Evidence of Stage Migration to Higher Risk Prostate Cancer and its Financial Implications in a Single Institution

Abstract

DXA scans at yearly timepoints (+/-6mos) were reviewed: nZ35 at 1 yr, nZ25 at 2 yrs, and nZ11 at 3 yrs. Mean BMD declines (g/cm 2) at FN, TH, and SP were:-0.026 (2.9%),-0.015 (1.4%), and-0.029 (2.3%) at 1 yr;-0.026 (2.7%),-0.045 (4.2%), and-0.027 (2%) at 2 yrs; and-0.042 (4.1%),-0.047 (4.4%), and-0.096 (7.6%) at 3 yrs. Comparisons of absolute and % BMD changes showed no significant difference in bone loss in FN vs SP or TH vs SP (all p values>0.05). In subsets with decrease in BMD at any site of 0.03 g/cm 2 , there remained no pattern of greater bone loss in FN vs SP (nZ45) or TH vs SP (nZ48). 21 declines in T-score criteria were observed, more often in spine than hip (9 SP, 6 FN, 6 TH). Of the 9 SP, 5 declined in SP only; and 3 FN and 2 TH declined without change in SP. Conclusion: Pelvic RT + LT-ADT for advanced PrCa was not associated with greater BMD decrease in the FN/TH (RT exposed) versus lumbar SP (not RT exposed). These preliminary results challenge the notion that the primary influence of bone loss and potential skeletal events in patients treated with RT + LT-ADT is due to the contributions of RT when LT-ADT is used; and should be verified prospectively.

Image-Guided Prostate Cryoablation: State-of-the-Art

“…Finally, thermal ablation may play a role in patients with low- or intermediate-stage and grade prostate cancer. An increasing awareness of the potential for the overtreatment of lower-risk prostate cancer has led to several centers reporting more patients presenting with higher risk, more aggressive prostate cancer, a phenomenon known as stage migration [ 69 , 70 , 71 ]. The future research may provide additional insight into the potential role of thermal ablation in the management of patients with prostate cancer, specifically, which patients are most likely to benefit from ablative therapies.…”