Topography of Prostate Cancer Recurrence After Radiation Therapy: A Detailed Mapping Study of Salvage Radical Prostatectomy Specimens

Takeda, Toshikazu; Tin, Amy; Corradi, Renato B.; Mamoor, Maha; Benfante, Nicole; Sjoberg, Daniel D.; Scardino, Peter T.; Eastham, James A.; Fine, Samson W.; Touijer, Karim

doi:10.1016/j.eururo.2017.08.005

Cited by 23 publications

(23 citation statements)

References 6 publications

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“…The seminal vesicles are located in the transitional zone and are often the site of recurrences. 32 Likewise, artefact reduction occurred in the apex, and tissue contrast improved. By increasing contouring precision, the probability of recurrences might be reduced.…”

Section: Discussionmentioning

confidence: 95%

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Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi‐institutional contouring study of gross tumour volumes and organs at risk on clinical cases

Hagen

Kretschmer²,

Würschmidt³

et al. 2019

J Med Imag Rad Onc

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Introduction Artefacts caused by dental implants and hip replacements may impede target volume definition and dose calculation accuracy. The iterative metal artefact reduction (iMAR) algorithm can provide a solution for this problem. The present study compares delineation of gross tumour volumes (GTVs) and organs at risk (OARs) in the pelvic and the head and neck (H & N) regions using computed tomography (CT) with and without iMAR, and thus the practical applicability of iMAR for routine clinical use. Methods The native planning CT and CT‐iMAR data of two typical clinical cases with image‐distorting artefacts were used for multi‐institutional contouring and analysis using the Dice similarity coefficient (DSC). GTV/OAR contours were compared with an intraobserver approach and compared to predefined reference structures. Results Mean volume for GTVprostate in the intraobserver approach decreased from 87 ± 44 cm3 (native CT) to 75 ± 22 cm3 (CT‐iMAR) (P = 0.168). Compared to the reference, DSC values for GTVProstate increased from 0.68 ± 0.15 to 0.78 ± 0.07 (CT vs. iMAR) (P < 0.05). In the H & N region, the reference for GTVTongue (34 cm3) was underestimated on both data sets. No significant improvement in DSC values (0.83 ± 0.06 (native CT) versus 0.86 ± 0.06 (CT‐iMAR)) was observed. Conclusion The use of iMAR improves the anatomical delineation at the transition of prostate and bladder in cases of bilateral hip replacement. In the H & N region, anatomical residual structures and experience were apparently sufficient for precise contouring.

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Section: Discussionmentioning

confidence: 95%

“…Consequently, we can assume that iMAR can have a positive effect on accurate dose distributions and, therefore, on tumour control. The seminal vesicles are located in the transitional zone and are often the site of recurrences . Likewise, artefact reduction occurred in the apex, and tissue contrast improved.…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi‐institutional contouring study of gross tumour volumes and organs at risk on clinical cases

Hagen

Kretschmer²,

Würschmidt³

et al. 2019

J Med Imag Rad Onc

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“…There is very little published data on outcomes for salvage RARP after HIFU-PA. sRARP after radiotherapy is associated with adverse pathologic features, high PSM rates, low continence rates, poor erectile function and higher anastomotic leak/stricture rates compared to primary RARP [8][9][10]. After PA, Nunes-Silva et al reported similar continence but worse sexual function and higher recurrence rates for sRARP compared to primary RARP in a matched-pair analysis [11].…”

Section: Introductionmentioning

confidence: 99%

Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation

et al. 2020

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Background: Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP.. The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA. Methods: Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed. Results: 45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2. Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications < 90 days occurred in 8.9, 6.7 and 2.2%; late (>90d) complications occurred in 13.2%. At sRARP pathology, ISUP 3-5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3). Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months. Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP.

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“…examined 77 patients with local recurrence after radiotherapy and reported that the percentage of patients with a pre-salvage clinical classification of T3 was 10%. However, 42% of the surgical specimens in this study showed SVI, and 58% showed EPE [20].…”

Section: Discussionmentioning

confidence: 99%

Whole-gland salvage treatment for recurrent prostate cancer after initial definitive radiotherapy: A case series of 125I brachytherapy and robot-assisted radical prostatectomy

Sutani¹,

Yorozu²,

Toya³

et al. 2019

jcb

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Purpose: To analyze outcomes following whole-gland salvage treatments applied to patients with pathology-proven, locally recurrent prostate cancer following primary definitive radiotherapy. Material and methods: Eighteen consecutive patients who received whole-gland salvage treatments at our institution were retrospectively reviewed. All patients underwent transperineal template-guided mapping biopsy (TTMB) using the standard iodine-125 (125 I) brachytherapy (BT) setup. Twelve patients received 125 I BT, and six patients underwent robot-assisted laparoscopic prostatectomy (RARP). Prostate-specific antigen (PSA) failure was determined using the Phoenix definition (nadir + 2 ng/ml) following BT and a PSA level of > 0.2 ng/ml following RARP. Toxicities were graded according to CTCAE version 4.0. Results: The median follow-up times were 71 and 11 months for the BT and RARP groups, respectively. In the BT group, the median dose to 90% of the prostate was 131 Gy. The median time to biochemical failure was 47 months, and the biochemical relapse-free survival (BRFS) rates were 56% (95% confidence interval [CI]: 33-94%) and 46% (95% CI: 25-88%) at 3 years and 5 years, respectively. Four patients (33%) developed grade 2 genitourinary (GU) toxicity, and two (17%) developed grade 3 GU toxicity. No patients developed grade ≥ 2 gastrointestinal (GI) toxicity. In the RARP group, three out of six patients (50%) had PSA failure, and four patients (67%) developed grade 2 GU toxicity. No patients developed grade 3 GU toxicity or grade ≥ 2 GI toxicity. On pre-salvage magnetic resonance imaging (MRI), no patients were suspected of having T3 or higher stage lesions. However, three patients (50%) had pT3a and two patients (33%) had pT3b (i.e., seminal vesicle invasion) stage lesions. Conclusions: Whole-gland salvage BT is an effective treatment with an acceptable toxicity profile. The pathology findings from RARP imply that there is a room for improvement in diagnoses made by MRI in the pre-salvage setting.

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Topography of Prostate Cancer Recurrence After Radiation Therapy: A Detailed Mapping Study of Salvage Radical Prostatectomy Specimens

Abstract: When recurrence is suspected, clinicians should include biopsy of the distal apex, areas surrounding the urethra, and seminal vesicles. This information will help tailor successful salvage treatments.

Cited by 23 publications

References 6 publications

Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi‐institutional contouring study of gross tumour volumes and organs at risk on clinical cases

Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi‐institutional contouring study of gross tumour volumes and organs at risk on clinical cases

Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation

Whole-gland salvage treatment for recurrent prostate cancer after initial definitive radiotherapy: A case series of 125I brachytherapy and robot-assisted radical prostatectomy

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