Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

Roach, Mack; Lizarraga, Tania L. Ceron; Lazar, Ann

doi:10.1016/j.ijrobp.2015.08.005

Cited by 49 publications

(43 citation statements)

References 38 publications

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“…In our study, we concluded that the 10-year CSS in men treated with radical prostatectomy and those treated with radiotherapy and endocrine therapy is nearly identical. When men were treated in compliance with the current standard of care suggested by the National Comprehensive Cancer Network guidelines, we noted that the median difference in 10-year CSS was ≤1% (95% CI -2% to 7%; P = 0.24) between the two treatment modalities 5 .…”

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confidence: 90%

“…For example, the limited data from a single phase III trial suggest that the benefits of radical prostatectomy are limited to men <65 years of age. By contrast, several phase III trials dating back >30 years that mostly included men >65 years of age provide level 1 evidence of a benefit of EBRT combined with endocrine therapy 5 . In our study, we concluded that the 10-year CSS in men treated with radical prostatectomy and those treated with radiotherapy and endocrine therapy is nearly identical.…”

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confidence: 99%

“…Finally, whether the availability of enhanced endocrine treatment (using next-generation antiandrogens) in combination with radio therapy will make radical prostatectomy obsolete is a controversial question 5,10 . No agreement among experts currently exists but results from a few studies provide some facts for this debate 5 .…”

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confidence: 99%

“…In addition, patients with high-risk disease usually require postoperative radiotherapy but no good evidence of improved survival compared with treatment based on radiotherapy only exists. Hence, the question arises whether the days of radical prostatectomy as a treatment modality are numbered 5 .…”

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confidence: 99%

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Combining endocrine treatment and radiotherapy: a bright future

Roach

2016

Nat Rev Urol

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The landmark Scandinavian Prostate Cancer Group-7 (SPCG-7) trial adds to a growing body of literature that establishes the critical role of external beam radiotherapy (EBRT) in men with clinically localized but unfavourable-risk prostate cancer who are being treated with endocrine therapy 1,2 . In this trial by Fosså et al. 1 , 875 patients (90% with high-risk disease) received a luteinizinghormone-releasing hormone (LHRH) agonist and flutamide for 3 months, at which point 436 men commenced EBRT and continued treatment with flutamide or bicalutamide and 439 men received flutamide or bicalutamide only. With a median follow-up duration of 12 years, the investigators found that men randomized to EBRT and endocrine therapy had a 50% reduction in prostate-cancer-specific mortality at 15 years compared with those randomized to endocrine therapy only (17% versus 34%; P <0.001). This improvement

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confidence: 90%

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confidence: 99%

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confidence: 99%

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Combining endocrine treatment and radiotherapy: a bright future

Roach

2016

Nat Rev Urol

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“…Because of its invasive and metastatic characteristics, less than 10% of patients are eligible for surgery at the time of diagnosis because the poor prognosis of the disease is related to late presentation, aggressive local invasion, and early metastasis. Conventional chemotherapy and radiotherapy are generally ineffective, and the emergence of drug resistance is also common [3,4]. …”

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confidence: 99%

Astaxanthin Inhibits PC-3 Xenograft Prostate Tumor Growth in Nude Mice

Wang

et al. 2017

Marine Drugs

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Prostate cancer (PCa), the most common malignancy in men, is a major cause of cancer deaths. A better understanding of the mechanisms that drive tumor initiation and progression may identify actionable targets to improve treatment of this patient group. As a dietary carotenoid, astaxanthin has been demonstrated to exert beneficial effects against inflammation, cardiovascular disease, oxidative damage, or different cancer sites. This study used intragastric administration of astaxanthin to detect its role on tumor proliferation, apoptosis, microRNA (miRNA) overexpression, and microbacteria composition change by establishing androgen-independent PCa cell PC-3 xenograft nude mice. Nude mice were inoculated with androgen-independent prostate cancer PC-3 cells subcutaneously. The intervention was started when tumors reached 0.5–0.6 cm in diameter. Mice were intragastrically administered 100 mg/kg astaxanthin (HA), 25 mg/kg astaxanthin (LA), or olive oil (TC). The results showed that 100 mg/kg astaxanthin significantly inhibited tumor growth compared to the TC group, with an inhibitory rate of 41.7%. A decrease of Ki67 and proliferating cell nuclear antigen (PCNA) as well as an increase of cleaved caspase-3 were observed in HA-treated tumors, along with increasing apoptotic cells, obtained by TUNEL assay. The HA significantly elevated the levels of tumor suppressors miR-375 and miR-487b in tumor tissues and the amount of Lactobacillus sp. and Lachnospiraceae in mice stools, while there was no significant difference between LA and TC groups. These results provide a promising regimen to enhance the therapeutic effect in a dietary supplement manner.

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