Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer

D’Amico, A.V.; Whittington, Richard; Malkowicz, S. Bruce; Schultz, Delray; Blank, Kenneth R.; Broderick, Gregory A.; Tomaszewski, John E.; Aa, Renshaw; Kaplan, Irving; Beard, Clair J.; Wein, Alan J.

doi:10.1016/s0022-5347(01)61700-2

Cited by 444 publications

(516 citation statements)

References 21 publications

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“…Of the 28 patients who had primary HIFU treatment the proportion in the low-, intermediate-and high-risk categories of D'Amico et al [6] were 21%, 57% and 21%, respectively, with a mean ( SD ) PSA level of 9.2 (6.7) ng/mL. Ten patients (36%) had received neoadjuvant ADT for 3 months and this was discontinued immediately after HIFU.…”

Section: Resultsmentioning

confidence: 96%

High‐intensity focused ultrasound for localized prostate cancer: initial experience with a 2‐year follow‐up

et al. 2009

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OBJECTIVE To report on the short‐term functional and oncological results, from one institution, of high‐intensity focused ultrasound (HIFU) for treating localized prostate cancer. PATIENTS AND METHODS Over a 3‐year period, 43 patients with localized prostate cancer were scheduled for HIFU in the primary (31) and salvage (12) settings using a second‐generation AblathermTM device (EDAP, Lyon, France). Oncological failure was defined by several criteria, including biochemical failure (assessed using both the Phoenix definition of the nadir + 2 ng/mL) and the current Food and Drug Administration (FDA) trial endpoint of a prostate‐specific antigen (PSA) level of ≥0.5 ng/mL, or starting salvage therapy, or the presence of cancer on biopsy after treatment. RESULTS Three patients had their procedures abandoned due to technical limitations/rectal wall thickness. The mean PSA levels in the primary and salvage groups were 9.2 and 5.1 ng/mL, respectively. The mean HIFU treatment time in the primary and salvage groups was 71.1 and 63.3 min, respectively. Using the Phoenix definition of biochemical failure, HIFU treatment failed in 13 patients in the primary group (46%) and five in the salvage group. Using the FDA trial endpoint, HIFU failed in 21 patients in the primary group (75%) and eight in the salvage group. One man died from metastatic prostate cancer 18 months after salvage HIFU. There were two urethral strictures in the primary (7%) and one in the salvage treatment group. There were two prostato‐rectal fistulae in the salvage HIFU group. CONCLUSIONS HIFU is proposed to be a minimally invasive low‐morbidity ablative treatment for localized prostate cancer, and with good efficacy. The present limited series is unable to support these claims. There were significant rates of complications and oncological failure in both the primary and salvage setting. As a result we have suspended our programme pending further evidence of its safety and efficacy.

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Section: Resultsmentioning

confidence: 96%

High‐intensity focused ultrasound for localized prostate cancer: initial experience with a 2‐year follow‐up

et al. 2009

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“…Patients were stratified into low-, intermediate-and high-risk groups. For the purpose of this analysis, cases with low-risk localized prostate cancer were defined according to the classification of D'Amico et al [3], i.e. Gleason score ≤ 6, with both primary and secondary Gleason grade ≤ 3, initial serum PSA level < 10 ng/mL, and clinical T stage T1 or T2a, using the 1997 TNM staging system [7].…”

Section: Methodsmentioning

confidence: 99%

“…The incidence has more than doubled over the past 20 years, at least in part as a result of PSA testing for case finding [1]. Localized prostate cancer is classified into risk groups defined by serum PSA level, biopsy Gleason score and clinical T stage [2][3][4]. These risk groups have been shown to predict the probability of biochemical recurrence after radical treatment, and are used as a guide to treatment decision-making.…”

Section: Introductionmentioning

confidence: 99%

Initial management of low‐risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry

et al. 2010

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Study Type – Therapy (outcomes research) Level of Evidence 2c OBJECTIVE To assess the patterns of care for low‐risk localized prostate cancer. Management of this condition is highly controversial, with a range of treatment options, but there are no published UK data. METHODS Data from the British Association of Urological Surgeons (BAUS) Cancer Registry were linked to the UK Association of Cancer registries postcode directory. The demographic and clinical characteristics, and the initial management of men diagnosed with low‐risk localized prostate cancer in the UK between 2000 and 2006 were analysed. RESULTS In all, 43 322 cases of localized prostate cancer were recorded in the BAUS Registry between 2000 and 2006, of which 8861 (20%) met the criteria for low‐risk disease. The proportion classified as low risk ranged from 16% in 2000 to 21% in 2006. The proportion of men with low‐risk disease opting for ‘watchful waiting’ increased from 0% to 39% over the same period. Treatment choice was associated with socio‐economic status. For example, radical prostatectomy was chosen by 34% of patients in the most affluent quintile, compared with 19% in the most deprived quintile (P= 0.01). CONCLUSION The management of low‐risk localized prostate cancer in the UK has changed markedly in recent years, and contrasts with that in the USA. The association observed between socio‐economic status and choice of treatment deserves further study.

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“…Pelvic lymph node dissection was carried out in all D'Amico high-risk prostate cancer or when the predicted risk of positive lymph node was more than 5 per cent. 12 A standard template was used in which the lymph nodes up to the ureteric crossing of the common iliac were removed. The judgment of performing a nerve-sparing surgery or not and the extent of it was made by the corresponding surgeon, after considering the risk of cancer and preoperative imaging.…”

Section: Methodsmentioning

confidence: 99%

Comparative study of laparoscopic radical prostatectomy and robot‐assisted radical prostatectomy on perioperative, oncological and functional outcomes

et al. 2017

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Aim The aim of the present study was to evaluate the perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) and robot‐assisted radical prostatectomy (RARP) performed at our centres. Patients and Methods All LRP and RARP performed from January 2011 to June 2016 were reviewed through electronic patient records. The preoperative cancer characteristics, perioperative parameters, pathology, oncological and functional outcomes were studied. Results A total of 136 men were included in the analysis. RARP had a significantly less estimated blood loss (933 mL vs 361 mL, P < 0.01) than LRP. Positive surgical margins were noted in 42.6 and 35.2 per cent for LRP and RARP. Four‐year biochemical recurrence‐free survival was 79.4 per cent. There were no difference across the two groups. The 3‐, 12‐, 24‐ and 36‐month continence rates were 51.6, 86.8, 86.6 and 84.6 per cent, respectively. Early continence was better in RARP. The Urogenital Distress Inventory‐6 was significantly lower for RARP at 6 weeks and 3 and 12 months, while the Incontinence Impact Questionnaires‐7 was lower for RARP at 6 weeks and at 3 months. The 3‐, 12‐, 24‐ and 36‐month erection sufficient for intercourse (ESI) rates were 11.6; 25.5; 28.4 and 21.4 per cent, respectively. More men achieved ESI after 12 months in RARP. The International Index of Erectile Function 5‐item version score was higher in RARP from 12 months onwards. Conclusion RARP appears to be a promising approach for greater minimally‐invasive benefit and functional outcome, without jeopardizing oncological control.

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Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer

Cited by 444 publications

References 21 publications

High‐intensity focused ultrasound for localized prostate cancer: initial experience with a 2‐year follow‐up

High‐intensity focused ultrasound for localized prostate cancer: initial experience with a 2‐year follow‐up

Initial management of low‐risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry

Comparative study of laparoscopic radical prostatectomy and robot‐assisted radical prostatectomy on perioperative, oncological and functional outcomes

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