Men Have Regret Years after Prostate Cancer Treatment

Excerpt:

“After years of introspection, about 15% of men with localized prostate cancer regretted the decisions they made regarding treatment, a survey of almost 1,000 patients showed.

“About twice as many men expressed regret after radical prostatectomy or radiation therapy as compared with active surveillance. The single biggest contributor to regret was treatment-associated sexual dysfunction, as reported in the Journal of Clinical Oncology.”

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Active Surveillance Preserves Quality of Life for Prostate Cancer Patients

Excerpt:

“Faced with the negative quality-of-life effects from surgery and radiation treatments for prostate cancer, low risk patients may instead want to consider active surveillance with their physician, according to a study released Tuesday by the Journal of the American Medical Association (JAMA).

“The Vanderbilt University Medical Center study led by Daniel Barocas, M.D., MPH, associate professor of Urologic Surgery, compared the side effects and outcomes of contemporary treatments for localized with in order to guide men with prostate cancer in choosing the best treatment for them.

“Surgery is considered by some to be the most definitive treatment, and there is evidence from other studies that it has better long-term cancer outcomes than radiation for higher-risk cancers, but it has more sexual and urinary side effects than radiation.”

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Phase III Results Support Novel Focal Therapy for Low-Risk Prostate Cancer

Excerpt:

“Padeliporfin vascular-targeted photodynamic therapy, a novel tissue-preserving treatment, may offer men with low-risk prostate cancer a safe and effective alternative to either active surveillance or radical therapy, according to the results of a phase III trial published in The Lancet Oncology.

“Among treatment-naïve patients with low-risk, localized prostate cancer, disease progression at 24 months was 28% among patients receiving padeliporfin vascular-targeted photodynamic therapy versus 58% in those receiving active surveillance (HR, 0.34; 95% CI, 0.24-0.46; P <.0001). The median time to progression was 28.3 months (95% CI, 26.0-30.6) versus 14.1 months (95% CI, 12.9-23.8; P <.0001), respectively.”

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Researchers Investigate New Targeted Therapy for Metastatic Prostate Cancer

Excerpt:

“Men with localized prostate cancer face good odds: Their relative five-year survival rate is nearly 100 percent. However, men with metastatic disease — prostate cancer that has spread to another organ like the lungs — have a relative five-year survival rate of only 29 percent.

“Currently, the mainstay treatment for metastatic prostate cancer is hormone therapy, which uses drugs to lower the levels of male sex hormones like testosterone in the body to slow the growth of prostate cancer. Two of the latest hormonal agents, abiraterone acetate and enzalutamide, have shown some improvements in overall survival. Unfortunately, hormone therapy isn’t a cure and most patients become resistant to the drugs.”

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Photodynamic Therapy Can Preserve Tissue in Low-Risk Prostate Cancer

Excerpt:

“Vascular-targeted photodynamic therapy with padeliporfin was significantly better than active surveillance over a 2-year period in men with low-risk localized prostate cancer, according to a new study. The treatment could allow men to avoid more radical therapy.

” ‘Focal therapy and active surveillance are both tissue-preserving strategies,’ wrote study authors led by Mark Emberton, MD, of University College London in the United Kingdom. ‘However, focal therapy differs from active surveillance in that it treats disease—by the process of selective tissue ablation—above a certain risk threshold and monitors disease below that threshold, because the latter is deemed to be clinically significant.’ ”

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Similar 10-Year Survival With Active Monitoring, Surgery, or Radiotherapy for PSA-Detected Clinically Localized Prostate Cancer

Excerpt:

“In the UK ProtecT trial reported in The New England Journal of Medicine, Freddie C. Hamdy, FRCS, FMedSci, of the University of Oxford, and colleagues found no significant differences in prostate cancer–specific or overall mortality among men with clinically localized prostate cancer detected by prostate-specific antigen (PSA) testing who underwent active monitoring, surgery, or radiotherapy. Metastases and disease progression were more common with active monitoring. Median follow-up in the study was 10 years.”

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HYPRO: Shorter RT Course No Better, Worse in Localized Prostate Cancer

Excerpt:

“A randomized phase III trial found that a hypofractionated radiotherapy (RT) regimen was not superior to, but generally equivalent to a conventional RT scheme in men with localized prostate cancer. The study joins a growing body of literature on hypofractionation in this malignancy, generally showing that the shorter courses are a reasonable option.

“A low α-β ratio for prostate cancer has generated interest in hypofractionation, as it could increase the tumor dose without increasing toxicities. ‘Moreover, hypofractionated radiotherapy is delivered in fewer fractions, improving patients’ convenience, hospital logistics, and possibly reducing healthcare costs,’ wrote study authors led by Luca Incrocci, MD, PhD, of Erasmus Medical Center Cancer Institute in Rotterdam, the Netherlands.

“A study was presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago that found a hypofractionated regimen of 60 Gy in 20 fractions was noninferior to conventional RT. Another, presented this past January at the ASCO Genitourinary Cancers Symposium, again found a 60 Gy/20 fractions regimen was noninferior to conventional RT and to another hypofractionated regimen of 57 Gy/19 fractions.”

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ASCO: Combo Tx Fails in Local High-Risk Prostate Ca

Excerpt:

“Neoadjuvant enzalutamide (ENZA) and abiraterone acetate (AA) plus 5 mg prednisone daily can be given safely for 6 months in men with localized high-risk prostate cancer prior to prostatectomy, a neoadjuvant study showed.

“However, the findings did not favor adding ENZA to augment AA plus leuprolide acetate (LHRHa) efficacy in localized high-risk prostate cancer, Eleni Efstathiou, MD, PhD, of the University of Texas MD Anderson Cancer Center, in Houston, said during a presentation at the American Society of Clinical Oncology.

“Pathologic downstaging (≤ pT2N0) occurred in 30% of patients treated with the combination therapy (AA+ENZA+ LHRHa) versus 52% of patients who received AA plus LHRHa alone (P=0.07), the study showed. Despite universal PSA depletion (≤ 0.1), a wide range of viable tumor was observed (volume 0-8.64 cc, cellularity 0-90%, and a tumor epithelial volume [TEV] 0-5.58 cc). TEV and stage were aligned.”

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Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”