No abstract

Background Many trials are evaluating therapies for men with metastatic hormone-sensitive prostate cancer (mHSPC). Objective To systematically review trials of prostate radiotherapy. Design, setting, and participants Using a prospective framework (framework for adaptive meta-analysis [FAME]), we prespecified methods before any trial results were known. We searched extensively for eligible trials and asked investigators when results would be available. We could then anticipate that a definitive meta-analysis of the effects of prostate radiotherapy was possible. We obtained prepublication, unpublished, and harmonised results from investigators. Intervention We included trials that randomised men to prostate radiotherapy and androgen deprivation therapy (ADT) or ADT only. Outcome measurements and statistical analysis Hazard ratios (HRs) for the effects of prostate radiotherapy on survival, progression-free survival (PFS), failure-free survival (FFS), biochemical progression, and subgroup interactions were combined using fixed-effect meta-analysis. Results and limitations We identified one ongoing (PEACE-1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR = 0.92, 95% confidence interval [CI] 0.81–1.04, p = 0.195) or PFS (HR = 0.94, 95% CI 0.84–1.05, p = 0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR = 0.74, 95% CI 0.67–0.82, p = 0.94 × 10 −8 ) and FFS (HR = 0.76, 95% CI 0.69–0.84, p = 0.64 × 10 −7 ), equivalent to ∼10% benefit at 3 yr. The effect of prostate radiotherapy varied by metastatic burden—a pattern consistent across trials and outcome measures, including survival (<5, ≥5; interaction HR = 1.47, 95% CI 1.11–1.94, p = 0.007). There was 7% improvement in 3-yr survival in men with fewer than five bone metastases. Conclusions Prostate radiotherapy should be considered for men with mHSPC with a low metastatic burden. Patient summary Prostate cancer that has spread to other parts of the body (metastases) is usually treated with hormone therapy. In men with fewer than five bone metastases, addition of prostate radiotherapy helped them live longer and should be considered.

RESULTS: Fifty pts were enrolled and 49 were evaluable for efficacy analysis. At the baseline, the median age was 73 (range 55-86), median PSA level was 28.3ng/mL (2.3-294.3), and Gleason score 8 was present in 45pts (90%). The median duration of initial ADT was 7.5 months (mo, 3.1-19.6) and 48 out of 50 pts experienced PSA progression 1 year while on initial ADT. All cases had treatment history of bicalutamide. Most pts showed high treatment adherence and the median treatment duration was 8.2 mo (0.5-22.9). PSA response rate was 55.1% (n¼27/49; 95%CI 41.3-68.1). The median time to PSA progression (TTPP) was 6.5 mo and the median radiographic progressionfree survival (rPFS) was 11.0 mo. The median Overall Survival was not reached. The treatment was well tolerated with 30% of grade 3 events.CONCLUSIONS: This is the first study to investigate the efficacy of AA+P in ADT poor responders. Our study demonstrated a consistent result on PSA response rate with previous studies, this might suggest that AA+P should be considered as an option for initial ADT poor responders. TTPP and rPFS were shorter than the results of previous studies. This trend was also reported in chemotherapy setting (Angelergues 2014 and Aljundi 2016); accordingly, shorter duration of effectiveness might still remain as a considerable point of treatment for this population.

Objective The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. Patients and Methods From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Results Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. Conclusion This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.

No abstract

ObjectivesTo describe the prostate cancer (PCa) detection rate, including clinically significant prostate cancer (csPCa), in a large cohort of patients who underwent transperineal ultrasonography‐guided systematic prostate biopsy (TPB‐US) using a probe‐mounted transperineal access system, with magnetic resonance imaging (MRI) cognitive fusion in case of a Prostate Imaging–Reporting and Data System grade 3–5 lesion, under local anaesthesia in an outpatient setting. Additionally, to compare the incidence of procedure‐related complications with a cohort of patients undergoing transrectal ultrasonography‐guided (TRB‐US) and transrectal MRI‐guided biopsies (TRB‐MRI).Patients and MethodsThis was an observational cohort study in men who underwent TPB‐US prostate biopsy in a large teaching hospital. For each participant, prostate‐specific antigen level, clinical tumour stage, prostate volume, MRI parameters, number of (targeted) prostate biopsies, biopsy International Society of Uropathology (ISUP) grade and procedure‐related complications were assessed. csPCa was defined as ISUP grade ≥2. Antibiotic prophylaxis was only given in those with an increased risk of urinary tract infection.ResultsA total of 1288 TPB‐US procedures were evaluated. The overall detection rate for PCa in biopsy‐naive patients was 73%, and for csPCa it was 63%. The incidence of hospitalization was 1% in TPB‐US (13/1288), compared to 4% in TRB‐US (8/214) and 3% in TRB‐MRI (7/219; P = 0.002).ConclusionsContemporary combined systematic and target TPB‐US with MRI cognitive fusion is easy to perform in an outpatient setting, with a high detection rate of csPCa and a low incidence of procedure‐related complications.

Samenvatting Nog steeds heeft een substantieel deel van de patiënten met prostaatcarcinoom reeds metastasen ten tijde van het stellen van de diagnose. Uit recente literatuur blijkt dat bij deze patiënten lokale radiotherapie van de prostaat geadviseerd dient te worden, mits zij een lage metastaselast hebben (volgens de CHAARTED-criteria). In dit artikel wordt de beschikbare literatuur hieromtrent besproken. Trefwoorden prostaatkanker • metastasen • lokale behandeling • radiotherapie Local therapy in primary metastatic prostate cancer Abstract A substantial proportion of patients with prostate cancer have metastases at the time of diagnosis. Recent literature suggests that local radiotherapy to the prostate should be advised in these patients, provided they have a low metastasic burden (as defined by the CHAARTED criteria). This article discusses the available literature. Keywords prostate cancer • metastases • local treatment • radiotherapy Introductie Hoewel het testen op prostaatspecifiek antigeen (PSA) heeft geleid tot eerdere detectie van prostaatcarcinoom, blijkt uit de Nederlandse PROZIB-database (Prostaatkanker Zorg In Beeld) dat nog steeds 15,8 % van de patiënten zich al ten tijde van de diagnose prostaatcarcinoom presenteren met drs. Liselotte M. S. Boevé

No abstract