Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy

Bravi, Carlo Andrea; Tin, Amy; Vertosick, Emily; Mazzone, Elio; Bandini, Marco; Dell’Oglio, Paolo; Stabile, Armando; Gandaglia, Giorgio; Fossati, Nicola; Sjoberg, Daniel D.; Touijer, Karim; Cozzarini, C.; Briganti, Alberto; Montorsi, Francesco; Eastham, James

doi:10.1016/j.urolonc.2019.09.018

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…Fifteen studies described the type of PLND, with extended or standard PLND being used in thirteen. Only two cohorts [21,22] did not report the number of nodes removed, which was always ≥10 in the remaining studies with the exception of Cai et al (mean of 5.2 nodes removed) [23]. The median number of positive nodes was reported in fifteen cohorts and was 3 and 2 in one and seven series respectively, and lower in the remaining cohorts.…”

Section: Patients' Featuresmentioning

confidence: 91%

“…Four series (n=5 studies) reported results for aRT (n=1,271 men) with (n=958) or without (n=100) concomitant ADT, whereas for 213 patients the authors did not specify if concomitant ADT was used [7,19,22,28,33]. All individuals included in these cohorts received whole pelvis aRT which included the prostatic bed and pelvic nodes.…”

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

“…All individuals included in these cohorts received whole pelvis aRT which included the prostatic bed and pelvic nodes. BCR was not reported whereas one series detailed CR-free survival [22]. Cancer-specific survival (n=3 series) ranged from 72.4% at 8 years to 86.7%-98% at 10 years.…”

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

“…Cancer-specific survival (n=3 series) ranged from 72.4% at 8 years to 86.7%-98% at 10 years. Overall survival ranged from 81% to 87.6% at 10 years [7,19,22,33]. Patients undergoing aRT generally showed more aggressive features compared to the observation group; 3 or more positive nodes were present in 30.1% and the majority had Gleason Score ≥8 (53.3%), pT3b (66.3%) and positive margins (66.8%) (Supplementary Material 4).…”

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

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Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review

Marra

Valério

Heidegger

et al. 2020

European Urology Oncology

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Introduction:The optimal management of prostate cancer (PCa) patients with lymph node invasion (LNI) at radical prostatectomy (RP) and pelvic lymph node dissection (PLND) still remains unclear.Objective: To assess the effectiveness of postoperative treatment strategies for pathologically node-positive PCa patients. The secondary aim was to identify the most relevant prognostic factors to guide the management of pN1 patients. Evidence Acquisition: A systematic review was performed in January 2020 using Medline, Embase and other databases. A total of 5,063 articles were screened and 26 studies including 12,537 men were selected for data synthesis and included in the current review according to the PRISMA recommendations.Evidence Synthesis: Ten-year biochemical recurrence (BCR)-, clinical recurrence (CR)-, cancer-specific (CSS)-and overall (OS)-survival rates ranged from 28% to 56%, 70% to 92%, 72% to 98% and 60% to 87.6%, respectively. A total of 7, 5, and 6 studies assessed the oncologic outcomes of observation, adjuvant radiotherapy (aRT) or adjuvant androgen-deprivation (ADT), respectively. Initial observation followed by salvage therapies at the time of recurrence represents a safe option in selected patients with low disease burden. The use of aRT with or without ADT might improve survival in men with locally advanced disease and a higher number of positive nodes.Risk stratification according to pathological Gleason score, the number of positive nodes, pathological stage and surgical margins status is key for risk stratification and selection of the optimal postoperative therapy. Limitations of this systematic review are the retrospective design of the studies included and the lack of data on adverse events. Conclusions:While the majority of men with pN1 disease would experience BCR after surgery, long-term disease-free survival has been reported in selected patients.Management options to improve oncologic outcomes include observation vs. adjuvant therapies such as aRT and/or ADT. Disease characteristics should be used to select the optimal postoperative management for pN1 PCa patients.

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Section: Patients' Featuresmentioning

confidence: 91%

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

Section: Adjuvant Radiotherapy With/without Adjuvant Adtmentioning

confidence: 99%

See 2 more Smart Citations

Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review

Marra

Valério

Heidegger

et al. 2020

European Urology Oncology

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“…Proper identification of patients at higher risk of recurrence who might benefit from additional treatments remains a difficult task for clinicians. To improve patient stratification and clinical management after sLND, persistently elevated PSA could be used as an easy and important prognosticator, as shown in the primary setting [17][18][19]. However, although there is some evidence that PSA response after sLND (namely, first postoperative PSA <0.2 ng/ml) correlates with oncologic outcomes [16], such a definition has never been validated or directly investigated.…”

Section: Introductionmentioning

confidence: 99%

Definition and Impact on Oncologic Outcomes of Persistently Elevated Prostate-specific Antigen After Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer After Radical Prostatectomy: Clinical Implications for Multimodal Therapy

Bravi

Droghetti

Fossati

et al. 2022

European Urology Oncology

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Background: The optimal definition and prognostic significance of persistently elevated prostate-specific antigen (PSA) after salvage lymph node dissection (sLND) for node-only recurrent prostate cancer (PCa) remain unknown.Objective: To assess the definition and clinical implications of persistently elevated PSA after sLND for node-only recurrent PCa after radical prostatectomy. Design, setting, and participants: The study included 579 patients treated with sLND at 11 high-volume centers between 2000 and 2016. Outcome measurements and statistical analysis: We assessed the linear relationship between the first PSA after sLND and death from PCa. Different definitions of PSA persistence were included in a multivariable model predicting cancer-specific mortality (CSM) after surgery to identify the best cutoff value. We investigated the association between PSA persistence and oncologic outcomes using multivariable regression models. Moreover, the effect of early androgen deprivation therapy (ADT) after sLND was tested according to PSA persistence status and estimated risk of CSM. Results and limitations: We found an inverse relationship between the first PSA after sLND and the probability of cancer-specific survival. PSA persistence defined as first postoperative PSA !0.3 ng/ml provided the best discrimination accuracy (C index 0.757). According to this cutoff, 331 patients (57%) experienced PSA persistence. The median follow-up for survivors was 48 mo (interquartile range 27-74). After adjusting for confounders, men with persistently elevated PSA had higher risk of clinical recurrence (hazard ratio [HR] 1.61), overall mortality (HR 2.20), and CSM (HR 2.59; all p < 0.001) after sLND. Early ADT administration after sLND improved survival only for patients with PSA persistence after surgery (HR 0.49; p = 0.024). Similarly, when PSA persistence status was included in multivariable models accounting for pathologic features, early ADT use after sLND was beneficial only for patients with a predicted risk of CSM at 5 yr of >10%. Conclusions: PSA persistence after sLND independently predicts adverse prognosis, with the best discrimination accuracy for CSM provided by a definition of PSA ! 0.3 ng/ml. We showed that when stratifying patients by final pathology results and PSA persistence status, early ADT use after sLND was beneficial only for patients with PSA persistence or with a calculated 5-yr risk of CSM of >10%, which could be useful as we await results from ongoing prospective trials. Patient summary: We found that for patients with prostate cancer who had lymph nodes removed after their cancer recurred, persistently elevated prostate-specific antigen (PSA) levels predict poorer prognosis. We showed that a PSA level of !0.3 ng/ml provides the best accuracy in identifying patients with worse prognosis. This may help to improve risk stratification after lymph node removal and allow physicians to optimize treatment strategies after surgery.

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A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer

et al. 2020

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Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy

Cited by 13 publications

References 19 publications

Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review

Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review

Definition and Impact on Oncologic Outcomes of Persistently Elevated Prostate-specific Antigen After Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer After Radical Prostatectomy: Clinical Implications for Multimodal Therapy

A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer

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