Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer
Publication date: Available online 10 November 2018Source: European UrologyAuthor(s): Sebastian Berg, Alexander P. Cole, Marieke J. Krimphove, Junaid Nabi, Maya Marchese, Stuart R. Lipsitz, Joachim Noldus, Toni K. Choueiri, Adam S. Kibel, Quoc-Dien TrinhAbstractA previous study comparing external beam radiation therapy with/without brachytherapy (EBRT ± BT) and radical prostatectomy (RP) for high-risk localized prostate cancer (PCa) did not find a difference in overall survival (OS) between the treatments. However, this study was limited by short follow-up and assessment of OS in patients of divergent age and comorbidities. We therefore compared OS of EBRT + BT versus RP in comparatively young (≤65 yr) and healthy men (Charlson Comorbidity Index = 0) with high-risk localized PCa in the National Cancer Database. Inverse probability of treatment weighting (IPTW) adjustment was used to balance baseline characteristics. Median follow-up was 92 mo (interquartile range 78–108). Using IPTW-adjusted Cox regression analysis, EBRT + BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio = 1.22, 95% confidence interval 1.05–1.43). In young and healthy men presenting with high-risk localized PCa, RP showed statistically significant OS benefit compared with EBRT + BT.Patient summaryIn an analysis restricted to young and healthy men presenting with high-risk local...
ConclusionEBRT + BT was associated with a significantly better prostate CSS compared with surgery or EBRT. EBRT alone was inferior to surgery by OS.
To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate risk prostate cancer (IRPC).
In this study we evaluate the lesion detection efficacy of18F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value.MethodsA total of 248 consecutive patients were evaluated and underwent scanning with18F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120 min after injection of a median dose of 311 MBq18F-DCFPyL.ResultsIn 214 out of 248 PET/CT scans (86.3%), at least one lesion sug...
CONCLUSIONS: In this systematic review and meta-analysis, we did not observe higher rate of BCR after TRT for nonmetastatic CaP patients after definitive local therapy. Based on these data, others and we have outlined a phase I/II trial assessing the safety and benefits of TRT in select men with secondary symptomatic hypogonadism who have no active disease after definitive local CaP therapy with curative intent. PMID: 31296421 [PubMed - as supplied by publisher]
Publication date: Available online 4 June 2019Source: European UrologyAuthor(s): Sebastian Berg, Alexander Cole, Quoc-Dien Trinh
Publication date: Available online 23 May 2019Source: European UrologyAuthor(s): Michael Froehner, Christian Thomas
CONCLUSION: We found no statistically significant difference in survival between RP and EBRT+BT. EBRT and brachytherapy had higher mortality, respectively, compared to RP. When including only radiotherapy patients who received ADT and, in the case of EBRT, a total dose ≥ 7920 cGy, there was no statistically significant difference in survival when comparing RP to EBRT or brachytherapy. These findings should be prospectively studied. PMID: 31109836 [PubMed - as supplied by publisher]
Cancer, still presenting one of the major challenges in modern healthcare, leads to more than 8.8 million deaths annually. While the main treatment options include surgery, chemotherapy, and radiotherapy, increasing attention is given to brachytherapy in e.g. the treatment of prostate cancer. Advantages of brachytherapy, as compared to radical prostatectomy and external beam radiation therapy, lie in the much higher radiation doses which can be given to the tumour tissue whilst sparing healthy tissue.
ConclusionssRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
ConclusionS-HIFU and S-RP could both be considered valuable LST options for patients with radiation-recurrent nonmetastatic PCa with sufficient life expectancy. S-RP is associated with more pad-dependent patients at 12 months.