- MeSH
- Early Detection of Cancer statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Prostatic Neoplasms * diagnosis epidemiology mortality prevention & control MeSH
- Prostate-Specific Antigen MeSH
- Diagnostic Screening Programs organization & administration MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Newspaper Article MeSH
BACKGROUND AND OBJECTIVE: Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes. MATERIAL AND METHODS: Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP. RESULTS: Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01). CONCLUSION: Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Recurrence, Local * pathology surgery blood MeSH
- Biomarkers, Tumor blood MeSH
- Prostatic Neoplasms * surgery pathology blood mortality MeSH
- Follow-Up Studies MeSH
- Prognosis MeSH
- Prostatectomy * methods MeSH
- Prostate-Specific Antigen * blood MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Salvage Therapy * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
Nástup účinnějších kombinací léčby metastazujícího hormonálně senzitivního karcinomu prostaty vychází z předchozího vývoje léčby kastračně rezistentního karcinomu prostaty. V článku jsou uvedeny základní principy a současné způsoby léčby v této linii včetně probíhajícího výzkumu ve studiích fáze III.
The emergence of more effective combinations for the treatment of metastatic hormone-sensitive prostate cancer is based on the previous development of treatment for castration-resistant prostate cancer. The article presents the current basic principles and methods of treatment in this line, including ongoing research in phase III studies.
- MeSH
- Survival Analysis MeSH
- Androgen Receptor Antagonists pharmacology therapeutic use MeSH
- Androgen Antagonists pharmacology therapeutic use MeSH
- Humans MeSH
- Meta-Analysis as Topic MeSH
- Neoplasm Metastasis * drug therapy MeSH
- Prostatic Neoplasms * drug therapy mortality MeSH
- Neoplasms, Hormone-Dependent * drug therapy mortality MeSH
- Antineoplastic Combined Chemotherapy Protocols pharmacology therapeutic use MeSH
- Randomized Controlled Trials as Topic MeSH
- Check Tag
- Humans MeSH
- Male MeSH
In the past, selection of intermediate clinical endpoints (ICEs) in prostate cancer (PCa) trials largely depended on qualitative assessments; however, the advancing quality of research necessitates a robust correlation with overall survival (OS). This review summarises the results from several high-quality meta-analyses that explored the validity of ICEs as surrogates for OS. We found strong evidence that metastasis-free survival can serve as an ICE in localized PCa. In advanced disease, valid ICEs were identified only within the context of metastatic hormone-sensitive PCa, including radiological and clinical progression-free survival; however, concerns remain regarding their use owing to the limited generalisability of the data used to validate their surrogacy. PATIENT SUMMARY: Intermediate clinical endpoints can reduce the costs of trials and allow earlier introduction of new treatment methods. This article summarises results from studies verifying the validity of these endpoints as surrogates for overall survival.
- MeSH
- Humans MeSH
- Survival Rate MeSH
- Prostatic Neoplasms * mortality therapy pathology MeSH
- Endpoint Determination MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Triplet therapy, androgen receptor signaling inhibitors (ARSIs) plus docetaxel plus androgen-deprivation therapy (ADT), is a novel guideline-recommended treatment for metastatic hormone-sensitive prostate cancer (mHSPC). However, the optimal selection of the patient most likely to benefit from triplet therapy remains unclear. METHODS: We performed a systematic review, meta-analysis, and network meta-analysis to assess the oncologic benefit of triplet therapy in mHSPC patients stratified by disease volume and compare them with doublet treatment regimens. Three databases and meeting abstracts were queried in March 2023 for randomized controlled trials (RCTs) evaluating patients treated with systemic therapy for mHSPC stratified by disease volume. Primary interests of measure were overall survival (OS). We followed the PRISMA guideline and AMSTAR2 checklist. RESULTS: Overall, eight RCTs were included for meta-analyses and network meta-analyses (NMAs). Triplet therapy outperformed docetaxel plus ADT in terms of OS in both patients with high-(pooled HR: 0.73, 95%CI 0.64-0.84) and low-volume mHSPC (pooled HR: 0.71, 95%CI 0.52-0.97). There was no statistically significant difference between patients with low- vs. high-volume in terms of OS benefit from adding ARSI to docetaxel plus ADT (p = 0.9). Analysis of treatment rankings showed that darolutamide plus docetaxel plus ADT (90%) had the highest likelihood of improved OS in patients with high-volume disease, while enzalutamide plus ADT (84%) had the highest in with low-volume disease. CONCLUSIONS: Triplet therapy improves OS in mHSPC patients compared to docetaxel-based doublet therapy, irrespective of disease volume. However, based on treatment ranking, triplet therapy should preferably be considered for patients with high-volume mHSPC while those with low-volume are likely to be adequately treated with ARSI + ADT.
- MeSH
- Androgen Receptor Antagonists therapeutic use MeSH
- Androgen Antagonists * therapeutic use MeSH
- Docetaxel * therapeutic use administration & dosage MeSH
- Humans MeSH
- Prostatic Neoplasms * drug therapy mortality pathology MeSH
- Antineoplastic Combined Chemotherapy Protocols * therapeutic use MeSH
- Randomized Controlled Trials as Topic MeSH
- Network Meta-Analysis as Topic * MeSH
- Tumor Burden MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
- Keywords
- Triplet režim,
- MeSH
- Androgen Antagonists pharmacology therapeutic use MeSH
- Antineoplastic Agents, Hormonal pharmacology therapeutic use MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Prostatic Neoplasms * surgery diagnosis drug therapy mortality MeSH
- Antineoplastic Combined Chemotherapy Protocols * pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- MeSH
- Humans MeSH
- Prostatic Neoplasms * mortality prevention & control MeSH
- Mass Screening MeSH
- Primary Prevention MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Newspaper Article MeSH
- Interview MeSH
AIM: To compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs. external beam radiotherapy (RT) in patients with ductal carcinoma (DC) of the prostate. MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified 369 DC patients, of whom 303 (82%) vs. 66 (18%) were treated with RP vs. RT, respectively. Kaplan-Meier plots and uni- and stepwise multivariate Cox regression models addressed CSM in the unmatched population. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), Kaplan-Meier curve and Cox regression models tested the effect of RP vs RT on CSM. RESULTS: Overall, RT patients were older, harbored higher PSA values, higher clinical T and higher Gleason grade groups. 5-year CSM rates were respectively 4.2 vs. 10% for RP vs. RT (HR 0.40, 95% CI 0.16-0.99, p = 0.048, favoring RP). At step-by-step multivariate Cox regression, after adding possible confounders, the central tendency of the HR for RP vs. RT approached 1. PSM resulted into 124 vs. 53 patients treated respectively with RP vs. RT. After PSM, as well as after IPTW, the protective effect of RP was no longer present (HR 1.16, 95% CI 0.23-5.73, p = 0.9 and 0.97, 95% CI 0.35-2.66, p = 0.9, respectively). CONCLUSIONS: Although CSM rate of ductal carcinoma RP patients is lower of that of RT patients, this apparent benefit disappears after statistical adjustment for population differences.
- MeSH
- Carcinoma, Ductal mortality radiotherapy therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Prostatic Neoplasms mortality radiotherapy therapy MeSH
- Prostatectomy methods MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
PURPOSE: To test for differences in cancer-specific mortality (CSM) rates in Hispanic/Latino prostate cancer patients according to treatment type, radical prostatectomy (RP) vs external beam radiotherapy (EBRT). METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 2290 NCCN (National Comprehensive Cancer Network) high-risk (HR) Hispanic/Latino prostate cancer patients. Of those, 893 (39.0%) were treated with RP vs 1397 (61.0%) with EBRT. First, cumulative incidence plots and competing risks regression models tested for CSM differences after adjustment for other cause mortality (OCM). Second, cumulative incidence plots and competing risks regression models were refitted after 1:1 propensity score matching (according to age, PSA, biopsy Gleason score, cT-stage, cN-stage). RESULTS: In NCCN HR patients, 5-year CSM rates for RP vs EBRT were 2.4 vs 4.7%, yielding a multivariable hazard ratio of 0.37 (95% CI 0.19-0.73, p = 0.004) favoring RP. However, after propensity score matching, the hazard ratio of 0.54 was no longer statistically significant (95% CI 0.21-1.39, p = 0.2). CONCLUSION: Without the use of strictest adjustment for population differences, NCCN high-risk Hispanic/Latino prostate cancer patients appear to benefit more of RP than EBRT. However, after strictest adjustment for baseline patient and tumor characteristics between RP and EBRT cohorts, the apparent CSM benefit of RP is no longer statistically significant. In consequence, in Hispanic/Latino NCCN high-risk patients, either treatment modality results in similar CSM outcome.
- MeSH
- Hispanic or Latino MeSH
- Risk Assessment MeSH
- Middle Aged MeSH
- Humans MeSH
- Prostatic Neoplasms mortality radiotherapy therapy MeSH
- Prostatectomy MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
