Therapeutic Sequences in the Treatment of High-Risk Prostate Cancer: Paving the Way Towards Multimodal Tailored Approaches

Marvaso, Giulia; Corrao, Giulia; Zaffaroni, Mattia; Pepa, Matteo; Augugliaro, Matteo; Volpe, Stefania; Musi, Gennaro; Luzzago, Stefano; Mistretta, F.A.; Verri, Elena; Rocca, Maria Cossu; Ferro, Matteo; Petralia, Giuseppe; Nolè, Franco; Cobelli, Ottavio De; Orecchia, Roberto; Jereczek‐Fossa, Barbara Alicja

doi:10.3389/fonc.2021.732766

Cited by 4 publications

(4 citation statements)

References 85 publications

(94 reference statements)

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“…The incidence of prostate cancer is on the rise worldwide [1,2]. There are various treatment options available, including hormonal therapy, radiation, carbon-ion radiotherapy, and radical prostatectomy [3][4][5]. Along with clinical information, including serum prostate-specific antigen (PSA) levels and imaging findings, histopathological diagnosis based on prostate needle core biopsy results is important to provide the most appropriate treatment [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

et al. 2022

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In prostate cancer, accurate diagnosis and grade group (GG) decision based on biopsy findings are essential for determining treatment strategies. Diagnosis by experienced urological pathologists is recommended; however, their contribution to patient benefits remains unknown. Therefore, we analyzed clinicopathological information to determine the significance of reassessment by experienced urological pathologists at a high-volume institution to identify factors involved in the agreement or disagreement of biopsy and surgical GGs. In total, 1325 prostate adenocarcinomas were analyzed, and the GG was changed in 452/1325 (34.1%) cases (359 cases were upgraded, and 93 cases were downgraded). We compared the highest GG based on biopsy specimens, with the final GG based on surgical specimens of 210 cases. The agreement rate between the surgical GG performed and assessed in our institute and the highest biopsy GG assessed by an outside pathologist was 34.8% (73/210); the agreement rate increased significantly to 50% (105/210) when biopsy specimens were reevaluated in our institute (chi-square test, P < 0.01). Multivariate logistic regression analysis showed that only the length of the lesion in the positive core with the highest GG in the biopsy was a significant factor for determining the agreement between biopsy GG and surgical GG, with an odds ratio of 1.136 (95% confidence interval: 1.057–1.221; P < 0.01). Thus, reassessment by experienced urological pathologists at high-volume institutions improved the agreement rate. However, it should be noted there is a high probability of discordance between a small number of lesions or short lesions and surgical GG.

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Section: Introductionmentioning

confidence: 99%

Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

et al. 2022

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“…Clinical stage cT3N0M0 prostate cancer is defined within the high-risk prostate cancer group in the European Association of Urology (EAU) and American Urological Association (AUA) guidelines [1]. External beam radiotherapy (EBRT), radical prostatectomy (RP), brachytherapy, focal treatment methods, androgen deprivation therapy (ADT), or combinations of these schemes constitute high-risk prostate cancer treatment protocols [2,3]. However, discussions remain for the treatment methods to be applied in high-risk prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Our Experience with Radical Prostatectomy and Extended Pelvic Lymph Node Dissection in the Treatment of Clinical Stage T3 Prostate Cancer and Its Possible Advantages

Kartal¹,

Alkış²,

Sevim³

et al. 2022

Grand J Urol

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Objective: To evaluate the impact of radical prostatectomy (RP) and extended pelvic lymph node dissection (EPLND) on the disease process in terms of oncological outcomes and quality of life in the treatment of clinical stage cT3N0M0 prostate cancer (PCa). Materials and Methods:The data of patients with cT3N0M0 who had undergone open radical prostatectomy and extended pelvic lymph node dissection in our clinic between January 2015 and March 2021 were analyzed retrospectively. Preoperative and postoperative data were compared in terms of oncological and functional outcomes. Biochemical recurrence was accepted as detection of PSA >0.2 ng/ml on consecutive measurements and biochemical disease-free survival time was calculated. Results:The mean age of 23 operated patients who met the study criteria, was 66.8±7.4 years. In the pathological staging, the organ-confined disease was detected in 10 (43.4%) patients. Surgical margin positivity was observed in 6 (26.2%), while lymph node positivity in 3 (13.1%) patients. Biochemical recurrence was detected in 7 (30.2%) patients during a mean follow-up period of 33.6±22.9 months. The mean biochemical disease-free survival time was 48.4±6.3 months. In the evaluations of the patients at the postoperative 6 th months, a 3.2±2.2-point decrease was found in the International Prostate Symptom Score (IPSS) (p=0.001) and a 13.1±5.0 point decrease in the International Index of Erectile Function (IIEF) score (p=<0.001). Conclusion: Radical prostatectomy and extended pelvic lymph node dissection applied in the treatment of locally advanced prostate cancer is seem to be an effective and safe treatment method in terms of oncological and functional outcomes.

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“…The National Comprehensive Cancer Network (NCCN) recommendation for the treatment of patients with high-risk prostate cancer is external-beam radiotherapy (EBRT) and longterm androgen deprivation therapy (ADT) (1)(2)(3)(4). Long-term ADT improves disease-free or overall survival in patients with high-risk prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

“…During ADT, most patients experience metabolic changes, such as an increase of weight and fat mass, and decreased muscle mass (3)(4)(5)(6)(7)(8)(9)(10). The changes in body composition are early adverse effects of the treatment and can be significant within the first 3-6 months of therapy (3).…”

Section: Introductionmentioning

confidence: 99%

Muscle Loss During Androgen Deprivation Therapy Is Associated With Higher Risk of Non-Cancer Mortality in High-Risk Prostate Cancer

et al. 2021

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The changes in body composition are early adverse effects of androgen deprivation therapy (ADT); however, their prognostic impact remains unclear in prostate cancer. This study aimed to evaluate the association between body composition changes and survival in patients with high-risk prostate cancer. We measured the skeletal muscle index (SMI) and total adipose tissue index (TATI) at the L3 vertebral level using computed tomography at baseline and within one year after initiating ADT in 125 patients with high-risk prostate cancer treated with radiotherapy and ADT between 2008 and 2018. Non-cancer mortality predictors were identified using Cox regression models. The median follow-up was 49 months. Patients experienced an average SMI loss of 5.5% over 180 days (95% confidence interval: -7.0 to -4.0; p<0.001) and TATI gain of 12.6% over 180 days (95% confidence interval: 9.0 to 16.2; p<0.001). Body mass index changes were highly and weakly correlated with changes in TATI and SMI, respectively (Spearman ρ for TATI, 0.78, p<0.001; ρ for SMI, 0.27, p=0.003). As a continuous variable, each 1% decrease in SMI was independently associated with a 9% increase in the risk of non-cancer mortality (hazard ratio: 1.09; p=0.007). Moreover, the risk of non-cancer mortality increased 5.6-fold in patients with SMI loss ≥5% compared to those with unchanged SMI (hazard ratio: 5.60; p=0.03). Body mass index and TATI were not associated with non-cancer mortality. Muscle loss during ADT is occult, independent of weight change, and independently associated with increased non-cancer mortality in patients with high-risk prostate cancer.

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Therapeutic Sequences in the Treatment of High-Risk Prostate Cancer: Paving the Way Towards Multimodal Tailored Approaches

Cited by 4 publications

References 85 publications

Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

Our Experience with Radical Prostatectomy and Extended Pelvic Lymph Node Dissection in the Treatment of Clinical Stage T3 Prostate Cancer and Its Possible Advantages

Muscle Loss During Androgen Deprivation Therapy Is Associated With Higher Risk of Non-Cancer Mortality in High-Risk Prostate Cancer

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