Phase 1 Trial of Stereotactic Body Radiation Therapy Neoadjuvant to Radical Prostatectomy for Patients With High-Risk Prostate Cancer

Parikh, Neil R.; Kishan, Amar U.; Kane, Nathanael; Diaz-Perez, Silvia; Ganapathy, Ekambaram; Nazarian, Ramin; Felix, Carol; Mathis, Colleen; Bradley, Margaret; Sachdeva, Amit; Wyatt, Bashir; Basehart, Vincent; Zomorodian, Nazy; Lin, Lin; King, Christopher R.; Kupelian, Patrick A.; Rettig, Matthew B.; Steinberg, Michael L.; Cao, Minsong; Knudsen, Beatrice S.; Elashoff, David; Schaue, Dörthe; Reiter, Robert E.; Nickols, Nicholas G.

doi:10.1016/j.ijrobp.2020.06.010

Cited by 13 publications

(8 citation statements)

References 16 publications

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“…Several clinical trials evaluating the safety of such an approach are currently active or completed. Recently published short-term results of a similar trial of 11 patients treated with preoperative SBRT to 24 Gy in three fractions over five days to the prostate and seminal vesicles followed by RP showed the highest GU toxicity of grade 2 and grade 3 in four (36.4%) and two (18.2%) patients, respectively [20].…”

Section: Discussionmentioning

confidence: 97%

“…In the study reported by Glicksman et al, two patients were found to have regional nodal disease after RP, and they were treated with ADT without additional radiotherapy [21,22]. The two patients in the study by Parikh et al who had pathologically positive pelvic lymph nodes were treated more aggressively with ADT and additional RT to the pelvic lymph nodes based upon multi-disciplinary recommendation [20]. The addition of adjuvant RT targeted at lymph nodes should be carefully considered and determined in multi-disciplinary fashion, as the population most likely to benefit has not been defined and carries the risk for significant increase in toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Phase I dose escalation trial of stereotactic radiotherapy prior to robotic prostatectomy in high risk prostate cancer

Liveringhouse

Sim

Yamoah

et al. 2021

Rep Pract Oncol Radiother.

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background:The aim of the study was to investigate the safety of combining preoperative stereotactic body radiotherapy (sBrT) with robotic radical prostatectomy (rp) for high risk prostate cancer (hrcap). Many patients with hrcap will require adjuvant or salvage radiotherapy after rp. The addition of preoperative sBrT before rp may spare patients from subsequent prolonged courses of rT.Materials and methods: eligible patients had NccN hrcap and received a total of 25 Gy or 30 Gy in five daily fractions of sBrT to the prostate and seminal vesicles followed by robotic rp with pelvic lymphadenectomy 31-45 days later. The primary endpoint was prevalence of acute genitourinary (GU) and gastrointestinal (GI) toxicity. secondary endpoints were patientreported quality of life (QOL) and biochemical recurrence (Bcr). results: Three patients received preoperative sBrT to 25 Gy and four received 30 Gy. Median follow-up was 18 months. highest toxicity was grade 2 and 3 in six (85.7%) and one (14.3%) patients, respectively. all patients developed grade 2 erectile dysfunction and 4 of 7 (57%) developed grade 2 urinary incontinence (UI) within a month after surgery. One patient developed acute grade 3 UI, but there was no grade ≥ 4 toxicity. One patient experienced acute grade 2 hemorrhoidal bleeding. On QOL, acute GU complaints were common and peaked within 3 months. Bowel symptoms were mild. Two patients with pN+ experienced Bcr. conclusions: preoperative sBrT before robotic rp in hrcap is feasible and safe. The severity of acute GU toxicity with preoperative sBrT may be worse than rp alone, while bowel toxicity was mild.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Phase I dose escalation trial of stereotactic radiotherapy prior to robotic prostatectomy in high risk prostate cancer

Liveringhouse

Sim

Yamoah

et al. 2021

Rep Pract Oncol Radiother.

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“…Neoadjuvant chemotherapy seems to be feasible and safe at the test dose, but the severity of urinary incontinence may be higher than that of radical prostatectomy alone. 18 Tafuri et al 19 do not recommend preoperative neoadjuvant endocrine therapy alone in that it does not provide any survival advantage.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of neoadjuvant chemohormonal therapy combined with laparoscopic radical prostatectomy in high-risk Prostate Cancer

Zhang¹,

Cai²,

Yan³

et al. 2022

Pak J Med Sci

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Objectives: To evaluate the clinical efficacy of neoadjuvant chemohormonal therapy (NCHT) combined with laparoscopic radical prostatectomy in high-risk prostate cancer (PCa). Methods: A randomized controlled trial was used in this study. Eighty patients with high-risk PCa treated in Tangshan Gongren Hospital from January 2017 to January 2019 were selected and randomly divided into two groups. The control group was given neoadjuvant endocrine therapy, while the research group was added NCHT to the control group. Three months later, the patients of two groups underwent laparoscopic radical prostatectomy. The changes of surgical indicators, adverse drug reactions, incidence of lower urinary tract symptoms, biochemical recurrence rate after follow-up, PSA progression-free survival and incidence of surgical complications were compared between the two groups. Results: After NCHT, the PSA level and prostate volume in the research group decreased significantly than those in the control group (P = 0.00). Surgical duration, postoperative hospital stay and retention time of drainage tube were significantly shorter and intraoperative blood loss was significantly less in the research group than those in the control group (P = 0.00). The incidence of lower urinary tract symptoms, biochemical recurrence and surgical complications in the research group were significantly lower than those in the control group, and the early recovery rate of urinary control and progression-free survival were significantly better than those in the control group (P < 0.05). Conclusion: NCHT combined with laparoscopic radical prostatectomy is a safe and effective treatment for high-risk PCa, which is worthy of promotion in clinical practice. doi: https://doi.org/10.12669/pjms.38.8.5469 How to cite this:Zhang P, Cai S, Yan C, Li L. Clinical efficacy of neoadjuvant chemohormonal therapy combined with laparoscopic radical prostatectomy in high-risk Prostate Cancer. Pak J Med Sci. 2022;38(8):---------. doi: https://doi.org/10.12669/pjms.38.8.5469 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…SBRT with elective nodal irradiation is being explored, such as in the SATURN trial [24]. As well, SBRT is also being investigated as a neoadjuvant therapy before radical prostatectomy in high-risk patients, with phase I trials showing feasibility and safety, though one recent phase I trial assessing maximum tolerable dose was stopped early due to unacceptable toxicity [25,26]. Additionally, some trials are looking at boosting the dominant intra-prostatic lesions to higher doses [27].…”

Section: Treatment Optionsmentioning

confidence: 99%

Evaluation of Patients for Radiotherapy for Prostate Adenocarcinoma

Wallach¹,

Stern²,

Karp³

et al. 2023

Radiation Therapy

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Prostate adenocarcinoma is the most common non-cutaneous malignancy among men in the United States, and the second leading cause of death. However, most prostate adenocarcinoma diagnoses are now diagnosed at early stages and are curable, or if they recur, are associated with such long survival times that the patients usually succumb to competing co-morbidities. This chapter would discuss a brief history of prostate cancer evaluation and its pertinence today, including the Gleason scoring system, advent of PSA testing, and development of the NCCN classification system that is used today. Alternative classification systems, such as the UCSF-CAPRA scoring system, would also be discussed. The latter half of the chapter will discuss the evolution from personalized medicine to precision medicine, including PSMA imaging and prostate cancer genomics, with ongoing trials and future directions. Furthermore, included within this chapter would be a discussion of selecting appropriate men for active surveillance, and appropriate regimens for active surveillance.

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Phase 1 Trial of Stereotactic Body Radiation Therapy Neoadjuvant to Radical Prostatectomy for Patients With High-Risk Prostate Cancer

Cited by 13 publications

References 16 publications

Phase I dose escalation trial of stereotactic radiotherapy prior to robotic prostatectomy in high risk prostate cancer

Phase I dose escalation trial of stereotactic radiotherapy prior to robotic prostatectomy in high risk prostate cancer

Clinical efficacy of neoadjuvant chemohormonal therapy combined with laparoscopic radical prostatectomy in high-risk Prostate Cancer

Evaluation of Patients for Radiotherapy for Prostate Adenocarcinoma

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