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By Alessandro Franciscon doctor
William U Shipley, Wendy Seiferheld, Himanshu R Lukka, Pierre P Major, Niall M Heney, David J Grignon, Oliver Sartor, Maltibehn P Patel, Jean-Paul Bahary, Anthony L Zietman, Thomas M Pisansky, Kenneth L Zeitzer, Colleen A F Lawton, Felix Y Feng, Richard D Lovett, Alexander G Balogh, Luis Souhami, Seth A Rosenthal, Kevin J Kerlin, James J Dignam, Stephanie L Pugh, Howard M Sandler
Background Salvage radiation therapy is often necessary in men who have undergone radical prostatectomy and have evidence of prostate-cancer recurrence signaled by a persistently or recurrently elevated prostate-specific antigen (PSA) level. Whether antiandrogen therapy with radiation therapy will further improve cancer control and prolong overall survival is unknown. Methods In a double-blind, placebo-controlled trial conducted from 1998 through 2003, we assigned 760 eligible patients who had undergone prostatectomy with a lymphadenectomy and had disease, as assessed on pathological testing, with a tumor stage of T2 (confined to the prostate but with a positive surgical margin) or T3 (with histologic extension beyond the prostatic capsule), no nodal involvement, and a detectable PSA level of 0...
February 2, 2017: New England Journal of Medicine
James R Broughman, Ronald C Chen
Historically, stage IV prostate cancer was considered incurable. Although node-positive and oligometastatic prostate cancers are both classified as stage IV, these likely represent distinct clinical groups, and some patients may be curable with aggressive multimodality treatments. There is a lack of randomized evidence, but retrospective studies suggest that radical prostatectomy or radiotherapy may improve survival in these patients. This is an area of great current research interest and prospective randomized trials are needed to help define the optimal treatments for these patients...
January 2017: Seminars in Radiation Oncology
Dirk Boehmer, Philippe Maingon, Philip Poortmans, Marie-Hélène Baron, Raymond Miralbell, Vincent Remouchamps, Christopher Scrase, Alberto Bossi, Michel Bolla
BACKGROUND AND PURPOSES: The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. PATIENTS AND METHODS: Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information...
June 2006: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Colleen A F Lawton, Jeff Michalski, Issam El-Naqa, Mark K Buyyounouski, W Robert Lee, Cynthia Menard, Elizabeth O'Meara, Seth A Rosenthal, Mark Ritter, Michael Seider
PURPOSE: Radiation therapy to the pelvic lymph nodes in high-risk prostate cancer is required on several Radiation Therapy Oncology Group (RTOG) clinical trials. Based on a prior lymph node contouring project, we have shown significant disagreement in the definition of pelvic lymph node volumes among genitourinary radiation oncology specialists involved in developing and executing current RTOG trials. MATERIALS AND METHODS: A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes...
June 1, 2009: International Journal of Radiation Oncology, Biology, Physics
Jeff M Michalski, Colleen Lawton, Issam El Naqa, Mark Ritter, Elizabeth O'Meara, Michael J Seider, W Robert Lee, Seth A Rosenthal, Thomas Pisansky, Charles Catton, Richard K Valicenti, Anthony L Zietman, Walter R Bosch, Howard Sandler, Mark K Buyyounouski, Cynthia Ménard
PURPOSE: To define a prostate fossa clinical target volume (PF-CTV) for Radiation Therapy Oncology Group (RTOG) trials using postoperative radiotherapy for prostate cancer. METHODS AND MATERIALS: An RTOG-sponsored meeting was held to define an appropriate PF-CTV after radical prostatectomy. Data were presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed. Using contours independently submitted by 13 radiation oncologists, a statistical imputation method derived a preliminary "consensus" PF-CTV...
February 1, 2010: International Journal of Radiation Oncology, Biology, Physics
Christian Carrie, Ali Hasbini, Guy de Laroche, Pierre Richaud, Stéphane Guerif, Igor Latorzeff, Stéphane Supiot, Mathieu Bosset, Jean-Léon Lagrange, Véronique Beckendorf, François Lesaunier, Bernard Dubray, Jean-Philippe Wagner, Tan Dat N'Guyen, Jean-Philippe Suchaud, Gilles Créhange, Nicolas Barbier, Muriel Habibian, Céline Ferlay, Philippe Fourneret, Alain Ruffion, Sophie Dussart
BACKGROUND: How best to treat rising prostate-specific antigen (PSA) concentration after radical prostatectomy is an urgent clinical question. Salvage radiotherapy delays the need for more aggressive treatment such as long-term androgen suppression, but fewer than half of patients benefit from it. We aimed to establish the effect of adding short-term androgen suppression at the time of salvage radiotherapy on biochemical outcome and overall survival in men with rising PSA following radical prostatectomy...
June 2016: Lancet Oncology
Graham D Smith, Tom Pickles, Juanita Crook, Andre-Guy Martin, Eric Vigneault, Fabio L Cury, Jim Morris, Charles Catton, Himu Lukka, Andrew Warner, Ying Yang, George Rodrigues
PURPOSE: To compare, in a retrospective study, biochemical failure-free survival (bFFS) and overall survival (OS) in low-risk and intermediate-risk prostate cancer patients who received brachytherapy (BT) (either low-dose-rate brachytherapy [LDR-BT] or high-dose-rate brachytherapy with external beam radiation therapy [HDR-BT+EBRT]) versus external beam radiation therapy (EBRT) alone. METHODS AND MATERIALS: Patient data were obtained from the ProCaRS database, which contains 7974 prostate cancer patients treated with primary radiation therapy at four Canadian cancer institutions from 1994 to 2010...
March 1, 2015: International Journal of Radiation Oncology, Biology, Physics
Laurence Klotz, Danny Vesprini, Perakaa Sethukavalan, Vibhuti Jethava, Liying Zhang, Suneil Jain, Toshihiro Yamamoto, Alexandre Mamedov, Andrew Loblaw
PURPOSE: Active surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer. PATIENTS AND METHODS: In a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable- or intermediate-risk prostate cancer were managed with an initial expectant approach...
January 20, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Timothy J Wilt, Michael K Brawer, Karen M Jones, Michael J Barry, William J Aronson, Steven Fox, Jeffrey R Gingrich, John T Wei, Patricia Gilhooly, B Mayer Grob, Imad Nsouli, Padmini Iyer, Ruben Cartagena, Glenn Snider, Claus Roehrborn, Roohollah Sharifi, William Blank, Parikshit Pandya, Gerald L Andriole, Daniel Culkin, Thomas Wheeler
BACKGROUND: The effectiveness of surgery versus observation for men with localized prostate cancer detected by means of prostate-specific antigen (PSA) testing is not known. METHODS: From November 1994 through January 2002, we randomly assigned 731 men with localized prostate cancer (mean age, 67 years; median PSA value, 7.8 ng per milliliter) to radical prostatectomy or observation and followed them through January 2010. The primary outcome was all-cause mortality; the secondary outcome was prostate-cancer mortality...
July 19, 2012: New England Journal of Medicine
Anna Bill-Axelson, Lars Holmberg, Hans Garmo, Jennifer R Rider, Kimmo Taari, Christer Busch, Stig Nordling, Michael Häggman, Swen-Olof Andersson, Anders Spångberg, Ove Andrén, Juni Palmgren, Gunnar Steineck, Hans-Olov Adami, Jan-Erik Johansson
BACKGROUND: Radical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. METHODS: Between 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases...
March 6, 2014: New England Journal of Medicine
George Rodrigues, Himu Lukka, Padraig Warde, Michael Brundage, Luis Souhami, Juanita Crook, Fabio Cury, Charles Catton, Gary Mok, Andre-Guy Martin, Eric Vigneault, Jim Morris, Andrew Warner, Sandra Gonzalez Maldonado, Tom Pickles
BACKGROUND: The Genitourinary Radiation Oncologists of Canada (GUROC) published a three-group risk stratification (RS) system to assist prostate cancer decision-making in 2001. The objective of this project is to use the ProCaRS database to statistically model the predictive accuracy and clinical utility of a proposed new multi-group RS schema. METHODS: The RS analyses utilized the ProCaRS database that consists of 7974 patients from four Canadian institutions. Recursive partitioning analysis (RPA) was utilized to explore the sub-stratification of groups defined by the existing three-group GUROC scheme...
November 2013: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Christopher R King
Radiotherapy (RT) after prostatectomy may potentially eradicate any residual localized microscopic disease in the prostate bed. The current dilemma is whether to deliver adjuvant RT solely on the basis of high-risk pathology (pT3 or positive margins), but in the absence of measurable prostate-specific antigen, or whether early salvage radiotherapy (SRT) would yield equivalent outcomes. Although the results of current randomized trials answering this very question remain years away, the best evidence to date supports early SRT as the better strategy...
July 2013: Seminars in Radiation Oncology
Alvin R Cabrera, W Robert Lee
This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported...
July 2013: Seminars in Radiation Oncology
M Roach, M DeSilvio, C Lawton, V Uhl, M Machtay, M J Seider, M Rotman, C Jones, S O Asbell, R K Valicenti, S Han, C R Thomas, W S Shipley
PURPOSE: This trial tested the hypothesis that combined androgen suppression (CAS) and whole-pelvic (WP) radiotherapy (RT) followed by a boost to the prostate improves progression-free survival (PFS) by 10% compared with CAS and prostate-only (PO) RT. This trial also tested the hypothesis that neoadjuvant and concurrent hormonal therapy (NCHT) improves PFS compared with adjuvant hormonal therapy (AHT) by 10%. MATERIALS AND METHODS: Eligibility included localized prostate cancer with an elevated prostate-specific antigen (PSA) < or = 100 ng/mL and an estimated risk of lymph node (LN) involvement of 15%...
May 15, 2003: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Ronald C Chen, R Bryan Rumble, D Andrew Loblaw, Antonio Finelli, Behfar Ehdaie, Matthew R Cooperberg, Scott C Morgan, Scott Tyldesley, John J Haluschak, Winston Tan, Stewart Justman, Suneil Jain
PURPOSE: To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. METHODS: The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations...
June 20, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
O Barbosa Neto, L Souhami, S Faria
PURPOSE: In 2002, at the McGill University Health Centre, we began a program of hypofractionated radiotherapy for patients with low risk prostate cancer as an alternative to conventionally fractionated radiotherapy. MATERIAL AND METHODS: Our initial hypofractionation regimen was 66 Gy given in 22 fractions, prescribed to the isocenter, delivered with 3D-conformal radiotherapy plan. The clinical target volume was the prostate gland and the planning target volume consisted of the clinical target volume plus a 7-mm margin in all directions...
October 2015: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Gregory P Swanson, Michael A Hussey, Catherine M Tangen, Joseph Chin, Edward Messing, Edith Canby-Hagino, Jeffrey D Forman, Ian M Thompson, E David Crawford
PURPOSE: Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research. PATIENTS AND METHODS: Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation...
June 1, 2007: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Andrew J Stephenson, Peter T Scardino, Michael W Kattan, Thomas M Pisansky, Kevin M Slawin, Eric A Klein, Mitchell S Anscher, Jeff M Michalski, Howard M Sandler, Daniel W Lin, Jeffrey D Forman, Michael J Zelefsky, Larry L Kestin, Claus G Roehrborn, Charles N Catton, Theodore L DeWeese, Stanley L Liauw, Richard K Valicenti, Deborah A Kuban, Alan Pollack
PURPOSE: An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. PATIENTS AND METHODS: Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients...
May 20, 2007: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Detlef Bartkowiak, Dirk Bottke, Reinhard Thamm, Alessandra Siegmann, Wolfgang Hinkelbein, Thomas Wiegel
BACKGROUND AND PURPOSE: In a retrospective analysis, we examined factors influencing the outcome of prostate cancer (PCa) patients receiving salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy (RP). MATERIAL AND METHODS: 306 patients received 3D-conformal SRT at a median pre-SRT PSA of 0.298 ng/ml. Post-SRT progression was defined as PSA ⩾0.2 ng/ml above nadir and rising further, or hormone treatment, or clinical recurrence. Data were analyzed with the Kaplan-Meier method and multivariable Cox regression...
January 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Mark A Sidhom, Andrew B Kneebone, Margot Lehman, Kirsty L Wiltshire, Jeremy L Millar, Rahul K Mukherjee, Thomas P Shakespeare, Keen-Hun Tai
BACKGROUND AND PURPOSE: Three randomised trials have demonstrated the benefit of adjuvant post-prostatectomy radiotherapy (PPRT) for high risk patients. Data also documents the effectiveness of salvage radiotherapy following a biochemical relapse post-prostatectomy. The Radiation Oncology Genito-Urinary Group recognised the need to develop consensus guidelines on to whom, when and how to deliver PPRT. MATERIALS AND METHODS: Draft guidelines were developed and refined at a consensus conference in June 2006 attended by 63 delegates where urological, radiotherapy and diagnostic imaging experts spoke on aspects of PPRT...
July 2008: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
2015-09-27 13:38:02
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