Very Early Salvage Radiotherapy Improves Distant Metastasis-Free Survival

Abugharib, Ahmed; Jackson, Will; Tumati, Vasu; Dess, Robert T.; Lee, Jae; Zhao, Shuang G.; Soliman, Moaaz; Zumsteg, Zachary S.; Mehra, Rohit; Feng, Felix Y.; Morgan, Todd M.; Desai, Neil B.; Spratt, Daniel E.

doi:10.1016/j.juro.2016.08.106

Cited by 77 publications

(68 citation statements)

References 19 publications

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“…Two multi-institutional retrospective studies showed an improved freedom from biochemical progression and distant metastases following very early SRT at a PSA <0.2 ng/ml as opposed to patients in which SRT was initiated at a PSA level of 0.2-0.5 ng/ml versus higher PSA values [23,24]. Such analyses are confounded by lead-time and length-time bias and the topic remains an area of uncertainty.…”

Section: 3mentioning

confidence: 99%

“…In the meantime, regarding SRT, recent retrospective studies suggest that initiating SRT at lower PSA values (< 0.2 ng/ml) improves biochemical progression free survival as compared with using the traditional recommended confirmed value of 0.2 ng/ml and rising for definition of biochemical relapse (BCR) [23,24]. These data were reflected by the votes of the panel wherein a significant proportion of panellists would initiate SRT below the PSA threshold recommended by current guidelines.…”

Section: 4mentioning

confidence: 99%

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Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

et al. 2018

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The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.

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Section: 3mentioning

confidence: 99%

Section: 4mentioning

confidence: 99%

Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

et al. 2018

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“…For patients who underwent RP, 2 out of 8 studies showed an inverse relationship with DM [23,26,27,38,39,41,43] and none of the 8 studies investigating PCSM as outcome showed a significant correlation [26,31,33,38 40,48,49].…”

Section: Positive Surgical Marginmentioning

confidence: 99%

Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review

et al. 2019

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Context. In men with prostate cancer (PCa) treated with curative intent, controversy exists regarding the impact of biochemical recurrence (BCR) on oncological patient outcomes. Objective. To perform a systematic review of the existing literature on BCR after treatment with curative intent for non-metastatic PCa. Objective 1 is to investigate whether oncological outcomes differ between patients with or without BCR. Objective 2 is to study which clinical factors and tumor features in patients with BCR have an independent prognostic impact on oncological outcomes. Evidence acquisition. Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. For objective 1, prospective and retrospective studies comparing survival outcomes of patients with or without BCR following radical prostatectomy (RP) or radical radiotherapy (RT) were included. For objective 2, all studies with at least 100 participants and reporting on prognostic features in patients with BCR were included. Risk-of-bias and confounding assessments were performed according to the Quality in Prognosis Studies (QUIPS) tool. Both a narrative synthesis and meta-analysis were undertaken. Evidence synthesis. Overall, 77 studies were included for analysis, of which 14 studies addressed objective 1, recruiting 20406 patients. Objective 2 was addressed by 71 studies with 29057, 11301 and 4272 patients undergoing RP, RT or a mixed population (mix of patients undergoing RP or RT as primary treatment) respectively. There was low risk of bias for study participation, confounders and statistical analysis. For most studies, attrition bias, prognostic and outcome measurements were not clearly reported. BCR was associated with worse survival rates, mainly in patients with a short PSA Doubling Time (PSA-DT) and high final Gleason score after RP or a short Interval to Biochemical Failure (IBF) after RT and high biopsy Gleason score. Conclusion. BCR has an impact on survival, but this effect appears to be limited to a subgroup of patients with specific clinical risk factors. A short PSA-DT and high final Gleason score after RP and a short IBF after RT and high biopsy Gleason score are the main factors which have a negative impact on survival. Patient summary. This review looks at the risk of dying in men who have a rising PSA blood test after curative surgery or radiotherapy. For many men a rising PSA does not mean they are at a higher risk of dying from prostate cancer in the longer term. Men with a PSA that rises shortly after they were treated with radiotherapy or a rapidly rising PSA after surgery and a high tumor-grade for both treatment modalities are at the highest risk of dying.

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“…In the NeuroSAFE cohort the areas of PSM were: base (two), apex (two) and circumferential (three). In the non-NeuroSAFE NS cohort the areas of PSM were: base (one), apex (14) and circumferential (six). In pT3 disease, the overall PSM rate for the NeuroSAFE and non-NeuroSAFE NS cohorts was 14.3% vs 41.2% (P = 0.042), respectively.…”

Section: Psm Ratesmentioning

confidence: 99%

The neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) approach to nerve sparing in robot‐assisted laparoscopic radical prostatectomy in a British setting – a prospective observational comparative study

et al. 2017

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Very Early Salvage Radiotherapy Improves Distant Metastasis-Free Survival

Cited by 77 publications

References 19 publications

Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review

The neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) approach to nerve sparing in robot‐assisted laparoscopic radical prostatectomy in a British setting – a prospective observational comparative study

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