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Khan S, Chang SH, Wang M, Kim EH, Schoen MW, Rocuskie-Marker C, Drake BF. Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer. JAMA Netw Open 2023; 6:e2348057. [PMID: 38109113 PMCID: PMC10728764 DOI: 10.1001/jamanetworkopen.2023.48057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Importance Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer. Objective To assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer. Design, Setting, and Participants This cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers. Exposure Local treatment with radical prostatectomy or radiation. Main Outcomes and Measures Main outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, >1 to ≤2 years, and >2 to ≤5 years) after initial treatment. Results This cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment. Conclusions and Relevance In this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.
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Affiliation(s)
- Saira Khan
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Mei Wang
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Eric H. Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Martin W. Schoen
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | | | - Bettina F. Drake
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
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Zhai T, Ma J, Liu Y, Li H, Peng Y, Guo W, Jia J, Wu X, Jiang H, Tian J, Wang D. The role of cytoreductive radical prostatectomy and lymph node dissection in bone-metastatic prostate cancer: A population-based study. Cancer Med 2023; 12:16697-16706. [PMID: 37366247 PMCID: PMC10501265 DOI: 10.1002/cam4.6292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUNDS The role of cytoreductive radical prostatectomy (cRP) for bone-metastatic prostate cancer (bmPCa) remains controversial. We aimed to figure out whether cRP and lymph node dissection (LND) can benefit bmPCa. METHODS 11,271 PCa patients with bone metastatic burden from 2010 to 2019 were identified using SEER-Medicare. Overall survival (OS) and cancer-specific survival (CSS) rates were visualized using Kaplan-Meier plots. Multivariable Cox regression analyses were constructed to examine the effects of cRP and LND on survival, after stratifying to age, prostate specific antigen (PSA), clinical stages, Gleason score, metastatic burden, radiotherapy, and chemotherapy status. RESULTS 317 PCa patients underwent cRP and cRP was increasingly performed for bmPCa from 2010 (2.2%) to 2019 (3.0%) (p < 0.05). In multi analyses, cRP was predisposed to a better OS or CSS in patients with age < 75, PSA < 98 ng/mL, bone-only metastatic sites or patients not receiving chemotherapy (all p < 0.05). For the patients undergoing cRP, LND especially extended LND was associated with a better OS or CSS (all p < 0.05). CONCLUSIONS cRP might benefit OS or CSS in young patients with low PSA and bone-only metastatic sites not receiving chemotherapy. And a clear OS or CSS benefit of LND especially extended LND was observed in patients undergoing cRP.
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Affiliation(s)
- Tingshuai Zhai
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Jinliang Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Yi Liu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Haitao Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Yanli Peng
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Wenmin Guo
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Jiedong Jia
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Xiaolin Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Huanrong Jiang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Jun Tian
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
| | - Dongwen Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116China
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Drake BF, Khan S, Wang M, Hicks V, Nichols K, Taylor M, Kim EH, Chang SH. Definitive treatment and risk of death among men diagnosed with metastatic prostate cancer at the Veterans Health Administration. Ann Epidemiol 2023; 79:24-31. [PMID: 36640917 DOI: 10.1016/j.annepidem.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the potential survival benefit associated with receipt of definitive treatment (radical prostatectomy or radiation), compared to non-definitive treatment (hormonal therapy or chemotherapy) among men with metastatic prostate cancer. METHODS A cohort of men diagnosed with metastatic (T4/M1/N1 or T4/M1) prostate cancer from 1999 to 2013 in the Veterans Health Administration were identified and followed to December 28, 2014. All-cause and prostate cancer-specific mortality were evaluated at 10 years for the T4/M1/N1 cohort and 8 years for the T4/M1/ cohort. The association of definitive treatment (radical prostatectomy or radiation), compared to non-definitive (hormonal therapy or chemotherapy) with both all-cause and prostate cancer-specific mortality was assessed using inverse probability of treatment weighted (IPTW) multivariable survival analyses. RESULTS The cohort included 2919 with T4/M1/N1 disease and 1479 men with T4/M1 disease. Receipt of definitive treatment was associated with a reduced risk of 10-year all-cause (Hazard Ratio (HR): 0.61; 95% Confidence Interval (CI): 0.57-0.65) and prostate cancer-specific mortality (HR: 0.50; 95% CI: 0.46-0.55) among men diagnosed with T4/M1/N1 met-astatic disease. Definitive treatment was similarly associated with a reduced risk of all-cause (HR: 0.84; 95% CI: 0.77-0.91) and prostate cancer-specific (HR: 0.81; 95% CI: 0.73-0.90) mortality among men diagnosed with T4/M1 only metastatic disease. CONCLUSIONS Definitive treatment may improve survival in men diagnosed with metastatic prostate cancer.
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Affiliation(s)
- Bettina F Drake
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO.
| | - Saira Khan
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Mei Wang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Veronica Hicks
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Kate Nichols
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO; Agendia, Inc, Irvine, CA
| | - Meghan Taylor
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO; Department of Behavioral Science and Health Education, College for Public Health and Social, Justice, Saint Louis University
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
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4
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Mao Y, Hu M, Yang G, Gao E, Xu W. Cytoreductive prostatectomy improves survival outcomes in patients with oligometastases: a systematic meta-analysis. World J Surg Oncol 2022; 20:255. [PMID: 35945562 PMCID: PMC9361652 DOI: 10.1186/s12957-022-02715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether cytoreductive prostatectomy (CRP) should be performed in patients with oligometastatic prostate cancer (OPC) remains controversial. The goal of this systematic meta-analysis was to assess the efficacy of CRP as a treatment for OPC. METHODS This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data sources included publications in the PubMed, Embase, the Cochrane Library, EBSCO, and Web of Science (SCI) databases as of May 2022. Eligible articles included prospective studies comparing the efficacy of CRP to a lack of CRP in patients with OPC. RESULTS In total, 10 publications incorporating 888 patients were analyzed. Tumor-reducing prostatectomy was found to have no significant effect on long-term or short-term OS [OR = 2.26, 95% CI (0.97, 5.28), P = 0.06] and [OR = 1.73, 95% CI (0.83, 3.58), P = 0.14], but it significantly improved patient long-term or short-term CSS [OR = 1.77, 95% CI (1.01, 310), P = 0.04] and [OR = 2.71, 95% CI (1.72, 4.29), P < 0.0001] and PFS [OR = 1.93, 95% CI (1.25, 2.97), P = 0.003]. CONCLUSION These results suggest that cytoreductive prostatectomy can confer survival benefits to OPC patients. TRIAL REGISTRATION INPLASY protocol 202260017 https://doi.org/10.37766/inplasy2022.6.0017 .
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Affiliation(s)
- Yifeng Mao
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Bengbu, 233030, Anhui, China
| | - Mingqiu Hu
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China. .,Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Bengbu, 233030, Anhui, China. .,Department of Urology, Maoming People's Hospital, Maoming, 525000, Guangdong, China.
| | - Gaowei Yang
- Department of Urology, Maoming People's Hospital, Maoming, 525000, Guangdong, China
| | - Erke Gao
- Department of Urology, Maoming People's Hospital, Maoming, 525000, Guangdong, China
| | - Wangwang Xu
- Department of Urology, Maoming People's Hospital, Maoming, 525000, Guangdong, China
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McCormick BZ, Chery L, Chapin BF. Contemporary outcomes following robotic prostatectomy for locally advanced and metastatic prostate cancer. Transl Androl Urol 2021; 10:2178-2187. [PMID: 34159100 PMCID: PMC8185652 DOI: 10.21037/tau-20-1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
While radical prostatectomy (RP) plays a prominent role in the management of localized prostate cancer, its role in high risk or metastatic disease is less clear. Due to changes in prostate cancer screening patterns, particularly those made by the United States Preventive Services Task Force, data is suggesting increasing incidences of high risk and metastatic disease, underlying the importance of continued research in this area. While past approaches to management may have discouraged surgical intervention, more contemporary approaches have attempted to evaluate its effectiveness and utility. The purpose of this review is an updated discussion of the current literature regarding surgical approaches to high risk prostate cancer. The PubMed and Medline databases were queried for English language articles related to the surgical management of high-risk prostate adenocarcinoma. In this review, we examine the utility of surgery as a single or multimodal approach to management with patients with high risk, locally advanced, and metastatic prostate cancer. Outcomes measures are reviewed including data on survival and recurrence rates. Functional outcomes are an important consideration in prostate cancer management and while data is more limited, this review examines some of the key findings. Finally, a discussion regarding surgical complication rates and ongoing clinical trials is addressed. While surgery appears to be promising in this patient cohort, there remains significant heterogeneity in the data that ongoing trials may be able to address. At its current level of understanding, surgery should be considered as a potential tool in patient management, but may play a more prominent role in a multi-modality setting for optimal outcomes.
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Affiliation(s)
- Barrett Z McCormick
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisly Chery
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Radiotherapy in the Management of Metastatic Hormone-Sensitive Prostate Cancer: What Is the Standard of Care? ACTA ACUST UNITED AC 2021; 26:87-93. [PMID: 31977391 DOI: 10.1097/ppo.0000000000000429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Systemic therapy has historically been the backbone of treatment for patients with metastatic disease. However, recent evidence suggests metastasis-directed therapy in those with oligometastatic disease (≤5 lesions) may improve progression-free and overall survival. Within prostate cancer-specific cohorts, metastasis-directed therapy also appears to delay the time to initiation of androgen deprivation therapy while also generally being associated with a mild toxicity profile and has thus garnered interest as a means to delay systemic therapy. Here we review the evidence surrounding the use of radiation therapy to metastatic sites in patients with metastatic hormone-sensitive prostate cancer.
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7
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Jin S, Wei J, Wang J, Wang B, Wu J, Gan H, Dai B, Qin X, Lin G, Wei Y, Yang C, Shen Y, Zhu Y, Zhu Y, Ye D. Prognostic Value of Local Treatment in Prostate Cancer Patients With Different Metastatic Sites: A Population Based Retrospective Study. Front Oncol 2020; 10:527952. [PMID: 33364186 PMCID: PMC7753115 DOI: 10.3389/fonc.2020.527952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 10/27/2020] [Indexed: 01/25/2023] Open
Abstract
Purpose Our study aims to examine the impact of definitive local therapy in prostate cancer patients with different metastatic sites. Methods Totally, 5,849 patients diagnosed with metastatic prostate carcinoma from 2010 to 2014 were selected from Surveillance, Epidemiology, and End Results (SEER). Log-rank analyses, multivariable regression analysis, and Kaplan-Meier methods were used to assess prognostic impact of local treatment in patients with different metastatic sites. Survival curves and forest plots were also plotted to describe the prognostic value of definitive local therapy. Results In our study, 159 patients received radical prostatectomy, and 62 received brachytherapy, while 5,628 did not receive local definitive local therapy. Survival analysis revealed that patients who received definitive local therapy had a better 5-year overall survival (OS) (P = 0.011) and cancer-specific survival (CSS) (P = 0.012). Multivariate regression analyses demonstrated that type of treatment was an independent prognostic indicator for OS (P = 0.011) and CSS (P = 0.012), along with age at diagnosis, chemotherapy, PSA level, and Gleason score. According to subgroup analysis, patients with bone metastasis or distant lymph node (LN) metastasis were significantly more likely to benefit from definitive local therapy. In addition, forest plots demonstrated that RP group had significant favorable OS and CSS in subgroups of younger age at diagnosis, T2-3 stage, N0-1 stage, Gleason score =7 or ≥8, bone metastasis, and distant LN metastasis. Conclusions Our study suggested that local therapy improved survival in prostate cancer patients with bone or distant LN metastasis. Furthermore, patients who were at T2-3 stage or Gleason score ≥7 also significantly benefit from definitive local therapy.
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Affiliation(s)
- Shengming Jin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaming Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junjie Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Beihe Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junlong Wu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hualei Gan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guowen Lin
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Jenjitranant P, Touijer KA. Role of surgery in oligometastatic prostate cancer. Prostate Int 2019; 7:125-130. [PMID: 31970136 PMCID: PMC6962728 DOI: 10.1016/j.prnil.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
Androgen deprivation therapy as single modality therapy was the standard management for oligometastatic prostate cancer (PCa). Current paradigm shifts toward a multimodality therapy approach, targeting all sites of disease, including treatment of the primary in the form of radical prostatectomy or radiation therapy. The objective of this article was to reveiw the literature regarding the role of surgery in oligometastatic PCa. PubMed and MEDLINE electronic databases were queried for English language articles from January 1, 1980 to March 31, 2019. Keywords use included oligometastatic PCa, metastatic prostate cancer (mPCa), radical prostatectomy, and cytoreductive prostatectomy. Preclinical, prospective, and retrospective studies were included. There is no published randomized controlled trials, evaluating the role of surgery in mPCa. Preclinical and retrospective data suggest benefit of primary tumor treatment in mPCa. Current literature supports the concept of cytoreductive surgery as it can prevent late symptomatic local progression, has acceptable complications, and may prolong survival in patients with mPCa. Surgery is a feasible procedure in mPCa which may improve outcome in mPCa. However, there is no Level 1 evidence, yet that support the role of surgery in mPCa. The results from well-organized prospective, randomized controlled trials are awaited before performing radical prostatectomy for mPCa in clinical practice.
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Affiliation(s)
- Pocharapong Jenjitranant
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI, Bangkok, 10400, Thailand
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim A. Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Serretta V, Valerio MR, Costa R, Tripoli V, Murabito A, Princiotta A, Scalici Gesolfo C, Borsellino N, Verderame F, Gebbia V, Licari M, Sanfilippo C. Radium-223 treatment in castration resistant bone metastatic prostate cancer. Should be the primary tumor always treated? Urol Oncol 2019; 37:964-969. [PMID: 31601517 DOI: 10.1016/j.urolonc.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radium-223 (223Ra) improves symptoms and survival in patients with bone metastatic castration-resistant prostate cancer (mCRPC). STUDY AIM To evaluate the impact of a previous radical prostatectomy (RP) on the outcome of 223Ra therapy in mCRPC patients. The primary prostate tumor left untreated could progress during 223Ra treatment. MATERIALS AND METHODS mCRPC symptomatic patients treated with 223Ra were enrolled. Luteinizing Hormone-Releasing Hormone analogue was maintained. No other anticancer therapy was given. 223Ra was administered i.v. at the dose of 55 kBq/kg every 4 weeks for 6 cycles. Patients were stratified according to previous RP or not. Hematological toxicity was monitored. Statistical analysis of 223Ra discontinuations, progressions, and deaths were performed. RESULTS Forty-four patients were enrolled, 16 (36.4%) previously received RP, 5 (11.3%) prostate radiotherapy and 23 (52.3%) maintained the primary prostate tumor after local treatment. All patients presented only bone metastases, 24 patients (54.5%) had more than 20. Twenty-six (59.1%) patients were treated after first or second line systemic chemotherapy. Treatment interruptions occurred in 14 patients (50%) with prostate and in 4 (25%) without (P = 0.04). After a median follow-up of 18 months (6-30 months), 15 (53.6%), and 7 (43.7%) progressions (P = 0.34) and 13 and 1 (6.2%) deaths (P = 0.04) occurred in patients with and without prostate respectively. CONCLUSION The presence of the primary prostate tumor seems to play a detrimental role in mCRPC patients undergoing 223Ra treatment in absence of other concomitant anticancer therapy. On the other hand a previous RP might play a protective role.
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Affiliation(s)
- Vincenzo Serretta
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy; GSTU Foundation, Statistics, Palermo, Italy.
| | - Maria Rosaria Valerio
- Department of Surgical, Oncological and Oral Sciences, Medical Oncology Unit, University of Palermo, Italy
| | - Renato Costa
- Nuclear Medicine Unit, University of Palermo, Italy
| | | | | | - Alessandro Princiotta
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy
| | - Cristina Scalici Gesolfo
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy
| | - Nicolò Borsellino
- Oncology Unit, "Buccheri La Ferla Fatebenefratelli" Civic Hospital, Palermo, Italy
| | | | | | - Maria Licari
- Nuclear Medicine Unit, University of Palermo, Italy
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Hou G, Zheng Y, Wei D, Li X, Wang F, Tian J, Zhang G, Yan F, Zhu Z, Meng P, Yuan J, Gao M, Li Z, Zhang B, Xing Z, Yuan J. Development and validation of a SEER-based prognostic nomogram for patients with bone metastatic prostate cancer. Medicine (Baltimore) 2019; 98:e17197. [PMID: 31574827 PMCID: PMC6775397 DOI: 10.1097/md.0000000000017197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Controversies exist between the previous two prognostic nomograms for patients with bone metastatic prostate cancer (PCa), and a nomogram applied to western patients has yet to be established. Thus, we aimed to build a reliable and generic nomogram to individualize prognosis.The independent prognostic factors were identified in a retrospective study of 1556 patients with bone metastatic PCa registered in the Surveillance, Epidemiology and End Results (SEER) database. Besides, the prognostic nomogram was developed using R software according to the result of multivariable Cox regression analysis. Then, the discriminative ability of the nomogram was assessed by analyses of receiver operating characteristic curves (ROC curves). We also performed 1-, 2-, and 3-year calibrations of the nomogram by comparing the predicted survival to the observed survival. Furthermore, the model was externally validated using the data of 711 patients diagnosed at different times enrolled in the SEER database.Age ≥70 years, Gleason score ≥8, PSA value of 201 to 900 ng/ml, stage T4, stage N1, with liver metastases, and Asian/Pacific ethnicity were identified as independent prognostic factors. In the primary cohort, 1-, 2-, and 3-year area under the ROC curve (AUC) of the nomogram for predicting cancer-specific survival (CSS) were 0.71, 0.70, and 0.70, respectively. Besides 1-, 2-, and 3-year AUC were 0.70, 0.68, and 0.69, respectively, in the external validation cohort. Moreover, calibration curves presented perfect agreements between the nomogram-predicted and actual 1-, 2-, and 3-year CSS rate in both the primary and external validation cohorts. In other words, our nomogram has great predictive accuracy and reliability in predicting 1-, 2-, and 3-year CSS for patients with bone metastatic prostate cancer.This study established and validated a prognostic nomogram applied to not only Asian patients but western patients with bone metastatic PCa, which will be useful for patients' counseling and clinical trial designing.
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Affiliation(s)
- Guangdong Hou
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Yu Zheng
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Di Wei
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Xi’an Li
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Fuli Wang
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Jingyang Tian
- Department of Otorhinolaryngology, Hainan Hospital of Chinese PLA General Hospital, Sanya, P.R. China
| | - Geng Zhang
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Fei Yan
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Zheng Zhu
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Ping Meng
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Jiarui Yuan
- St. George's University School of Medicine, Grenada, West Indies
| | - Ming Gao
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi’an, P.R. China
| | - Zhibin Li
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Bin Zhang
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Zibao Xing
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, the Air Force Medical University, Xi’an
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11
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Sasse AD, Dos Reis RB, Nogueira LM, Maluf FC, Herchenhorn D, Smaletz O, Lima VS, Schutz F, Bastos D, Wiermann EG, Morbeck IAP, Jardim LF, Souza VC, Carvalho IT, Leite ETT, Nardozza A, Pompeo ACL, Bretas F, Leal MLDO, Sadi MV, da Ponte JRT, Carvalhal GF. Second brazilian consensus on the treatment of advanced prostate cancer - a SBOC-SBU-SBRT panel review. Int Braz J Urol 2019; 45:449-458. [PMID: 31038861 PMCID: PMC6786127 DOI: 10.1590/s1677-5538.ibju.2018.0798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/09/2019] [Indexed: 01/04/2023] Open
Abstract
Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.
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Affiliation(s)
| | - Rodolfo Borges Dos Reis
- Departamento de Urologia, Universidade de São Paulo- USP, Campus de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Lucas Mendes Nogueira
- Divisão de Urologia e Departamento de Cirurgia Hospital das Clínicas, Universidade Federal de MG - UFMG, Belo Horizonte, MG, Brasil
| | | | | | - Oren Smaletz
- Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Fábio Schutz
- Hospital Beneficência Portuguesa de São Paulo, SP, Brasil
| | - Diogo Bastos
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo - ICESP, SP, Brasil
| | | | | | - Leonardo Fontes Jardim
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo - ICESP, SP, Brasil
| | | | | | | | - Archimedes Nardozza
- Departamento de Urologia e Cirurgia, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | | | | | | | - Marcus Vinicius Sadi
- Departamento de Urologia e Cirurgia, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | | | - Gustavo F Carvalhal
- Divisão de Urologia e Departamento de Cirurgia, Pontifícia Universidade Católica do Rio Grande do Sul - PUC RS, Porto Alegre, RS, Brasil
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12
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Murakami T, Otsubo S, Namitome R, Shiota M, Inokuchi J, Takeuchi A, Kashiwagi E, Tatsugami K, Eto M. Clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy. Mol Clin Oncol 2018; 9:575-581. [PMID: 30279989 DOI: 10.3892/mco.2018.1718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 11/06/2022] Open
Abstract
The present study investigated clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy (RARP). The study included 625 Japanese cases treated with RARP between 2009 and 2017. The association between clinical factors (age, overweight status, prostate volume, clinical T-stage, nerve sparing, lympho-node dissection, and the number of experienced cases) and perioperative outcomes (operation time, estimated blood loss, catheterization duration, and perioperative complication) were analyzed. Results revealed that overweight status, prostate volume, lymph-node dissection, and the number of experienced cases were associated with operation time. For estimated blood loss, the identified risk factors were overweight status, prostate volume, nerve sparing, lymph-node dissection, and the number of experienced cases. Lymph-node dissection and the number of experienced cases were also associated with catheterization duration. Additionally, only lymph-node dissection was associated with increased perioperative complication. Taken together, the present study identified several clinical factors affecting perioperative outcomes in RARP. This information may help surgeons to estimate perioperative outcomes as well as to inform patients.
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Affiliation(s)
- Tomohiko Murakami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Satoshi Otsubo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ryo Namitome
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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13
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Abstract
Treatment of high-risk prostate cancer (HRPCa) is challenging. Local staging and metastatic evaluation are important for the patient management. Recently, prostate-specific membrane antigen (PSMA)-based imaging modalities such as PSMA PET/CT and PET/MRI have received significant attention for detection of recurrent prostate cancer sites with elevated prostate-specific antigen levels, after therapy. Current evidence suggests that these imaging modalities may also have a role for the management of patients with HRPCa. In this review, we discuss PSMA-based imaging modalities in the management of patients with HRPCa.
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14
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Antonelli A, Palumbo C, Veccia A, Grisanti S, Triggiani L, Zamboni S, Furlan M, Simeone C, Magrini S, Berruti A. Biological effect of neoadjuvant androgen-deprivation therapy assessed on specimens from radical prostatectomy: a systematic review. MINERVA UROL NEFROL 2018; 70:370-379. [DOI: 10.23736/s0393-2249.18.03022-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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15
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Hahn AW, Higano CS, Taplin ME, Ryan CJ, Agarwal N. Metastatic Castration-Sensitive Prostate Cancer: Optimizing Patient Selection and Treatment. Am Soc Clin Oncol Educ Book 2018; 38:363-371. [PMID: 30231388 DOI: 10.1200/edbk_200967] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The treatment landscape for metastatic castration-sensitive prostate cancer (mCSPC) has rapidly evolved over the past 5 years. Although androgen-deprivation therapy (ADT) is still the backbone of treatment, the addition of docetaxel or abiraterone acetate has improved outcomes for patients with mCSPC and become standard of care. With multiple treatment options available for patients with mCSPC, treatment selection to optimize patient outcomes has become increasingly difficult. Here, we review the clinical trials involving ADT plus docetaxel or abiraterone and provide clinicians with guidelines for treatment. Although surgery and/or radiation are standard of care for localized, intermediate- and high-risk prostate cancer, these treatments are not routinely used as part of initial treatment plans for patients with de novo mCSPC. Recent clinical data are challenging that dogma, and we review the literature on the addition of surgery and radiation to systemic therapy for mCSPC. Finally, the standard of care for oligometastatic prostate cancer (a subset of mCSPC with limited metastases) has not been established compared with that for some other cancers. We discuss the recent studies on metastasis-directed therapy for treatment of oligometastatic prostate cancer.
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Affiliation(s)
- Andrew W Hahn
- From the Division of Oncology, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, University of California-San Francisco, Helen Diller Comprehensive Cancer Center, San Francisco, CA
| | - Celestia S Higano
- From the Division of Oncology, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, University of California-San Francisco, Helen Diller Comprehensive Cancer Center, San Francisco, CA
| | - Mary-Ellen Taplin
- From the Division of Oncology, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, University of California-San Francisco, Helen Diller Comprehensive Cancer Center, San Francisco, CA
| | - Charles J Ryan
- From the Division of Oncology, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, University of California-San Francisco, Helen Diller Comprehensive Cancer Center, San Francisco, CA
| | - Neeraj Agarwal
- From the Division of Oncology, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT; Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, University of California-San Francisco, Helen Diller Comprehensive Cancer Center, San Francisco, CA
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16
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Li R, Ravizzini GC, Gorin MA, Maurer T, Eiber M, Cooperberg MR, Alemozzaffar M, Tollefson MK, Delacroix SE, Chapin BF. The use of PET/CT in prostate cancer. Prostate Cancer Prostatic Dis 2017; 21:4-21. [PMID: 29230009 DOI: 10.1038/s41391-017-0007-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/28/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) has recently emerged as a promising diagnostic imaging platform for prostate cancer. Several radiolabelled tracers have demonstrated efficacy for cancer detection in various clinical settings. In this review, we aim to illustrate the diverse use of PET/CT with different tracers for the detection of prostate cancer. METHODS We searched MEDLINE using the terms 'prostate cancer', 'PET', 'PET/CT' and 'PET/MR'). The current review was limited to 18F-NaF PET/CT, choline-based PET/CT, fluciclovine PET/CT and PSMA-targeted PET/CT, as these modalities have been the most widely adopted. RESULTS NaF PET/CT has shown efficacy in detecting bone metastases with high sensitivity, but relatively low specificity. Currently, choline PET/CT has been the most extensively studied modality. Although having superior specificity, choline PET/CT suffers from low sensitivity, especially at low PSA levels. Nevertheless, choline PET/CT was found to significantly improve upon conventional imaging modalities (CIM) in the detection of metastatic lesions at biochemical recurrence (BCR). Newer methods using fluciclovine and PSMA-targeted radiotracers have preliminarily demonstrated great promise in primary and recurrent staging of prostate cancer. However, their superior efficacy awaits confirmation in larger series. CONCLUSIONS PET/CT has emerged as a promising staging modality for both primary and recurrent prostate cancer. Newer tracers have increased detection accuracies for small, incipient metastatic foci. The clinical implications of these occult PET/CT detected disease foci require organized evaluation. Efforts should be aimed at defining their natural history as well as responsiveness and impact of metastasis-directed therapy.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA.
| | - Gregory C Ravizzini
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | | | | | | | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, LA, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
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17
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Ramamurthy C, Doyle J, Uzzo RG, Kutikov A, Smaldone MC, Geynisman DM. Role of collaboration between urologists and medical oncologists in the advanced prostate cancer space. Urol Oncol 2017; 35:665-669. [DOI: 10.1016/j.urolonc.2017.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
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