scholarly journals Radical prostatectomy vs radiotherapy in high-risk prostate cancer patients: two centre experience

2015 ◽  
Vol 13 (4) ◽  
pp. 234-243
Author(s):  
Albertas Ulys ◽  
Agne Ulyte ◽  
Pavel Dziameshka ◽  
Oleg Sukonko ◽  
Sergei Krasny ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Gleason Score ◽  
Independent Predictor ◽  
Progression Free Survival ◽  
Free Survival ◽  
T Stage ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Background/objectiveThere are no randomized trials on the comparative effectiveness of radical prostatectomy (RP) and radiotherapy (RT) for high-risk prostate cancer. Our aim was to compare treatment outcomes of high-risk prostate cancer after RP and RT, including overall survival (OS), biochemical-progression-free survival (bPFS) and disease-progression-free survival (dPFS), using two cancer treatments centers’ patient data.MethodsData on high-risk prostate cancer patients between 2005 and 2009 were retrospectively reviewed in two cancer centers: National Cancer Institute, Vilnius, Lithuania and N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus; 210 patients were included in the study group treated with RP (n = 174) or RT (n = 36). The mean follow-up time was 5.6 and 6.6 years, respectively.ResultsLower T stage was an independent predictor of better OS (p = 0.01) and bPFS (p = 0.03). Only the highest Gleason score ≥8 was significantly predictive of a worse OS (p = 0.05), bPFS (p = 0.02) and dPFS (p = 0.001). A high PSA level was predictive of a worse bPFS (p = 0.007 for PSA ≥20) and dPFS (p = 0.008 for ≥20). The treatment modality in this study was insignificant after T stage, Gleason score and PSA level adjustment for OS, bPFS survival and dPFS survival (p = 0.17, p = 0.39, p = 0.20).ConclusionsThe T stage, Gleason score and pretreatment PSA level are significant factors for OS, bPFS survival, and dPFS survival of highrisk prostate cancer patients. Treatment option (RP or RT) was not an independent predictor of survival in this study.

scholarly journals Radical prostatectomy vs radiotherapy in high-risk prostate cancer patients: two centre experience

2015 ◽  
Vol 13 (4) ◽  
pp. 234-243
Author(s):  
Albertas Ulys ◽  
Agne Ulyte ◽  
Pavel Dziameshka ◽  
Oleg Sukonko ◽  
Sergei Krasny ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Gleason Score ◽  
Independent Predictor ◽  
Progression Free Survival ◽  
Free Survival ◽  
T Stage ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Background/objectiveThere are no randomized trials on the comparative effectiveness of radical prostatectomy (RP) and radiotherapy (RT) for high-risk prostate cancer. Our aim was to compare treatment outcomes of high-risk prostate cancer after RP and RT, including overall survival (OS), biochemical-progression-free survival (bPFS) and disease-progression-free survival (dPFS), using two cancer treatments centers’ patient data.MethodsData on high-risk prostate cancer patients between 2005 and 2009 were retrospectively reviewed in two cancer centers: National Cancer Institute, Vilnius, Lithuania and N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus; 210 patients were included in the study group treated with RP (n = 174) or RT (n = 36). The mean follow-up time was 5.6 and 6.6 years, respectively.ResultsLower T stage was an independent predictor of better OS (p = 0.01) and bPFS (p = 0.03). Only the highest Gleason score ≥8 was significantly predictive of a worse OS (p = 0.05), bPFS (p = 0.02) and dPFS (p = 0.001). A high PSA level was predictive of a worse bPFS (p = 0.007 for PSA ≥20) and dPFS (p = 0.008 for ≥20). The treatment modality in this study was insignificant after T stage, Gleason score and PSA level adjustment for OS, bPFS survival and dPFS survival (p = 0.17, p = 0.39, p = 0.20).ConclusionsThe T stage, Gleason score and pretreatment PSA level are significant factors for OS, bPFS survival, and dPFS survival of highrisk prostate cancer patients. Treatment option (RP or RT) was not an independent predictor of survival in this study.

Delaying conformal radiation therapy in high-risk prostate cancer patients lowers the actuarial distant metastases free survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15614-15614
Author(s):  
R. A. Nakamura ◽  
C. R. Monti ◽  
F. A. Trevisan ◽  
J. C. Prestes ◽  
M. R. Cruz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Gleason Score ◽  
Treatment Time ◽  
Distant Metastases ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Biochemical Progression

15614 Background: It is not well documented on medical literature the value of time to treat prostate cancer. This study was performed to evaluate the value of treatment time with conformal radiotherapy (3DCRT) in high-risk prostate cancer patients. Methods: From October 1997 to January 2002, 116 patients with high-risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. The median age was 65 years-old. High risk patients were defined as patients with PSA > 20 ng/ml, and/or T3 clinical stage and/or Gleason score > 7, or two factors of intermediate risk (PSA >= 10 and < 20 ng/ml, T2b-T2c and Gleason score = 7). The median time from diagnosis to 3DCRT was 2.9 months (0.9–134.9). The median doses of radiation on prostate and on seminal vesicles were 81 Gy (72–82.8) and 61.2 Gy (45–77.4), respectively. The neoadjuvant and concomitant androgen suppression therapy were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall survival, the 5-year actuarial biochemical progression-free survival and the 5-year actuarial distant metastases free survival were 84.3%, 64.7% and 88.6%, respectively. The 5-year actuarial distant metastases free survival for patients treated with 3DCRT less than or equal to 5 months was 92.5% versus 72.1% for patients treated with 3DCRT > 5 months (p=0.0076). The 5-year actuarial distant metastases free survival for patients with biochemichal progression was 68.8% versus 100% for patients with no biochemical progression (p 65 years-old (p=0.0160). Conclusions: The study suggests that delaying 3DCRT in high-risk prostate cancer patients lowers the actuarial distant metastases free survival. Biochemical progression may be a strong prognostic factor for distant metastases and, consequently, poor quality of life. No significant financial relationships to disclose.

Increasing overall survival with neoadjuvant and concomitant hormonal therapy plus conformal radiotherapy for high risk prostate cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14641-14641
Author(s):  
M. R. Cruz ◽  
R. A. Nakamura ◽  
C. R. Monti ◽  
J. C. Prestes ◽  
F. A. Trevisan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Gleason Score ◽  
Clinical Stage ◽  
Conformal Radiotherapy ◽  
Seminal Vesicles ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Risk Patients

14641 Objective: To evaluate the value of neoadjuvant (NHT) and concomitant hormonal therapy (CHT) for high risk prostate cancer patients treated with conformal radiotherapy (3DCRT). Methods: From October 1997 to January 2002, 116 patients with high risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. High risk patients were defined as patients with PSA >20 ng/ml, and/or T3 clinical stage and/or Gleason score >7, or two factors of intermediate risk (PSA ≥10 and <20 ng/ml, T2b-T2c and Gleason score >7). The NHT and CHT were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. The prostate and seminal vesicles median doses were 81 Gy (72–82.8) and 61.2 Gy (45–77.4) respectively. The median time from diagnosis to 3DCRT was 2,9 months (0.9–134.9). Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall (OS) and 5-year biochemical progression-free survival (BPFS) were 84.3% and 64.7% respectively. The OS for patients submitted to NHT was 89.8% versus 76.4% for patients that were not submitted to (p = 0.0139). Patients that received CHT had an OS of 89.6% versus 73.4% for patients that did not receive CHT (p = 0.0201). Gleason score, clinical stage and seminal vesicles irradiation were significant to BPFS (p = 0.0372, p = 0.0412 and p = 0.0321 respectively). Conclusions: NHT and CHT increased OS of high risk prostate cancer of patients. Gleason score and clinical stage were important prognostic factors to BPFS. Seminal vesicles irradiation is recommended for high risk patients. No significant financial relationships to disclose.

The importance of surgical margins for biochemical recurrence in high-risk prostate cancer patients.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 75-75
Author(s):  
Victor Srougi ◽  
Rafael Sanchez-Salas ◽  
Fernando P. Secin ◽  
Igor Nunes-Silva ◽  
Mohammed Baghdadi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Surgical Margins ◽  
Pathological Stage ◽  
Free Survival ◽  
Positive Surgical Margins ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

75 Background: High-risk prostate cancer (PCa) is associated with greater risk of biochemical recurrence and cancer specific lethality. A multi-modal treatment is required for this group of patients, comprising surgery as part of it. However, the role of surgery as monotherapy is still under investigation. The purpose of this study is to analyze the influence of surgical margins on biochemical recurrence (BCR) among patients with high-risk prostate cancer (PCa) treated with robot assisted radical prostatectomy (RARP) since the start of our robotic program. Methods: We retrospectively analyzed our prospectively collected database of 5695 minimally invasive prostatectomies performed between 2000 and 2015. Clinical, pathological and oncological outcomes were evaluated in patients fulfilling Damico´s high risk characteristics. Primary endpoint was BCR, defined as post-operative PSA ≥ 0,2. Patients with neoadjuvant or adjuvant therapy were excluded. BCR was estimated with Kaplan-Meier curves. Cox proportional hazards regression was used to estimate variables associated with BCR. Results: We identified 199 high-risk PCa patients treated with RARP during the study period. Gleason score ≥ 8, PSA ≥ 20 and clinical stage ≥ T2c were present in 44%, 35% and 11% of the patients, respectively. The rate of positive surgical margins was 25%. With a median follow-up of 23 months (interquartile 12 – 34 months), 31% of the patients had BCR. Five-year BCR-free survival was 34,5%. Gleason score ≥ 8, PSA ≥ 20 and positive surgical margins were not predictors of BCR. A positive correlation of pathological stage ≥ T3 and BCR was found with (HR = 2.9; 95% CI = 1.2-6.9). Conclusions: The 5-years BCR-free survival was poor despite a low rate of positive surgical margins, when compared to historical series. We found that pathological stage ≥ T3 has a significant correlation with the BCR and that negative surgical margins do not assure good prognosis for high-risk patients.

The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: A systematic review and meta-analysis.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 369-369
Author(s):  
Zhipeng Wang ◽  
Yuchao Ni ◽  
Junru Chen ◽  
Guangxi Sun ◽  
Xingming Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Sexual Function ◽  
Meta Analysis ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
T Stage ◽  
High Risk Prostate Cancer ◽  
Subgroup Analyses ◽  
Risk Prostate Cancer

369 Background: The optimal treatment for patients with high-risk prostate cancer (PCa) remains debate and selection of patients to receive proper therapy is still an unsettled question. This systematical review was to compare the effectiveness of prostatectomy (RP) and radiotherapy (RT) in patients with high risk prostate cancer (PCa) and to select candidates for optimal treatment. Methods: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) and 95% CI of included studies. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS); the secondary outcomes were biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS) and clinical recurrence-free survival (CRFS). The meta-analysis was performed using Review Manager 5.3. Subgroup analyses were conducted according to GS, T stage and RT types. Quality of life (QOL) was compared with these two treatments. Results: A total of 25 studies were included. Overall, RP showed more survival benefits than RT on CSS (P=0.003) and OS (P=0.002), while RT was associated with a better BRFS (P=0.002) and MFS (P=0.004). Subgroup analyses showed RT was associated with similar or even better survival outcomes compared to RP in patients with high GS, high T stage or received external beam radiotherapy plus brachytherapy (EBRT+BT). As for QOL, RP was associated with poorer urinary and sexual function but better performance in the bowel domain. Conclusions: RP could prolong the survival time of patients with high risk PCa; however, RT could delay disease progression, and combined RT (EBRT+BT) even brought better CSS and similar OS than RP. RT might be the prior choice for patients with high T stage or high GS. RP could lead to poorer urinary and sexual function, while brought better performance in the bowel domain.

Pelvic lymph node recurrence in high-risk prostate cancer following prostate-only radiotherapy

2021 ◽  
pp. 1-5
Author(s):  
Sameed Hussain ◽  
Muhammad Imran Wajid ◽  
Muhammad Omer ◽  
Muhammad Yousuf Khan ◽  
Talha Maqsood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Free Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Abstract Introduction: High-risk prostate cancer is the most common presentation at our institute among patients with non-metastatic prostate cancer. Traditionally, pelvic lymph nodes were given a prophylactic dose of radiotherapy while the prostate was given a curative dose of radiation. This study aims to evaluate patterns of failure in patients who had prostate-only radiation at our centre. Materials and Methods: All high-risk prostate cancer patients who underwent radical radiotherapy to prostate only since 2014 were retrospectively analysed. Local T stage, baseline prostate-specific antigen (PSA) and Gleason score were recorded. Bone scan and staging CT scan data were collected. Various dose levels prescribed to prostate were analysed. The follow-up records of these patients were assessed. Patients who failed in pelvic lymph nodes were recorded separately. Overall survival and failure-free survival were calculated using Kaplan–Meier curve. Results: One-hundred five patients fulfilling the inclusion criteria were analysed. Only three patients developed recurrence in pelvic lymph node following prostate-only radiotherapy (PORT). Five year overall survival was 77% while failure-free survival was 64%. Forty patients had a PSA failure after a median follow-up of 62 months. Conclusions: Most high-risk prostate cancer patients who progress following hormone therapy and PORT have metastases outside pelvis. Till further conclusive evidence is available PORT can be considered as a safe option.

High-risk prostate cancer: factors predicting biochemical recurrence after radical prostatectomy

2015 ◽  
Vol 22 (3) ◽  
pp. 161-168
Author(s):  
Albertas Ulys ◽  
Agnė Ulytė ◽  
Pavel Dziameshka ◽  
Oleg Sukonko ◽  
Sergei Krasny ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Biochemical Recurrence ◽  
Perineural Invasion ◽  
Surgical Margins ◽  
T Stage ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Background/objective. Predictive criteria are needed to evaluate the risk of disease progression after radical prostatectomy. Such criteria would help to select patients most likely to benefit from adjuvant or multimodality treatment. Our aim was to identify predictive factors for biochemical recurrence among the  pre- and post-operative parameters in high-risk prostate cancer patients after radical prostatectomy. Methods. Data on high-risk prostate cancer patients between 2005 and 2009 were retrospectively reviewed in two cancer centers: National Cancer Institute, Vilnius, Lithuania, and N.  N.  Alexandrov National Cancer Centre of Belarus, Minsk, Belarus. 199 patients were selected for the  study. The  pre-operative independent variables were T stage, pretreatment PSA level and Gleason score. Surgical margins and perineural invasion were additionally known for 122 patients. The outcomes measured were biochemical recurrence free and overall survival. The mean follow-up time was 5.8 years. Results. Lower T stage (p = 0.001) and pretreatment PSA (p = 0.0001) were associated with better survival. In the multivariate analysis of pre-operative factors, high T stage (p = 0.008) and pretreatment PSA (p = 0.009) were predictive of biochemical recurrence. When postoperative parameters were included in the multivariate analysis, only pretreatment PSA (p = 0.01), positive surgical margins (p = 0.003) and perineural invasion (p = 0.03) remained relevant independent predictors of biochemical recurrence. Conclusions. Pretreatment PSA, positive surgical margins and perineural invasion were independent predictors of biochemical recurrence after radical prostatectomy in high-risk prostate cancer patients, while the  T stage became insignificant after adjusting for postoperative parameters.

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