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Cancers
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Advances in Prostate Cancer Radiotherapy
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Advances in Prostate Cancer Radiotherapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 9043

Special Issue Editors

Dr. Sean P. Collins

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Guest Editor
Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC 20007, USA
Interests: prostate cancer; radiation therapy
Dr. Thomas Kole

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Guest Editor
Department of Radiation Oncology, The Valley Health Hospital, Ridgewood, NJ 07450, USA
Interests: prostate cancer; SBRT
Dr. Olusola Obayomi-Davies

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Guest Editor
Department of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, GA 30060, USA
Interests: prostate cancer; radiotherapy; SBRT
Dr. Nima Aghdam

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Guest Editor
Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
Interests: prostate cancer; radiotherapy; SBRT
Dr. Jonathan W. Lischalk

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Guest Editor
Department of Radiation Oncology, Perlmutter Cancer Center, New York University Langone Hospital—Long Island, New York, NY 10023, USA
Interests: prostate cancer; radiotherapy
Special Issues, Collections and Topics in MDPI journals
Dr. Michael C. Repka

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Guest Editor
Department of Radiation Oncology, Perlmutter Cancer Center, New York University Langone Hospital—Long Island, New York, NY 10023, USA
Interests: prostate cancer; SBRT
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Since the advent of routine PSA screening, the majority of prostate cancers are diagnosed when confined to the prostate and may be treated with curative intent. Non-operative treatment using radiation therapy has been well established as a primary definitive treatment modality due to its equivalence in terms of efficacy as compared to radical prostatectomy. Over the past several decades, radiation technology has made significant advances in treatment delivery through the use of inverse planning and enhanced stereotactic image guidance. This has resulted in greater treatment precision and more favorable outcomes due to tumor dose escalation, as well as decreased treatment-related morbidity. During this time, stereotactic body radiotherapy (SBRT) or ultrahypofractionated treatment courses have emerged as safe and effective alternatives to longer conventional courses of radiation treatment. This Special Issue will focus on the evolving role of SBRT in the treatment of prostate cancer, including the influence of biological imaging, dose escalation, image guidance, and modulation of androgen signaling.

Dr. Sean P. Collins
Dr. Thomas Kole
Dr. Olusola Obayomi-Davies
Dr. Nima Aghdam
Dr. Jonathan W. Lischalk
Dr. Michael C. Repka
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • radiotherapy
  • biological imaging
  • dose escalation
  • image guidance
  • androgen signaling

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Published Papers (4 papers)

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Research

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18 pages, 1299 KiB  
Article
Association Between Medicaid Expansion and Insurance Status, Risk Group, Receipt, and Refusal of Treatment Among Men with Prostate Cancer
by Tej A. Patel, Bhav Jain, Edward Christopher Dee, Khushi Kohli, Sruthi Ranganathan, James Janopaul-Naylor, Brandon A. Mahal, Kosj Yamoah, Sean M. McBride, Paul L. Nguyen, Fumiko Chino, Vinayak Muralidhar, Miranda B. Lam and Neha Vapiwala
Cancers 2025, 17(3), 547; https://doi.org/10.3390/cancers17030547 - 6 Feb 2025
Viewed by 888
Abstract
Background: Although the Patient Protection and Affordable Care Act (ACA) has been associated with increased Medicaid coverage among prostate cancer patients, the association between Medicaid expansion with risk group at diagnosis, time to treatment initiation (TTI), and the refusal of locoregional treatment [...] Read more.
Background: Although the Patient Protection and Affordable Care Act (ACA) has been associated with increased Medicaid coverage among prostate cancer patients, the association between Medicaid expansion with risk group at diagnosis, time to treatment initiation (TTI), and the refusal of locoregional treatment (LT) among patients requires further exploration. Methods: Using the National Cancer Database, we performed a retrospective cohort analysis of all patients aged 40 to 64 years diagnosed with localized prostate cancer from 2011 to 2016. Difference-in-difference (DID) analysis was used to compare changes in insurance status, risk group at diagnosis, TTI, and the refusal of LT among patients residing in Medicaid expansion versus non-expansion states. In a secondary analysis, we used DID to compare changes in the above outcomes among racial minorities versus White patients living in expansion states. Results: Of the 112,434 patients with prostate cancer in our analysis, 50,958 patients lived in Medicaid expansion states, and 61,476 patients lived in non-expansion states. In the adjusted analysis, we found that the proportion of uninsured patients (adjusted DID: −0.87%; 95% confidence interval [95% CI]: −1.28 to −0.46) and patients who refused radiation therapy (adjusted DID: −0.71%; 95% CI: −0.95 to −0.47) decreased more in expansion states compared to non-expansion states. Similarly, we observed that the racial disparity of select outcomes in expansion states narrowed, as racial minorities experienced larger absolute decreases in uninsured status and the refusal of radiation therapy (RT) regimens than White patients following ACA implementation (p < 0.01 for all). However, residence in a Medicaid expansion state was not associated with changes in risk group at diagnosis, TTI, nor the refusal of LT (p > 0.01 for all); racial disparities in TTI were also exacerbated in expansion states following ACA implementation. Conclusions: The association between Medicaid expansion and prostate cancer outcomes and disparities remains unclear. While ACA implementation was associated with increased insurance coverage and decreased refusal of RT, there was no significant association with earlier risk group at diagnosis, TTI within 180 days, or refusal of LT. Similarly, racial minorities in expansion states had larger decreases in uninsured status and the refusal of RT regimens, as well as smaller increases in intermediate-/high-risk disease at presentation than White patients following ACA implementation, but experienced no significant changes in TTI. More research is needed to understand how Medicaid expansion affects cancer outcomes and whether these effects are borne equitably among different populations. Full article
(This article belongs to the Special Issue Advances in Prostate Cancer Radiotherapy)
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13 pages, 420 KiB  
Article
Radiobiological Meta-Analysis of the Response of Prostate Cancer to Different Fractionations: Evaluation of the Linear–Quadratic Response at Large Doses and the Effect of Risk and ADT
by Juan Pardo-Montero, Isabel González-Crespo, Antonio Gómez-Caamaño and Araceli Gago-Arias
Cancers 2023, 15(14), 3659; https://doi.org/10.3390/cancers15143659 - 18 Jul 2023
Cited by 1 | Viewed by 1662
Abstract
The purpose of this work was to investigate the response of prostate cancer to different radiotherapy schedules, including hypofractionation, to evaluate potential departures from the linear–quadratic (LQ) response, to obtain the best-fitting parameters for low-(LR), intermediate-(IR), and high-risk (HR) prostate cancer and to [...] Read more.
The purpose of this work was to investigate the response of prostate cancer to different radiotherapy schedules, including hypofractionation, to evaluate potential departures from the linear–quadratic (LQ) response, to obtain the best-fitting parameters for low-(LR), intermediate-(IR), and high-risk (HR) prostate cancer and to investigate the effect of ADT on the radiobiological response. We constructed a dataset of the dose–response containing 87 entries/16,536 patients (35/5181 LR, 32/8146 IR, 20/3209 HR), with doses per fraction ranging from 1.8 to 10 Gy. These data were fit to tumour control probability models based on the LQ model, linear–quadratic–linear (LQL) model, and a modification of the LQ (LQmod) model accounting for increasing radiosensitivity at large doses. Fits were performed with the maximum likelihood expectation methodology, and the Akaike information criterion (AIC) was used to compare the models. The AIC showed that the LQ model was superior to the LQL and LQmod models for all risks, except for IR, where the LQL model outperformed the other models. The analysis showed a low α/β for all risks: 2.0 Gy for LR (95% confidence interval: 1.7–2.3), 3.4 Gy for IR (3.0–4.0), and 2.8 Gy for HR (1.4–4.2). The best fits did not show proliferation for LR and showed moderate proliferation for IR/HR. The addition of ADT was consistent with a suppression of proliferation. In conclusion, the LQ model described the response of prostate cancer better than the alternative models. Only for IR, the LQL model outperformed the LQ model, pointing out a possible saturation of radiation damage with increasing dose. This study confirmed a low α/β for all risks. Full article
(This article belongs to the Special Issue Advances in Prostate Cancer Radiotherapy)
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11 pages, 2222 KiB  
Article
Genomic Prostate Score: A New Tool to Assess Prognosis and Optimize Radiation Therapy Volumes and ADT in Intermediate-Risk Prostate Cancer
by Yazid Belkacemi, Kamel Debbi, Gabriele Coraggio, Jérome Bendavid, Maya Nourieh, Nhu Hanh To, Mohamed Aziz Cherif, Carolina Saldana, Alexandre Ingels, Alexandre De La Taille and Gokoulakrichenane Loganadane
Cancers 2023, 15(3), 945; https://doi.org/10.3390/cancers15030945 - 2 Feb 2023
Cited by 3 | Viewed by 2426
Abstract
Genomic classifiers such as the Genomic Prostate Score (GPS) could help to personalize treatment for men with intermediate-risk prostate cancer (I-PCa). In this study, we aimed to evaluate the ability of the GPS to change therapeutic decision making in I-PCa. Only patients in [...] Read more.
Genomic classifiers such as the Genomic Prostate Score (GPS) could help to personalize treatment for men with intermediate-risk prostate cancer (I-PCa). In this study, we aimed to evaluate the ability of the GPS to change therapeutic decision making in I-PCa. Only patients in the intermediate NCCN risk group with Gleason score 3 + 4 were considered. The primary objective was to assess the impact of the GPS on risk stratification: NCCN clinical and genomic risk versus NCCN clinical risk stratification alone. We also analyzed the predictive role of the GPS for locally advanced disease (≥pT3+) and the potential change in treatment strategy. Thirty patients were tested for their GPS between November 2018 and March 2020, with the median age being 70 (45–79). Twenty-three patients had a clinical T1 stage. Eighteen patients were classified as favorable intermediate risk (FIR) based on the NCCN criteria. The median GPS score was 39 (17–70). Among the 23 patients who underwent a radical prostatectomy, Gleason score 3 + 4 was found in 18 patients. There was a significant correlation between the GPS and the percentage of a Gleason grade 4 or higher pattern in the surgical sample: correlation coefficient r = 0.56; 95% CI = 0.2–0.8; p = 0.005. In this study, the GPS combined with NCCN clinical risk factors resulted in significant changes in risk group. Full article
(This article belongs to the Special Issue Advances in Prostate Cancer Radiotherapy)
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Review

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14 pages, 1148 KiB  
Review
MRI-Guided Radiation Therapy for Prostate Cancer: The Next Frontier in Ultrahypofractionation
by Cecil M. Benitez, Michael L. Steinberg, Minsong Cao, X. Sharon Qi, James M. Lamb, Amar U. Kishan and Luca F. Valle
Cancers 2023, 15(18), 4657; https://doi.org/10.3390/cancers15184657 - 21 Sep 2023
Cited by 5 | Viewed by 2917
Abstract
Technological advances in MRI-guided radiation therapy (MRIgRT) have improved real-time visualization of the prostate and its surrounding structures over CT-guided radiation therapy. Seminal studies have demonstrated safe dose escalation achieved through ultrahypofractionation with MRIgRT due to planning target volume (PTV) margin reduction and [...] Read more.
Technological advances in MRI-guided radiation therapy (MRIgRT) have improved real-time visualization of the prostate and its surrounding structures over CT-guided radiation therapy. Seminal studies have demonstrated safe dose escalation achieved through ultrahypofractionation with MRIgRT due to planning target volume (PTV) margin reduction and treatment gating. On-table adaptation with MRI-based technologies can also incorporate real-time changes in target shape and volume and can reduce high doses of radiation to sensitive surrounding structures that may move into the treatment field. Ongoing clinical trials seek to refine ultrahypofractionated radiotherapy treatments for prostate cancer using MRIgRT. Though these studies have the potential to demonstrate improved biochemical control and reduced side effects, limitations concerning patient treatment times and operational workflows may preclude wide adoption of this technology outside of centers of excellence. In this review, we discuss the advantages and limitations of MRIgRT for prostate cancer, as well as clinical trials testing the efficacy and toxicity of ultrafractionation in patients with localized or post-prostatectomy recurrent prostate cancer. Full article
(This article belongs to the Special Issue Advances in Prostate Cancer Radiotherapy)
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