Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy

Messing, Edward M.; Manola, Judith; Yao, Jorge L.; Kiernan, Maureen; Crawford, David; Wilding, George; diSant’Agnese, P. Anthony; Trump, Donald L.

doi:10.1016/s1470-2045(06)70700-8

Cited by 817 publications

(507 citation statements)

References 27 publications

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“…PSA kinetics can help identify these patients [22] but often involve multiple PSA measurements that can result in a delay of secondary therapy. Risk assessment tools that can accurately predict cancer recurrence and progression would allow a more timely institution of additional treatments that might be beneficial for selected patients [23][24][25]. Among the 109 published prediction tools [3], only 8 take advantage of pathologic information gained from RP, and very few of these tools have been validated.…”

Section: Discussionmentioning

confidence: 99%

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

et al. 2014

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“…Many clinical studies suggest that early androgen ablation may offer a survival benefit in patients with advanced prostate cancer and may prolong the time to the development of androgen-independent prostate cancer [24][25][26]. Other studies indicate that early castration offers no survival advantage and might not be needed [27,28].…”

Section: Discussionmentioning

confidence: 99%

Early and delayed castrations confer a similar survival advantage in TRAMP mice

Zhang¹,

Xu²,

Huang³

et al. 2009

Asian J Androl

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The most appropriate time to introduce androgen deprivation therapy for prostate cancer remains controversial. Our aim was to evaluate the effects of early versus delayed surgical castration on prostate cancer progression and survival in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. TRAMP mice were randomly divided into three groups: the early castration group (on which castration was performed at the age of 4 weeks), the delayed castration group (on which castration was performed when abdominal tumours could be palpated), and the sham-castrated group. Mice were monitored daily throughout their lives until cancer-related death or the development of an obviously moribund appearance, at which time the individual mouse was killed. Androgen receptor expression in prostate tumours was also evaluated. The results shows that the average lifespan in early castration, delayed castration and sham-castrated groups were 54.1 weeks, 59.9 weeks and 39.1 weeks, respectively. Both early castration and delayed castration conferred a statistically significant survival advantage when compared with the sham-castrated group (P < 0.001). However, the difference in lifespan between the early castration group and the delayed castration group was not statistically significant (P = 0.85). The increase in lifespan in the TRAMP mice that received either early or delayed castration correlated with lower G/B value (genitourinary tract weight/body weight) at death than the sham-castrated mice. In conclusion, early and delayed castrations in TRAMP mice prolonged survival to a similar extent. This finding may provide a guide for clinical practice in prostate cancer therapy.

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“…13,14 Staging information obtained through PLND may help to determine the need for additional therapies. Messing et al, 15,16 in a multiinstitutional randomized trial of 98 men with lymph node-positive prostate cancer, demonstrated that patients receiving immediate androgen deprivation therapy (ADT) had significant improved overall survival, prostate-cancer specific survival, and progression-free survival compared with patients who received ADT at the time of symptomatic recurrence or detection of distant metastases. More recently, a retrospective study in node-positive prostate cancer patients demonstrated that the delivery of adjuvant radiotherapy and ADT was associated with a higher cancer-specific survival (CSS) and biochemical recurrence (BCR)-free survival compared with patients receiving ADT alone.…”

Section: Ongoing Controversies In Plndmentioning

confidence: 99%

mentioning

confidence: 99%

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Since the initial report of robot-assisted laparoscopic prostatectomy (RALP) in 2001, the technique has gained rapid acceptance and utilization. When compared with more traditional forms of surgical intervention, there is still much debate with respect to cost, and impact on potency and continence. Less often is the focus on oncologic outcomes. Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently underreported during robotic procedures. Herein, we review the current controversies on the value and extent of PLND and the status of emerging data regarding robot-assisted PLND. IntroductionRadical prostatectomy has undergone an evolution in technique over many decades with older procedures being largely replaced by newer ones due to perceived superiority of oncologic outcomes or diminution of operative morbidity. [1][2][3] In the United States, da Vinci robot-assisted laparoscopic prostatectomy (RALP) has gained rapid popularity because of the facility with which it allows laparoscopic skills to be transferred to even non-laparoscopically trained surgeons. 4 Thus, the benefits of laparoscopy, enhanced optical magnification, decreased blood loss, and minimal incisions can be obtained without prolonged learning curves. Any time a new technique is introduced, it must be compared with current methods to ascertain at least equivalent outcomes, in addition to assessment of benefits, and limitations. To this end, there have been recent publications from the centers of excellence attempting to compare RALP to radical retropubic and pure laparoscopic techniques. 5,6 However, there has been a paucity of literature addressing pelvic lymph node dissection (PLND) at the time of RALP. This is not the case with all urologic robot-assisted procedures; recent literature on robot-assisted radical cystectomy has specifically focused on feasibility and adequacy of robot-assisted PLND. 7 Thus, the lack of literature on robot-assisted PLND at RALP may reflect that PLND at the time of prostatectomy performed through open technique (or otherwise) is a controversial topic. Important questions remain regarding patient selection, potential benefit and anatomic extent of the dissection, nodal yield, and complication rates. We will review these controversies and the state of the literature regarding RALP PLND in this context. Ongoing controversies in PLNDIn the United States, prostate cancer is the most commonly diagnosed noncutaneous cancer and the second-leading cause of cancer death among men. In 2008, 186 320 men were diagnosed with, and 28 660 men died of, prostate cancer in the United States. 8 The advent of prostate-specific antigen (PSA) screening has led to a profound stage migration such that men diagnosed in the PSA era are younger and have lower clinical and pathologic stage and lower mortality rates, and when treated they have improved margin-free status and biochemical progression-free survival and decreased extracapsular extension a...

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Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy

Cited by 817 publications

References 27 publications

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

Early and delayed castrations confer a similar survival advantage in TRAMP mice

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

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