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Thread: (O) Locally Advanced Prostate Cancer

  1. #1

    (O) Locally Advanced Prostate Cancer

    Table of Contents

    Note: See also (P) Metastatic Prostate Cancer. There is overlap in journal articles, which often cover both oligometasatic and metastatic cancer. Oligometastic refers to cases with only a few (usually less than 3-5) metastases, which can be local and/or distant.

    A title in all caps does not reflect any emphasis; it is simply how it appeared on the page I copied from.
    Studies in red are new additions.


    [#1] Nine-year prostate cancer survival differences between aggressive versus conservative therapy in men with advanced and metastatic prostate cancer [2018]

    [#2] Current treatment strategies for advanced prostate cancer [2017]

    [#3] Efficacy of Local Treatment in Prostate Cancer Patients with Clinically Pelvic Lymph Node-positive Disease at Initial Diagnosis [2018]

    [#4] Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy, and their combination [2017]

    [#5] Locally advanced and high risk prostate cancer: The best indication for initial radical prostatectomy? [2014]

    [#6] Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer [2017]

    [#7] Ten year final results of the TROG 03.04 (RADAR) randomised phase 3 trial evaluating duration of androgen suppression zoledronate for locally advanced prostate cancer [2018]

    [#8] Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017 [2018]

    [#9] Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer [2018]

    [#10] Radiotherapy Plus Total Androgen Block Versus Radiotherapy Plus LHRH Analog Monotherapy for Non-metastatic Prostate Cancer [2018]

    [#11] Bone-targeted therapies to reduce skeletal morbidity in prostate cancer [2018]

    [#12] Long-term androgen deprivation, with or without radiotherapy, in locally-advanced prostate cancer: Updated results from a phase III randomized trial [2018]

    [#13] Health-related quality of life (HRQoL) deterioration and pain progression in men with non-metastatic castration-resistant prostate cancer (M0 CRPC): Results from the PROSPER study [2018]

    [#14] Systemic treatments for high-risk localized prostate cancer [2018]

    [#15] Definitive Radiation Therapy and Survival in Clinically Node-Positive Prostate Cancer [2018]

    [#16] Elderly patients aged ≥ 75 years with locally advanced prostate cancer may benefit from local treatment: a population-based propensity score-adjusted analysis [2018]

    [#17] Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations [2017]

    [#18] Treatment of Oligometastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Review [2018]

    [#19] Survival outcomes of locally advanced prostate cancer in patients aged < 50 years after local therapy in the contemporary US population [2018]

    [#20] COMPARATIVE EFFECTIVENESS OF LOCAL AND SYSTEMIC THERAPY FOR T4 PROSTATE CANCER [2018]

    [#21] Impact of Adjuvant Radiotherapy in Node-positive Prostate Cancer Patients: The Importance of Patient Selection [2018]

    [#22] Local ablative stereotactic body radiotherapy for oligometastatic prostate cancer [2018]

    [#23] Will Image-guided Metastasis-directed Therapy Change the Treatment Paradigm of Oligorecurrent Prostate Cancer? [2018]

    [#24] Non-metastatic castration resistant prostate cancer: a review of current and emerging medical therapies [2018]

    [#25] Node-positive Nonmetastatic Prostate Cancer: Time to Reconsider Prognostic Staging? [2018]

    [#26] Worth a local treatment? – Analysis of modern radiotherapy concepts for oligometastatic prostate cancer [2018]

    [#27] Survival and secondary interventions following treatment for locally-advanced prostate cancer [2018]

    [#28] Updates in advanced prostate cancer 2018 [2018]

    [#29] Survival and secondary interventions following treatment for locally-advanced prostate cancer [2018]

    [#30] Recent trends in the management of advanced prostate cancer [2018]


    [#31] Management of Prostate Cancer Patients with Clinically Positive Lymph Nodes [2019]

    [#32] Adjuvant Chemotherapy for High-Risk Localized Prostate Cancer: Time for Change or Need More Time to Change? [2019]

    [#33] Management of cT4 Prostate Cancer [2019]

    [#34] Apalutamide and overall survival in non-metastatic castration-resistant prostate cancer [2019]


    Since October:

    [#35] 2019 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC) [2019]

    Last edited by DjinTonic; 10-15-2019 at 06:08 PM.

  2. #2
    [Table of Contents p.2]

  3. #3
    [Table of Contents p.3]

  4. #4
    [Table of Contents p.4]

  5. #5
    [#1]
    Nine-year prostate cancer survival differences between aggressive versus conservative therapy in men with advanced and metastatic prostate cancer [2018]

    https://www.ncbi.nlm.nih.gov/pubmed/29499075

    Abstract

    BACKGROUND:
    To the authors' knowledge, the survival benefit of local therapy in the setting of advanced prostate cancer remains unknown. The authors investigated whether prostate-directed treatment with either surgery or radiotherapy versus conservative treatment in the setting of locally advanced or metastatic disease was associated with improved survival within a cohort of men from the Centers for Disease Control and Prevention's (CDC) Breast and Prostate Cancer Data Quality and Patterns of Care Study (CDC POC-BP).

    METHODS:
    Men diagnosed with locally advanced (cT3-T4 or N+ and M0) or metastatic prostate cancer were identified. The authors compared survival by treatment type, categorized as conservative (androgen deprivation therapy only) versus aggressive (radical prostatectomy or any type of radiotherapy). Nine-year overall survival and prostate cancer-specific survival were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to determine factors independently associated with 9-year prostate cancer-specific survival.

    RESULTS:
    For men with advanced, nonmetastatic prostate cancer, conservative treatment alone was associated with a 4 times higher likelihood of prostate cancer mortality compared with men treated with surgery (hazard ratio, 4.18; 95% confidence interval, 1.44-12.14). In contrast, no difference was found between conservative versus aggressive treatment after adjusting for covariates for men with metastatic disease. The 9-year prostate cancer-specific survival rate was 27% for those receiving aggressive treatment versus 24% for men undergoing conservative treatment.

    CONCLUSIONS:
    The authors did not observe a survival advantage with local therapy in addition to standard androgen deprivation therapy for men with metastatic prostate cancer. However, the results of the current study did affirm advantages in the setting of locally advanced disease. Aggressive local therapy in the setting of metastatic disease needs to be studied carefully before clinical adoption.
    [Emphasis mine]

    First Forum post: https://www.cancerforums.net/threads/54448-9-year-survival-differences-aggressive-vs-conservative-treatment-for-advanced-PC

  6. #6
    [#2]
    Current treatment strategies for advanced prostate cancer [2017]

    http://onlinelibrary.wiley.com/doi/10.1111/iju.13512/full

    Review of drugs and trials, 2000-2017

    Abstract

    During the past decade, treatment strategies for patients with advanced prostate cancer involving stage IV (T4N0M0, N1M0 or M1) hormone-sensitive prostate cancer and recurrent prostate cancer after treatment with curative intent, as well as castration-resistant prostate cancer, have extensively evolved with the introduction and approval of several new agents including sipuleucel-T, radium-223, abiraterone, enzalutamide and cabazitaxel, all of which have shown significant improvement on overall survival. The appropriate use of these agents and the proper sequencing of these agents are still not optimized. The results of several recently reported randomized controlled trials and retrospective studies could assist in developing a treatment strategy for advanced prostate cancer. In addition, prospective studies and molecular characterization of tumors to address these issues are ongoing.
    First Forum post: https://www.cancerforums.net/threads/53835-Current-treatment-strategies-for-advanced-prostate-cancer

  7. #7
    [#3]
    Efficacy of Local Treatment in Prostate Cancer Patients with Clinically Pelvic Lymph Node-positive Disease at Initial Diagnosis
    [2018, Full Text]

    http://www.europeanurology.com/article/S0302-2838(17)30697-8/fulltext

    Abstract

    Background
    There is limited evidence supporting the use of local treatment (LT) for prostate cancer (PCa) patients with clinically pelvic lymph node-positive (cN1) disease.

    Objective
    To examine the efficacy of any form of LT  androgen deprivation therapy (ADT) in treating these individuals.

    Design, setting, and participants
    Using the National Cancer Database (2003–2011), we retrospectively identified 2967 individuals who received LT  ADT versus ADT alone for cN1 PCa. Only radical prostatectomy (RP) and radiation therapy (RT) were considered as definitive LT.

    Intervention
    LT  ADT versus ADT alone.

    Outcome measurements and statistical analysis
    Instrumental variable analyses (IVA) were performed using a two-stage residual inclusion approach to compare overall mortality (OM)-free survival between patients who received LT  ADT versus ADT alone. The same methodology was used to further compare OM-free survival between patients who received RP  ADT versus RT  ADT.

    Results and limitations
    Overall, 1987 (67%) and 980 (33%) patients received LT  ADT and ADT alone, respectively. In the LT  ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP  ADT and RT  ADT, respectively. In IVA, LT  ADT was associated with a significant OM-free survival benefit (hazard ratio = 0.31, 95% confidence interval [CI] = 0.13–0.74, p = 0.007), when compared with ADT alone. At 5 yr, OM-free survival was 78.8% (95% CI: 74.1–83.9%) versus 49.2% (95% CI: 33.9–71.4%) in the LT  ADT versus ADT alone groups. When comparing RP  ADT versus RT  ADT, IVA showed no significant difference in OM-free survival between the two treatment modalities (hazard ratio = 0.54, 95% CI = 0.19–1.52, p = 0.2). Despite the use of an IVA, our study may be limited by residual unmeasured confounding.

    Conclusions
    Our findings show that PCa patients with clinically pelvic lymph node-positive disease may benefit from any form of LT  ADT over ADT alone. While not necessarily curative by itself, the use of RP or RT could be the first step in a multi-modality approach aiming at providing the best cancer control outcomes for these individuals.

    Patients summary
    We examined the role of local treatment for clinically pelvic lymph node-positive prostate cancer. We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone.
    [Emphasis mine]

  8. #8
    [#4] Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy, and their combination [2017, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647755/

    Abstract
    Locally advanced prostate cancer (LAPC) is defined as histologically proven T3–4 prostatic adenocarcinoma. In this review, we define the individual roles of radiotherapy (RT), short-term (ST-) and long-term (LT-) androgen deprivation therapy (ADT), and their combination in multimodal therapy for LAPC. Despite limitations in comparing the clinical outcomes among published papers, in the present study, a trend of 10-year clinical outcomes was roughly estimated by calculating the average rates weighted by the cohort number. With RT alone, the following rates were estimated: 87% biochemical failure, 34% local failure (LF), 48% distant metastasis (DM), 38% overall survival (OS), and 27% disease-specific mortality (DSM). Those associated with ADT alone were 74% BCF, 54% OS, and 25% DSM, which appeared to be better than those of RT alone. The addition of ADT to RT produced a notable local and systemic effect, regardless of ST- or LT-ADT. The LF rate decreased from 34% with RT alone to 21% with ST-ADT and further to 15% with LT-ADT. The DM and DSM rates also showed a similar trend among RT alone, RT+ST-ADT, and RT+LT-ADT. The combination of RT+LT-ADT resulted in the best long-term clinical outcomes, indicating that both RT and ADT are important parts of multimodal therapy.

    ...

    Conclusions
    We reviewed the studies related to the roles of radiotherapy, androgen deprivation therapy, and their combination for LAPC. In conclusion, RT+LT-ADT results in the best long-term clinical outcomes, in which both RT and ADT are crucial parts of multimodal therapy. Further refinement of combined modality therapy needs to be explored.

  9. #9
    [#5]
    Locally advanced and high risk prostate cancer: The best indication for initial radical prostatectomy?
    [2014, Full Text]

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832883/

    Abstract
    High risk prostate cancer is a deadly disease that needs aggressive treatment. High risk prostate cancer is often treated with androgen deprivation therapy or combined radiohormonotherapy while there is a place for surgery in cases of operable and resectable locally advanced or high risk disease. This review summarises the results of the different treatment strategies for locally advanced and high risk prostate cancer. Radical prostatectomy monotherapy or in combination with radiotherapy and/or hormonal treatment are analysed. They show that radical prostatectomy is an effective treatment modality for these tumours. After surgery, the results of the pathology and the follow-up of serum PSA may indicate the need of additional adjuvant or salvage treatment strategies.

    Conclusion
    It is very likely that RP is an effective form of treatment for locally advanced and high-grade tumours. The best candidates for RP are patients who were clinically over-staged or over-graded by the puncture biopsy and whose tumours were subsequently found to be locally confined, to have limited extracapsular extension, or to be moderately differentiated. However, this does not mean that more advanced stages or grades are necessarily a contraindication for surgery. In younger patients, even advanced tumours and Gleason scores ≥8 are best managed initially by surgery. The increased use of nomograms and modern imaging techniques is helpful in recognising patients with locally advanced disease or high-grade disease most likely to benefit from surgical treatment.

    Urologists must use the pathologic results, which indicate the need for additional postoperative treatment, to improve the final outcome. Further studies will be required to clarify whether neoadjuvant (chemo)-HT, adjuvant/salvage (chemo)-HT, and adjuvant/salvage RT can improve the results of RP.

  10. #10
    [#6]
    Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer
    [2017]

    https://www.thegreenjournal.com/article/S0167-8140(17)30414-0/abstract

    Abstract

    Background
    Single-dose high-dose-rate brachytherapy (HDR-BT), in a Phase-II study, was compared to two or three fractions in intermediate and high-risk localized prostate cancer.

    Patients and methods
    293 patients received 1  19 Gy or 1  20 Gy (A = 49), 2  13 Gy (B = 138 ), or 3  10.5 Gy (C = 106) and assessed with prospective measures of serum PSA, late genitourinary (GU) and gastrointestinal (GI) morbidity using RTOG scales and the International Prostate Symptom Score (IPSS).

    Results
    Median follow-up is 49, 63 and 108 months (A, B and C, respectively). At 4 years biochemical relapse free survival was 94% (A), 93% (B) and 91% (C) (p = 0.54). Risk-category was the only significant independent predictor of relapse (p < 0.0001). Kaplan–Meier 4-year-estimates of GU-3 were 2% (A and B) and 11% (C). GI-3 was 0% (A and B) and 1% (C). No GU or GI grade-4 events were observed. IPSS ≥ 20 was 11% (A), 9% (B) and 16% (C) (p = 0.9). Prevalence of GU-3 was ≤4% in the 3 groups at all times; GI-3 was low or non-existent. Prevalence of catheter use was ≤6% in all groups.

    Conclusions
    A single dose of 19–20 Gy achieves similar rates of late morbidity and biochemical control compared to 2 and 3 fractions.
    Last edited by DjinTonic; 05-02-2018 at 05:33 AM.

 

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