Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer

Published on Feb 1, 2017in The New England Journal of Medicine74.699
路 DOI :10.1056/NEJMOA1607529
William U. Shipley100
Estimated H-index: 100
(Harvard University),
W. Seiferheld18
Estimated H-index: 18
+ 19 AuthorsHoward M. Sandler96
Estimated H-index: 96
Sources
Abstract
BackgroundSalvage radiation therapy is often necessary in men who have undergone radical prostatectomy and have evidence of prostate-cancer recurrence signaled by a persistently or recurrently elevated prostate-specific antigen (PSA) level. Whether antiandrogen therapy with radiation therapy will further improve cancer control and prolong overall survival is unknown. MethodsIn a double-blind, placebo-controlled trial conducted from 1998 through 2003, we assigned 760 eligible patients who had undergone prostatectomy with a lymphadenectomy and had disease, as assessed on pathological testing, with a tumor stage of T2 (confined to the prostate but with a positive surgical margin) or T3 (with histologic extension beyond the prostatic capsule), no nodal involvement, and a detectable PSA level of 0.2 to 4.0 ng per milliliter to undergo radiation therapy and receive either antiandrogen therapy (24 months of bicalutamide at a dose of 150 mg daily) or daily placebo tablets during and after radiation therapy. The p...
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References24
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#1Justin C. Voog (Harvard University)H-Index: 8
#2Rebecca PaulusH-Index: 35
Last. Jason A. Efstathiou (Harvard University)H-Index: 55
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Abstract Background Androgen deprivation therapy (ADT) is associated with coronary heart disease and diabetes in men with prostate cancer (PCa); however, controversy exists regarding ADT and cardiovascular mortality (CVM) with limited data for lower risk disease. Objective We conducted a hypothesis-generating retrospective analysis to evaluate the relationship between short-course ADT and CVM in patients with clinically localized PCa enrolled in a phase III trial. Design, setting, and participan...
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#1Matthew R. Cooperberg (UCSF: University of California, San Francisco)H-Index: 74
#2Peter R. Carroll (UCSF: University of California, San Francisco)H-Index: 141
Letters RESEARCH LETTER Trends in Management for Patients With Localized Prostate Cancer, 1990-2013 A growing literature supports the safety and efficacy of active surveillance for patients with low-risk prostate cancer. How- ever, the experience behind this literature is based almost en- tirely in academic centers, and prior reports have consis- tently found surveillance generally underused in most other settings. 1,2 Conversely, high-risk tumors have been under- treated with androgen deprivati...
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#1Richard K. Valicenti (UC Davis: University of California, Davis)H-Index: 43
#2Ian M. Thompson (University of Texas Health Science Center at San Antonio)H-Index: 110
Last. Martha M. FaradayH-Index: 11
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Purpose: The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy. Methods and Materials: A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additi...
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#1Jeffrey K. Mullins (NYU: New York University)H-Index: 22
#2Zhaoyong Feng (NYU: New York University)H-Index: 25
Last. Stacy Loeb (NYU: New York University)H-Index: 68
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Purpose: Radical prostatectomy has decreased prostate cancer specific mortality in men with clinically localized prostate cancer. We report oncological outcomes of the longest running series of nerve sparing radical retropubic prostatectomy on the 30th anniversary of the inaugural operation.Materials and Methods: A total of 4,478 men underwent anatomical radical retropubic prostatectomy, as performed by a single surgeon (PCW), at the Johns Hopkins Medical Institutions from 1982 to 2011, without ...
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#1Timothy J Wilt (UMN: University of Minnesota)H-Index: 105
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During the median follow-up of 10.0 years, 171 of 364 men (47.0%) assigned to radi cal prostatectomy died, as compared with 183 of 367 (49.9%) assigned to observation (hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.08; P = 0.22; absolute risk reduction, 2.9 percentage points). Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation (hazard ratio, 0.63; 95% CI, 0.36 to 1.09; P = 0.09; absolu...
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#1Jason A. Efstathiou (Harvard University)H-Index: 55
#2Kyounghwa BaeH-Index: 25
Last. Matthew R. SmithH-Index: 102
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Purpose Gonadotropin-releasing hormone (GnRH) agonists are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about potential impact on cardiovascular mortality. We assessed the relationship between GnRH agonists and cardiovascular mortality in a large randomized phase III trial of men treated with or without adjuvant goserelin after radiation therapy (RT) for locally advanced prostate cancer. Patients and Methods Bet...
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#1Jason A. Efstathiou (Harvard University)H-Index: 55
#2Kyounghwa Bae (Radiation Therapy Oncology Group)H-Index: 25
Last. Matthew R. Smith (Harvard University)H-Index: 102
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Abstract Objectives Gonadotropin-releasing hormone agonists (GnRHa) are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about their potential effects on cardiovascular mortality. We assessed the relationship between duration of GnRHa therapy and cardiovascular mortality in a large randomized trial of men treated with short-term versus longer-term adjuvant goserelin and radiation therapy (RT) for locally advanced pr...
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#1Bruce J. Trock (Johns Hopkins University)H-Index: 86
#2Misop Han (AMA: American Medical Association)H-Index: 61
Last. Patrick C. WalshH-Index: 151
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Nearly 60 000 men (27% of newly diagnosed cases) will have undergone radical prostatectomy in 2007.1 Although surgery provides excellent cancer control, approximately 15% to 40% of these men will experience cancer recurrence within 5 years,2,3 usually manifested only by elevated prostate-specific antigen (PSA) level. It is currently difficult to determine whether increasing serum PSA level after surgery represents an isolated recurrence at the surgical site or occult metastases that cannot be de...
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#1Andrew J. Stephenson (Cleveland Clinic)H-Index: 57
#2Peter T. ScardinoH-Index: 159
Last. Alan PollackH-Index: 83
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Purpose An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods Using multivariable Co...
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#1Chris Parker (The Royal Marsden NHS Foundation Trust)H-Index: 83
#2Noel W. Clarke (University of Salford)H-Index: 71
Last. Matthew R. SydesH-Index: 70
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RADICALS is a large, international randomised controlled trial addressing two of the most important questions in postoperative management after radical prostatectomy: the timing of postoperative radiotherapy (immediate vs early salvage) and the duration of hormone therapy (none vs short term vs long term) used in addition to prostate bed radiotherapy. It has been funded by the Clinical Trials Awards Advisory Committee and will be run by the Medical Research Council Clinical Trials Unit, in colla...
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#2Melvin L.K. Chua (NUS: National University of Singapore)H-Index: 25
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Abstract null null Purpose/Objective null Risk-stratification for post-prostatectomy radiotherapy (PORT) using conventional clinicopathologic indexes leads to substantial over- and under-treatment. Better patient selection could spare unnecessary toxicities and improve outcomes. We investigated the prognostic utility of unfavorable subpathologies intraductal carcinoma and cribriform architecture (IDC/CA), and a 22-gene Decipher genomic classifier (GC) in prostate cancer (PCa) patients receiving ...
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#1Luca F. Valle (UCLA: University of California, Los Angeles)H-Index: 8
#2Eric J. Lehrer (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 14
Last. Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 19
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Abstract Context Management of locally recurrent prostate cancer after definitive radiotherapy remains controversial due to the perceived high rates of severe genitourinary (GU) and gastrointestinal (GI) toxicity associated with any local salvage modality. Objective To quantitatively compare the efficacy and toxicity of salvage radical prostatectomy (RP), high-intensity focused ultrasound (HIFU), cryotherapy, stereotactic body radiotherapy (SBRT), low鈥揹ose-rate (LDR) brachytherapy, and high-dose...
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#1Peter E. Lonergan (UCSF: University of California, San Francisco)H-Index: 12
#2Janet E. Cowan (UCSF: University of California, San Francisco)H-Index: 43
Last. Peter R. Carroll (UCSF: University of California, San Francisco)H-Index: 141
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#1Jennifer le Guevelou (Geneva College)
#2V茅rane Achard (Geneva College)H-Index: 6
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Last. Felipe Cou帽ago (UEM: European University of Madrid)H-Index: 8
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#1Menka Khoobchandani (MU: University of Missouri)
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#1N. Benziane-Ouaritini (Argonne National Laboratory)
#2P. Sargos (Argonne National Laboratory)H-Index: 2
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#1Sophia C. Kamran (Harvard University)H-Index: 16
#2Anthony L. Zietman (Harvard University)H-Index: 80
OBJECTIVES To present an overview of radiation therapy (RT) for prostate cancer over the past decade. METHODS The literature on prostate cancer radiation therapy was reviewed and summarised. Radiation therapy (RT) for prostate cancer has dramatically evolved in the past decade, with superior techniques and exciting advances, pushing the role of the radiation oncologist to new frontiers. RESULTS Innovations in imaging, treatment delivery, and a deeper understanding of biology has resulted in more...
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#1Nicholas G. Zaorsky (Penn State Cancer Institute)H-Index: 28
#2Jeremie Calais (UCLA: University of California, Los Angeles)H-Index: 20
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More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurren...
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