Prostatectomy Plus Radiotherapy May Improve Survival in Advanced Prostate Cancer

Excerpt:

“Patients who underwent primary radical prostatectomy followed by radiotherapy for locally or regionally advanced prostate cancer had better survival outcomes than patients treated with radiotherapy plus androgen deprivation therapy, according to findings from a population-based, retrospective study published in Cancer.

” ‘There is a lot of debate about whether to remove the whole prostate and follow-up with radiation therapy or, as a second option, spare the prostate and treat it using radiation therapy plus hormone-blocking therapy,’ Grace Lu-Yao, PhD, associate director of population science at the Sidney Kimmel Cancer Center at Jefferson Health, said in a press release. ‘Our study suggests that removing the prostate followed by adjuvant radiotherapy is associated with greater OS in men with prostate cancer.’ ”

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What to Expect When Active Surveillance Leads to Prostatectomy

Excerpt:

“A high proportion of men who entered active surveillance for early prostate cancer had one or more high-risk disease characteristics when they subsequently had radical prostatectomy, a Swedish study showed.

“Medical records showed that 52 of 132 men had at least one adverse pathology feature at radical prostatectomy. All the men initially opted for active surveillance, and the median time from enrollment to surgery was 1.9 years.”

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Adjuvant Radiotherapy Improves Outcomes for High-Risk Prostate Cancer

Excerpt:

“Adjuvant radiotherapy appeared associated with better outcomes than surveillance followed by early-salvage radiotherapy among patients with prostate cancer with adverse pathological features who underwent prostatectomy, according to study results published in JAMA Oncology.

” ‘It remains very controversial whether patients with high-risk features after a radical prostatectomy for prostate cancer should receive adjuvant radiation therapy to prevent a recurrence of their prostate cancer as measured by a rise in PSA, or whether we should observe patients after surgery and only radiate those who demonstrate a detectable PSA,’ Rahul D. Tendulkar, MD, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today.”

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Androgen Blockade and Salvage ­Radiation Therapy in Prostate Cancer: Cautious Optimism Amid Unanswered Questions

Excerpt:

“The recent report of results of RTOG 9601 by Shipley et al in The New England Journal of Medicine—reviewed in this issue of The ASCO Post—strongly supports the variably used practice of adding ‘androgen blockade’ to salvage radiation therapy in men with a rising prostate-specific antigen (PSA) after radical prostatectomy. The findings show a clear reduction in prostate cancer–specific and overall mortality with the addition of 2 years of bicalutamide to salvage radiation therapy. Another likely (although not demonstrated) benefit is the reduction in the need to treat patients with subsequent life-long continuous or intermittent androgen blockade at the expense of treating all men with 2 years of bicalutamide.”

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Expert Highlights Clinical Benefits of Prostatectomy

Excerpt:

“For patients with prostate cancer, prostatectomy—whether laparoscopic or robotic—can provide a significant clinical benefit, according to Gregory Zagaja, MD. Between the 2 prostatectomy techniques, he adds, the results have been fairly comparable.

“In an interview with Targeted Oncology, Zagaja, professor of Surgery, director of the Prostate Cancer Center at the University of Chicago Medicine, discussed the benefits of radical prostatectomy and other ongoing developments with surgery in prostate cancer.”

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'End of Controversy': Robotic Prostatectomy Is Winner

Excerpt:

“The long-running debate about which surgical method is best for removing a cancerous prostate is over, a urologic surgeon declares in an editorial published in the July issue of the Journal of Urology.

” ‘Robotic prostatectomy has superior or at least equal oncologic efficacy and complication rates compared to open prostatectomy,’ writes Michael O. Koch, MD, from the Indiana University School of Medicine in Indianapolis. ‘I believe the most current literature supports that view and this debate should finally be put to rest.’

“Dr Koch presents himself as an impartial judge, saying that he has ‘substantial surgical experience with both techniques.’

“Dr Koch’s editorial, partially entitled the ‘End of the Controversy,’ accompanies a study that prompted his declaration and compares the rival procedures.”

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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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Surgery Improves Survival Rates for Men With Prostate Cancer If Radiation Treatments Fail

“Approximately 14 percent of men will be diagnosed with prostate cancer at some point in their lifetimes, according to the National Institutes of Health. Radiation therapy traditionally has been a primary treatment for the cancer, but one-fourth of men have a recurrence of prostate cancer within five years after the therapy. Now, a University of Missouri School of Medicine researcher has found that a complex procedure to remove the prostate achieves excellent long-term survival for men after radiation therapy has failed.

” ‘Prostate cancer, unfortunately, is a common cancer, and more than 27,000 men are estimated to have died from the disease in 2015,’ said Naveen Pokala, M.D., an assistant professor in the Division of Urology at the MU School of Medicine and lead author of the study. ‘By studying a national database of prostate cancer cases, we found that a procedure known as salvage radical prostatectomy can greatly increase a man’s chance of survival when traditional radiation therapy has failed to eradicate the cancer.’ ”


Postprostatectomy Radiation Therapy Yields Low Toxicity and Favorable Patient-Reported Quality of Life

“A prospective study of guideline-based, postoperative, image-guided intensity-modulated radiation therapy in patients with prostate cancer found low toxicity profiles and favorable patient-reported quality of life following treatment, with researchers concluding that toxicity and health-related quality of life should not impact the recommendation of radiation therapy following prostatectomy. The research was published by Berlin et al in Practical Radiation Oncology.

“Postprostatectomy radiation therapy has been reported as underutilized, with randomized trials showing the benefit of adjuvant radiation therapy, but only about 10% of patients receiving the treatment. One potential reason for underutilization could be concern over side effects or a negative impact on health-related quality of life.”