Value Of Local Treatment Research Articles

PD63-01 RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH-RISK, VERY-HIGH RISK, OR METASTATIC PROSTATE CANCER: ONCOLOGIC RESULTS FROM THE MUSIC STATEWIDE COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD63)1 Apr 2020PD63-01 RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH-RISK, VERY-HIGH RISK, OR METASTATIC PROSTATE CANCER: ONCOLOGIC RESULTS FROM THE MUSIC STATEWIDE COLLABORATIVE Brian Lane*, Silvia Mora, Ji Qi, Todd Morgan, Christopher Brede, James Peabody, Arvin George, and for the Michigan Urological Surgery Improvement Collaborative Brian Lane*Brian Lane* More articles by this author , Silvia MoraSilvia Mora More articles by this author , Ji QiJi Qi More articles by this author , Todd MorganTodd Morgan More articles by this author , Christopher BredeChristopher Brede More articles by this author , James PeabodyJames Peabody More articles by this author , Arvin GeorgeArvin George More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000980.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guideline-recommended management of high risk (HR) prostate cancer (PCa) is radical prostatectomy with pelvic lymph node dissection (RP+PLND) or radiation therapy with/without systemic therapy. Increasingly, patients with regional (N1) and distant (M1) metastases are being considered for definitive local therapy. We investigated the oncologic outcomes of surgery for patients categorized as HR, very-high risk (VHR), or with suspected metastatic (N1 and/or M1) PCa at the time of RP. METHODS: The MUSIC registry was queried for all RP from 1/2012 to 12/ 2018. Of the 9208 patients, 2023 patients (22%) were classified as having HR PCa or higher. HR PCa was defined as having PSA≥20 or cT3-4 or biopsy grade group (bGG) 4-5;VHR PCa was defined as having ≥2 HR features, or >4 cores of bGG 4-5, or primary pattern 5. Metastatic PCa was defined as clinical N1 and/or M1 disease. The pre-treatment and oncologic outcomes of the HR, VHR, and metastatic groups were compared. Kaplan-Meier analysis of biochemical recurrence (BCR) and multivariable analyses were performed with significance set at p<0.05. RESULTS: At median follow-up of 20.8 months after RP, overall 3-year BCR-free probability was 66% for HR, 49% for VHR, and 47% for metastatic PCa patients (p<0.001). In multivariable analysis, the highly significant (p<0.001) predictors of BCR included PSA (Hazard Ratio: 3.35 (95%CI:2.32,4.83) for PSA>50, 2.35 (1.87,2.96) for PSA 20-50, and 2.07 (1.71,2.51) for PSA 10-20 vs. PSA<10) and risk group (1.63 (1.22,2.18) for metastatic and 1.45 (1.18,1.77) for VHR vs. HR). bGG 3-5, cT2-T4, and African-American race were significant BCR predictors. CONCLUSIONS: Nearly 25% of RP were performed for HR or higher PCa. Although these patients are clearly at higher risk for BCR and many received additional treatments for PCa, the majority are disease-free 3 years after surgery. RP appears to be an oncologically-sound approach for patients with HR and VHR PCa. Patients with suspicion of N1 or M1 disease that undergo RP appear to have similar oncologic outcomes to non-metastatic VHR patients. The value of local treatment in the setting of confirmed metastatic disease is the focus of ongoing clinical trials, and is best performed in this setting. Source of Funding: Betz Family Endowment for Cancer ResearchBlue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1292-e1292 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Lane* More articles by this author Silvia Mora More articles by this author Ji Qi More articles by this author Todd Morgan More articles by this author Christopher Brede More articles by this author James Peabody More articles by this author Arvin George More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

The management of high-risk, locally advanced, prostate cancer radiation therapy

The management of high-risk, locally advanced, prostate cancer radiation therapy

The value of local treatment in patients with primary, disseminated, multifocal Ewing sarcoma (PDMES)

The value of local treatment in patients with primary, disseminated, multifocal Ewing sarcoma (PDMES) was investigated. We analyzed 120 patients registered into the European Ewing Tumor Working Initiative of National Groups (EURO-E.W.I.N.G. 99) trial at the trial center of Muenster from 1998 to 2006. Median age was 16.2 years. Local treatment of the primary tumor was surgery in 26 of 120 patients, surgery and radiotherapy in 21 patients, and definitive radiotherapy in 40 patients. For treatment of metastases, 6 of 120 patients received surgery; 9 patients, surgery and radiotherapy; and 33 patients, definitive radiotherapy. Forty-seven (39%) patients had local treatment of both the primary tumor and metastases, 41 (34%) patients of either the primary tumor or metastases, and 32 (27%) received no local therapy. Event-free survival (EFS) at 3 years was 0.24 (95% CI, 0.16-0.33). Univariate analyses demonstrated the impact of local therapy given to the primary tumor: 3-year EFS was 0.25 with surgery, 0.47 with surgery and radiotherapy, 0.23 with radiotherapy, and 0.13 when no local therapy was administered (P < .001). Three-year EFS in PDMES was also influenced by the local treatment: surgery, 0.33; surgery and radiotherapy, 0.56; radiotherapy, 0.35; no local therapy, 0.16 (P = .003). Three-year EFS was 0.39 in patients who received local treatment of both primary tumor and PDMES, compared with 0.17 in patients with any local treatment of either primary tumor or PDMES and 0.14 in patients with no local therapy (P < .001). Multivariate analysis showed absence of local treatment to be the major risk factor (HR = 2.21; P = .027; n = 20). Local therapy of involved sites is important for patients with PDMES and should complement systemic treatment whenever possible.