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Greco C, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Marques J, Fuks Z. Early PSA density kinetics predicts biochemical and local failure following extreme hypofractionated radiotherapy in intermediate-risk prostate cancer. Radiother Oncol 2022; 169:35-42. [DOI: 10.1016/j.radonc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Finelli A, Beer TM, Chowdhury S, Evans CP, Fizazi K, Higano CS, Kim J, Martin L, Saad F, Saarela O. Comparison of Joint and Landmark Modeling for Predicting Cancer Progression in Men With Castration-Resistant Prostate Cancer: A Secondary Post Hoc Analysis of the PREVAIL Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2112426. [PMID: 34129025 PMCID: PMC8207237 DOI: 10.1001/jamanetworkopen.2021.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Dynamic prediction models may help predict radiographic disease progression in advanced prostate cancer. OBJECTIVE To assess whether dynamic prediction models aid prognosis of radiographic progression risk, using ongoing longitudinal prostate-specific antigen (PSA) assessments. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used data from the PREVAIL study to compare dynamic models for predicting disease progression. The PREVAIL study was a phase 3, multinational, double-blind, placebo-controlled randomized clinical trial of enzalutamide for prostate cancer conducted from September 2010 to September 2012. A total of 773 men with metastatic castration-resistant prostate cancer (CRPC) who had never received chemotherapy and had no baseline visceral disease were treated with enzalutamide. For illustration, 4 patients were selected based on PSA kinetics or PSA response in case studies. Data were analyzed from July 2018 to September 2019. MAIN OUTCOMES AND MEASURES Landmark and joint models were applied to dynamically predict radiographic progression-free survival (PFS) using longitudinal PSA profile, baseline PSA, lactate dehydrogenase, and hemoglobin levels. The main outcome was radiographic PFS as predicted using landmark and joint models. Current PSA and PSA change were considered longitudinal biomarkers possibly associated with radiographic PFS. Predictive performance was evaluated using Brier score for overall prediction errors (PEs) and area under the curve (AUC) for model discriminative capability. Case studies were illustrated using dynamic prediction plots. RESULTS A total of 763 men with metastatic CRPC treated with enzalutamide (mean [SD] age, 71.2 [8.5] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 28.4 [4.6]) were included in the analysis. Current PSA and PSA change were associated with radiographic PFS in all models. Adding the PSA slope, compared with the landmark models using current PSA alone, improved the prediction of 5-month prospect of radiographic progression, with relative gains of 5.7% in prediction (PE [SE], 0.132 [0.008] vs 0.140 [0.008]) and 7.7% in discrimination (AUC [SE], 0.800 [0.018] vs 0.743 [0.018]) at month 10. In joint models with linear vs nonlinear PSA, prediction of 5-month risk of radiographic progression was improved when PSA trajectories were not assumed to be linear, with 8.0% relative gain in prediction (PE [SE], 0.150 [0.006] vs 0.138 [0.005]) and 19.4% relative gain in discrimination (AUC [SE], 0.653 [0.022] vs 0.780 [0.016]) at month 10. Predictions were affected by amount of marker information accumulated and prespecified assumptions. PSA changes affected progression risk more strongly at later vs earlier follow-up. CONCLUSIONS AND RELEVANCE This prognostic study found that prediction of radiographic PFS was improved when longitudinal PSA information was added to baseline variables. In a population of patients with metastatic CRPC, dynamic predictions using landmark or joint models may help identify patients at risk of progression.
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Affiliation(s)
- Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tomasz M. Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Simon Chowdhury
- St Thomas’ Hospitals and Sarah Cannon Research Institute, London, United Kingdom
| | - Christopher P. Evans
- Department of Urologic Surgery, UC Davis Comprehensive Cancer Center, University of California, Davis
| | - Karim Fizazi
- Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Celestia S. Higano
- University of Washington, Seattle
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janet Kim
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Lisa Martin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fred Saad
- Centre Hospitalier de l’Université de Montréal/CRCHUM, Montréal, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Interim Prostate-Specific Antigen: Predicting for Biochemical Failure During Salvage Radiation Therapy After Prostatectomy. Adv Radiat Oncol 2021; 6:100646. [PMID: 33912736 PMCID: PMC8071726 DOI: 10.1016/j.adro.2021.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/09/2020] [Accepted: 12/13/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose A subset of patients treated with postprostatectomy radiation therapy for biochemical recurrence after surgery fail to respond because of microscopic disease beyond the irradiated prostate bed. This work aims to determine whether a rising interim prostate-specific antigen (PSA) during radiation therapy can predict the likelihood of subsequent biochemical recurrence. Methods and Materials Between 2010 and 2016, 185 patients had salvage radiation therapy to a dose of 68 Gy without androgen deprivation therapy for a rising PSA level after radical prostatectomy. Patients had their PSA recorded on the first day of radiation therapy and again after completing the 25th fraction (of 34 total fractions). Biochemical failure after radiation therapy was defined as a PSA value ≥0.2 ng/mL within 2 years after radiation therapy. Both univariate and multivariate Cox regression models were used for statistical analysis. Factors with a P value of <.2 in univariate analysis were then used in a multivariate analysis. Results The 2-year freedom from biochemical failure was 60% (95% confidence interval, 53%-67%). When assessing the interim PSA, 143 patients (77%) had a drop in interim PSA; of these patients, 71% had 2-year biochemical control. Forty-two patients (23%) had a stable or rising interim PSA, and only 24% of these patients had 2-year biochemical control. On multivariate analysis, a drop in PSA during radiation therapy (P < .0001) and a positive surgical margin (P < .0001) were significant factors for freedom from subsequent biochemical failure, and seminal vesicle invasion was associated with biochemical failure at 2 years (P = .019). All patients with a rising interim PSA, negative surgical margin, and seminal vesicle invasion ultimately had biochemical failure at 2 years. Conclusions A PSA rise during salvage radiation therapy is prognostic of biochemical failure at 2 years. Factors such as seminal vesicle invasion and a negative surgical margin also predict for poor responders to salvage radiation therapy.
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Hwang ME, Mayeda M, Liz M, Goode-Marshall B, Gonzalez L, Elliston CD, Spina CS, Padilla OA, Wenske S, Deutsch I. Stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer: toxicity profile and early oncologic outcomes. Radiat Oncol 2019; 14:136. [PMID: 31375119 PMCID: PMC6679492 DOI: 10.1186/s13014-019-1346-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Multiple phase I-II clinical trials have reported on the efficacy and safety of prostate stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer. However, few have reported outcomes for prostate SBRT using periprostatic hydrogel spacer (SpaceOAR; Augmenix). Herein, we report safety and efficacy outcomes from our institutional prostate SBRT experience with SpaceOAR placement. Methods Fifty men with low- or intermediate-risk prostate cancer treated at a single institution with linear accelerator-based SBRT to 3625 cGy in 5 fractions, with or without androgen deprivation therapy (ADT) were included. All patients underwent SpaceOAR and fiducial marker placement followed by pre-treatment MRI. Toxicity assessments were conducted at least weekly while on treatment, 1 month after treatment, and every follow-up visit thereafter. Post-treatment PSA measurements were obtained 4 months after SBRT, followed by every 3–6 months thereafter. Acute toxicity was documented per RTOG criteria. Results Median follow up time was 20 (range 4–44) months. Median PSA at time of diagnosis was 7.4 (2.7–19.5) ng/ml. Eighteen men received 6 months of ADT for unfavorable intermediate risk disease. No PSA failures were recorded. Median PSA was 0.9 ng/mL at 20 months; 0.08 and 1.32 ng/mL in men who did and did not receive ADT, respectively. Mean prostate-rectum separation achieved with SpaceOAR was 9.6 ± 4 mm at the prostate midgland. No grade ≥ 3 GU or GI toxicity was recorded. During treatment, 30% of men developed new grade 2 GU toxicity (urgency or dysuria). These symptoms were present in 30% of men at 1 month and in 12% of men at 1 year post-treatment. During treatment, GI toxicity was limited to grade 1 symptoms (16%), although 4% of men developed grade 2 symptoms during the first 4 weeks after SBRT. All GI symptoms were resolving by the 1 month post-treatment assessment and no acute or late rectal toxicity was reported > 1 month after treatment. Conclusions Periprostatic hydrogel placement followed by prostate SBRT resulted in minimal GI toxicity, and favorable early oncologic outcomes. These results indicate that SBRT with periprostatic spacer is a well-tolerated, safe, and convenient treatment option for localized prostate cancer. Electronic supplementary material The online version of this article (10.1186/s13014-019-1346-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark E Hwang
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Mark Mayeda
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Maria Liz
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Brenda Goode-Marshall
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Lissette Gonzalez
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Carl D Elliston
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Catherine S Spina
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Oscar A Padilla
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, New York, 10032, USA
| | - Israel Deutsch
- Department of Radiation Oncology, Columbia University Medical Center, New York, 10032, USA.
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Conteduca V, Crabb SJ, Scarpi E, Hanna C, Maines F, Joyce H, Fabbri P, Derosa L, Massari F, Lolli C, Zarif S, Jones RJ, Caffo O, Elliott T, De Giorgi U. Association Between Early PSA Increase and Clinical Outcome in Patients Treated with Enzalutamide for Metastatic Castration Resistant Prostate Cancer. Mol Diagn Ther 2017; 20:255-63. [PMID: 27020582 DOI: 10.1007/s40291-016-0196-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Prostate-specific antigen (PSA) decline by 50 % from the baseline to 12 weeks (PSA50w12) is currently used to predict response to treatment and clinical outcome of patients with metastatic castration-resistant prostate cancer (mCRPC). We evaluated the association between PSA changes at 4 weeks and clinical outcome. PATIENTS AND METHODS Eligible patients had PSA levels assessed at baseline, and monthly during enzalutamide treatment. Early PSA increase was defined as an increased PSA level at 4 weeks ≥20 % (PSA + 20w4) from baseline. Early PSA decline was defined as a PSA response at 4 weeks ≥30 % (PSA30w4) and ≥50 % (PSA50w4) from baseline. Progression-free survival (PFS), overall survival (OS) and their 95 % confidence intervals (CI) were evaluated by the Kaplan-Meier method and compared with the log-rank test. The impact of early PSA increase and decline on PFS and OS was evaluated by Cox regression analyses. RESULTS We assessed 193 patients with median age of 73 years (range 43-91 years). The median follow-up was 11.7 months (range 0.5-27.4 months). PSA + 20w4 predicted both PFS and OS [HR 6.50 (95 % CI 2.63-16.07; p < 0.0001) and HR 10.54 (95 % CI 4.02-27.64; p < 0.0001), respectively], whereas PSA30w4 and PSA50w4 predicted only PFS [HR 0.37 (95 % CI 0.21-0.67; p = 0.0009) and HR 0.34 (95 % CI 0.19-0.60; p = 0.0003), respectively]. CONCLUSIONS An early PSA increase, defined as a PSA level at 4 weeks ≥20 % (PSA + 20w4), could be useful to quickly identify patients unlikely to benefit from enzalutamide. Larger studies are needed to confirm PSA + 20W4 as an early biomarker of primary resistance to enzalutamide.
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Affiliation(s)
- Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, FC, Italy
| | - Simon J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Emanuela Scarpi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, FC, Italy
| | | | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | | | - Paolo Fabbri
- Oncology Unit, Cervesi Hospital, Cattolica, Italy
| | - Lisa Derosa
- Medical Oncology Department, Santa Chiara Hospital, Pisa, Italy
| | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, FC, Italy
| | - Sunnya Zarif
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Robert J Jones
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | | | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, FC, Italy.
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Biomarkers of Outcome in Patients With Localized Prostate Cancer Treated With Radiotherapy. Semin Radiat Oncol 2017; 27:11-20. [DOI: 10.1016/j.semradonc.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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7
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Bellefqih S, Hadadi K, Mezouri I, Maghous A, Marnouche E, Andaloussi K, Elmarjany M, Sifat H, Mansouri H, Benjaafar N. Association de radiothérapie et d’hormonothérapie dans la prise en charge des cancers localisés de la prostate : où en est-on ? Cancer Radiother 2016; 20:141-50. [DOI: 10.1016/j.canrad.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/21/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
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8
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Matei DV, Ferro M, Jereczek-Fossa BA, Renne G, Crisan N, Bottero D, Mazzarella C, Terracciano D, Autorino R, De Cobelli O. Salvage radical prostatectomy after external beam radiation therapy: a systematic review of current approaches. Urol Int 2015; 94:373-82. [PMID: 25765848 DOI: 10.1159/000371893] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. OBJECTIVE The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. METHODS A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. RESULTS Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. CONCLUSIONS Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.
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9
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Fizazi K, Pagliaro L, Laplanche A, Fléchon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Martin AL, Journeau F, Reckova M, Logothetis C, Culine S. Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol 2014; 15:1442-1450. [PMID: 25456363 DOI: 10.1016/s1470-2045(14)70490-5] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor prognosis germ-cell tumours are only cured in about half of patients. We aimed to assess whether treatment intensification based on an early tumour marker decline will improve progression-free survival for patients with germ-cell tumours. METHODS In this phase 3, multicentre, randomised trial, patients were enrolled from France (20 centres), USA (one centre), and Slovakia (one centre). Patients were eligible if they were older than 16 years, had evidence of testicular, retroperitoneal, or mediastinal non-seminomatous germ cell tumours based on histological findings or clinical evidence and highly elevated serum human chorionic gonadotropin or alfa-fetoprotein concentrations that matched International Germ Cell Cancer Consensus Group poor prognosis criteria. After one cycle of BEP (intravenous cisplatin [20 mg/m(2) per day for 5 days], etoposide [100 mg/m(2) per day for 5 days], and intramuscular or intravenous bleomycin [30 mg per day on days 1, 8, and 15]), patients' human chorionic gonadotropin and alfa-fetoprotein concentrations were measured at day 18-21. Patients with a favourable decline in human chorionic gonadotropin and alfa-fetoprotein continued BEP (Fav-BEP group) for 3 additonal cycles, whereas patients with an unfavourable decline were randomly assigned (1:1) to receive either BEP (Unfav-BEP group) or a dose-dense regimen (Unfav-dose-dense group), consisting of intravenous paclitaxel (175 mg/m(2) over 3 h on day 1) before BEP plus intravenous oxaliplatin (130 mg/m(2) over 3 h on day 10; two cycles), followed by intravenous cisplatin (100 mg/m(2) over 2 h on day 1), intravenous ifosfamide (2 g/m(2) over 3 h on days 10, 12, and 14), plus mesna (500 mg/m(2) at 0, 3, 7 and 11 h), and bleomycin (25 units per day, by continuous infusion for 5 days on days 10-14; two cycles), with granulocyte-colony stimulating factor (lenograstim) support. Centrally blocked computer-generated randomisation stratified by centre was used. The primary endpoint was progression-free survival and the efficacy analysis was done in the intention-to-treat population. The planned trial accrual was completed in May, 2012, and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT00104676. FINDINGS Between Nov 28, 2003, and May 16, 2012, 263 patients were enrolled and 254 were available for tumour marker assessment. Of these 51 (20%) had a favourable marker assessment, and 203 (80%) had an unfavourable tumour marker decline; 105 were randomly assigned to the Unfav-dose-dense group and 98 to the Unfav-BEP group. 3-year progression-free survival was 59% (95% CI 49-68) in the Unfav-dose-dense group versus 48% (38-59) in the Unfav-BEP group (HR 0·66, 95% CI 0·44-1·00, p=0·05). 3-year progression-free survival was 70% (95% CI 57-81) in the Fav-BEP group (HR 0·66, 95% CI 0·49-0·88, p=0·01 for progression-free survival compared with the Unfav-BEP group). More grade 3-4 neurotoxic events (seven [7%] vs one [1%]) and haematotoxic events occurred in the Unfav-dose-dense group compared with in the Unfav-BEP group; there was no difference in grade 1-2 febrile neutropenia (18 [17%] vs 18 [18%]) or toxic deaths (one [1%] in both groups). Salvage high-dose chemotherapy plus a stem-cell transplant was required in six (6%) patients in the Unfav-dose-dense group and 16 (16%) in the Unfav-BEP group. INTERPRETATION Personalised treatment with chemotherapy intensification reduces the risk of progression or death in patients with poor prognosis germ-cell tumours and an unfavourable tumour marker decline. FUNDING Institut National du Cancer (Programme Hospitalier de Recherche Clinique).
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, Department of Cancer Medicine, Villejuif, France.
| | - Lance Pagliaro
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Agnes Laplanche
- Institut Gustave Roussy, Department of Biostatistics, Villejuif, France
| | - Aude Fléchon
- Centre Léon Bérard, Department of Cancer Medicine, Lyon, France
| | | | | | - Pierre Kerbrat
- Centre Eugène Marquis, Department of Cancer Medicine, Rennes, France
| | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Department of Cancer Medicine, Angers, France
| | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Department of Cancer Medicine, Nantes, France
| | | | - Guilhem Roubaud
- Institut Bergonié, Department of Cancer Medicine, Bordeaux, France
| | - Gwenaëlle Gravis
- Institut Paoli Calmette, Department of Cancer Medicine, Marseille, France
| | | | | | - Claude Linassier
- Centre Hospitalo-Universitaire, Department of Cancer Medicine, Tours, France
| | | | | | - Florence Journeau
- Institut Gustave Roussy, Department of Biostatistics, Villejuif, France
| | | | | | - Stephane Culine
- Hôpital Saint Louis, Department of Cancer Medicine, Paris, France
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10
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Blanchard P, Bakkour M, De Crevoisier R, Levy A, Baumert H, Patard JJ, Wibault P, Fizazi K, Bossi A. Early PSA level decline is an independent predictor of biochemical and clinical control for salvage postprostatectomy radiotherapy. Urol Oncol 2014; 33:108.e15-20. [PMID: 25176583 DOI: 10.1016/j.urolonc.2014.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND To improve the early detection of responders to salvage external beam radiotherapy (RT) after radical prostatectomy (RP). METHODS Between 2002 and 2007, in a single institution, 136 consecutive patients received salvage RT to a dose of 66 Gy without androgen-deprivation therapy after RP for a rising prostate-specific antigen (PSA) level. PSA measurements were systematically performed before RT (PSART), at the fifth week of RT (PSA5), and in the follow-up at least twice a year (every 6 mo). The PSA level decline during RT was expressed as PSA ratio (PSA5/PSART). Two different definitions of biochemical failure after salvage RT were considered: PSA level>0.4 ng/ml and PSA>PSA nadir post-RT +0.4 ng/ml. Statistical analyses included univariate and multivariate Cox regression models. RESULTS The median follow-up was 60 months. The 5-year freedom from biochemical and clinical failure rates were 57% (95% CI: 48%-66%) and 92% (95% CI: 87%-97%), respectively. The mean PSA5 was 0.61 ng/ml (range: 0-7) and the mean PSA ratio was 0.67 (0-1.7). A PSA ratio<1 was a significant prognostic factor in multivariate analysis for both definitions of biochemical failure (P = 0.01 for both) and for clinical failure (P = 0.005). CONCLUSIONS For patients undergoing salvage RT after RP for a rising PSA level, the absence of PSA level decline during RT is predictive of biochemical and clinical failure and may be used to rapidly identify poor responders.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France; University Paris Sud, France.
| | - Moudar Bakkour
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | | | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Hervé Baumert
- Department of Urology, Hôpital Saint Joseph, Paris, France
| | | | - Pierre Wibault
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Karim Fizazi
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France; University Paris Sud, France
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
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11
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Predictive clinical indicators of biochemical progression in advanced prostate cancer patients receiving Leuplin depot as androgen deprivation therapy. PLoS One 2014; 9:e105091. [PMID: 25121948 PMCID: PMC4133301 DOI: 10.1371/journal.pone.0105091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/20/2014] [Indexed: 01/08/2023] Open
Abstract
Therapeutic planning and counseling for advanced prostate cancer patients receiving androgen deprivation therapy (ADT) is complicated because the prognoses are highly variable. The purpose of this study is to identify predictive clinical indicators of biochemical progression (BCP). In this retrospective analysis, data from 107 newly diagnosed patients (from November 1995 to April 2008) with advanced prostate adenocarcinoma receiving Leuprorelin acetate depot were analyzed. Data was collected from the computerized registry of two collaborating medical centers in Taiwan. Cox regression and Kaplan-Meier analyses were used to evaluate the relationship between potential predictive parameters and BCP. Univariate analysis revealed that predictors of BCP included (1) initial serum prostate-specific antigen (PSA) (hazard ratio [HR], 1.00; 95% confidence interval [CI] 1.00–1.00); (2) log of initial PSA (HR, 1.35; 95% CI 1.17–1.56); (3) PSA density at diagnosis (HR, 1.00; 95% CI 1.00–1.01), and (4) pathological bone fracture (HR, 2.22; 95% CI 1.20–4.11). Age (HR, 0.94; 95% CI 0.91–0.98) and hemoglobin levels (HR, 0.86; 95% CI 0.76–0.97) were also associated with greater risk of BCP. After adjusting for age, pathologic fracture, and hemoglobin level, the initial PSA and PSA density were no longer significantly associated with BCP. However, age and hemoglobin levels continued to be associated with greater risk of BCP (P≤0.007). Using Kaplan-Meier analysis, patients with higher initial PSA concentration, pathological bone fracture, and low hemoglobin had a greater probability of BCP. Thus, low hemoglobin and age are predictive indicators of BCP and therefore early indicators of BCP despite ADT therapy.
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12
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Zhang C, Jing T, Wang F, Gao X, Xu C, Sun Y. Chemotherapy plus estramustine for management of castration-resistant prostate cancer: meta-analysis of randomized controlled trials. Actas Urol Esp 2014; 38:184-91. [PMID: 24507454 DOI: 10.1016/j.acuro.2013.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/17/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Estramustine, an agent with both hormonal and non-hormonal effects in men, is supposed to be effective in treating castration-resistant prostate cancer. However, previous studies have reported conflicting results. We conducted this meta-analysis to evaluate the efficacy and toxicity of additional estramustine to chemotherapy. METHODS Data sources including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register were searched to identify potentially relevant randomized controlled trials. Prostate specific antigen (PSA) response, overall survival, and grade 3 to 4 toxicity were analyzed. RESULTS Seven randomized controlled trials, a total of 839 patients, were enrolled. The pooled odds ratio for PSA response was 3.02 (95% CI=1.69-5.39, P=.0002); the pooled hazard ratio for overall survival was .95 (95% CI=.80-1.14, P=.58); the pooled odds ratio for nausea/vomiting and cardiovascular toxicity were 3.90 (95% CI=1.05-14.45, P=.04) and 2.22 (95% CI=1.15-4.30, P=.02). No significant difference was detected for neutropenia, anemia, thrombocytopenia, diarrhea, fatigue, or neuropathy (P>.05). CONCLUSIONS According to this meta-analysis, chemotherapy with additional estramustine increased the PSA response rate. However, it increased the risk of grade 3 or 4 adverse effects such as nausea/vomiting and cardiovascular events, and the overall survival was not improved for castration-resistant prostate cancer patients.
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Affiliation(s)
- C Zhang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - T Jing
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - F Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - X Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - C Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Y Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
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13
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Al-Ubaidi FLT, Schultz N, Loseva O, Egevad L, Granfors T, Helleday T. Castration therapy results in decreased Ku70 levels in prostate cancer. Clin Cancer Res 2013; 19:1547-56. [PMID: 23349316 DOI: 10.1158/1078-0432.ccr-12-2795] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Neoadjuvant castration improves response to radiotherapy of prostate cancer. Here, we determine whether castration therapy impairs nonhomologous end-joining (NHEJ) repair of DNA double-strand breaks (DSB) by downregulating Ku70 protein expression. EXPERIMENTAL DESIGN Twenty patients with locally advanced prostate cancer were enrolled, and 6 to 12 needle core biopsy specimens were taken from the prostate of each patient before treatment. Bilateral orchidectomy was conducted in eight patients and 12 patients were treated with a GnRH agonist. After castration, two to four similar biopsies were obtained, and the levels of Ku70 and γ-H2AX foci were determined by immunofluorescence in verified cancer tissues. RESULTS We observed that the androgen receptor binds directly to Ku70 in prostate tissue. We also found a reduction of the Ku70 protein levels in the cell nuclei in 12 of 14 patients (P < 0.001) after castration. The reduction in Ku70 expression correlated significantly with decreased serum prostate-specific antigen (PSA) levels after castration, suggesting that androgen receptor activity regulates Ku70 protein levels in prostate cancer tissue. Furthermore, a significant correlation between the reductions of Ku70 after castration versus changes induced of castration of γ-H2AX foci could be seen implicating a functional linkage of decreased Ku70 levels and impaired DNA repair. CONCLUSIONS Castration therapy results in decreased levels of the Ku70 protein in prostate cancer cells. Because the Ku70 protein is essential for the NHEJ repair of DSBs and its downregulation impairs DNA repair, this offers a possible explanation for the increased radiosensitivity of prostate cancer cells following castration.
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Affiliation(s)
- Firas L T Al-Ubaidi
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
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14
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Nishiyama T. Androgen deprivation therapy in combination with radiotherapy for high-risk clinically localized prostate cancer. J Steroid Biochem Mol Biol 2012; 129:179-90. [PMID: 22269996 DOI: 10.1016/j.jsbmb.2011.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 12/25/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
Androgen deprivation therapy (ADT) has remained the main therapeutic option for patients with advanced prostate cancer (PCa) for about 70 years. Several reports and our findings revealed that aggressive PCa can occur under a low dihydrotestosterone (DHT) level environment where the PCa of a low malignancy with high DHT dependency cannot easily occur. Low DHT levels in the prostate with aggressive PCa are probably sufficient to propagate the growth of the tumor, and the prostate with aggressive PCa can produce androgens from the adrenal precursors more autonomously than that with non-aggressive PCa does under the low testosterone environment with testicular suppression. In patients treated with ADT the pituitary-adrenal axis mediated by adrenocorticotropic hormone has a central role in the regulation of androgen synthesis. Several experimental studies have confirmed the potential benefits from the combination of ADT with radiotherapy (RT). A combination of external RT with short-term ADT is recommended based on the results of phase III randomized trials. In contrast, the combination of RT plus 6 months of ADT provides inferior survival as compared with RT plus 3 years of ADT in the treatment of locally advanced PCa. Notably, randomized trials included patients with diverse risk groups treated with older RT modalities, a variety of ADT scheduling and duration and, importantly, suboptimal RT doses. The use of ADT with higher doses of RT or newer RT modalities has to be properly assessed.
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Affiliation(s)
- Tsutomu Nishiyama
- Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Niigata 951-8510, Japan.
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15
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Fizazi K, Lesaunier F, Delva R, Gravis G, Rolland F, Priou F, Ferrero JM, Houedé N, Mourey L, Theodore C, Krakowski I, Berdah JF, Baciuchka M, Laguerre B, Fléchon A, Ravaud A, Cojean-Zelek I, Oudard S, Labourey JL, Lagrange JL, Chinet-Charrot P, Linassier C, Deplanque G, Beuzeboc P, Geneve J, Davin JL, Tournay E, Culine S. A phase III trial of docetaxel–estramustine in high-risk localised prostate cancer: A planned analysis of response, toxicity and quality of life in the GETUG 12 trial. Eur J Cancer 2012; 48:209-17. [DOI: 10.1016/j.ejca.2011.10.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
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16
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Supiot S, Rio E, Clément-Colmou K, Bouchot O, Rigaud J. Suivi après la radiothérapie des cancers de la prostate : bases scientifiques, rapport coût–bénéfice. Cancer Radiother 2011; 15:540-5. [DOI: 10.1016/j.canrad.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 05/23/2011] [Indexed: 01/21/2023]
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17
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Doyen J, Alix-Panabières C, Hofman P, Parks SK, Chamorey E, Naman H, Hannoun-Lévi JM. Circulating tumor cells in prostate cancer: a potential surrogate marker of survival. Crit Rev Oncol Hematol 2011; 81:241-56. [PMID: 21680196 DOI: 10.1016/j.critrevonc.2011.05.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 03/23/2011] [Accepted: 05/18/2011] [Indexed: 02/07/2023] Open
Abstract
Prostate-specific antigen (PSA) levels in blood are widely used in prostate cancer (PCa) for the management of this disease at every stage of progression. Currently, PSA levels combined with clinical stage and Gleason score provide the best predictor of survival and the main element to monitor treatment efficiency. However, these areas could be improved by utilizing emerging biomarkers. Recently, circulating tumor cells (CTCs) and disseminating tumor cells (DTCs) have been detected in PCa and may be a new surrogate candidate. Here we provide a systematic review of the literature in order to describe the current evidence of CTC/DTC surrogacy regarding outcome of prostate cancer patients. We also discuss several markers that could be used to increase the sensitivity and specificity of CTC/DTC detection. CTC/DTC detection is performed using a wide variety of techniques. Initially, reverse transcriptase polymerase chain reaction (RT-PCR) based methods were utilized with weak correlation between their positive detection and patients' outcome. More recent immunological techniques have indicated a reproducible correlation with outcome. Such surrogate markers may enable clinicians to provide early detection for inefficient treatments and patients with poor prognosis that are candidates for treatment intensification. Dissecting the micrometastasis phenomenon in CTCs/DTCs is a key point to increase surrogacy of this biomarker.
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Affiliation(s)
- Jérôme Doyen
- Department of Radiation Oncology, Antoine-Lacassagne Cancer Center, Nice, France.
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18
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Early choline levels from 3-tesla MR spectroscopy after exclusive radiation therapy in patients with clinically localized prostate cancer are predictive of plasmatic levels of PSA at 1 year. Int J Radiat Oncol Biol Phys 2011; 81:e407-13. [PMID: 21605949 DOI: 10.1016/j.ijrobp.2011.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/08/2011] [Accepted: 03/09/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the time course response of prostate metabolism to irradiation using magnetic resonance spectroscopy (MRS) at 3-month intervals and its impact on biochemical control. METHODS AND MATERIALS Between January 2008 and April 2010, 24 patients with localized prostate cancer were prospectively enrolled in the Evaluation of the Response to Irradiation with MR Spectroscopy (ERIS) trial. All the patients had been treated with intensity-modulated radiation therapy with or without long-term adjuvant hormonal therapy (LTHT) and underwent 3-T MRS and prostate-specific antigen (PSA) assays at baseline and every 3 months thereafter up to 12 months. RESULTS After radiation, the mean normalized citrate level (citrate/water) decreased significantly over time, both in the peripheral zone (PZ) (p = 0.0034) and in the entire prostate (p = 0.0008), whereas no significant change was observed in mean normalized choline levels (choline/water) in the PZ (p = 0.84) and in the entire prostate (p = 0.95). At 6 months after radiation, the mean choline level was significantly lower in the PZ for patients with a PSA value of ≤0.5 ng/mL at 12 months (4.9 ± 1.7 vs. 7.1 ± 1.5, p = 0.0378). Similar results were observed at 12 months in the PZ (6.2 ± 2.3 vs. 11.4 ± 4.1, p = 0.0117 for choline level and 3.4 ± 0.7 vs. 16.1 ± 6.1, p = 0.0054 for citrate level) and also in the entire prostate (6.2 ± 1.9 vs. 10.4 ± 3.2, p = 0.014 for choline level and 3.0 ± 0.8 vs. 13.3 ± 4.7, p = 0.0054 for citrate level). For patients receiving LTHT, there was no correlation between choline or citrate levels and PSA value, either at baseline or at follow-up. CONCLUSIONS Low normalized choline in the PZ, 6 months after radiation, predicts which patients attained a PSA ≤0.5 ng/mL at 1 year. Further analyses with longer follow-up times are warranted to determine whether or not these new biomarkers can conclusively predict the early radiation response and the clinical outcome for patients with or without LTHT.
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19
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Richaud P, Chapet O, Azria D, Soulié M, Salomon L, Hennequin C, Culine S. [Prostate cancer 2010. Therapeutic innovations]. Cancer Radiother 2011; 15:7-11. [PMID: 21513892 DOI: 10.1016/s1278-3218(11)70002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
During the annual congress of the SFRO, a symposium, on "Therapeutic innovations", described some of the burning questions in the treatment of prostate cancer. What is the best technique to perform radiation dose escalation, brachytherapy or Intensity modulated radiotherapy? Rational has been highlighted for both techniques, but without a prospective comparative trial, no definitive answer could be given today. The role of neo-adjuvant hormonal treatment, before surgery or radiotherapy is still discussed, particularly in the area of LH-RH antagonists which have a rapid and profound anti-hormonal effect. At least, the salvage treatment for biochemical relapse after external beam irradiation has been discussed: surgery, cryotherapy, and High-Intensity focalised ultrasons and the timing of hormonal treatment.
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Affiliation(s)
- P Richaud
- Département de Radiothérapie Oncologique, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux, France
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20
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Dal Pra A, Cury FL, Souhami L. Radiation therapy and androgen deprivation in the management of high risk prostate cancer. Int Braz J Urol 2011; 37:161-75; discussion 176-9. [DOI: 10.1590/s1677-55382011000200003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2010] [Indexed: 02/01/2023] Open
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21
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de Crevoisier R, Fizazi K. Reply to Early PSA decrease is an independent predictive factor of clinical failure and specific survival in patients with localized prostate cancer treated with radiotherapy combined or not with androgen deprivation therapy. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Heyns C. Early PSA decrease is an independent predictive factor of clinical failure and specific survival in patients with localized prostate cancer treated with radiotherapy combined or not with androgen deprivation therapy. Ann Oncol 2010; 21:903-904. [DOI: 10.1093/annonc/mdp554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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