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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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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In Obese Prostate Cancer Patients, Robotic Surgery Reduces Risk of Blood Loss

Excerpt:

“The study by senior author Gopal Gupta, MD and colleagues is published in the journal Current Urology. Dr. Gupta is an assistant professor in the Department of Urology of Loyola University Chicago Stritch School of Medicine.

“Researchers examined records of 9,108 obese men who underwent radical prostatectomy (removal of the prostate gland and some surrounding tissue). Among all patients, 60.4 percent underwent robotic-assisted radical prostatectomy and 39.6 percent underwent open prostatectomy.

“Compared with patients who had open surgery, patients undergoing robotic-assisted surgery were 83 percent less likely to require blood transfusions and 72 percent less likely to require prolonged hospital stays. But robotic-assisted surgery did not reduce the risk of infections and other complications, the study found.”

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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.’ ”


Adding ADT to RT Improved PFS After Radical Prostatectomy

“Assigning men in biological relapse after radical prostatectomy to combined salvage treatment with hormone therapy and radiation therapy significantly delayed disease progression compared with radiation therapy alone, according to the results of the GETUG-AFU 16 phase III trial (abstract 5006).

“ ‘Salvage radiotherapy combined with limited androgen deprivation therapy improves the 5-year progression-free survival rate compared to radiotherapy alone,’ said study presenter Christian Carrie, MD, of the department of radiation oncology at the University of Lyon-Centre Leon Berard. ‘There is no significant difference in overall survival, but the follow-up is still too short.’

“Between October 2006 and March 2010, 743 patients were enrolled in GETUG-AFU 16 and randomly assigned to radiation therapy alone (n = 374) or radiation plus hormone therapy with goserelin 10.8 mg for 6 months (n = 369). The primary endpoint of the trial was progression-free survival.”


Recurrence of Prostate Cancer Detected Earlier with Innovative PSMA-Ligand PET/CT

“A recent study reported in The Journal of Nuclear Medicine compared use of the novel Ga-68-PSMA-ligand PET/CT with other imaging methods and found that it had substantially higher detection rates of prostate-specific membrane antigen (PSMA) in patients with biochemical recurrence after radical prostatectomy. Discovering a recurrence early can strongly influence further clinical management, so it is especially noteworthy that this hybrid PSMA-ligand identified a large number of positive findings in the clinically important range of low PSA-values (<0.5ng/mL).

“According to the CDC, prostate cancer is the most common cancer among men in the United States, after non-melanoma skin cancer. While many men with prostate cancer die from other causes, prostate cancer remains one of the leading causes of cancer death among men of all races. Treatment and survival after recurrence depend on many factors, but early detection of the recurrence is certainly key.

“Matthias Eiber, MD, corresponding author of the study, noted, ‘The study is the first to examine this highly promising PET tracer in the use of a homogeneous patient collective consisting of only those with biochemical recurrence after radical prostatectomy. It found superb detection rates compared to other tracers, like choline, or imaging modalities, like MRI. For patients, this means that the referring urologist can receive earlier and more precise information about the site and extent of metastatic disease. Physicians will also be better able estimate whether a PSMA-PET scan might be useful in a specific setting.’ “


Active Surveillance Avoids Urinary, Sexual Declines of Radical Prostatectomy

“Active surveillance and radical prostatectomy conferred similar mental health outcomes in patients with low-risk prostate cancer; however, the surgical procedure was linked to worse urinary and sexual outcomes, according to study results.

“ ‘It is important to consider health-related quality-of-life outcomes when deciding on an approach to minimize both the physical and psychological burden of the disease and its treatment,’ Jennifer Cullen, PhD, MPH, of the Center for Prostate Disease Research at the Department of Defense, and colleagues wrote. ‘To help patients weigh the costs and benefits of [prostate cancer] management strategies, studies that examine the impact of treatment choice on short-term and long-term [health-related quality of life] are warranted. Patients who are managed with [active surveillance] may be spared some of the decline in physical [health-related quality of life] compared with patients who receive definitive treatments, such as radical prostatectomy, but they could concomitantly suffer greater mental health declines because of the anxiety of delaying therapy.’ “

“Cullen and colleagues evaluated data from 389 patients with low-risk prostate cancer enrolled in the Center for Prostate Disease Research Multicenter National Database. Of the patients, 58.6% (n = 228) of patients underwent radical prostatectomy, whereas 19.8% (n = 77) received active surveillance. The remaining 84 patients selected other treatment options and were excluded.”


Use of Radiotherapy After Prostate Cancer Surgery Declining, Despite Evidence of Benefit

“Despite strong evidence and guidelines supporting its use, post-surgical radiation therapy for prostate cancer patients at risk of recurrence is declining in the United States. The study, published online in the journal European Urology, finds fewer than 10 percent of patients at risk of recurrence received postoperative radiotherapy within six months of surgery in the U.S.

“Although radical prostatectomy (RP) is a common curative treatment for localized prostate cancer, about 30% of patients will develop biochemical recurrence after surgery, meaning their prostate-specific antigen (PSA) level will again rise. For some patients with more aggressive cancers, as many as 60% to 70% can experience biochemical recurrence (also called biochemical failure).

“Three large randomized prospective clinical trials, two done in Europe and one in the United States, have demonstrated that postoperative radiotherapy (RT) in patients with adverse pathological features reduces risk of PSA recurrence, may prevent the need for androgen deprivation therapy (ADT), and may reduce metastasis and improve survival.”