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Diagnosis and Treatment of Prostate Adenocarcinoma

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

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 24856

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Assoc. Prof. Takahiro Kimura

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Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
Interests: Medical therapy for prostate cancer, Surgery for genitourinary cancer, Pathology of prostate caner

Assist. Prof. Shoji Kimura

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Guest Editor

Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
Interests: Medical therapy for prostate cancer; surgery for genitourinary cancer; pathology of prostate cancer

Special Issue Information

Dear Colleagues,

Prostate cancer is the second most frequently diagnosed cancer and the fifth leading cause of cancer-related deaths among men worldwide. Over the last several years, significant advances in the diagnostic and therapeutic modalities of prostate cancer have revolutionized its management in daily practice. Magnetic resonance imaging/ultrasound fusion guided biopsy improves the accuracy of prostate biopsy, and next-generation imaging modalities, such as prostate-specific membrane antigen-based positron emission tomography, can detect low-volume metastases and are useful for the staging of locally advanced cancer. Focal therapy is a novel, minimally invasive therapeutic approach to cancer. It has been reported that the early administration of drugs such as docetaxel and abiraterone acetate (which were previously used for castration-resistant prostate cancer) in patients with hormone-sensitive cancer is significantly associated with improved overall survival. In this Special Issue, experts in this field will review recent progress in important topics associated with prostate cancer.

Assoc. Prof. Takahiro Kimura
Assist. Prof. Shoji Kimura
Guest Editors

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Keywords

prostate cancer
MRI/ultrasound fusion guided biopsy
next-generation imaging modalities
focal therapy
metastatic hormone-sensitive prostate cancer

Published Papers (11 papers)

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Editorial

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3 pages, 186 KiB

Open AccessEditorial

Diagnosis and Treatment of Prostate Adenocarcinoma

by Shoji Kimura and Takahiro Kimura

Cancers 2021, 13(15), 3660; https://doi.org/10.3390/cancers13153660 - 21 Jul 2021

Cited by 3 | Viewed by 1476

Abstract

Prostate cancer is the second most common cancer and the fifth leading cause of cancer-related death among men worldwide [...] Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

Research

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16 pages, 1492 KiB

Open AccessArticle

Optimizing External Beam Radiotherapy as per the Risk Group of Localized Prostate Cancer: A Nationwide Multi-Institutional Study (KROG 18-15)

by Seo Hee Choi, Young Seok Kim, Jesang Yu, Taek-Keun Nam, Jae-Sung Kim, Bum-Sup Jang, Jin Ho Kim, Youngkyong Kim, Bae Kwon Jeong, Ah Ram Chang, Young-Hee Park, Sung Uk Lee, Kwan Ho Cho, Jin Hee Kim, Hunjung Kim, Youngmin Choi, Yeon Joo Kim, Dong Soo Lee, Young Ju Shin, Su Jung Shim, Won Park and Jaeho Cho Show full author list Hide full author list

Cancers 2021, 13(11), 2732; https://doi.org/10.3390/cancers13112732 - 31 May 2021

Cited by 1 | Viewed by 2570

Abstract

Purpose: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. Methods and Materials: We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. Results: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524–0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy_1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy_1.5 were significant factors in the high-risk group, whereas ≥170 Gy_1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy_1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. Conclusions: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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12 pages, 1129 KiB

Open AccessArticle

Impact of Grade Groups on Prostate Cancer-Specific and Other-Cause Mortality: Competing Risk Analysis from a Large Single Institution Series

by Daimantas Milonas, Tomas Ruzgas, Zilvinas Venclovas, Mindaugas Jievaltas and Steven Joniau

Cancers 2021, 13(8), 1963; https://doi.org/10.3390/cancers13081963 - 19 Apr 2021

Cited by 9 | Viewed by 1653

Abstract

Objective: To assess the risk of cancer-specific mortality (CSM) and other-cause mortality (OCM) using post-operative International Society of Urological Pathology Grade Group (GG) model in patients after radical prostatectomy (RP). Patients and Methods: Overall 1921 consecutive men who underwent RP during 2001 to 2017 in a single tertiary center were included in the study. Multivariate competing risk regression analysis was used to identify significant predictors and quantify cumulative incidence of CSM and OCM. Time-depending area under the curve (AUC) depicted the performance of GG model on prediction of CSM. Results: Over a median follow-up of 7.9-year (IQR 4.4-11.7) after RP, 235 (12.2%) deaths were registered, and 52 (2.7%) of them were related to PCa. GG model showed high and stable performance (time-dependent AUC 0.88) on prediction of CSM. Cumulative 10-year CSM in GGs 1 to 5 was 0.9%, 2.3%, 7.6%, 14.7%, and 48.6%, respectively; 10-year OCM in GGs was 15.5%, 16.1%, 12.6%, 17.7% and 6.5%, respectively. The ratio between 10-year CSM/OCM in GGs 1 to 5 was 1:17, 1:7, 1:2, 1:1, and 7:1, respectively. Conclusions: Cancer-specific and other-cause mortality differed widely between GGs. Presented findings could aid in personalized clinical decision making for active treatment. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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12 pages, 264 KiB

Open AccessArticle

Latest Comprehensive Medical Resource Consumption in Robot-Assisted versus Laparoscopic and Traditional Open Radical Prostatectomy: A Nationwide Population-Based Cohort Study

by Szu-Yuan Wu, Shyh-Chyi Chang, Chang-I Chen and Chung-Chien Huang

Cancers 2021, 13(7), 1564; https://doi.org/10.3390/cancers13071564 - 29 Mar 2021

Cited by 8 | Viewed by 1799

Abstract

Background: Few studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups. Purpose: To estimate long-term medical resource consumption among patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). Patients and Methods: Participants were men enrolled in the Taiwan Cancer Registry with localized PC diagnosis who received radical prostatectomy. After adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the number of urology outpatient clinic visits required, proportion of patients being hospitalized for urinary diseases or surgical complications, and medical reimbursement for urinary diseases or surgical complications following ORP, LRP, or RARP in the first, second, and third years. Results: No differences were observed in the median number of urology outpatient clinic visits between the three types of surgical modalities up to the second year after ORP, LRP, and RARP (median: 15, 10, and seven visits, respectively; p < 0.001), but significant differences were observed in the third year. Similarly, with RARP (10.9% versus 18.7% in ORP and 9.8% in LRP; p = 0.0014), the rate of hospitalization for urinary diseases or surgical complications decreased in the third year. Medical reimbursement for urinary diseases or surgical complications reduced after RARP compared with that for ORP and LRP, with approximately 22% reduction in the first year (p = 0.0052) and 20–40% reduction in the third year (p value = 0.0024). Conclusions: Medical resource consumption in the RARP group was less compared with those in the ORP and LRP groups. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

17 pages, 1550 KiB

Open AccessFeature PaperArticle

Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma

by Szu-Yuan Wu, Shyh-Chyi Chang, Chang-I Chen and Chung-Chien Huang

Cancers 2021, 13(7), 1517; https://doi.org/10.3390/cancers13071517 - 25 Mar 2021

Cited by 7 | Viewed by 2095

Abstract

Purpose: To estimate the oncologic outcomes of radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) with short-term androgen-deprivation therapy (ADT) in relatively young men with unfavorable intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network (NCCN-UIR-PC). Patients and Methods: We enrolled relatively young men (≤65 years) from the Taiwan Cancer Registry who had been diagnosed as having NCCN-UIR-PC and who had received RP or high-dose IMRT (at least ≥72 Gy) with short-term ADT (4–6 months). After propensity score matching of the confounders, Cox proportional regression was used to model the time from the index date (i.e., date of diagnosis) to all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM). Results: The corresponding adjusted hazard ratios (95% confidence intervals) of the risk of all-cause death, BF, LRR, and DM were 2.76 (1.36–5.60, p = 0.0050), 2.74 (1.72–4.84, p < 0.0001), 1.28 (1.09–1.90, p = 0.0324), and 2.11 (1.40–4.88, p = 0.0052), respectively. Conclusions: RP is superior to high-dose IMRT with short-term ADT in terms of oncologic outcomes for relatively young men with UIR-PC. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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12 pages, 609 KiB

Open AccessArticle

Rare Germline Pathogenic Variants Identified by Multigene Panel Testing and the Risk of Aggressive Prostate Cancer

by Tú Nguyen-Dumont, James G. Dowty, Robert J. MacInnis, Jason A. Steen, Moeen Riaz, Pierre-Antoine Dugué, Anne-Laure Renault, Fleur Hammet, Maryam Mahmoodi, Derrick Theys, Helen Tsimiklis, Gianluca Severi, Damien Bolton, Paul Lacaze, Robert Sebra, Eric Schadt, John McNeil, Graham G. Giles, Roger L. Milne and Melissa C. Southey

Cancers 2021, 13(7), 1495; https://doi.org/10.3390/cancers13071495 - 24 Mar 2021

Cited by 13 | Viewed by 2655

Abstract

While gene panel sequencing is becoming widely used for cancer risk prediction, its clinical utility with respect to predicting aggressive prostate cancer (PrCa) is limited by our current understanding of the genetic risk factors associated with predisposition to this potentially lethal disease phenotype. This study included 837 men diagnosed with aggressive PrCa and 7261 controls (unaffected men and men who did not meet criteria for aggressive PrCa). Rare germline pathogenic variants (including likely pathogenic variants) were identified by targeted sequencing of 26 known or putative cancer predisposition genes. We found that 85 (10%) men with aggressive PrCa and 265 (4%) controls carried a pathogenic variant (p < 0.0001). Aggressive PrCa odds ratios (ORs) were estimated using unconditional logistic regression. Increased risk of aggressive PrCa (OR (95% confidence interval)) was identified for pathogenic variants in BRCA2 (5.8 (2.7–12.4)), BRCA1 (5.5 (1.8–16.6)), and ATM (3.8 (1.6–9.1)). Our study provides further evidence that rare germline pathogenic variants in these genes are associated with increased risk of this aggressive, clinically relevant subset of PrCa. These rare genetic variants could be incorporated into risk prediction models to improve their precision to identify men at highest risk of aggressive prostate cancer and be used to identify men with newly diagnosed prostate cancer who require urgent treatment. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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14 pages, 1865 KiB

Open AccessArticle

Prognostic Value of High-Sensitivity Modified Glasgow Prognostic Score in Castration-Resistant Prostate Cancer Patients Who Received Docetaxel

by Keisuke Ando, Shinichi Sakamoto, Shinpei Saito, Maihulan Maimaiti, Yusuke Imamura, Tomokazu Sazuka, Nobuo Sato, Akira Komiya, Naohiko Anzai and Tomohiko Ichikawa

Cancers 2021, 13(4), 773; https://doi.org/10.3390/cancers13040773 - 12 Feb 2021

Cited by 13 | Viewed by 2058

Abstract

The Glasgow prognostic score, a marker of systemic inflammation, is associated with clinical outcomes in different cancers including prostate cancer. However, there is no evidence for the relationship between the high-sensitivity modified Glasgow prognostic score (Hs-mGPS) in prostate cancer and its prognosis. This study aimed to investigate the prognostic significance of Hs-mGPS in castration-resistant prostate cancer (CRPC) treated with docetaxel. We retrospectively analyzed clinical datasets from 131 CRPC patients who received docetaxel treatment at Chiba University Hospital and a related hospital. Clinical factors including Hs-mGPS before docetaxel treatment were evaluated according to overall survival. The numbers of patients with Hs-mGPS of 0, 1, and 2 were 88, 30, and 13, respectively. The median prostate-specific antigen (PSA) level was 28.9 ng/mL. The median testosterone level was 13.0 ng/dL. The percentages of bone and visceral metastases were 80.8% and 10.2%, respectively. For overall survival, Hs-mGPS ≥ 1 (hazard ratio of 2.41; p = 0.0048), testosterone ≥ 13.0 ng/dL (hazard ratio of 2.23; p = 0.0117), and PSA ≥ 28.9 ng/mL (hazard ratio of 2.36; p = 0.0097) were significant poor prognostic factors in the multivariate analysis. The results of the two-group analysis showed that a higher Hs-mGPS was associated with high PSA, alkaline phosphatase, and testosterone levels. The median testosterone levels for Hs-mGPS of 0, 1, and 2 were 9.0, 16.5, and 23.0, respectively. Based on the multivariate analysis, we created a combined score with three prognostic factors: Hs-mGPS, testosterone, and PSA. The low-risk group (score of 0–1) showed a significantly longer overall survival compared to the intermediate-risk (score of 2–3) and high-risk (score of 4) groups (p < 0.0001). Our results demonstrated that an elevated Hs-mGPS was an independent prognostic factor in CRPC patients treated with docetaxel therapy. Risk classification based on Hs-mGPS, testosterone, and PSA may be useful in predicting the prognosis of CRPC patients. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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13 pages, 738 KiB

Open AccessArticle

Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database

by Shyh-Chyi Chang, Chia-Hao Hsu, Yi-Chu Lin and Szu-Yuan Wu

Cancers 2021, 13(3), 488; https://doi.org/10.3390/cancers13030488 - 27 Jan 2021

Cited by 16 | Viewed by 1963

Abstract

Purpose: To examine the effect of hospital volume on positive surgical margin (PSM) and biochemical-failure-free survival (BFS) rates in patients with prostate cancer (PC) undergoing robotic-assisted or nonrobotic-assisted radical prostatectomy (RP). Patients and Methods: The patients were men collected in the National Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP from 44 multi-institutes in Taiwan. The logistic regression method was used to analyze the risk from RP to PSM in included patients with hospital volume (i.e., number of patients with PC receiving robotic RP per year), and the Cox proportional hazards method was used to analyze the time from the index date to biochemical recurrence. Results: After propensity score adjustment, compared with hospitals with >100 patients/year, the adjusted odds ratios (aORs; 95% confidence intervals) of PSM in the robotic RP group in hospitals with 1–25, 26–50, and 51–100 patients/year were 2.25 (2.10–3.11), 1.42 (1.25–2.23), and 1.33 (1.13–2.04), respectively (type III p < 0.0001). Sensitivity analysis indicated that the aORs of PSM were 1.29 (1.07–1.81), 1.07 (0.70–1.19), and 0.61 (0.56–0.83), respectively, for patients receiving robotic RP compared with nonrobotic RP within hospitals with 1–25, 26–50, and 51–100 patients/year, respectively. Compared with hospitals with >100 patients/year, the adjusted hazard ratios (aHRs) of biochemical failure in the robotic RP group were 1.40 (1.04–1.67), 1.34 (1.06–1.96), and 1.31 (1.05–2.15) in hospitals with 1–25, 26–50, and 51–100 patients/year, respectively. Conclusions: Hospital volume significantly affected PSM and BFS in robotic RP, but not in nonrobotic RP. When patients with PC want to receive robotic RP, it should be performed in a relatively high-volume hospital (>100 patients/year). Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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14 pages, 747 KiB

Open AccessFeature PaperArticle

There Are No Differences in Positive Surgical Margin Rates or Biochemical Failure–Free Survival among Patients Receiving Open, Laparoscopic, or Robotic Radical Prostatectomy: A Nationwide Cohort Study from the National Cancer Database

by Shyh-Chyi Chang, Ho-Min Chen and Szu-Yuan Wu

Cancers 2021, 13(1), 106; https://doi.org/10.3390/cancers13010106 - 31 Dec 2020

Cited by 12 | Viewed by 2070

Abstract

Purpose: To estimate the rates of positive surgical margin (PSM) and biochemical failure–free survival (BFS) among patients with prostate cancer (PC) receiving open, laparoscopic, or robotic radical prostatectomy (RP). Patients and Methods: The patients were men enrolled in the Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP. After adjustment for confounders, logistic regression was used to model the risk of PSM following RP. After adjustment for confounders, Cox proportional regression was used to model the time from the index (i.e., surgical) date to biochemical recurrence. Results: The adjusted odds ratios (95% CIs) of PSM risk after propensity score adjustment for laparoscopic versus open, robotic versus open, and robotic versus laparoscopic RP 95% CIs were 1.25 (0.88 to 1.77; p = 0.2064), 1.16 (0.88 to 1.53; p = 0.2847), and 0.93 (0.70 to 1.24; p = 0.6185), respectively. The corresponding adjusted hazard ratios (95% CIs) of risk of biochemical failure after propensity score adjustment were 1.16 (0.93 to 1.47; p = 0.1940), 1.10 (0.83 to 1.47; p = 0.5085), and 0.95 (0.74 to 1.21; p = 0.6582). Conclusions: No significant differences in PSM or BFS were observed among patients receiving open, laparoscopic, or robotic RP. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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11 pages, 2421 KiB

Open AccessSystematic Review

Prognostic Significance of Prostate-Specific Antigen Persistence after Radical Prostatectomy: A Systematic Review and Meta-Analysis

by Shoji Kimura, Fumihiko Urabe, Hiroshi Sasaki, Takahiro Kimura, Kenta Miki and Shin Egawa

Cancers 2021, 13(5), 948; https://doi.org/10.3390/cancers13050948 - 24 Feb 2021

Cited by 15 | Viewed by 2042

Abstract

We performed a systematic review and meta-analysis to assess the prognostic value of prostate-specific antigen (PSA) persistence 4–8 weeks after radical prostatectomy (RP) in patients with prostate cancer, using studies from Medline, Scopus, and Cochrane Library, on 10 October 2020. Studies were eligible if they compared patients with postoperative PSA persistence 4–8 weeks after RP to those without such persistence to assess the value of PSA persistence in prognosticating biochemical recurrence (BCR), disease recurrence, cancer-specific mortality (CSM), and overall mortality (OM) by multivariable analysis. Our review and analysis included nine studies published between 2008 and 2019 with 14,455 patients. Of those studies, 12.0% showed postoperative PSA persistence. PSA persistence was associated with BCR (HR: 4.44, 95% CI: 2.84–6.93), disease recurrence (HR: 3.43, 95% CI: 1.62–7.25), and CSM (HR: 2.32, 95% CI: 1.83–2.95). We omitted meta-analysis on the association of PSA persistence with OM due to an insufficient number of studies. PSA persistence was associated with disease recurrence in a sub-group of patients with pathological nodal involvement (HR: 5.90, 95% CI: 3.76–9.24). Understanding detection of PSA persistence at 4–8 weeks after RP might be useful for patient counseling, follow-up scheduling, and clinical decision-making regarding adjuvant therapies. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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16 pages, 1539 KiB

Open AccessSystematic Review

Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review

by Mohammad Abufaraj, Abdelmuez Siyam, Mustafa Rami Ali, Rodrigo Suarez-Ibarrola, Lin Yang, Beat Foerster and Shahrokh F. Shariat

Cancers 2021, 13(2), 244; https://doi.org/10.3390/cancers13020244 - 11 Jan 2021

Cited by 6 | Viewed by 3366

Abstract

Purpose: To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. Methods: This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. Results: The rates of severe urinary incontinence ranged from 28–88%, 4.5–42%, 0–6.5%, 2.4–8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5–3.4, 3.5–12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. Conclusions: local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)

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