New Insights into Prostate Cancer Diagnosis and Treatment

A topical collection in Current Oncology (ISSN 1718-7729). This collection belongs to the section "Genitourinary Oncology".

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Collection Editor
Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
Interests: prostate cancer; breast cancer; neuro-endocrine tumor/carcinoma

Topical Collection Information

Dear Colleagues,

Prostate cancer (PCa) is the second most common cancer and the third leading cause of oncology-related death in men in the high-income countries. Curative therapy for PCa is surgical radical prostatectomy and/or local radiation therapy; however, approximately 5% to 20% of men will continue to have detectable or persistent levels of the tumor marker prostate-specific antigen (PSA) after primary treatment, and 27% to 53% will develop a PSA increase 5 years later in terms of biochemical recurrence.

Depending on tumor stage, the 5-year survival rate for these patients varies from 100% in early tumor stage to only 30% in patients with advanced cancer. Therefore, it is important to detect and accurately assess the stage of the disease as early as possible.

In this respect, prostate-specific membrane antigen (abbreviated as PSMA), which is normally expressed in all types of prostate tissue, including inflammatory, benign, and malignant prostate tissue, has recently become the focus of research. Their levels in patients with PCa and especially those with aggressive types and metastatic as well as castration-resistant PCa increase up to 1000-fold their normal levels and negatively correlate with androgen levels. Thus, these receptors are an exceptionally attractive theranostics molecule for the diagnosis and therapy of prostate tumor and its related metastases. They have subsequently emerged as the target of numerous diagnostic and therapeutic studies, highlighting the critical role of these receptors in the further therapeutic management of patients with prostate cancer.

Dear colleagues, I look forward to your interesting contributions and your valuable experiences with PSMA in the field of PCa.

Dr. Sazan Rasul
Collection Editor

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Keywords

  • prostate cancer
  • prostate-specific membrane antigen
  • tumor staging
  • PET-CT/MRI
  • theranostics

Published Papers (17 papers)

2023

Jump to: 2022, 2021

18 pages, 3402 KiB  
Article
Differences in the Volatilomic Urinary Biosignature of Prostate Cancer Patients as a Feasibility Study for the Detection of Potential Biomarkers
by Giulia Riccio, Cristina V. Berenguer, Rosa Perestrelo, Ferdinando Pereira, Pedro Berenguer, Cristina P. Ornelas, Ana Célia Sousa, João Aragão Vital, Maria do Carmo Pinto, Jorge A. M. Pereira, Viviana Greco and José S. Câmara
Curr. Oncol. 2023, 30(5), 4904-4921; https://doi.org/10.3390/curroncol30050370 - 10 May 2023
Cited by 1 | Viewed by 2535
Abstract
Prostate cancer (PCa) continues to be the second most common malignant tumour and the main cause of oncological death in men. Investigating endogenous volatile organic metabolites (VOMs) produced by various metabolic pathways is emerging as a novel, effective, and non-invasive source of information [...] Read more.
Prostate cancer (PCa) continues to be the second most common malignant tumour and the main cause of oncological death in men. Investigating endogenous volatile organic metabolites (VOMs) produced by various metabolic pathways is emerging as a novel, effective, and non-invasive source of information to establish the volatilomic biosignature of PCa. In this study, headspace solid-phase microextraction combined with gas chromatography–mass spectrometry (HS-SPME/GC-MS) was used to establish the urine volatilomic profile of PCa and identify VOMs that can discriminate between the two investigated groups. This non-invasive approach was applied to oncological patients (PCa group, n = 26) and cancer-free individuals (control group, n = 30), retrieving a total of 147 VOMs from various chemical families. This included terpenes, norisoprenoid, sesquiterpenes, phenolic, sulphur and furanic compounds, ketones, alcohols, esters, aldehydes, carboxylic acid, benzene and naphthalene derivatives, hydrocarbons, and heterocyclic hydrocarbons. The data matrix was subjected to multivariate analysis, namely partial least-squares discriminant analysis (PLS-DA). Accordingly, this analysis showed that the group under study presented different volatomic profiles and suggested potential PCa biomarkers. Nevertheless, a larger cohort of samples is required to boost the predictability and accuracy of the statistical models developed. Full article
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22 pages, 2080 KiB  
Review
Underlying Features of Prostate Cancer—Statistics, Risk Factors, and Emerging Methods for Its Diagnosis
by Cristina V. Berenguer, Ferdinando Pereira, José S. Câmara and Jorge A. M. Pereira
Curr. Oncol. 2023, 30(2), 2300-2321; https://doi.org/10.3390/curroncol30020178 - 15 Feb 2023
Cited by 15 | Viewed by 5954
Abstract
Prostate cancer (PCa) is the most frequently occurring type of malignant tumor and a leading cause of oncological death in men. PCa is very heterogeneous in terms of grade, phenotypes, and genetics, displaying complex features. This tumor often has indolent growth, not compromising [...] Read more.
Prostate cancer (PCa) is the most frequently occurring type of malignant tumor and a leading cause of oncological death in men. PCa is very heterogeneous in terms of grade, phenotypes, and genetics, displaying complex features. This tumor often has indolent growth, not compromising the patient’s quality of life, while its more aggressive forms can manifest rapid growth with progression to adjacent organs and spread to lymph nodes and bones. Nevertheless, the overtreatment of PCa patients leads to important physical, mental, and economic burdens, which can be avoided with careful monitoring. Early detection, even in the cases of locally advanced and metastatic tumors, provides a higher chance of cure, and patients can thus go through less aggressive treatments with fewer side effects. Furthermore, it is important to offer knowledge about how modifiable risk factors can be an effective method for reducing cancer risk. Innovations in PCa diagnostics and therapy are still required to overcome some of the limitations of the current screening techniques, in terms of specificity and sensitivity. In this context, this review provides a brief overview of PCa statistics, reporting its incidence and mortality rates worldwide, risk factors, and emerging screening strategies. Full article
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23 pages, 953 KiB  
Review
An Updated Systematic and Comprehensive Review of Cytoreductive Prostatectomy for Metastatic Prostate Cancer
by Takafumi Yanagisawa, Pawel Rajwa, Tatsushi Kawada, Kensuke Bekku, Ekaterina Laukhtina, Markus von Deimling, Muhammad Majdoub, Marcin Chlosta, Pierre I. Karakiewicz, Axel Heidenreich, Takahiro Kimura and Shahrokh F. Shariat
Curr. Oncol. 2023, 30(2), 2194-2216; https://doi.org/10.3390/curroncol30020170 - 10 Feb 2023
Cited by 2 | Viewed by 1940
Abstract
(1) Background: Local therapy is highly promising in a multimodal approach strategy for patients with low-volume metastatic prostate cancer (mPCa). We aimed to systematically assess and summarize the safety, oncologic, and functional outcomes of cytoreductive prostatectomy (cRP) in mPCa. (2) Methods: Three databases [...] Read more.
(1) Background: Local therapy is highly promising in a multimodal approach strategy for patients with low-volume metastatic prostate cancer (mPCa). We aimed to systematically assess and summarize the safety, oncologic, and functional outcomes of cytoreductive prostatectomy (cRP) in mPCa. (2) Methods: Three databases were queried in September 2022 for publications that analyzed mPCa patients treated with cytoreductive prostatectomy without restrictions. The outcomes of interest were progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), perioperative complication rates, and functional outcomes following cRP. (3) Results: Overall, 26 studies were included in this systematic review. Among eight population-based studies, cRP was associated with a reduced risk of CSS and OS compared with no local therapy (NLT) after adjusting for the effects of possible confounders. Furthermore, one population-based study showed that cRP reduced the risk of CSS even when compared with radiotherapy (RT) of the prostate after adjusting for the effects of possible confounders. In addition, one randomized controlled trial (RCT) demonstrated that local therapy (comprising 85% of cRP) significantly improved the prostate-specific antigen (PSA)-PFS and OS. Overall, cRP had acceptable perioperative complication rates and functional outcomes. (4) Conclusions: Mounting evidence suggests that cRP offers promising oncological and functional outcomes and technical feasibility and that it is associated with limited complications. Well-designed RCTs that limit selection bias in patients treated with cRP are warranted. Full article
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9 pages, 599 KiB  
Article
Dual-Tracer PET-MRI-Derived Imaging Biomarkers for Prediction of Clinically Significant Prostate Cancer
by Bernhard Grubmüller, Nicolai A. Huebner, Sazan Rasul, Paola Clauser, Nina Pötsch, Karl Hermann Grubmüller, Marcus Hacker, Sabrina Hartenbach, Shahrokh F. Shariat, Markus Hartenbach and Pascal Baltzer
Curr. Oncol. 2023, 30(2), 1683-1691; https://doi.org/10.3390/curroncol30020129 - 30 Jan 2023
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Abstract
Purpose: To investigate if imaging biomarkers derived from 3-Tesla dual-tracer [(18)F]fluoromethylcholine (FMC) and [68Ga]Ga-PSMAHBED-CC conjugate 11 (PSMA)-positron emission tomography can adequately predict clinically significant prostate cancer (csPC). Methods: We assessed 77 biopsy-proven PC patients who underwent 3T dual-tracer PET/mpMRI followed [...] Read more.
Purpose: To investigate if imaging biomarkers derived from 3-Tesla dual-tracer [(18)F]fluoromethylcholine (FMC) and [68Ga]Ga-PSMAHBED-CC conjugate 11 (PSMA)-positron emission tomography can adequately predict clinically significant prostate cancer (csPC). Methods: We assessed 77 biopsy-proven PC patients who underwent 3T dual-tracer PET/mpMRI followed by radical prostatectomy (RP) between 2014 and 2017. We performed a retrospective lesion-based analysis of all cancer foci and compared it to whole-mount histopathology of the RP specimen. The primary aim was to investigate the pretherapeutic role of the imaging biomarkers FMC- and PSMA-maximum standardized uptake values (SUVmax) for the prediction of csPC and to compare it to the mpMRI-methods and PI-RADS score. Results: Overall, we identified 104 cancer foci, 69 were clinically significant (66.3%) and 35 were clinically insignificant (33.7%). We found that the combined FMC+PSMA SUVmax were the only significant parameters (p < 0.001 and p = 0.049) for the prediction of csPC. ROC analysis showed an AUC for the prediction of csPC of 0.695 for PI-RADS scoring (95% CI 0.591 to 0.786), 0.792 for FMC SUVmax (95% CI 0.696 to 0.869), 0.852 for FMC+PSMA SUVmax (95% CI 0.764 to 0.917), and 0.852 for the multivariable CHAID model (95% CI 0.763 to 0.916). Comparing the AUCs, we found that FMC+PSMA SUVmax and the multivariable model were significantly more accurate for the prediction of csPC compared to PI-RADS scoring (p = 0.0123, p = 0.0253, respectively). Conclusions: Combined FMC+PSMA SUVmax seems to be a reliable parameter for the prediction of csPC and might overcome the limitations of PI-RADS scoring. Further prospective studies are necessary to confirm these promising preliminary results. Full article
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11 pages, 821 KiB  
Article
Is an Endorectal Balloon Beneficial for Rectal Sparing after Spacer Implantation in Prostate Cancer Patients Treated with Hypofractionated Intensity-Modulated Proton Beam Therapy? A Dosimetric and Radiobiological Comparison Study
by Dalia Ahmad Khalil, Jörg Wulff, Danny Jazmati, Dirk Geismar, Christian Bäumer, Paul-Heinz Kramer, Theresa Steinmeier, Stefanie Schulze Schleithoff, Stephan Tschirdewahn, Boris Hadaschik and Beate Timmermann
Curr. Oncol. 2023, 30(1), 758-768; https://doi.org/10.3390/curroncol30010058 - 06 Jan 2023
Cited by 1 | Viewed by 1923
Abstract
Background: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). Methods: Ten patients with localized [...] Read more.
Background: The aim of this study is to examine the dosimetric influence of endorectal balloons (ERB) on rectal sparing in prostate cancer patients with implanted hydrogel rectum spacers treated with dose-escalated or hypofractionated intensity-modulated proton beam therapy (IMPT). Methods: Ten patients with localized prostate cancer included in the ProRegPros study and treated at our center were investigated. All patients underwent placement of hydrogel rectum spacers before planning. Two planning CTs (with and without 120 cm3 fluid-filled ERB) were applied for each patient. Dose prescription was set according to the h strategy, with 72 Gray (Gy)/2.4 Gy/5× weekly to prostate + 1 cm of the seminal vesicle, and 60 Gy/2 Gy/5× weekly to prostate + 2 cm of the seminal vesicle. Planning with two laterally opposed IMPT beams was performed in both CTs. Rectal dosimetry values including dose-volume statistics and normal tissue complication probability (NTCP) were compared for both plans (non-ERB plans vs. ERB plans). Results: For ERB plans compared with non-ERB, the reductions were 8.51 ± 5.25 Gy (RBE) (p = 0.000) and 15.76 ± 11.11 Gy (p = 0.001) for the mean and the median rectal doses, respectively. No significant reductions in rectal volumes were found after high dose levels. The use of ERB resulted in significant reduction in rectal volume after receiving 50 Gy (RBE), 40 Gy (RBE), 30 Gy (RBE), 20 Gy (RBE), and 10 Gy (RBE) with p values of 0.034, 0.008, 0.003, 0.001, and 0.001, respectively. No differences between ERB and non-ERB plans for the anterior rectum were observed. ERB reduced posterior rectal volumes in patients who received 30 Gy (RBE), 20 Gy (RBE), or 10 Gy (RBE), with p values of 0.019, 0.003, and 0.001, respectively. According to the NTCP models, no significant reductions were observed in mean or median rectal toxicity (late rectal bleeding ≥ 2, necrosis or stenosis, and late rectal toxicity ≥ 3) when using the ERB. Conclusion: ERB reduced rectal volumes exposed to intermediate or low dose levels. However, no significant reduction in rectal volume was observed in patients receiving high or intermediate doses. There was no benefit and also no disadvantage associated with the use of ERB for late rectal toxicity, according to available NTCP models. Full article
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2022

Jump to: 2023, 2021

14 pages, 1324 KiB  
Article
Combining Molecular Subtypes with Multivariable Clinical Models Has the Potential to Improve Prediction of Treatment Outcomes in Prostate Cancer at Diagnosis
by Lewis Wardale, Ryan Cardenas, Vincent J. Gnanapragasam, Colin S. Cooper, Jeremy Clark and Daniel S. Brewer
Curr. Oncol. 2023, 30(1), 157-170; https://doi.org/10.3390/curroncol30010013 - 22 Dec 2022
Viewed by 1595
Abstract
Clinical management of prostate cancer is challenging because of its highly variable natural history and so there is a need for improved predictors of outcome in non-metastatic men at the time of diagnosis. In this study we calculated the model score from the [...] Read more.
Clinical management of prostate cancer is challenging because of its highly variable natural history and so there is a need for improved predictors of outcome in non-metastatic men at the time of diagnosis. In this study we calculated the model score from the leading clinical multivariable model, PREDICT prostate, and the poor prognosis DESNT molecular subtype, in a combined expression and clinical dataset that were taken from malignant tissue at prostatectomy (n = 359). Both PREDICT score (p < 0.0001, IQR HR = 1.59) and DESNT score (p < 0.0001, IQR HR = 2.08) were significant predictors for time to biochemical recurrence. A joint model combining the continuous PREDICT and DESNT score (p < 0.0001, IQR HR = 1.53 and 1.79, respectively) produced a significantly improved predictor than either model alone (p < 0.001). An increased probability of mortality after diagnosis, as estimated by PREDICT, was characterised by upregulation of cell-cycle related pathways and the downregulation of metabolism and cholesterol biosynthesis. The DESNT molecular subtype has distinct biological characteristics to those associated with the PREDICT model. We conclude that the inclusion of biological information alongside current clinical prognostic tools has the potential to improve the ability to choose the optimal treatment pathway for a patient. Full article
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8 pages, 3216 KiB  
Article
Intraoperative 3D-US-mpMRI Elastic Fusion Imaging-Guided Robotic Radical Prostatectomy: A Pilot Study
by Marco Oderda, Giorgio Calleris, Daniele D’Agate, Marco Falcone, Riccardo Faletti, Marco Gatti, Giancarlo Marra, Alessandro Marquis and Paolo Gontero
Curr. Oncol. 2023, 30(1), 110-117; https://doi.org/10.3390/curroncol30010009 - 22 Dec 2022
Cited by 1 | Viewed by 1796
Abstract
Introduction: When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of [...] Read more.
Introduction: When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of intraoperative 3D-TRUS-mpMRI elastic fusion imaging to guide RARP and to evaluate its impact on the surgical strategy. Methods: We prospectively enrolled 11 patients with organ-confined mpMRI-visible prostate cancer (PCa), histologically confirmed at transperineal fusion biopsy using Koelis Trinity. Before surgery, the 3D model of the prostate generated at biopsy was updated, showing both mpMRI lesions and positive biopsy cores, and was displayed on the Da Vinci robotic console using TilePro™ function. Results: Intraoperative 3D modeling was feasible in all patients (median of 6 min). The use of 3D models led to a major change in surgical strategy in six cases (54%), allowing bilateral instead of monolateral NS, or monolateral NS instead of non-NS, to be performed. At pathologic examination, no positive surgical margins (PSMs) were reported. Bilateral PCa presence was detected in one (9%), four (36%), and nine (81%) patients after mpMRI, biopsy, and RARP, respectively. Extracapsular extension was found in two patients (18%) even if it was not suspected at MRI. Conclusions: Intraoperative 3D-TRUS-mpMRI modeling with Koelis Trinity is feasible and reliable, helping the surgeon to maximize functional outcomes without increasing the risk of positive surgical margins. The location of positive biopsy cores must be registered in 3D models, given the rates of bilateral involvement not seen at mpMRI. Full article
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12 pages, 1082 KiB  
Article
Development of a Prediction Model for Positive Surgical Margin in Robot-Assisted Laparoscopic Radical Prostatectomy
by Ying Hao, Qing Zhang, Junke Hang, Linfeng Xu, Shiwei Zhang and Hongqian Guo
Curr. Oncol. 2022, 29(12), 9560-9571; https://doi.org/10.3390/curroncol29120751 - 06 Dec 2022
Cited by 4 | Viewed by 1654
Abstract
A positive surgical margin (PSM) is reported to have some connection to the occurrence of biochemical recurrence and tumor metastasis in prostate cancer after the operation. There are no clinically usable models and the study is to predict the probability of PSM after [...] Read more.
A positive surgical margin (PSM) is reported to have some connection to the occurrence of biochemical recurrence and tumor metastasis in prostate cancer after the operation. There are no clinically usable models and the study is to predict the probability of PSM after robot-assisted laparoscopic radical prostatectomy (RALP) based on preoperative examinations. It is a retrospective cohort from a single center. The Lasso method was applied for variable screening; logistic regression was employed to establish the final model; the strengthened bootstrap method was adopted for model internal verification; the nomogram and web calculator were used to visualize the model. All the statistical analyses were based on the R-4.1.2. The main outcome was a pathologically confirmed PSM. There were 151 PSMs in the 903 patients, for an overall positive rate of 151/903 = 16.7%; 0.727 was the adjusted C statistic, and the Brier value was 0.126. Hence, we have developed and validated a predictive model for PSM after RALP for prostate cancer that can be used in clinical practice. In the meantime, we observed that the International Society of Urological Pathology (ISUP) score, Prostate Imaging Reporting and Data System (PI-RADS) score, and Prostate-Specific Antigen (PSA) were the independent risk factors for PSM. Full article
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27 pages, 1290 KiB  
Article
Comparative Prospective and Longitudinal Analysis on the Platelet-to-Lymphocyte, Neutrophil-to-Lymphocyte, and Albumin-to-Globulin Ratio in Patients with Non-Metastatic and Metastatic Prostate Cancer
by Stefano Salciccia, Marco Frisenda, Giulio Bevilacqua, Pietro Viscuso, Paolo Casale, Ettore De Berardinis, Giovanni Battista Di Pierro, Susanna Cattarino, Gloria Giorgino, Davide Rosati, Francesco Del Giudice, Antonio Carbone, Antonio Pastore, Benjamin I. Chung, Michael L. Eisenberg, Riccardo Autorino, Simone Crivellaro, Flavio Forte, Alessandro Sciarra, Gianna Mariotti and Alessandro Gentilucciadd Show full author list remove Hide full author list
Curr. Oncol. 2022, 29(12), 9474-9500; https://doi.org/10.3390/curroncol29120745 - 03 Dec 2022
Cited by 4 | Viewed by 1607
Abstract
Purpose: To prospectively evaluate the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) diagnostic and prognostic predictive value in a stratified population of prostate cancer (PC) cases. Methods: Population was divided based on the clinical and histologic diagnosis in: Group A: [...] Read more.
Purpose: To prospectively evaluate the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) diagnostic and prognostic predictive value in a stratified population of prostate cancer (PC) cases. Methods: Population was divided based on the clinical and histologic diagnosis in: Group A: benign prostatic hyperplasia (BPH) cases (494 cases); Group B: all PC cases (525 cases); Group B1: clinically significant PC (426 cases); Group B2: non-metastatic PC (416 cases); Group B3: metastatic PC (109 cases). NLR, PLR, and AGR were obtained at the time of the diagnosis, and only in cases with PC considered for radical prostatectomy, determinations were also repeated 90 days after surgery. For each ratio, cut-off values were determined by receiver operating characteristics curve (ROC) analysis and fixed at 2.5, 120.0, and 1.4, respectively, for NLR, PLR, and AGR. Results: Accuracy in predictive value for an initial diagnosis of clinically significant PC (csPC) was higher using PLR (0.718) when compared to NLR (0.220) and AGR (0.247), but, despite high sensitivity (0.849), very low specificity (0.256) was present. The risk of csPC significantly increased only according to PLR with an OR = 1.646. The percentage of cases with metastatic PC significantly increased according to high NLR and high PLR. Accuracy was 0.916 and 0.813, respectively, for NLR and PLR cut-off, with higher specificity than sensitivity. The risk of a metastatic disease increased 3.2 times for an NLR > 2.5 and 5.2 times for a PLR > 120 and at the multivariate analysis. Conclusion: PLR and NLR have a significant predictive value towards the development of metastatic disease but not in relation to variations in aggressiveness or T staging inside the non-metastatic PC. Our results suggest an unlikely introduction of these analyses into clinical practice in support of validated PC risk predictors. Full article
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8 pages, 250 KiB  
Article
Acute Toxicity and Quality of Life in a Post-Prostatectomy Ablative Radiation Therapy (POPART) Multicentric Trial
by Raffaella Lucchini, Ciro Franzese, Suela Vukcaj, Giorgio Purrello, Denis Panizza, Valeria Faccenda, Stefano Andreoli, Gian Luca Poli, Davide Baldaccini, Lorenzo Lo Faro, Stefano Tomatis, Luigi Franco Cazzaniga, Marta Scorsetti and Stefano Arcangeli
Curr. Oncol. 2022, 29(12), 9349-9356; https://doi.org/10.3390/curroncol29120733 - 30 Nov 2022
Cited by 6 | Viewed by 2901
Abstract
Background: The aim of this study was to investigate the feasibility of ultrahypofractionated radiotherapy to the prostate bed in patients with biochemical and/or clinical relapse following radical prostatectomy who were enrolled in the prospective, observational, multicentric POPART trial (NCT04831970). Methods: Patients with post-radical [...] Read more.
Background: The aim of this study was to investigate the feasibility of ultrahypofractionated radiotherapy to the prostate bed in patients with biochemical and/or clinical relapse following radical prostatectomy who were enrolled in the prospective, observational, multicentric POPART trial (NCT04831970). Methods: Patients with post-radical prostatectomy PSA levels of ≥0.1–2.0 ng/mL and/or local relapse at PSMA PET/CT or multiparametric MRI were treated with Linac-based SBRT on the prostate bed up to a total dose of 32.5 Gy in five fractions every other day (EQD21.5 = 74.2 Gy). Maximum acute toxicity was assessed using the Common Terminology Criteria for Adverse Events version 5 scale. International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) and Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores were assessed at baseline and during the follow-up. Results: From April 2021 to June 2022, thirty men with a median age of 72 years (range 55–82) were enrolled in three centers. The median PSA level before RT was 0.30 ng/mL (range 0.18–1.89 ng/mL). At 3 months post-treatment, no GI or ≥2 GU side effects were reported; three patients (10%) experienced Grade 1 GU toxicity. No changes in ICIQ-SF or in the urinary domains of EPIC-CP were observed, while a transient worsening was registered in the bowel domain. At the same time point, all but two patients, who progressed distantly, were found to be biochemically controlled with a median post-treatment PSA level of 0.07 ng/mL (range 0–0.48 ng/mL). Conclusions: Our preliminary findings show that SBRT can be safely extended to the postoperative setting, without an increase in short-term toxicity or a significant decline in QoL. Long-term results are needed to confirm this strategy. Full article
7 pages, 900 KiB  
Communication
Nondetectable Prostate Carcinoma (pT0) after Radical Prostatectomy: A Narrative Review
by Nikolaos Kalampokis, Nikolaos Grivas, Markos Karavitakis, Ioannis Leotsakos, Ioannis Katafigiotis, Marcio Covas Moschovas, Henk van der Poel and European Association of Urology (EAU) Young Academic Urologists (YAU) Robotic Urology Working Group
Curr. Oncol. 2022, 29(3), 1309-1315; https://doi.org/10.3390/curroncol29030111 - 23 Feb 2022
Cited by 1 | Viewed by 1876
Abstract
(1) Background: Following radical prostatectomy (RP), the absence of a demonstrable tumor on the specimen of a previously histologically proven malignancy is known as the pT0 stage. The aim of our present study is to perform a narrative review of current literature in [...] Read more.
(1) Background: Following radical prostatectomy (RP), the absence of a demonstrable tumor on the specimen of a previously histologically proven malignancy is known as the pT0 stage. The aim of our present study is to perform a narrative review of current literature in order to determine the frequency and oncological outcomes in patients with pT0 disease. (2) Methods: A narrative review of all available literature was performed. (3) Results: The incidence of pT0 ranges between 0.07% and 1.3%. Predictors of the pT0 stage are only a single biopsy core with low-grade cancer, a cancer length not exceeding 2 mm and a high prostate volume. Biochemical recurrence ranges between 0 and 11%. (4) Conclusions: The absence of malignancy in the RP specimen despite a previous positive biopsy is a rare and unpredictable finding. Although the prognosis is considered to be excellent in most of the cases, a continued close follow-up is warranted. Full article
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6 pages, 650 KiB  
Case Report
Diagnostic and Therapeutic Challenges in a Patient with Synchronous Very High-Risk Prostate Adenocarcinoma and Anal Carcinoma
by Jonathan Wallach, Irini Youssef, Andrea Leaf and David Schwartz
Curr. Oncol. 2022, 29(1), 377-382; https://doi.org/10.3390/curroncol29010033 - 15 Jan 2022
Cited by 1 | Viewed by 2381
Abstract
A 79-year-old HIV-negative Caucasian man with a medical history of smoking 20 pack-years (quit 40 years prior), early-stage non-small cell lung cancer status post-lobectomy 13 years earlier at an outside hospital without evidence of recurrence, and benign prostatic hypertrophy was diagnosed with synchronous [...] Read more.
A 79-year-old HIV-negative Caucasian man with a medical history of smoking 20 pack-years (quit 40 years prior), early-stage non-small cell lung cancer status post-lobectomy 13 years earlier at an outside hospital without evidence of recurrence, and benign prostatic hypertrophy was diagnosed with synchronous very high-risk prostate adenocarcinoma and early-stage anal basaloid squamous cell carcinoma. He proceeded to undergo concurrent treatment for these tumors, consisting of androgen deprivation therapy, external beam radiation therapy, and a brachytherapy boost for the prostate adenocarcinoma; for the anal carcinoma, he was treated with definitive chemoradiation. Over 3.5 years since the completion of radiotherapy, he remains in clinical and biochemical remission. Full article
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2021

Jump to: 2023, 2022

11 pages, 980 KiB  
Article
Prospective Randomized Phase II Study of Stereotactic Body Radiotherapy (SBRT) vs. Conventional Fractionated Radiotherapy (CFRT) for Chinese Patients with Early-Stage Localized Prostate Cancer
by Darren M. C. Poon, Daisy Lam, Kenneth C. W. Wong, Cheuk-Man Chu, Michael Cheung, Frankie Mo, Joyce Suen, Chi-Fai Ng and Anthony T. C. Chan
Curr. Oncol. 2022, 29(1), 27-37; https://doi.org/10.3390/curroncol29010003 - 22 Dec 2021
Cited by 2 | Viewed by 3179
Abstract
Background: Stereotactic body radiotherapy (SBRT) has potential radiobiologic and economic advantages over conventional fractionated radiotherapy (CFRT) in localized prostate cancer (PC). This study aimed to compare the effects of these two distinct fractionations on patient-reported quality of life (PRQOL) and tolerability. Methods: In [...] Read more.
Background: Stereotactic body radiotherapy (SBRT) has potential radiobiologic and economic advantages over conventional fractionated radiotherapy (CFRT) in localized prostate cancer (PC). This study aimed to compare the effects of these two distinct fractionations on patient-reported quality of life (PRQOL) and tolerability. Methods: In this prospective phase II study, patients with low- and intermediate-risk localized PC were randomly assigned in a 1:1 ratio to the SBRT (36.25 Gy/5 fractions/2 weeks) or CFRT (76 Gy/38 fractions/7.5 weeks) treatment groups. The primary endpoint of variation in PRQOL at 1 year was assessed by changes in the Expanded Prostate Cancer Index Composite (EPIC) questionnaire scores and analysed by z-tests and t-tests. Results: Sixty-four eligible Chinese men were treated (SBRT, n = 31; CFRT, n = 33) with a median follow-up of 2.3 years. At 1 year, 40.0%/46.9% of SBRT/CFRT patients had a >5-point decrease in bowel score (p = 0.08/0.28), respectively, and 53.3%/46.9% had a >2-point decrease in urinary score (p = 0.21/0.07). There were no significant differences in EPIC score changes between the arms at 3, 6, 9 and 12 months, but SBRT was associated with significantly fewer grade ≥ 1 acute and 1-year late gastrointestinal toxicities (acute: 35% vs. 87%, p < 0.0001; 1-year late: 64% vs. 84%, p = 0.03), and grade ≥ 2 acute genitourinary toxicities (3% vs. 24%, p = 0.04) compared with CFRT. Conclusion: SBRT offered similar PRQOL and less toxicity compared with CFRT in Chinese men with localized PC. Full article
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10 pages, 560 KiB  
Article
Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy
by Benedikt Hoeh, Felix Preisser, Mike Wenzel, Clara Humke, Clarissa Wittler, Jan L. Hohenhorst, Maja Volckmann-Wilde, Jens Köllermann, Thomas Steuber, Markus Graefen, Derya Tilki, Pierre I. Karakiewicz, Andreas Becker, Luis A. Kluth, Felix K. H. Chun and Philipp Mandel
Curr. Oncol. 2021, 28(6), 4738-4747; https://doi.org/10.3390/curroncol28060399 - 15 Nov 2021
Cited by 8 | Viewed by 2142
Abstract
Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and [...] Read more.
Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1–10, 11–50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. Results: From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1–10 g, 11–50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1–10 g vs. 11–50 g vs. >50 g, Ref: <1 g; all p < 0.05). Conclusions: Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence. Full article
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7 pages, 2819 KiB  
Brief Report
Single-Center Comparison of [64Cu]-DOTAGA-PSMA and [18F]-PSMA PET–CT for Imaging Prostate Cancer
by Siroos Mirzaei, Rainer Lipp, Shahin Zandieh and Asha Leisser
Curr. Oncol. 2021, 28(5), 4167-4173; https://doi.org/10.3390/curroncol28050353 - 15 Oct 2021
Cited by 2 | Viewed by 2079
Abstract
Introduction: the diagnostic performance of [64Cu]-DOTAGA-PSMA PET–CT imaging was compared retrospectively to [18F]-PSMA PET–CT in prostate cancer patients with recurrent disease and in the primary staging of selected patients with advanced local and possible metastatic disease. Methods: We retrospectively [...] Read more.
Introduction: the diagnostic performance of [64Cu]-DOTAGA-PSMA PET–CT imaging was compared retrospectively to [18F]-PSMA PET–CT in prostate cancer patients with recurrent disease and in the primary staging of selected patients with advanced local and possible metastatic disease. Methods: We retrospectively selected a total of 100 patients, who were consecutively examined in our department, with biochemical recurrence after radical prostatectomy or who had progressive local and possible metastatic disease in the last 3 months prior to this investigation. All patients were examined with a dedicated PET–CT scanner (Biograph; Siemens Healthineers). A total of 250 MBq (3.5 MBq per kg bodyweight, range 230–290 MBq) of [64Cu]-DOTAGA-PSMA or [18-F]-PSMA was applied intravenously. PET images were performed 1 h post-injection (skull base to mid-thigh). The maximum standardized uptake values (SUVmax) of PSMA-positive lesions and the mean standardized uptake value (SUVmean) of the right liver lobe were measured. Results: All but 9/50 of the patients (18%; PSA range: 0.01–0.7 µg/L) studied with [64Cu]-DOTAGA-PSMA and 6/50 of the ones (12%; PSA range: 0.01–4.2) studied with [18F]-PSMA had at least one positive PSMA lesion shown by PET–CT. The total number of lesions was higher with [64Cu]-DOTAGA-PSMA (209 vs. 191); however, the median number of lesions was one for [64Cu]-DOTAGA-PSMA and two for [18F]-PSMA. Interestingly, the median SUVmean of the right liver lobe was slightly higher for [18F]-PSMA (11.8 vs. 8.9). Conclusions: [64Cu]-DOTAGA-PSMA and [18F]-PSMA have comparable detection rates for the assessment of residual disease in patients with recurrent or primary progressive prostate cancer. The uptake in the liver is moderately different, and therefore at least the SUVs of the lesions in both studies would not be comparable. Full article
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13 pages, 1141 KiB  
Article
Renal and Salivary Gland Functions after Three Cycles of PSMA-617 Therapy Every Four Weeks in Patients with Metastatic Castration-Resistant Prostate Cancer
by Tim Wollenweber, Lucia Zisser, Elisabeth Kretschmer-Chott, Michael Weber, Bernhard Grubmüller, Gero Kramer, Shahrokh F. Shariat, Markus Mitterhauser, Stefan Schmitl, Chrysoula Vraka, Alexander R. Haug, Marcus Hacker, Markus Hartenbach and Sazan Rasul
Curr. Oncol. 2021, 28(5), 3692-3704; https://doi.org/10.3390/curroncol28050315 - 23 Sep 2021
Cited by 5 | Viewed by 2708
Abstract
Background: [177Lu]Lu-PSMA-617 radioligand therapy (PSMA-RLT) could affect kidney and salivary gland functions in metastatic castration-resistant prostate cancer (mCRPC) patients. Methods: We retrospectively analyzed clinical, renal, and salivary scintigraphy data and salivary [68Ga]Ga-PSMA-11 ligand PET scan measures such as metabolic [...] Read more.
Background: [177Lu]Lu-PSMA-617 radioligand therapy (PSMA-RLT) could affect kidney and salivary gland functions in metastatic castration-resistant prostate cancer (mCRPC) patients. Methods: We retrospectively analyzed clinical, renal, and salivary scintigraphy data and salivary [68Ga]Ga-PSMA-11 ligand PET scan measures such as metabolic volume and SUVmax values of 27 mCRPC men (mean age 71 ± 7 years) before and 4 weeks after receiving three cycles of PSMA-RLT every 4 weeks. Twenty-two patients additionally obtained renal and salivary scintigraphy prior to each cycle. A one-way ANOVA, post-hoc Scheffé test and Cochran’s Q test were applied to assess organ toxicity. Results: In total, 54 PSMA PET scans, 98 kidney, and 98 salivary scintigraphy results were evaluated. There were no significant differences for the ejection fraction, peak time, and residual activity after 5 min for both parotid and submandibular glands prior to each cycle and 4 weeks after the last cycle. Similarly, no significant differences in serum creatinine and renal scintigraphy parameters were observed prior to each cycle and 4 weeks after the last treatment. Despite there being no changes in the metabolic volume of both submandibular glands, SUVmax values dropped significantly (p < 0.05). Conclusion: Results evidenced no alterations in renal function and only minimal impairment of salivary function of mCRPC patients who acquired an intense PSMA-RLT regimen every 4 weeks. Full article
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12 pages, 618 KiB  
Systematic Review
Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response
by Bernhard Grubmüller, Victoria Jahrreiss, Stephan Brönimann, Fahad Quhal, Keiichiro Mori, Axel Heidenreich, Alberto Briganti, Derya Tilki and Shahrokh F. Shariat
Curr. Oncol. 2021, 28(4), 2881-2892; https://doi.org/10.3390/curroncol28040252 - 29 Jul 2021
Cited by 15 | Viewed by 2809
Abstract
A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of [...] Read more.
A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended. Full article
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