). Urethra-sparing high-intensity focused ultrasound might prevent prolonged bladder outlet obstruction, and could be a treatment option for localized prostate cancer.

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

To investigate the dose-dependent effect of androgen deprivation therapy (ADT) on adverse cardiac events in elderly men with non-metastatic prostate cancer (PCa) stratified according to life expectancy. A total of 50384 men diagnosed with localized PCa between 1992 and 2007 were identified within the Surveillance, Epidemiology, and End Results registry areas. We compared those who received ADT within 2years of PCa diagnosis with those who did not, calculated as monthly equivalent doses of GnRH agonists (<8, ≥8 doses), or orchiectomy. Men were further stratified according to life expectancy (<5years, 5-10years and >10years). Adjusted Cox hazard models assessed the risk of new-onset coronary heart disease (CHD), acute myocardial infarction (AMI), sudden cardiac death (SCD) and cardiac-related interventions, as well as any of these events. Overall, patients receiving GnRH agonists were more likely to experience a cardiac event, with the most pronounced effect among those receiving ≥8 doses (hazard ratio [HR] <8 doses: 1.13, 95% confidence interval [CI] 1.09-1.16, and HR ≥8 doses: 1.18, 95% CI 1.14-1.22; both P < 0.001). The effect of prolonged (≥8 doses) GnRH agonist use on cardiac events was sustained across all strata of life expectancy; however, there was no effect among men with a life expectancy of <5years and when use of GnRH agonists was limited to <8 doses (HR 0.99, 95% CI 0.67-1.46; P = 0.964). The use of GnRH agonists was associated with a higher risk of CHD (HR <8 doses: 1.13, 95% CI 1.09-1.17 and HR ≥8 doses: 1.17, 95% CI 1.13-1.21; both P< 0.001). Conversely, the use of GnRH was generally not associated with an increased risk of AMI or SCD, except for men who received ≥8 doses of GnRH agonists and had a life expectancy of ≥5years, who were at a significantly higher risk of SCD (HR for life expectancy 5-10years: 1.19, 95% CI 1.06-1.33; P = 0.003 and HR for life expectancy >10years: 1.16, 95% CI 1.04-1.29; P = 0.006). Finally, orchiectomy was not associated with overall cardiac events, AMI or SCD, and was protective with regard to cardiac-related interventions (HR 0.78, 95% CI 0.68-0.90, P = 0.001). Exposure to ADT with GnRH agonists is associated with an increased risk of cardiac events in elderly men with localized PCa and a decent life expectancy. Clinicians should carefully weigh the risks and benefits of ADT in patients with a prolonged life expectancy. Routine screening and lifestyle interventions are warranted in at-risk subpopulations treated with ADT.