J Clin Oncol 23: by American Society of Clinical Oncology INTRODUCTION

Size: px
Start display at page:

Download "J Clin Oncol 23: by American Society of Clinical Oncology INTRODUCTION"

Transcription

1 VOLUME 23 NUMBER 28 OCTOBER JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Predictors of Prostate Cancer Specific Mortality After Radical Prostatectomy or Radiation Therapy Ping Zhou, Ming-Hui Chen, David McLeod, Peter R. Carroll, Judd W. Moul, and Anthony V. D Amico From the Department of Radiation Oncology, Brigham and Women s Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Statistics, University of Connecticut, Storrs, CT; Department of Surgery and Urology Service, Center for Prostate Disease Research, Uniformed Services University and Walter Reed Army Medical Center, Bethesda, MD; Department of Urology, University of California, San Francisco, CA; and Department of Urology, Duke University, Durham, NC. Submitted January 21, 2005; accepted June 9, Supported by the Department of Defense Center for Prostate Disease Research funded by the US Army Medical Research and Materiel Command, Fort Detrick, MD. Authors disclosures of potential conflicts of interest are found at the end of this article. Address reprint requests to Ping Zhou, MD, PhD BROF, 375 Longwood Ave, Boston, MA 02215; pzhou@ partners.org by American Society of Clinical Oncology X/05/ /$20.00 DOI: /JCO A B S T R A C T Purpose We evaluated predictors of prostate cancer specific mortality (PCSM) after prostate-specific antigen (PSA) failure after radical prostatectomy (RP) or radiation therapy (RT). Patients and Methods A total of 1,159 men with clinically localized prostate cancer treated with RP (n 498) or RT (n 661) developed PSA failure, and they formed the study cohort. Competing risk regression analyses were used to evaluate whether previously identified predictors of time to metastasis, including post-treatment PSA doubling time (PSA-DT), Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. The cumulative incidence method was used to estimate PCSM after PSA failure. Results A post-rp PSA-DT of less than 3 months (hazard ratio [HR], 54.9; 95% CI, 16.7 to 180), a post-rt PSA-DT of less than 3 months (HR, 12.8; 95% CI, 7.0 to 23.1), and a biopsy Gleason score of 8 to 10 (HR, 6.1; 95% CI, 3.4 to 10.7) for patients treated with RT were significantly associated with PCSM. Post-RP estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with PSA-DT of less than 3 months v 3 months. Post-RT estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of 8 v 7, respectively, and PSA-DT of less than 3 months; these rates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT 3 months. Conclusion Patients at high risk for PCSM after PSA failure can be identified based on post-rp PSA-DT or post-rt PSA-DT and biopsy Gleason score. These parameters may be useful in identifying patients for a randomized trial evaluating hormonal therapy with or without docetaxel. J Clin Oncol 23: by American Society of Clinical Oncology INTRODUCTION Prostate-specific antigen (PSA) defined recurrence as many as 10 years after radical prostatectomy (RP) 1 or external-beam radiation therapy (RT) 2 for patients with clinically localized prostate cancer occurs in up to 30% of patients. However, only a small subset of these patients will develop clinical evidence of metastases, and even a smaller cohort will die of prostate cancer because of competing causes of mortality. 3 To identify patients for whom a PSAdefined recurrence is likely to translate into death from prostate cancer, investigators have tried to identify factors predictive of recurrence and prostate cancer specific mortality (PCSM) after PSA failure. Specifically, Pound et al 4 evaluated the natural history of progression to metastases after postoperative PSA failure and found that time to PSA relapse, Gleason score, and posttreatment PSA doubling time (PSA-DT) were predictive of the time to the development of 6992

2 Predictors of Prostate Cancer Mortality metastatic disease. Other investigators have also shown that PSA-DT after RP or RT is statistically significantly associated with the time to distant disease recurrence. 5-9 However, because of the protracted course of prostate cancer and competing causes of mortality in this patient population, 3 defining the determinants of PCSM after PSAdefined recurrence can be difficult A recent update of the Johns Hopkins University experience suggested that PSA-DT was significantly associated with PCSM after RP. 15 A multi-institutional study of patients treated with RP or RT demonstrated that a post-treatment PSA-DT of less than 3 months seemed to be a surrogate for PCSM after PSA-defined recurrence. 12 Specifically, men with a PSA-DT of less than 3 months had a median survival of 6 years after PSA failure. More recently, a multi-institutional study of RT-treated patients found that both a PSA-DT of less than 10 months and an interval to PSA failure of 2 years were significantly associated with distant metastasis-free survival after PSA failure. 10 In this study, we evaluated whether previously identified predictors of time to metastasis, including the posttreatment PSA-DT, Gleason score, and interval to PSA failure, could also predict time to PCSM after PSA failure. Identifying clinical factors associated with PCSM will serve as the basis for patient selection for randomized trials of hormonal therapy with or without additional systemic therapy in the setting of an increasing PSA after RP or RT. PATIENTS AND METHODS Patient Selection and Treatment Two multi-institutional databases, Cancer of the Prostate Strategic Urologic Research Endeavor 16 and the Center for Prostate Disease Research, 17 which contain baseline, treatment, and follow-up information on 8,669 patients treated with RP or RT between January 1, 1988, and January 1, 2002, for patients with clinical stage T1c-4 NX or N0 M0 (ie, localized or locally advanced, nonmetastatic) prostate cancer formed the database on which this study was based. One thousand one hundred fifty-nine patients, including 498 patients treated surgically and 661 patients treated with RT, developed PSA-defined recurrence and had complete information available for analysis; these patients formed the study cohort. An approved and signed internal review board informed consent form was obtained for each patient before study entry. Patients treated surgically were permitted to have received up to 3 months of neoadjuvant androgen suppression therapy (AST) because the 5-year results of a randomized trial 18 showed no statistically significant impact on PSA outcome when 3 months of neoadjuvant AST was added to RP. All RP-treated men had an undetectable PSA level ( 0.2 ng/ml) after surgery, and all RTtreated men had a PSA nadir before the subsequent increase. All patients in our study received hormonal therapy at some point after PSA-defined recurrence and before the bone scan was positive. The median PSA when hormonal therapy was initiated was 9.4 and 9.8 ng/ml for the RP and RT groups, respectively. The median age at presentation for the 498 patients treated with RP and the 661 patients treated with RT was 64.3 years (range, 34.3 to 96.8 years) and 71.1 years (range, 43.7 to 87.9 years), respectively. The pretreatment clinical characteristics of these 1,159 patients stratified by the treatment received are listed in Table 1. Staging and Follow-Up In all patients, staging evaluation involved a history and physical examination, including a digital rectal examination (DRE), serum PSA, and a transrectal ultrasound-guided needle biopsy of the prostate to determine Gleason score histologic grading. 19 The prostate biopsy was generally performed transrectally with an 18-gauge Tru-Cut needle (Travenol Laboratories, Deerfield, IL). Before 1996, patients generally had a computed tomography scan of the pelvis and a bone scan. After 1996, patients with PSA less than 10 ng/ml and a biopsy Gleason score 6 usually did not undergo radiographic staging because of the less than 1% chance that these studies would reveal metastatic disease. 20 The clinical stage was obtained from the DRE findings using the 2002 American Joint Committee on Cancer staging system. 21 Radiologic and biopsy information was not used to determine clinical stage. PSA levels were commonly measured with assays from Hybritech (San Diego, CA), Tosoh (Foster City, CA), or Abbott Lab (Chicago, IL). The median follow-up time for the 498 patients treated with RP and the 661 patients treated with RT was 6.8 years (range, 0.6 to 13.5 years) and 6.5 years (range, 1.0 to 14.3 years), respectively; follow-up started on the first day of treatment. The median Table 1. Pretreatment Clinical Characteristics of the 498 Surgically Treated and 661 Radiation-Treated Patients Who Developed PSA-Defined Recurrence Clinical Characteristic Surgery No. of Patients % Radiation No. of Patients % PSA level, ng/ml Median Biopsy Gleason score AJCC stage T1c T2a T2b T2c T3, Age, years Median Abbreviations: PSA, prostate-specific antigen; AJCC, American Joint Committee on Cancer

3 Zhou et al follow-up time for the 464 living patients at the end of follow-up in the RP group and the 552 living patients in the RT group was 6.9 years (range, 0.6 to 13.2 years) and 6.6 years (range, 1.0 to 14.3 years), respectively. Before PSA-defined recurrence, as specified by the American Society for Therapeutic Radiology and Oncology consensus criteria, 22 patients generally had a serum PSA level evaluation and a DRE every 3 months after RT for 2 years, then every 6 months for an additional 3 years, and then annually thereafter. The median follow-up time after PSA-defined recurrence for the 498 RP-treated patients and the 661 RT-treated patients was 4.0 years (range, 0.3 to 11.8 years) and 3.6 years (range, 0.02 to 12.0 years), respectively; the corresponding follow-up time for living patients was 4.0 years (range, 0.3 to 11.8 years) and 3.7 years (0.02 to 12.0 years), respectively. Overall, there were 102 prostate cancer specific deaths, including 25 in the RP group and 77 in the RT group. Determination of the cause of death was based on death certificate. Statistical Methods Calculation of the PSA-DT has been previously described. 12 PSA-DT was calculated by assuming first-order kinetics and by using a minimum of three PSA measurements closest in time to the initiation of hormonal therapy, each separated by a minimum of 3 months and each with a PSA increase of more than 0.2 ng/ml. By using PSA values closest in time to the start of hormonal therapy, the PSA-DT calculated should represent the worst-case scenario in the setting of an accelerating PSA increase or a shortening PSA-DT over time. For patients treated with RT, the nadir PSA level was subtracted from the post-rt PSA level before the PSA-DT was determined. This way, the magnitude of the PSA-DT would be the same for RP-treated patients and RT-treated patients who experienced the same absolute increase in PSA level. Competing risks methodology was used for the entire analysis of this article to take into account the competing causes of mortality. Competing risk regression analyses (based on Gray s R-package cmprsk test 23 ) were used to evaluate the ability of post-treatment PSA-DT, interval to PSA failure, and Gleason score to predict time to death from prostate cancer after PSA-defined recurrence in 1,159 patients treated with RP (498 patients) or RT (661 patients) who had experienced PSA failure. The biopsy Gleason score was used for men treated with RT, whereas the prostatectomy Gleason score was used for men treated with RP. Time 0 was considered the day of PSA-defined recurrence, which was defined as the midpoint between the PSA nadir and first increase. 22 The PSA-DT, interval to PSA failure, and Gleason score were treated first as continuous variables and then as categoric variables in separate competing risk regression analyses. The categories selected for the PSA-DT and interval to PSA failure were 3 months and 2 years, respectively. The categories selected for Gleason score were 6, 7, and 8 to 10. Baseline groups were defined as PSA-DT 3 months, interval to PSA failure more than 2 years, and Gleason score 6. These breakpoints for PSA-DT, interval to PSA failure, and Gleason score were suggested in previous studies to be clinically useful categories for predicting time to distant metastases and time to PCSM after PSA failure. 4,7,11,12,14 The hazard ratios (HRs) of PCSM for PSA-DT, interval to PSA failure, and Gleason score were calculated for the individual cohorts of men treated with RP or RT on the basis of the coefficients from the competing risk regression model and reported with 95% CIs. For the purpose of illustration, estimates of PCSM after PSA-defined recurrence were calculated using the cumulative incidence method 24 and were graphically displayed. Comparisons of the estimates of cumulative incidence of PCSM after PSA failure between groups were made using the K-sample tests to take into consideration the competing risks of mortality. 25 RESULTS Patient Characteristics One thousand one hundred fifty-nine patients developed PSA-defined recurrence, including 498 patients treated with RP and 661 patients treated with RT. The clinical characteristics of the 1,159 patients before RP or RT are listed in Table 1. Post-RP Predictors of PCSM When evaluated in univariable analyses, only PSA-DT (P.003) was a significant predictor of time to PCSM after Table 2. Predictors of Time to Prostate Cancer Specific Mortality After PSA-Defined Recurrence in Patients Treated With Surgery or Radiation Therapy Surgery Radiation MVA MVA Predictor UVA P HR 95% CI P UVA P HR 95% CI P Continuous variable model PSA-DT to to Gleason score to to Interval to PSA failure to to Categoric variable model PSA-DT 3 months to to Gleason score to to to to Interval to PSA failure 2 years to to Abbreviations: UVA, univariable analysis; MVA, multivariable analysis; HR, hazard ratio; PSA, prostate-specific antigen; DT, doubling time. Gleason score refers to prostatectomy or biopsy Gleason score for men treated surgically or with radiation therapy, respectively. In the categoric variable model, the baseline groups are PSA-DT 3 months, Gleason score 6, and interval to PSA failure 2 years JOURNAL OF CLINICAL ONCOLOGY

4 Predictors of Prostate Cancer Mortality PSA-defined recurrence (Table 2). Neither Gleason score nor interval to PSA failure was significantly associated with time to PCSM (Table 2). Similarly, on multivariable analyses, only PSA-DT as a continuous variable or a categoric variable was significant (Table 2). The HR of PCSM was 54.9 (95% CI, 16.7 to 180) for patients with a PSA-DT of less than 3 months compared with 3 months. The estimated rates of PCSM 5 years after PSA failure were 31% (95% CI, 17% to 45%) v 1% (95% CI, 0% to 2%) for patients with a PSA-DT of less than 3 months v 3 months, respectively. Of note, 13% of men treated surgically who experienced a PSA-defined recurrence in this study had a PSA-DT of less than 3 months. A significant association with PCSM was not noted for RP Gleason score (P.16) or interval to PSA failure (P.22), as illustrated in Figures 1 and 2, respectively, and summarized in Table 2. Post-RT Predictors of PCSM When evaluated in univariable analyses, all three predictors, including PSA-DT (P.002), biopsy Gleason score (P.0001), and interval to PSA failure (P.004), were significantly associated with time to PCSM after PSA failure (Table 2). On multivariable analysis, PSA-DT as a continuous and categoric variable was a significant independent predictor of time to PCSM, resulting in an HR of 12.8 (95% CI, 7.0 to 23.1) for patients with a PSA-DT of less than 3 months compared with 3 months (Table 2). In contrast to the findings in patients treated with RP, biopsy Gleason score as a continuous and categoric variable (Gleason score Fig 2. Cumulative incidence estimates of prostate cancer specific mortality after radical prostatectomy stratified by prostate-specific antigen (PSA) doubling time (PSA-DT) and interval to PSA failure. Pairwise, two-sided, K-sample test showed P values as follows: for PSA-DT of less than 3 months (interval to PSA failure 2 v 2 years), P.95; for PSA-DT of 3 months (interval 2 v 2 years), P.41. of8to10v 6) was significantly associated with PCSM in men treated with RT (Table 2 and Fig 3). The HR of PCSM was 6.1 (95% CI, 3.4 to 10.7) for patients with a biopsy Gleason score of 8 to 10 compared with 6. The estimated rates of PCSM 5 years after PSA failure were 75% (95% CI, Fig 1. Cumulative incidence estimates of prostate cancer specific mortality after radical prostatectomy stratified by prostate-specific antigen (PSA) doubling time (PSA-DT) and prostatectomy Gleason score. Pairwise, twosided, K-sample test showed P values as follows: for PSA-DT of less than 3 months (prostatectomy Gleason score 8 v 7), P.37; for PSA-DT of 3 months (prostatectomy Gleason score 8 v 7), P.58. Fig 3. Cumulative incidence estimates of prostate cancer specific mortality after radiation therapy stratified by prostate-specific antigen (PSA) doubling time (PSA-DT) and biopsy Gleason score. Pairwise, two-sided, K-sample test showed P values as follows: for PSA-DT of less than 3 months (biopsy score 8 v 7), P.0001; for PSA-DT of 3 months (biopsy Gleason score 8 v 7), P

5 Zhou et al 59% to 92%) v 35% (95% CI, 24% to 47%) for patients with a biopsy Gleason score of 8 v 7, respectively, and a PSA-DT of less than 3 months; these estimates were 15% (95% CI, 0.8% to 28%) v 4% (95% CI, 1% to 6%), respectively, for patients with a PSA-DT of 3 months. Of note, 21% of men treated with RT in this study who experienced a PSAdefined recurrence had a PSA-DT of less than 3 months. In addition, 9% of men had a PSA-DT of 3 months and a biopsy Gleason score of 8. A significant association between PCSM and interval to PSA failure was not noted (P.94), as illustrated in Figure 4. DISCUSSION An increasing PSA level after RP 1 or external-beam RT 2 for men with clinically localized prostate cancer is a significant clinical problem in the management of prostate cancer. Because of the heterogeneity of this patient population with regard to the risk of dying from prostate cancer as opposed to competing causes of mortality, it is important to identify the group of patients at high risk of PCSM because these are the patients who need effective systemic treatment beyond hormonal therapy. Therefore, such patients would be ideally suited for a randomized study comparing the use of AST alone with AST plus a chemotherapy that targets hormone-refractory prostate cancer. Consistent with the published studies, the results of this study demonstrated that the post-rp and post-rt Fig 4. Cumulative incidence estimates of prostate cancer specific mortality after radiation therapy stratified by prostate-specific antigen (PSA) doubling time (PSA-DT) and interval to PSA failure. Pairwise, two-sided, K-sample test showed P values as follows: for PSA-DT of less than 3 months (interval to PSA failure 2 v 2 years), P.12; for PSA-DT of 3 months (interval 2 v 2 years), P.31. PSA-DT was significantly associated with the time to PCSM after PSA failure. In addition, biopsy Gleason score was an independent predictor of time to PCSM in men treated with RT. Of note, competing risks methodology was used for the entire statistical analysis of this article to take into account the competing causes of mortality. Of clinical importance, 13% of RP-treated men in this study who experienced a PSA-defined recurrence had a PSA-DT less than 3 months. In addition, 30% of RT-treated men with PSA failure in this study had a PSA-DT of less than 3 months or a combination of PSA-DT of 3 months and a biopsy Gleason score 8. These patients were at high risk for PCSM after PSA failure. The rapid increase in PSA level after primary local therapy suggests that the recurrent and/or residual prostate cancer cells responsible for the PSA increase are, in part, androgen independent. This is suggested by the high estimates of PCSM 5 years after PSA failure in patients with a post-treatment PSA-DT of less than 3 months or a biopsy Gleason score 8 in the case of RT-treated patients (Figs 1 to 4) despite the use of hormonal therapy initiated after PSA failure. The role of chemotherapy in treating hormonerefractory prostate cancer has been evaluated in several randomized clinical trials, and only two recent phase III studies have shown significant survival benefit with the addition of chemotherapy. 30,31 Both studies used docetaxelbased regimens administered together with prednisone 31 or estramustine 30 and compared the effects to mitoxantrone and prednisone, which is an accepted standard therapy in treating hormone-refractory prostate cancer. These studies demonstrated that the regimen including docetaxel was associated with significant improvement in median survival, PSA response, and quality of life compared with the standard treatment. Therefore, docetaxel-based chemotherapy could be the therapy of choice to study in a randomized clinical trial comparing AST alone with AST plus chemotherapy in a group of men at high risk of PCSM after PSA failure after RP or RT. The current study has demonstrated that up to 30% of RT-treated patients and up to 13% of RP-treated patients who experience PSA failure are at increased risk of PCSM. Therefore, this group of patients may be the optimal patient population in a proposed randomized study comparing AST with or without docetaxelbased chemotherapy. Potential limitations of this study need to be considered. First, the exact timing of salvage hormonal therapy was not considered in this study. Specifically, we calculated PSA-DT based on at least the last three PSA values closest in time to the initiation of hormonal therapy, which should represent the worst-case scenario after PSA failure in the setting of an accelerating PSA increase or a shortening PSA-DT. Therefore, the results of this study apply to patients in whom hormonal therapy is initiated at a PSA level of approximately 10 ng/ml after PSA-defined recurrence and with a negative 6996 JOURNAL OF CLINICAL ONCOLOGY

6 Predictors of Prostate Cancer Mortality bone scan. If administering salvage hormonal therapy at the time of PSA failure, as opposed to later, is shown to prolong survival, then the predictors of PCSM determined in this report would need to be re-evaluated in a study in which all men received salvage hormonal therapy at the time of PSA failure. Second, the median follow-up time of this study was almost 7 years, which is still relatively short given the long natural history of prostate cancer. Perhaps with longer follow-up, Gleason score 7 disease and longer PSA-DT of possibly up to 6 months would also be associated with increased risk of PCSM. Third, the lack of significance of a prostatectomy Gleason score of 8 to 10 to predict PCSM in surgically managed patients may be explained by the lack of power because only 25 patients died of prostate cancer in the surgical group. Therefore, with a larger surgical cohort and longer follow-up, prostatectomy Gleason score might also become significant for PCSM after PSA failure. Fourth, the current database does not contain baseline information on the testosterone levels of the patients. It has been recognized that testosterone can be low in approximately 15% of men who are beginning hormonal therapy 32,33 ; thus, some men may have been functionally castrated before all therapy. As a result, PSA failure in these men may effectively be a hormone-refractory relapse. Whether adjuvant chemotherapy will prolong survival in these men is unclear. In conclusion, patients with clinically localized prostate cancer who are at high risk for PCSM after post-rp or post-rt PSA failure have been identified as those men with a post-rp or post-rt PSA-DT of less than 3 months or, in the case of RT-treated patients, a biopsy Gleason score of 8. Enrollment of these men onto a randomized clinical trial evaluating AST with or without docetaxel in the setting of an increasing PSA level after RP or RT should be considered. Authors Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES 1. Han M, Partin AW, Zahurak M, et al: Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 169: , Shipley WU, Thames HD, Sandler HM, et al: Radiation therapy for clinically localized prostate cancer: A multi-institutional pooled analysis. JAMA 281: , Albertsen PC, Hanley JA, Gleason DF, et al: Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 280: , Pound CR, Partin AW, Eisenberger MA, et al: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281: , Patel A, Dorey F, Franklin J, et al: Recurrence patterns after radical retropubic prostatectomy: Clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol 158: , Ward JF, Blute ML, Slezak J, et al: The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 170: , Lee WR, Hanks GE, Hanlon A: Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: Clinical observations. J Clin Oncol 15: , Sartor CI, Strawderman MH, Lin XH, et al: Rate of PSA rise predicts metastatic versus local recurrence after definitive radiotherapy. Int J Radiat Oncol Biol Phys 38: , Hanlon AL, Diratzouian H, Hanks GE: Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. Int J Radiat Oncol Biol Phys 53: , Kuban DA, Thames H, Horwitz E, et al: Predicting outcome after PSA failure in prostate cancer patients treated by radiation: Who needs salvage therapy. Int J Radiat Oncol Biol Phys 60:S167, 2004 (suppl 1) 11. Sandler HM, Dunn RL, McLaughlin PW, et al: Overall survival after prostate-specificantigen-detected recurrence following conformal radiation therapy. Int J Radiat Oncol Biol Phys 48: , D Amico AV, Moul JW, Carroll PR, et al: Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst 95: , Albertsen PC, Hanley JA, Penson DF, et al: Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation. J Urol 171: , D Amico AV, Cote K, Loffredo M, et al: Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 20: , Partin AW, Eisenberger MA, Sinibaldi VJ, et al: Prostate specific antigen doubling time (PSADT) predicts for distant failure and prostate cancer specific survival (PCSS) in men with biochemical relapse after radical prostatectomy (RP). Presented at the Annual Meeting of American Urologic Association, San Francisco, CA, May 8-13, Lubeck DP, Litwin MS, Henning JM, et al: The CaPSURE database: A methodology for clinical practice and research in prostate cancer CaPSURE Research Panel Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 48: , Sun L, Gancarczy K, Paquette EL, et al: Introduction to the Department of Defense Center for Prostate Disease Research Multicenter National Prostate Cancer Database, and analysis of changes in PSA-era. Urol Oncol 6: , Soloway MS, Pareek K, Sharifi R, et al: Neoadjuvant androgen ablation before radical prostatectomy in ct2bnxmo prostate cancer: 5-year results. J Urol 167: , The Veterans Administration Cooperative Urological Research Group, Gleason DF: Histologic grading and staging of prostatic carcinoma, in Tannenbaum M (ed): Urologic Pathology. Philadelphia, PA, Lea & Febiger, 1977, pp Lee CT, Oesterling JE: Using prostatespecific antigen to eliminate the staging radionuclide bone scan. Urol Clin North Am 24: , Greene FL, Page DL, Fleming ID, et al: American Joint Committee on Cancer Manual for Staging Cancer (ed 6). New York, NY, Springer- Verlag, Cox JD: Consensus statement: Guidelines for PSA following radiation therapy American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 37: , Fine JP, Gray RJ: A proportional hazards model for the sub-distribution of a competing risk. J Am Stat Assoc 94: , Gaynor JJ, Feur EJ, Tan CC, et al: On the use of cause-specific failure and conditional failure probabilities: Examples from clinical oncology data. J Am Stat Assoc 88: , Gray RJ: A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16: , Berry W, Dakhil S, Modiano M, et al: Phase III study of mitoxantrone plus low dose prednisone versus low dose prednisone alone in patients with asymptomatic hormone refractory prostate cancer. J Urol 168: , Ernst DS, Tannock IF, Winquist EW, et al: Randomized, double-blind, controlled trial of mitoxantrone/prednisone and clodronate versus mitoxantrone/ prednisone and placebo in patients with hormone refractory prostate cancer and pain. J Clin Oncol 21: , Kantoff PW, Halabi S, Conaway M, et al: Hydrocortisone with or without mitoxantrone in men with hormone-refractory prostate cancer:

7 Zhou et al Results of the Cancer and Leukemia Group B 9182 study. J Clin Oncol 17: , Tannock IF, Osoba D, Stockler MR, et al: Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: A Canadian randomized trial with palliative end points. J Clin Oncol 14: , Petrylak DP, Tangen CM, Hussain MH, et al: Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 351: , Tannock IF, de Wit R, Berry WR, et al: Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351: , Harper ME, Pierrepoint CG, Griffiths K: Carcinoma of the prostate: Relationship of pretreatment hormone levels to survival. Eur J Cancer Clin Oncol 20: , Zhang PL, Rosen S, Veeramachaneni R, et al: Association between prostate cancer and serum testosterone levels. Prostate 53: , JOURNAL OF CLINICAL ONCOLOGY

journal of medicine The new england Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy abstract

journal of medicine The new england Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy abstract The new england journal of medicine established in 1812 july 8, 4 vol. 31 no. 2 Preoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical Prostatectomy Anthony V. D Amico, M.D.,

More information

When PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy

When PSA fails. Urology Grand Rounds Alexandra Perks. Rising PSA after Radical Prostatectomy When PSA fails Urology Grand Rounds Alexandra Perks Rising PSA after Radical Prostatectomy Issues Natural History Local vs Metastatic Treatment options 1 10 000 men / year in Canada 4000 RRP 15-year PSA

More information

Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series

Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series Post Radical Prostatectomy Radiation in Intermediate and High Risk Group Prostate Cancer Patients - A Historical Series E. Z. Neulander 1, Z. Wajsman 2 1 Department of Urology, Soroka UMC, Ben Gurion University,

More information

RADICAL PROSTATECTOMY IS ONE

RADICAL PROSTATECTOMY IS ONE ORIGINAL CONTRIBUTION Risk of Prostate Cancer Specific Mortality Following Biochemical Recurrence After Radical Prostatectomy Stephen J. Freedland, MD Elizabeth B. Humphreys, BS Leslie A. Mangold, MS Mario

More information

Outcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer

Outcomes Following Negative Prostate Biopsy for Patients with Persistent Disease after Radiotherapy for Prostate Cancer Clinical Urology Post-radiotherapy Prostate Biopsy for Recurrent Disease International Braz J Urol Vol. 36 (1): 44-48, January - February, 2010 doi: 10.1590/S1677-55382010000100007 Outcomes Following Negative

More information

Information Content of Five Nomograms for Outcomes in Prostate Cancer

Information Content of Five Nomograms for Outcomes in Prostate Cancer Anatomic Pathology / NOMOGRAMS IN PROSTATE CANCER Information Content of Five Nomograms for Outcomes in Prostate Cancer Tarek A. Bismar, MD, 1 Peter Humphrey, MD, 2 and Robin T. Vollmer, MD 3 Key Words:

More information

Treatment Failure After Primary and Salvage Therapy for Prostate Cancer

Treatment Failure After Primary and Salvage Therapy for Prostate Cancer 307 Treatment Failure After Primary and Salvage Therapy for Prostate Cancer Likelihood, Patterns of Care, and Outcomes Piyush K. Agarwal, MD 1 Natalia Sadetsky, MD, MPH 2 Badrinath R. Konety, MD, MBA 2

More information

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1.

NIH Public Access Author Manuscript World J Urol. Author manuscript; available in PMC 2012 February 1. NIH Public Access Author Manuscript Published in final edited form as: World J Urol. 2011 February ; 29(1): 11 14. doi:10.1007/s00345-010-0625-4. Significance of preoperative PSA velocity in men with low

More information

estimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c.

estimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c. . JOURNAL COMPILATION 2008 BJU INTERNATIONAL Urological Oncology PREDICTION OF AGGRESSIVE RECURRENCE AFTER RP SCHROECK et al. BJUI BJU INTERNATIONAL Do nomograms predict aggressive recurrence after radical

More information

TREATMENT OPTIONS FOR LOCALIZED PROSTATE CANCER: QUALITY-ADJUSTED LIFE YEARS AND THE EFFECTS OF LEAD-TIME

TREATMENT OPTIONS FOR LOCALIZED PROSTATE CANCER: QUALITY-ADJUSTED LIFE YEARS AND THE EFFECTS OF LEAD-TIME ADULT UROLOGY TREATMENT OPTIONS FOR LOCALIZED PROSTATE CANCER: QUALITY-ADJUSTED LIFE YEARS AND THE EFFECTS OF LEAD-TIME VIBHA BHATNAGAR, SUSAN T. STEWART, WILLIAM W. BONNEY, AND ROBERT M. KAPLAN ABSTRACT

More information

Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer

Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Original Article Outcomes of Radical Prostatectomy in Thai Men with Prostate Cancer Sunai Leewansangtong, Suchai Soontrapa, Chaiyong Nualyong, Sittiporn Srinualnad, Tawatchai Taweemonkongsap and Teerapon

More information

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy

Preoperative Gleason score, percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy JBUON 2013; 18(4): 954-960 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE Gleason score, percent of positive prostate and PSA in predicting biochemical

More information

Recent Progress in Management of Advanced Prostate Cancer

Recent Progress in Management of Advanced Prostate Cancer Review Article [1] April 15, 2005 By Philip W. Kantoff, MD [2] Androgen-deprivation therapy, usually with combined androgen blockade, is standard initial treatment for advanced prostate cancer. With failure

More information

The Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients With Prostate Cancer

The Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients With Prostate Cancer 55 The Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients With Prostate Cancer Matthew C. Abramowitz, MD 1 Tiaynu Li, MA 2 Mark K. Buyyounouski, MD 1 Eric Ross, PhD 2 Robert

More information

Understanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD

Understanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics

More information

VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE

VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE Session 3 Advanced prostate cancer VALUE AND ROLE OF PSA AS A TUMOUR MARKER OF RESPONSE/RELAPSE 1 PSA is a serine protease and the physiological role is believed to be liquefying the seminal fluid PSA

More information

BJUI. Long-term overall survival and metastasis-free survival for men with prostate-specific antigenrecurrent

BJUI. Long-term overall survival and metastasis-free survival for men with prostate-specific antigenrecurrent 21 THE AUTHORS; 21 Urological Oncology DETERMINANTS OF SURVIVAL IN PSA-RECURRENT PROSTATE CANCER AFTER PROSTATECTOMY ANTONARAKIS ET AL. BJUI Long-term overall survival and metastasis-free survival for

More information

Long-Term Risk of Clinical Progression After Biochemical Recurrence Following Radical Prostatectomy: The Impact of Time from Surgery to Recurrence

Long-Term Risk of Clinical Progression After Biochemical Recurrence Following Radical Prostatectomy: The Impact of Time from Surgery to Recurrence EUROPEAN UROLOGY 59 (2011) 893 899 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Prostate Cancer Editorial by Bertrand D. Guillonneau and Karim Fizazi on

More information

Division of Urologic Surgery and Duke Prostate Center (DPC), Duke University School of Medicine, Durham, NC

Division of Urologic Surgery and Duke Prostate Center (DPC), Duke University School of Medicine, Durham, NC LHRH AGONISTS: CONTEMPORARY ISSUES The Evolving Definition of Advanced Prostate Cancer Judd W. Moul, MD, FACS Division of Urologic Surgery and Duke Prostate Center (DPC), Duke University School of Medicine,

More information

Prostate Cancer: 2010 Guidelines Update

Prostate Cancer: 2010 Guidelines Update Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer

More information

JAMA. 1998;280:

JAMA. 1998;280: Original Contributions Biochemical Outcome After Radical Prostatectomy, Radiation Therapy, or Interstitial for Clinically Localized Prostate Cancer Anthony V. D Amico, MD, PhD; Richard Whittington, MD;

More information

Introduction. Original Article

Introduction. Original Article bs_bs_banner International Journal of Urology (2015) 22, 363 367 doi: 10.1111/iju.12704 Original Article Prostate-specific antigen level, stage or Gleason score: Which is best for predicting outcomes after

More information

Supported by M. D. Anderson Cancer Center physician investigator funds. We thank Gerald E. Hanks, MD, for help and guidance with this project.

Supported by M. D. Anderson Cancer Center physician investigator funds. We thank Gerald E. Hanks, MD, for help and guidance with this project. 1496 Biochemical and Clinical Significance of the Posttreatment Prostate-Specific Antigen Bounce for Prostate Cancer Patients Treated With External Beam Radiation Therapy Alone A Multiinstitutional Pooled

More information

The Natural History of Noncastrate Metastatic Prostate Cancer after Radical Prostatectomy

The Natural History of Noncastrate Metastatic Prostate Cancer after Radical Prostatectomy european urology 51 (2007) 940 948 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer The Natural History of Noncastrate Metastatic Prostate Cancer after Radical

More information

Radiation dose has been reported to be an important determinant

Radiation dose has been reported to be an important determinant 538 The Relationship of Increasing Radiotherapy Dose to Reduced Distant Metastases and Mortality in Men with Prostate Cancer Rojymon Jacob, M.D. 1 Alexandra L. Hanlon, Ph.D. 2 Eric M. Horwitz, M.D. 1 Benjamin

More information

Prostate-specific antigen half-life: a new predictor of progressionfree survival and overall survival in Chinese prostate cancer patients

Prostate-specific antigen half-life: a new predictor of progressionfree survival and overall survival in Chinese prostate cancer patients Original Article Asian Journal of Andrology (2009) 11: 443 450 2009 AJA, SIMM & SJTU All rights reserved 1008-682X/09 $ 32.00 www.nature.com/aja npg 443 : a new predictor of progressionfree survival and

More information

J Clin Oncol 28: by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 28: by American Society of Clinical Oncology INTRODUCTION VOLUME 28 NUMBER 1 JANUARY 1 2010 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer

More information

BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY

BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY BIOCHEMICAL RECURRENCE POST RADICAL PROSTATECTOMY AZHAN BIN YUSOFF AZHAN BIN YUSOFF 2013 SCENARIO A 66 year old man underwent Robotic Radical Prostatectomy for a T1c Gleason 4+4, PSA 15 ng/ml prostate

More information

CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM

CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM RAPID COMMUNICATION CME ARTICLE CONTEMPORARY UPDATE OF PROSTATE CANCER STAGING NOMOGRAMS (PARTIN TABLES) FOR THE NEW MILLENNIUM ALAN W. PARTIN, LESLIE A. MANGOLD, DANA M. LAMM, PATRICK C. WALSH, JONATHAN

More information

Best Papers. F. Fusco

Best Papers. F. Fusco Best Papers UROLOGY F. Fusco Best papers - 2015 RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND This cohort reflects the current clinical

More information

Open clinical uro-oncology trials in Canada

Open clinical uro-oncology trials in Canada Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1

More information

NIH Public Access Author Manuscript Clin Genitourin Cancer. Author manuscript; available in PMC 2015 October 01.

NIH Public Access Author Manuscript Clin Genitourin Cancer. Author manuscript; available in PMC 2015 October 01. NIH Public Access Author Manuscript Published in final edited form as: Clin Genitourin Cancer. 2014 October ; 12(5): e181 e187. doi:10.1016/j.clgc.2014.02.008. The Impact of Differing Gleason Scores at

More information

concordance indices were calculated for the entire model and subsequently for each risk group.

concordance indices were calculated for the entire model and subsequently for each risk group. ; 2010 Urological Oncology ACCURACY OF KATTAN NOMOGRAM KORETS ET AL. BJUI Accuracy of the Kattan nomogram across prostate cancer risk-groups Ruslan Korets, Piruz Motamedinia, Olga Yeshchina, Manisha Desai

More information

Policy. not covered Sipuleucel-T. Considerations Sipuleucel-T. Description Sipuleucel-T. be medically. Sipuleucel-T. covered Q2043.

Policy. not covered Sipuleucel-T. Considerations Sipuleucel-T. Description Sipuleucel-T. be medically. Sipuleucel-T. covered Q2043. Cellular Immunotherapy forr Prostate Cancer Policy Number: 8.01.53 Origination: 11/2010 Last Review: 11/2014 Next Review: 11/2015 Policy BCBSKC will provide coverage for cellular immunotherapy for prostate

More information

HHS Public Access Author manuscript Prostate Cancer Prostatic Dis. Author manuscript; available in PMC 2015 September 01.

HHS Public Access Author manuscript Prostate Cancer Prostatic Dis. Author manuscript; available in PMC 2015 September 01. Change in PSA velocity is a predictor of overall survival in men with biochemically-recurrent prostate cancer treated with nonhormonal agents: Combined analysis of four phase-2 trials Daniel L. Suzman,

More information

Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy

Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy October- 2015 ESMO 2004 October- 2015 Fyraftensmøde 2 2010 October- 2015 Fyraftensmøde 3 SWOG 9916 OS

More information

Hormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice

Hormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice european urology supplements 5 (2006) 362 368 available at www.sciencedirect.com journal homepage: www.europeanurology.com Hormone Therapy for Prostate Cancer: Guidelines versus Clinical Practice Antonio

More information

Validation of the 2015 Prostate Cancer Grade Groups for Predicting Long-Term Oncologic Outcomes in a Shared Equal-Access Health System

Validation of the 2015 Prostate Cancer Grade Groups for Predicting Long-Term Oncologic Outcomes in a Shared Equal-Access Health System Original Article Validation of the 2015 Prostate Cancer Grade Groups for Predicting Long-Term Oncologic Outcomes in a Shared Equal-Access Health System Ariel A. Schulman, MD 1 ; Lauren E. Howard, MS 2

More information

Multiinstitutional Validation of the UCSF Cancer of the Prostate Risk Assessment for Prediction of Recurrence After Radical Prostatectomy

Multiinstitutional Validation of the UCSF Cancer of the Prostate Risk Assessment for Prediction of Recurrence After Radical Prostatectomy 2384 Multiinstitutional Validation of the UCSF Cancer of the Prostate Risk Assessment for Prediction of Recurrence After Radical Prostatectomy Matthew R. Cooperberg, MD, MPH 1 Stephen J. Freedland, MD

More information

Prognostic value of the Gleason score in prostate cancer

Prognostic value of the Gleason score in prostate cancer BJU International (22), 89, 538 542 Prognostic value of the Gleason score in prostate cancer L. EGEVAD, T. GRANFORS*, L. KARLBERG*, A. BERGH and P. STATTIN Department of Pathology and Cytology, Karolinska

More information

Corey C Foster 1, William C Jackson 1, Benjamin C Foster 1, Skyler B Johnson 1, Felix Y Feng 1 and Daniel A Hamstra 1,2*

Corey C Foster 1, William C Jackson 1, Benjamin C Foster 1, Skyler B Johnson 1, Felix Y Feng 1 and Daniel A Hamstra 1,2* Foster et al. Radiation Oncology 2014, 9:245 RESEARCH Open Access Less advanced disease at initiation of salvage androgen deprivation therapy is associated with decreased mortality following biochemical

More information

Early outcomes of active surveillance for localized prostate cancer

Early outcomes of active surveillance for localized prostate cancer Original Article ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER HARDIE et al. Early outcomes of active surveillance for localized prostate cancer CLAIRE HARDIE, CHRIS PARKER, ANDREW NORMAN*, ROS EELES,

More information

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD

CLINICAL TRIALS Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer AN OPEN-LABEL, MULTICENTER, RANDOMIZED PHASE II

More information

Name of Policy: Cellular Immunotherapy for Prostate Cancer

Name of Policy: Cellular Immunotherapy for Prostate Cancer Name of Policy: Cellular Immunotherapy for Prostate Cancer Policy #: 432 Latest Review Date: July 2014 Category: Medical Policy Grade: A Background/Definitions: As a general rule, benefits are payable

More information

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD CLINICAL TRIALS Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS

More information

Open clinical uro-oncology trials in Canada

Open clinical uro-oncology trials in Canada Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada bladder cancer A PHASE II PROTOCOL FOR PATIENTS WITH STAGE T1

More information

When radical prostatectomy is not enough: The evolving role of postoperative

When radical prostatectomy is not enough: The evolving role of postoperative When radical prostatectomy is not enough: The evolving role of postoperative radiation therapy Dr Tom Pickles Clinical Associate Professor, UBC. Chair, Provincial Genito-Urinary Tumour Group BC Cancer

More information

Definition Prostate cancer

Definition Prostate cancer Prostate cancer 61 Definition Prostate cancer is a malignant neoplasm that arises from the prostate gland and the most common form of cancer in men. localized prostate cancer is curable by surgery or radiation

More information

Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer

Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer Guidelines for the Management of Prostate Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group

More information

NIH Public Access Author Manuscript Int J Radiat Oncol Biol Phys. Author manuscript; available in PMC 2010 November 9.

NIH Public Access Author Manuscript Int J Radiat Oncol Biol Phys. Author manuscript; available in PMC 2010 November 9. NIH Public Access Author Manuscript Published in final edited form as: Int J Radiat Oncol Biol Phys. 2008 May 1; 71(1): 9 15. doi:10.1016/j.ijrobp.2007.09.033. TUMOR VOLUME CHANGES ON 1.5 TESLA ENDORECTAL

More information

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD

Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD Open clinical uro-oncology trials in Canada Eric Winquist, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED PLACEBO-CONTROLLED, DOUBLE-BLIND

More information

Prostate Cancer Update 2017

Prostate Cancer Update 2017 Prostate Cancer Update 2017 Arthur L. Burnett, MD, MBA, FACS Patrick C. Walsh Distinguished Professor of Urology The James Buchanan Brady Urological Institute The Johns Hopkins Medical Institutions Baltimore,

More information

Prostate Cancer Local or distant recurrence?

Prostate Cancer Local or distant recurrence? Prostate Cancer Local or distant recurrence? Diagnostic flowchart Vanessa Vilas Boas Urologist VFX Hospital FEBU PSA - only recurrence PSA recurrence: 27-53% of all patients undergoing treatment with curative

More information

Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients

Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients Comparison of external radiation therapy vs radical prostatectomy in lymph node positive prostate cancer patients R Kuefer 1, BG Volkmer 1, M Loeffler 1, RL Shen 2, L Kempf 3, AS Merseburger 4, JE Gschwend

More information

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer Published Ahead of Print on December 15, 1 as 1.1/JCO.1.55.119 The latest version is at http://jco.ascopubs.org/cgi/doi/1.1/jco.1.55.119 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Long-Term

More information

Vol. 36, pp , 2008 T1-3N0M0 : T1-3. prostate-specific antigen PSA. 68 Gy National Institutes of Health 10

Vol. 36, pp , 2008 T1-3N0M0 : T1-3. prostate-specific antigen PSA. 68 Gy National Institutes of Health 10 25 Vol. 36, pp. 25 32, 2008 T1-3N0M0 : 20 2 18 T1-3 N0M0 1990 2006 16 113 59.4-70 Gy 68 Gy 24 prostate-specific antigen PSA 1.2 17.2 6.5 5 91 95 5 100 93 p 0.04 T3 PSA60 ng ml 68 Gy p 0.0008 0.03 0.04

More information

Phase II Clinical Trial of GM-CSF Treatment in Patients with Hormone-Refractory or Hormone-Naïve Adenocarcinoma of the Prostate

Phase II Clinical Trial of GM-CSF Treatment in Patients with Hormone-Refractory or Hormone-Naïve Adenocarcinoma of the Prostate ORIGINAL RESEARCH Phase II Clinical Trial of GM-CSF Treatment in Patients with Hormone-Refractory or Hormone-Naïve Adenocarcinoma of the Prostate Robert J. Amato and Joan Hernandez-McClain Genitourinary

More information

Rationale for Multimodality Therapy for High Risk Localized Prostate Cancer

Rationale for Multimodality Therapy for High Risk Localized Prostate Cancer Rationale for Multimodality Therapy for High Risk Localized Prostate Cancer 100 80 60 Cancer Death Rates for Men, US 1930-2002 Rate Per 100,000 Lung William K. Oh, M.D. 40 Stomach Colon & rectum Prostate

More information

in 32%, T2c in 16% and T3 in 2% of patients.

in 32%, T2c in 16% and T3 in 2% of patients. BJUI Gleason 7 prostate cancer treated with lowdose-rate brachytherapy: lack of impact of primary Gleason pattern on biochemical failure Richard G. Stock, Joshua Berkowitz, Seth R. Blacksburg and Nelson

More information

National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design:

National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) Trial design: Open clinical uro-oncology trials in Canada Eric Winquist, MD, Mary J. Mackenzie, MD, George Rodrigues, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A PHASE III STUDY OF IRESSA

More information

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD

Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD Open clinical uro-oncology trials in Canada George Rodrigues, MD, Mary J. Mackenzie, MD, Eric Winquist, MD London Health Sciences Centre, London, Ontario, Canada BLADDER CANCER A MULTICENTRE, RANDOMIZED

More information

J Clin Oncol 26: by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 26: by American Society of Clinical Oncology INTRODUCTION VOLUME 26 NUMBER 4 FEBRUARY 1 28 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Short-Term Neoadjuvant Androgen Deprivation Therapy and External-Beam Radiotherapy for Locally Advanced Prostate

More information

Published on The YODA Project (

Published on The YODA Project ( Principal Investigator First Name: David Last Name: Lorente Degree: MD Primary Affiliation: Medical Oncology Service, Hospital Provincial de Castellón E-mail: lorente.davest@gmail.com Phone number: +34

More information

Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy

Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy Cagney et al. BMC Urology (2017) 17:60 DOI 10.1186/s12894-017-0250-2 RESEARCH ARTICLE Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy

More information

Correspondence should be addressed to Taha Numan Yıkılmaz;

Correspondence should be addressed to Taha Numan Yıkılmaz; Advances in Medicine Volume 2016, Article ID 8639041, 5 pages http://dx.doi.org/10.1155/2016/8639041 Research Article External Validation of the Cancer of the Prostate Risk Assessment Postsurgical Score

More information

VALUE OF PSA AS TUMOUR MARKER OF RELAPSE AND RESPONSE. ELENA CASTRO Spanish National Cancer Research Centre

VALUE OF PSA AS TUMOUR MARKER OF RELAPSE AND RESPONSE. ELENA CASTRO Spanish National Cancer Research Centre VALUE OF PSA AS TUMOUR MARKER OF RELAPSE AND RESPONSE ELENA CASTRO Spanish National Cancer Research Centre Prostate Preceptorship. Lugano 17-18 October 2017 Prostate Specific Antigen (PSA) has a role in:

More information

GUIDELINEs ON PROSTATE CANCER

GUIDELINEs ON PROSTATE CANCER GUIDELINEs ON PROSTATE CANCER (Text update March 2005: an update is foreseen for publication in 2010. Readers are kindly advised to consult the 2009 full text print of the PCa guidelines for the most recent

More information

Overview of Radiotherapy for Clinically Localized Prostate Cancer

Overview of Radiotherapy for Clinically Localized Prostate Cancer Session 16A Invited lectures: Prostate - H&N. Overview of Radiotherapy for Clinically Localized Prostate Cancer Mack Roach III, MD Department of Radiation Oncology UCSF Helen Diller Family Comprehensive

More information

2015 myresearch Science Internship Program: Applied Medicine. Civic Education Office of Government and Community Relations

2015 myresearch Science Internship Program: Applied Medicine. Civic Education Office of Government and Community Relations 2015 myresearch Science Internship Program: Applied Medicine Civic Education Office of Government and Community Relations Harguneet Singh Science Internship Program: Applied Medicine Comparisons of Outcomes

More information

ORIGINAL INVESTIGATION. Impact of Biochemical Recurrence in Prostate Cancer Among US Veterans. having prostate cancer, assessment

ORIGINAL INVESTIGATION. Impact of Biochemical Recurrence in Prostate Cancer Among US Veterans. having prostate cancer, assessment ORIGINAL INVESTIGATION Impact of Biochemical Recurrence in Prostate Cancer Among US Veterans Edward M. Uchio, MD; Mihaela Aslan, PhD; Carolyn K. Wells, MPH; Juan Calderone, MD; John Concato, MD, MS, MPH

More information

PSA is rising: What to do? After curative intended radiotherapy: More local options?

PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinik und Poliklinik für Urologie und Kinderurologie Direktor: Prof. Dr. H. Riedmiller PSA is rising: What to do? After curative intended radiotherapy: More local options? Klinische und molekulare Charakterisierung

More information

PROVIDING TREATMENT INFORMATION FOR PROSTATE CANCER PATIENTS

PROVIDING TREATMENT INFORMATION FOR PROSTATE CANCER PATIENTS PROVIDING TREATMENT INFORMATION FOR PROSTATE CANCER PATIENTS For patients with localized disease on biopsy* For patients with adverse pathology after prostatectomy Contact the GenomeDx Customer Support

More information

Post Radical Prostatectomy Adjuvant Radiation in Patients with Seminal Vesicle Invasion - A Historical Series

Post Radical Prostatectomy Adjuvant Radiation in Patients with Seminal Vesicle Invasion - A Historical Series Post Radical Prostatectomy Adjuvant Radiation in Patients with Seminal Vesicle Invasion - A Historical Series E. Z. Neulander 1, K. Rubinov 2, W. Mermershtain 2, Z. Wajsman 3 1 Department of Urology, Soroka

More information

Prior-Cancer Diagnosis in Men with Nonmetastatic Prostate Cancer and the Risk of Prostate-Cancer-Specific and All-Cause Mortality

Prior-Cancer Diagnosis in Men with Nonmetastatic Prostate Cancer and the Risk of Prostate-Cancer-Specific and All-Cause Mortality Prior-Cancer Diagnosis in Men with Nonmetastatic Prostate Cancer and the Risk of Prostate-Cancer-Specific and All-Cause Mortality The Harvard community has made this article openly available. Please share

More information

PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS

PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ADULT UROLOGY PREVALENCE OF PROSTATE CANCER AMONG HYPOGONADAL MEN WITH PROSTATE-SPECIFIC ANTIGEN LEVELS OF 4.0 ng/ml OR LESS ABRAHAM MORGENTALER AND ERNANI LUIS RHODEN ABSTRACT Objectives. To determine

More information

Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia

Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia Paul F. Schellhammer, M.D. Eastern Virginia Medical School Urology of Virginia Norfolk, Virginia Virginia - Chesapeake Bay Landfall: Virginia Beach, April 29 th, 1607 PSA Failure after Radical Prostatectomy

More information

UCSF UC San Francisco Previously Published Works

UCSF UC San Francisco Previously Published Works UCSF UC San Francisco Previously Published Works Title Patterns of practice in the United States: insights from CaPSURE on prostate cancer management. Permalink https://escholarship.org/uc/item/24j7405c

More information

UC San Francisco UC San Francisco Previously Published Works

UC San Francisco UC San Francisco Previously Published Works UC San Francisco UC San Francisco Previously Published Works Title Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: Results from the Shared Equal

More information

Prostate Cancer: Is There Standard Treatment? Who has prostate cancer? In this article:

Prostate Cancer: Is There Standard Treatment? Who has prostate cancer? In this article: Focus on CME at l Université de Montréal Prostate Cancer: Is There Standard Treatment? Pierre I. Karakiewicz, MD, FRCSC; Paul Perrotte, MD, FRCSC; Fred Saad, MD, FRCSC In this article: 1. Risk factors

More information

Since the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors

Since the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors 2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.

More information

Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era ORIGINAL RESEARCH Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era Ahva Shahabi, MPH, PhD; 1* Raj Satkunasivam, MD; 2* Inderbir S. Gill, MD; 2 Gary Lieskovsky,

More information

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer Review Article [1] February 01, 2004 By David C. Beyer, MD [2] The options available for patients with recurrent prostate cancer

More information

When exogenous testosterone therapy is. adverse responses can be induced.

When exogenous testosterone therapy is. adverse responses can be induced. Theoretical tips It has been reasoned that discontinuation of ADT in nonorchiectomized patients may have detrimental effect on patients with CRPC as discontinuation of ADT can result in renewed release

More information

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

Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes ORIGINAL RESEARCH Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes Michael J. Metcalfe, MD ; Patricia Troncoso, MD 2 ; Charles C. Guo,

More information

PROSTATE-SPECIFIC ANTIGEN (PSA) is a sensitive

PROSTATE-SPECIFIC ANTIGEN (PSA) is a sensitive Prostate-Specific Antigen Doubling Times Are Similar in Patients With Recurrence After Radical Prostatectomy or Radiotherapy: A Novel Analysis By Bryan D. Leibman, Ozdal Dillioglugil, Peter T. Scardino,

More information

Timing of Androgen Deprivation: The Modern Debate Must be conducted in the following Contexts: 1. Clinical States Model

Timing of Androgen Deprivation: The Modern Debate Must be conducted in the following Contexts: 1. Clinical States Model Timing and Type of Androgen Deprivation Charles J. Ryan MD Associate Professor of Clinical Medicine UCSF Comprehensive Cancer Center Timing of Androgen Deprivation: The Modern Debate Must be conducted

More information

Predictive factors of late biochemical recurrence after radical prostatectomy

Predictive factors of late biochemical recurrence after radical prostatectomy JJCO Japanese Journal of Clinical Oncology Japanese Journal of Clinical Oncology, 2017, 47(3) 233 238 doi: 10.1093/jjco/hyw181 Advance Access Publication Date: 9 December 2016 Original Article Original

More information

Please consider the following information on ZYTIGA (abiraterone acetate). ZYTIGA - Compendia Communication - NCCN LATITUDE and STAMPEDE June 2017

Please consider the following information on ZYTIGA (abiraterone acetate). ZYTIGA - Compendia Communication - NCCN LATITUDE and STAMPEDE June 2017 Page 1 of 2 Janssen Scientific Affairs, LLC 1125 Trenton-Harbourton Road PO Box 200 Titusville, NJ 08560 800.526.7736 tel 609.730.3138 fax June 08, 2017 Joan McClure 275 Commerce Drive #300 Fort Washington,

More information

2/14/09. Why Discuss this topic? Managing Local Recurrences after Radiation Failure. PROSTATE CANCER Second Treatment

2/14/09. Why Discuss this topic? Managing Local Recurrences after Radiation Failure. PROSTATE CANCER Second Treatment Why Discuss this topic? Mack Roach III, MD Professor and Chair Radiation Oncology UCSF Managing Local Recurrences after Radiation Failure 1. ~15 to 75% of CaP pts recur after definitive RT. 2. Heterogeneous

More information

Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer

Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer ORIGINAL ARTICLE Correlation of Gleason Scores Between Needle-Core Biopsy and Radical Prostatectomy Specimens in Patients with Prostate Cancer Teng-Fu Hsieh, Chao-Hsian Chang, Wen-Chi Chen, Chien-Lung

More information

Management of Prostate Cancer

Management of Prostate Cancer Management of Prostate Cancer An ESMO Perspective Alan Horwich Conflicts of Interest Disclosure Alan Horwich I have no personal conflicts of interest relating to prostate cancer. European Incidence and

More information

Journal of American Science 2018;14(1)

Journal of American Science 2018;14(1) Salvage Radiotherapy Following Radical Prostatectomy: The Proper Timing and Clinical Benefits Mohamed F. Sheta 1, MD, Esam A. Abo-Zena 1, MD and Mohamed H. Radwan 2, MD 1 Department of Clinical Oncology,

More information

doi: /j.ijrobp CLINICAL INVESTIGATION

doi: /j.ijrobp CLINICAL INVESTIGATION CME doi:10.1016/j.ijrobp.2010.07.2004 Int. J. Radiation Oncology Biol. Phys., Vol. 81, No. 5, pp. 1293 1301, 2011 Copyright Ó 2011 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see

More information

Biochemical progression-free survival in localized prostate cancer patients treated with definitive external beam radiotherapy

Biochemical progression-free survival in localized prostate cancer patients treated with definitive external beam radiotherapy Electronic Physician (ISSN: 2008-5842) http://www.ephysician.ir October 2015, Volume: 7, Issue: 6, Pages: 1330-1335, DOI: 10.14661/1330 Biochemical progression-free survival in localized prostate cancer

More information

Evaluation of prognostic factors after radical prostatectomy in pt3b prostate cancer patients in Japanese population

Evaluation of prognostic factors after radical prostatectomy in pt3b prostate cancer patients in Japanese population Japanese Journal of Clinical Oncology, 2015, 45(8) 780 784 doi: 10.1093/jjco/hyv077 Advance Access Publication Date: 15 May 2015 Original Article Original Article Evaluation of prognostic factors after

More information

Changes in PSA Kinetics Predict Metastasis- Free Survival in Men with PSA-Recurrent Prostate Cancer Treated With Nonhormonal Agents

Changes in PSA Kinetics Predict Metastasis- Free Survival in Men with PSA-Recurrent Prostate Cancer Treated With Nonhormonal Agents Changes in PSA Kinetics Predict Metastasis- Free Survival in Men with PSA-Recurrent Prostate Cancer Treated With Nonhormonal Agents Combined Analysis of 4 Phase II Trials Emmanuel S. Antonarakis, MD; Marianna

More information

To treat or not to treat: When to treat! A case presentation

To treat or not to treat: When to treat! A case presentation To treat or not to treat: When to treat! A case presentation Filip Ameye, MD,Phd Universitary Hospitals Leuven, Belgium Departement of Urology Prostate Center A case presentation Pt. 76 y. Mild LUTS (07/1999)

More information

Radical prostatectomy as radical cure of prostate cancer in a high risk group: A single-institution experience

Radical prostatectomy as radical cure of prostate cancer in a high risk group: A single-institution experience MOLECULAR AND CLINICAL ONCOLOGY 1: 337-342, 2013 Radical prostatectomy as radical cure of prostate cancer in a high risk group: A single-institution experience NOBUKI FURUBAYASHI 1, MOTONOBU NAKAMURA 1,

More information

reviews LHRH Agonists in the Treatment of Advanced Carcinoma of the Prostate therapy

reviews LHRH Agonists in the Treatment of Advanced Carcinoma of the Prostate therapy reviews therapy LHRH Agonists in the Treatment of Advanced Carcinoma of the Prostate Martin I. Resnick, MD, Lester Persky Professor and Chief, Department of Urology, Case Western Reserve University School

More information

Radiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008

Radiation Therapy for Prostate Cancer. Resident Dept of Urology General Surgery Grand Round November 24, 2008 Radiation Therapy for Prostate Cancer Amy Hou,, MD Resident Dept of Urology General Surgery Grand Round November 24, 2008 External Beam Radiation Advances Improving Therapy Generation of linear accelerators

More information