Long-term biopsy outcomes in prostate cancer patients treated with external beam radiotherapy: a systematic review and meta-analysis

Singh, Saurabh; Moore, Caroline M.; Punwani, Shonit; Mitra, Anita; Bandula, Steve

doi:10.1038/s41391-021-00323-6

Cited by 5 publications

(3 citation statements)

References 38 publications

(36 reference statements)

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“…At 12-month follow-up, treatment failure for any disease was seen in 35%, and for clinically significant disease in 21%. These rates are comparable to biopsy results after external beam radiation therapy including stereotactic body radiation [ 89 ]. Functional outcome was comparable to HIFU with preservation of potency in 75% and only transient urinary dysfunction.…”

Section: Introductionsupporting

confidence: 65%

The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer

Duan

Iagaru

2022

Cancer Imaging

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In the era of precision medicine, oncological imaging techniques are advancing at a rapid pace, particularly molecular imaging with promising new targets for prostate cancer (PC) such as gastrin releasing peptide receptors (GRPR) along the established and indispensable prostate specific membrane antigen (PSMA). As PC is characterized by heterogenous tumor biology ranging from indolent to aggressive disease, distinguishing clinically significant tumors from indolent disease is critical. Multiparametric MRI- and PET-targeted prostate biopsies mitigate the shortcomings and risks of standard systematic template biopsy by identifying more significant cancers.Focal treatment for localized disease is a minimally invasive approach that targets the index tumor – the lesion of the highest grade – while sparing the surrounding healthy tissue. Real-time MRI-guidance and thermal control with MR-thermometry, improves treatment accuracy and results in lower rates of functional side effects. PET imaging could be an useful tool to assess response to treatment compared to invasive prostate biopsies.In this comprehensive review, we focus on the image-guided detection and treatment of localized primary prostate cancer, its current status and future perspectives.

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Section: Introductionsupporting

confidence: 65%

The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer

Duan

Iagaru

2022

Cancer Imaging

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“… 8 The rates of clinically significant disease and any disease were 23/111 (21%) and 39/111 (35%), similar to the rates of positive biopsy after modern EBRT including stereotactic body radiation therapy. 8 , 21 In contrast, the rate of MRI-visible lesions after TULSA was 30% including equivocal findings ( Table 2 ). 8 …”

Section: Discussionmentioning

confidence: 97%

Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer: A Systematic Review

Dora

Clarke

Frey

et al. 2022

Journal of Endourology

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Purpose: MRI-guided transurethral ultrasound ablation (TULSA) uses real-time MR thermometry feedback to target prostate disease. We systematically review the literature to synthesize efficacy, functional, and safety outcomes and assess the influence of planned ablation fraction on outcome. Materials and Methods: PubMed, Embase, and the Cochrane Library were searched from inception to June 2021 following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting at least one efficacy, functional, or safety outcome after a single TULSA treatment were included. The relationship of freedom from salvage treatment and potency preservation with planned ablation volume was modeled. Results: Two hundred twenty-four patients were treated in 10 studies with up to a 5-year follow-up, mainly for primary localized prostate cancer (PCa) plus smaller cohorts with recurrent PCa, and locally advanced PCa (LAPC). The prostate-specific antigen decline from baseline up to 2 years, including focal to whole-gland ablation plans, was 54% to 97%. The rate of salvage treatment after one TULSA treatment for primary PCa was 7% to 17%. Continence and potency preservation were from 92% to 100% and from 75% to 98%. Urinary symptoms were stable in men with good voiding function at baseline, and 85% of men with concurrent PCa and lower urinary tract symptoms met the criteria for improvement. Symptom relief in a small cohort of men with LAPC was observed. Grade III adverse events were incurred by 13/224 men (6%), with no rectal injury/fistula or Grade IV complication. The planned ablation fraction was linearly related to salvage-free survival. The relationship between potency preservation and planned ablation fraction followed a sigmoid curve. Conclusions: As an alternative to conventional treatments, TULSA is safe and effective for prostate tissue ablation in men with primary PCa. There is also evidence that TULSA delivers effective relief of urinary symptoms while treating PCa in a single, low-morbidity procedure. The likelihood of freedom from additional treatment or potency preservation is associated with the planned ablation fraction.

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“…A positive prostate biopsy after primary RT for PCa is predictive of progression to metastasis and worse cancer-specific survival [60,61]. However, post-RT biopsy has some limitations and is not routinely performed to assess for treatment failure unless there is biochemical evidence of treatment failure [62].…”

Section: Indication For Prostate Biopsy After Primary Radiation Therapymentioning

confidence: 99%

Evaluation of Recurrent Disease after Radiation Therapy for Patients Considering Local Salvage Therapy: Past vs. Contemporary Management

Adams,

Deivasigamani,

Mottaghi

et al. 2023

Cancers

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Recurrent prostate cancer after primary treatment with radiation therapy is a common problem. Patients with localized recurrence may benefit from salvage therapy, but careful patient selection is crucial because not all patients will benefit from local salvage therapy, and salvage therapy has increased morbidity compared to primary treatments for prostate cancer. This review aims to provide an overview of the evaluation of patients with recurrent disease after radiation therapy and how it is continuing to evolve with increasing data on outcomes, as well as improving technologies and techniques. Our enhanced understanding of treatment outcomes and risk stratification has influenced the identification of patients who may benefit from local salvage treatment. Advances in imaging and biopsy techniques have enhanced the accuracy of locating the recurrence, which affects treatment decisions. Additionally, the growing interest in image-targeted ablative therapies that have less morbidity and complications than whole-gland therapies for suitable patients influences the evaluation process for those considering focal salvage therapy. Although significant changes have been made in the diagnostic evaluation of patients with recurrent disease after radiation therapy, it remains unclear whether these changes will ultimately improve patient outcomes.

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Long-term biopsy outcomes in prostate cancer patients treated with external beam radiotherapy: a systematic review and meta-analysis

Cited by 5 publications

References 38 publications

The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer

The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer

Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer: A Systematic Review

Evaluation of Recurrent Disease after Radiation Therapy for Patients Considering Local Salvage Therapy: Past vs. Contemporary Management

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