Postradiotherapy prostate biopsies: what do they really mean? results for 498 patients

Crook, Juanita; Malone, Shawn; Perry, Gad; Bahadur, Yasir A.; Robertson, Susan J.; Abdolell, Mohamed

doi:10.1016/s0360-3016(00)00637-4

Cited by 239 publications

(136 citation statements)

References 31 publications

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“…The data presented here also suggest that the early identification of local persistence and consequent salvage therapy before the manifestation of BF should be a goal of future research. These findings support the more routine use of postradiotherapy biopsies at 2-3 years, since positive biopsies strongly predict for eventual BF (32,33). Interval hazard rates for biochemical failure during each 2-year time interval after radiotherapy, according to the ASTRO definition (3 consecutive rises in PSA, backdated) (16) and the Nadir +2 definition (PSA ≥ nadir + 2 ng/mL) (17)(18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 74%

Radiation dose and late failures in prostate cancer

Morgan

Hanlon

Horwitz

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To quantify the impact of radiotherapy (RT) dose escalation on the timing of biochemical failure (BF) and distant metastasis (DM) for prostate cancer treated with RT alone.Methods and Materials-A total of 667 men with clinically localized intermediate and high risk prostate cancer treated with 3D-conformal RT alone were retrospectively analyzed. The interval hazard rates of DM and biochemical failure (BF), using ASTRO and Phoenix (Nadir+2) definitions, were determined. Median follow-up was 77 months.Results-Multivariate analysis showed that increasing RT dose was independently associated with decreased ASTRO BF (P<.0001), Nadir+2 BF (P=.001), and DM (P=.006). The preponderance (85%) of ASTRO BF occurred at ≤4 years after RT, while Nadir+2 BF was more evenly spread over years 1-10, with 55% BF in ≤4 years. RT dose escalation caused a shift in the BF from earlier to later years. The interval hazard function for DM appeared to be biphasic (early and late peaks) overall and for the <74 Gy group. In patients receiving ≥74 Gy, there was a reduction in the risk of DM in both the early and late waves, although the late wave appears reduced to a greater degree.Conclusions-The ASTRO definition of BF systematically underestimates late BF due to backdating. RT dose escalation diminished and delayed BF; the delay suggests that there may still be local persistence in some patients. For DM, higher RT dose reduced both the early and late waves, suggesting that persistence of local disease contributes to both.

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Section: Discussionmentioning

confidence: 74%

Radiation dose and late failures in prostate cancer

Morgan

Hanlon

Horwitz

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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“…CRYO results in immediate local control, whereas radiotherapy takes at least 24 months to achieve the local treatment effect. 15 Estimates of the cumulative incidence of failure were based on the methods of Gray, 16 which account for the competing risks of death from causes other than prostate cancer. Not accounting for competing risks would lead to an overestimate of the failure rate.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the clinical importance of positive biopsies after EBRT is unknown. 15,24 Because of this uncertainty, we included biopsy only as a secondary endpoint to assess local control; it was not part of the definition of failure.…”

Section: Gastrointestinalmentioning

confidence: 99%

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

Donnelly

Saliken

Brasher

et al. 2009

Cancer

138

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BACKGROUND: Localized prostate cancer can be treated several different ways, but head-to-head comparisons of treatments are infrequent. The authors of this report conducted a randomized, unblinded, noninferiority trial to compare cryoablation with external beam radiotherapy in these patients. METHODS: From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were assigned randomly to receive either cryoablation or radiotherapy (122 men in each arm). All received neoadjuvant antiandrogen therapy. The primary endpoint was disease progression at 36 months based on a trifecta definition: 1) radiologic evidence of metastatic disease, or 2) initiation of further antineoplastic therapy, or 3) biochemical failure. Two definitions of biochemical failure were used: 1) 2 consecutive rises in prostate-specific antigen (PSA) with a final value >1.0 ng/mL, and 2) a rise above PSA nadir þ 2 ng/mL. Secondary endpoints included overall survival, disease-specific survival, and prostate biopsy at 36 months. RESULTS: The median follow-up was 100 months. Disease progression at 36 months was observed in 23.9% (PSA nadir þ 2 ng/mL, 17.1%) of men in the cryoablation arm and in 23.7% (PSA nadir þ 2 ng/mL, 13.2%) of men in the radiotherapy arm. No difference in overall or disease-specific survival were observed. At 36 months, more patients in the radiotherapy arm had a cancer-positive biopsy (28.9%) compared with patients in the cryoablation arm (7.7%). CONCLUSIONS: The observed difference in disease progression at 36 months was small, 0.2%; however, because of the wide confidence interval, from À10.8% to 11.2%, it was not possible to rule out inferiority (defined a priori as a 10% difference). With longer term follow-up, the trend favors cryoablation. Significantly fewer positive biopsies were documented after cryoablation than after radiotherapy. Cancer 2010;116:323-30.

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“…On the other hand, positive post-treatment biopsies are accepted as an independent predictor of outcome (23,24). The biopsies are accepted as an independent predictor of outcome (23,24). In any case, these low rates of positive biopsies after HDR results show that HDR reliably ablates prostate cancer and fulfills the first criterion for an ablative technology.…”

Section: Discussionmentioning

confidence: 99%

“…Positive biopsy rates after radiation therapy, however, are not an accepted gold standard of treatment efficacy in part because of the relatively long time it takes for irradiated prostate cancer to achieve a pathophysiologic response and the risk of false positives. On the other hand, positive post-treatment biopsies are accepted as an independent predictor of outcome (23,24). The biopsies are accepted as an independent predictor of outcome (23,24).…”

Section: Discussionmentioning

confidence: 99%

Focal high-dose-rate brachytherapy: A dosimetric comparison of hemigland vs. conventional whole-gland treatment

et al. 2013

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PURPOSE: To determine the utility of focal high-dose-rate brachytherapy for localized prostate cancer, we investigated the impact on target coverage and dose to organs at risk (OARs) with hemigland (HG) compared with whole-gland (WG) treatment. METHODS AND MATERIALS:A total of 10 WG implants were used to generate 10 WG and 20 HG (left and right) treatment plans optimized with the inverse planning simulation annealing algorithm using Oncentra MasterPlan (Nucletron B.V., Veenendaal, The Netherlands). The standard distribution of 17e18 catheters designed for WG was used to generate HG plans. The same OARs namely bladder, rectum, and urethra contours and dose constraints were applied for HG and WG plans. The HG contour was a modification of the WG contour whereby the urethra divided the prostate into HGs.

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Postradiotherapy prostate biopsies: what do they really mean? results for 498 patients

Cited by 239 publications

References 31 publications

Radiation dose and late failures in prostate cancer

Radiation dose and late failures in prostate cancer

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

Focal high-dose-rate brachytherapy: A dosimetric comparison of hemigland vs. conventional whole-gland treatment

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