Influence of Local Tumor Control on Distant Metastases and Cancer Related Mortality After External Beam Radiotherapy for Prostate Cancer

Zeléfsky, Michael J.; Reuter, Victor E.; Fuks, Zvi; Scardino, Peter T.; Shippy, Alison M.

doi:10.1016/j.juro.2007.11.063

Cited by 172 publications

(103 citation statements)

References 14 publications

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“…Of the three patients who developed Grade 3 urinary toxicity, two were characterized at baseline as having Grade 2 symptoms, and one patient was classified as having Grade 1 symptoms at baseline. The median IPSS at baseline was 6 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], and the median IPSS at last followup was 12 (range, 1-30). Resolution of an elevated IPSS was seen in 41% of patients (returned within 2 points of baseline) within a median time of 4.5 months.…”

Section: Toxicity Outcomesmentioning

confidence: 99%

A Phase II Study of Salvage High-Dose-Rate Brachytherapy for the Treatment of Locally Recurrent Prostate Cancer after Definitive External Beam Radiotherapy

et al. 2013

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PURPOSE-We report the toxicity and biochemical tumor control outcome of a prospective Phase II study using high-dose-rate brachytherapy (HDR) alone as a salvage therapy for recurrent disease after external beam radiotherapy (EBRT).METHODS-Forty-two patients with biopsy-proven recurrence were enrolled on a Phase II study of salvage HDR monotherapy using iridium-192. Median pretreatment EBRT dose was 8100 cGy (6840-8640 cGy) and the median time from completion of EBRT to salvage HDR was 73 months. The protocol prescription dose of 3200 cGy was delivered in four fractions over 30 hours in a single insertion. Median followup after salvage HDR was 36 months (6-67 months). RESULTS-The actuarial prostate-specific antigen biochemical relapse-free survival and distant metastases-free survival rates at 5 years were 68.5% and 81.5%, respectively. Cause-specific survival was 90.3%. Late genitourinary Grade 1and 2 toxicities were found in 38% and 48%, respectively, and one patient developed Grade 3 urinary incontinence. Late Grade 1 and 2 gastrointestinal toxicity was noted in 17% and 8% of patients, respectively. Three patients (7%) developed Grade 2 late urinary toxicity (urethral stricture), which were corrected with urethral dilatation, and one patient developed Grade 3 urinary incontinence. No Grade 4 toxicities were observed.CONCLUSIONS-Genitourinary toxicity was the most commonly encountered toxicity observed after salvage HDR but severe toxicities were uncommon. Salvage HDR is an effective and welltolerated modality for locally recurrent prostate cancer and should be considered even for patients who have previously been treated with ultra-high dose levels of EBRT.Open access under CC BY-NC-ND license.

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Section: Toxicity Outcomesmentioning

confidence: 99%

A Phase II Study of Salvage High-Dose-Rate Brachytherapy for the Treatment of Locally Recurrent Prostate Cancer after Definitive External Beam Radiotherapy

et al. 2013

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“…Zelefsky et al demonstrated that 10-year PSA relapse-free survival was 59% for patients with negative biopsies, compared to 49% for those with severe treatment effect and only 3% for those with NTE on biopsy. 10 Although the patients with severe treatment effect Number of cores total, median (IQR) 11 ( had lower 10-year PSA survival rates, this was not statistically significant and did not correlate with metastasis-free survival or CSS. Vance et al looked at the clinical outcome of patients based on routine biopsy at two years as stratified by those with negative (no cancer), atypical/suspicious cells (not diagnostic of carcinoma), CTE, and NTE.…”

Section: Discussionmentioning

confidence: 90%

Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes

Metcalfe

Troncoso

Guo

et al. 2017

CUAJ

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Introduction: Prostate biopsies following localized radiation therapy for prostate cancer often demonstrate residual prostatic carcinoma with treatment effect (CTE). The final oncological outcome of prostatic CTE is currently uncertain. We studied the pathological and oncological outcomes for a large cohort of patients who had CTE on post-radiation therapy biopsy and subsequently underwent salvage radical prostatectomy (SRP). Methods: A single-centre retrospective review of all SRPs performed from 1995-2014 was performed. Cases were selected for this analysis if they had had a post-radiation "for-cause" biopsy. Biopsy results were compared to final pathology results following SRP. Pathological and clinical outcomes were compared by extent of treatment effect seen on the post-radiation biopsy. Results: A total of 70 patients who had salvage prostatectomy at MD Anderson Cancer Centre from 2007-2015 met study criteria. CTE was found on biopsy in the absence of other adenocarcinoma in 16 patients. Among them, one (7%) patient had no evidence of carcinoma at the time of salvage prostatectomy, four (27%) had CTE, three (20%) had adenocarcinoma with minimal or partial treatment effect (PTE), and seven (47%) had adenocarcinoma with no treatment effect (NTE). For those with CTE on biopsy, 69% had biochemical recurrence at a median time of 0.4 years (interquartile range [IQR] 0.22-1.52) vs. 52% for all patients (median 0.44 years, IQR 0.11-1.70) and 47% for those with no treatment effect (median 0.62 years, IQR 0.05-1.90). Metastasis developed after salvage prostatectomy in 11.8% of the whole cohort (8/68, median time to metastasis was 3.03 years, IQR 2.45-4.47), 26.7% of patients with CTE (median 3.2 years, IQR 1.96-4.44), and 6.7% of patients with NTE (median 2.45 years, IQR 0.98-2.86). Median recurrence-free survival was 2.78 years (95% confidence interval [CI] 0.84-5.43) for all patients, 0.51 years (95% CI 0.22-2.35) for those with CTE, and 4.95 years (95% CI 0.95-7.08) for those with NTE; the difference was not significant (p=0.13). On multivariate analysis, pre-SRP biopsy Gleason grade <7 (hazard ratio [HR] 0.38; 95% CI 0.14-1.02) and number of biopsy cores positive for carcinoma (HR 1.11; 95% CI 1.00-1.22) were significant for prediction of cancer recurrence. Conclusions:Patients undergoing salvage prostatectomy for CTE or PTE demonstrated in a for-cause biopsy after radiation therapy had pathological evidence of viable, untreated cancer in more than 50% of cases and were at significant risk of adverse pathological features. Patients with CTE may therefore benefit from salvage radical prostatectomy. Our study is limited by its retrospective nature and sample size. More studies are required to further validate our findings and assess the benefit of SRP in this population.

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“…Many studies have shown increased incidence of local recurrence, distant metastasis, and death from prostate cancer for those patients with a positive post-radiation biopsy (11,12). Our retrospective study specifically examined outcomes for patients with a negative post-radiation prostate biopsy.…”

Section: Commentsmentioning

confidence: 99%

Outcomes Following Negative Prostate Biopsy for Patients With Persistent Disease After Radiotherapy for Prostate Cancer

2008

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Purpose: When faced with biochemical recurrence after definitive radiotherapy for prostate cancer, clinicians must determine whether the recurrence is local or systemic. Post radiotherapy prostate biopsies to detect persistent local disease are difficult to interpret histopathologically and are subject to sampling error. Our study examines outcomes for patients with a negative prostate biopsy performed for rising prostate-specific antigen (PSA) levels after prostate radiation. Materials and Methods:We performed a retrospective review of 238 prostate cancer patients with a negative biopsy following definitive radiotherapy. Seventy-five of these patients had biochemical recurrence at the time of biopsy. A negative biopsy was defined as the absence of prostate cancer without radiation-treatment effect in the specimen. Results: Patients underwent biopsy at a mean of 41 months after the completion of radiation. They had a mean PSA of 6. Patients were followed for an average of 63 months. Thirty-two patients (43%) developed metastasis, and 11 (15%) died of prostate cancer despite a negative post-radiation biopsy. Five of nine patients (56%) with sequential biopsies had a positive second biopsy. Conclusions: Patients with PSA recurrence and a negative post-radiation biopsy have a high chance of persistent local disease, progression, and death from prostate cancer. Furthermore, an initial negative biopsy does not rule-out local recurrence. Patients with biochemical recurrence after radiotherapy for prostate cancer need to be evaluated earlier for local recurrence.

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Influence of Local Tumor Control on Distant Metastases and Cancer Related Mortality After External Beam Radiotherapy for Prostate Cancer

Cited by 172 publications

References 14 publications

A Phase II Study of Salvage High-Dose-Rate Brachytherapy for the Treatment of Locally Recurrent Prostate Cancer after Definitive External Beam Radiotherapy

A Phase II Study of Salvage High-Dose-Rate Brachytherapy for the Treatment of Locally Recurrent Prostate Cancer after Definitive External Beam Radiotherapy

Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes

Outcomes Following Negative Prostate Biopsy for Patients With Persistent Disease After Radiotherapy for Prostate Cancer

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