Importance of non‐regional lymph nodes in assigning risk in primary metastatic prostate cancer

Ali, Adnan; Hoyle, Alex; Mistry, Hitesh; Clarke, Noel W.

doi:10.1111/bju.14400

Cited by 15 publications

(14 citation statements)

References 32 publications

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“…Compensating for this association by a matching procedure leads to higher‐risk levels in the cohort with a post‐RP undetectable PSA and a loss of cases with most adverse characteristics in the ‘persistent’ group, for whom matches seem to be rare amongst men whose PSA level is zero or <0.1 ng/mL after RP. Similar shifts have also been documented in other risk‐matching studies, where cases from a substantially bigger subgroup were selected to fit a smaller group . Consequently, in our present analysis, the PFS curves converge after risk‐adjustment, so that no significant dependence of PFS on the post‐RP PSA response could be shown.…”

Section: Discussionsupporting

confidence: 84%

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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Objective To test whether salvage radiotherapy (SRT) in patients with lymph node negative (N0) prostate cancer is equally effective with persistent prostate‐specific antigen (PSA) and PSA rising from the undetectable range (<0.1 ng/mL) after radical prostatectomy (RP). Patients and methods We assessed post‐SRT PSA progression‐free survival (PFS) in 555 patients with prostate cancer. The entire cohort was compared with a risk‐adjusted subgroup of 112 patient pairs with matching pre‐RP PSA level (±10 ng/mL), Gleason score (≤6 vs 7 vs ≥8), and pre‐SRT PSA level (±0.5 ng/mL). Results The median follow‐up was 6.1 years. After RP, PSA was undetectable in 422 and persistent in 133 patients. PSA persistence and a pre‐SRT PSA level of ≥0.5 ng/mL reduced Kaplan–Meier rates of PFS significantly. In multivariate analysis of the entire cohort and after risk adjustment, the pre‐SRT PSA level but not post‐RP PSA persistence was a significant parameter. In the matched cohort's subgroup with early SRT at a PSA level of <0.5 ng/mL, a trend towards a worse outcome with post‐RP PSA persistence was observed. Delayed SRT with a PSA level ≥0.5 ng/mL led to a PFS of <30%, irrespective of the post‐RP PSA level. Conclusion In patients with N0 prostate cancer with post‐RP PSA persistence, early SRT at a PSA level <0.5 ng/mL seems to be less effective than in recurrent patients with post‐RP undetectable PSA. They might benefit from intensified therapy, but larger case numbers are required to substantiate this conclusion. In patients with a PSA level ≥0.5 ng/mL and higher‐risk features associated with post‐RP PSA persistence, SRT alone is unlikely to provide long‐term freedom from further progression.

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Section: Discussionsupporting

confidence: 84%

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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“…Nearly 25% of the patients enrolled in the other two trials presented with metastatic disease after previous radical treatment. That group of patients has a different natural history to those presenting with de-novo M1 disease [20,21]. Consequently, the low metastatic burden sub-groups in the CHAARTED and the GETUG-15 trials had fewer than 160 de-novo mHNPC patients each [10].…”

Section: Discussionmentioning

confidence: 99%

Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial

et al. 2019

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Background: STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients.Methods: We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC þ docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional.

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“…Variations in the prevalence of "low-burden" disease across these definitions can vary between 23% and 44%, potentially influencing volume-based treatment decisions [18]. Current definitions also fail to acknowledge the poor prognostic implication of combined bone and metastatic nodal disease [19]. Emerging exploratory analysis within oligometastatic HNPC patients treated with prostatic radiotherapy suggests that nodal and/or fewer than four bone metastases stratify patients with the greatest accuracy [20].…”

Section: _ T D $ D I F F ] [ 3 8 _ T D $ D I F F ]mentioning

confidence: 99%

Abiraterone in “High-” and “Low-risk” Metastatic Hormone-sensitive Prostate Cancer

et al. 2019

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Background: Abiraterone acetate received licencing for use in only "high-risk" metastatic hormone-naïve prostate cancer (mHNPC) following the LATITUDE trial findings. However, a "risk"-related effect was not seen in the STAMPEDE trial. There remains uncertainty as to whether men with LATITUDE "low-risk" M1 disease benefit from androgen deprivation therapy (ADT) combined with abiraterone acetate and prednisolone (AAP). Objective: Evaluation of heterogeneity of effect between LATITUDE high-and low-risk M1 prostate cancer patients receiving ADT + AAP in the STAMPEDE trial. Design, setting, and participants: A post hoc subgroup analysis of the 2017 STAMPEDE "abiraterone comparison". Staging scans for M1 patients contemporaneously randomised to ADT or ADT + AAP within the STAMPEDE trial were evaluated centrally and blind to treatment assignment. Stratification was by risk according to the criteria set out in the LATITUDE trial. Exploratory subgroup stratification incorporated the CHAARTED criteria. Outcome measurements and statistical analysis: The primary outcome measure was overall survival (OS) and the secondary outcome measure was failure-free survival (FFS). Further exploratory analysis evaluated clinical skeletal-related events, progression-free survival (PFS), and prostate cancer-specific death. Standard Cox-regression and Kaplan-Meier survival estimates were employed for analysis.

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Importance of non‐regional lymph nodes in assigning risk in primary metastatic prostate cancer

Cited by 15 publications

References 32 publications

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial

Abiraterone in “High-” and “Low-risk” Metastatic Hormone-sensitive Prostate Cancer

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