Treatment effects in prostate cancer

Abstract

Nonsurgical treatments for prostate cancer include androgen-deprivation therapy (ADT), radiation therapy (RT), ablative therapies, chemotherapy, and newly emerging immunotherapies. These approaches can be used alone or in combination depending on the clinical scenario. ADT is typically reserved for high-risk locally or systemically advanced disease that is not amenable to curative surgery. Radiation therapy can be used instead of surgery as primary therapy with curative intent for low-intermediate-risk disease as well as for control of locally advanced disease not suitable for surgery. Ablative therapies can be used as primary therapy for low-intermediate-risk disease or as salvage therapy for clinically localized disease where RT has failed. Chemotherapy and immune-based therapies are currently used for androgen-independent disease, although the indications for these approaches may well change as new data from clinical trials accrue. Pathologists should be able to recognize tissue changes associated with these treatments to provide information that will optimize patient management. This is particularly true in situations where clinical history of recent or remote nonsurgical treatment is not provided with the specimen. In the absence of this information, pathologists encountering the features described herein are encouraged to review patient records or communicate directly with clinical colleagues to determine how a given patient was treated and when.

Comparison of machine learning algorithms to predict clinically significant prostate cancer of the peripheral zone with multiparametric MRI using clinical assessment categories and radiomic features

“…The sampling bias is problematic as the risk group influences the therapeutic approach [1,4,8,10]. Definition of clinically significant PCa is a challenging dynamic process with ongoing debates [10][11][12][13]. Patients with Gleason Grade Group (GrG) ≤ 2 have a much better prognosis than those with GrG ≥ 3 [11,12].…”

“…Patients with Gleason Grade Group (GrG) ≤ 2 have a much better prognosis than those with GrG ≥ 3 [11,12]. Furthermore, patients with GrG ≤ 2 may be feasible for active surveillance or ablative therapies [13]. There is a high need to optimize non-invasive risk stratification [14].…”

False-Negative Histopathologic Diagnosis of Prostatic Adenocarcinoma

“…42,43 The architectural histopathologic changes in PAC after androgen-deprivation therapy include glands with compressed lumina, single cells, and cords, clusters, chains, and solid sheets. 44 There can be a decrease in size and density of glands of adenocarcinoma and cytoplasmic volume loss, similar to benign prostatic atrophy. 45,46 At low-power magnification there may be an apparent absence of glands but increased cellularity ( Figure 5, A).…”

“…The histopathologic appearance of prostatic adenocarcinoma after radiation therapy is variable, from no effect to marked effect ( Figure 5, C). 42,44,49 Radiation therapy can cause a decrease in the number of adenocarcinoma glands and can produce changes similar to those seen in androgendeprivation therapy with haphazardly distributed single cells and carcinoma cells having foamy cytoplasm and pyknotic nuclei. These single cells with marked radiotherapy effect can be deceptively benign appearing and confused with macrophages ( Figure 5, C and D).…”

Endogenous Galectin-1 in T Lymphocytes Regulates Anti-prostate Cancer Immunity

“…Prostate cancer (PCa) is a major challenge for public health worldwide; epidemiological studies place it as the second-screening and the fifth-leading cause of cancer death in adult men ( 1 ). Suitable treatments currently exist for this type of cancer if detected early; in contrast, new treatment options are required for advanced stages of the disease ( 2 ). Immunotherapy is a validated alternative for the advanced stages of PCa, e.g., Sipuleucel-T (Provenge®) is the first immune-based therapy approved by the US Food and Drug Administration for this type of cancer ( 3 ).…”