Hereditary Prostate Cancer
Dongyou Liu in Handbook of Tumor Syndromes, 2020
The association of family history of prostate cancer with aggressiveness of disease has been inconsistent. Some studies reported higher cancer-specific and overall mortality in familial cases compared to sporadic cases [59]. These findings were consistent with a study conducted in the pre-PSA era which reported greater risk of biochemical recurrence among patients with a family history of prostate cancer [60]. Other studies have not found an association of family history of prostate cancer and advanced disease. One study of 471 men undergoing radical prostatectomy evaluated biochemical recurrence after prostatectomy by family history of prostate cancer and first-degree relative with death from prostate cancer and found that those with first-degree relatives who died from prostate cancer did not have an increased likelihood of high-risk/aggressive prostate cancer or biochemical recurrence [61]. Greater studies in diverse populations are needed to lend insights into familial association to aggressive prostate cancer.
Radionuclide-based Diagnosis and Therapy of Prostate Cancer
Michael Ljungberg in Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Amino acids are essential to cell metabolism and growth. Several amino acid transporter systems are overexpressed in PCa. Anti-1-amino-3-[18F]Flurocyclobutane-1-carboxylic acid (18F-fluciclovine-FACBC) is a non-naturally occurring amino acid, and its transport is primarily mediated by sodium-dependent amino acid transporters. Because the amino acid transporters that are most involved in 18F-fluciclovine transport mediate influx and efflux of amino acids, washout of the radiotracer occurs over time. The specificity of 18F-fluciclovine for PCa relies on altered metabolic pathways overexpressed in PCa. Studies have shown a detection rate of 40 per cent for patients with biochemical recurrence and a PSA level of 0.79 ng/mL or less. Direct comparison between 18F-fluciclovine and 11C-choline PET/CT has demonstrated overall superior imaging performance for 18F-fluciclovine in biochemically recurrent PCa. A good overview of 18F-Fluciclovine is found in Parent and Schuster and colleagues [71].
High-Intensity Focused Ultrasound (HIFU)
Ayman El-Baz, Gyan Pareek, Jasjit S. Suri in Prostate Cancer Imaging, 2018
Partial gland ablation has increased in frequency as practitioners are now looking to treat localized disease while also preserving quality of life. Whole-gland HIFU has shown promising long-term function and oncologic outcomes and as imaging and ablative technologies have improved, a new shift toward partial ablation and focal therapy has been seen. Current literature includes studies that have studied short- and mid-term functional and oncologic outcomes of partial-gland HIFU in the treatment of prostate cancer. However, the current studies do not have comparison to whole-gland ablation, or with other modalities of ablation. Despite these shortcomings, a systematic review of current partial-gland ablation studies did show that CSS was 100% for the median follow-up. However, 10% of men in the primary treatment group and 37% in the salvage group had to receive additional treatment.14 Two-year rates of biochemical recurrence ranged from 42% to 67% in the salvage therapy setting. These are comparable to biochemical failure rates following radiotherapy, which are reported as 50% at 5 years out.
Target definition in salvage postoperative radiotherapy for prostate cancer: 18F-fluorocholine PET/CT assessment of local recurrence
Published in Acta Oncologica, 2018
Osman El Kabbaj, Philippe Robin, David Bourhis, Gurvan Dissaux, Nicola Rosenfelder, Antoine Valeri, Georges Fournier, Pierre-Yves Salaun, Olivier Pradier, Jean-Pierre Malhaire, Ronan Abgral, Ulrike Schick
Radical prostatectomy (RP) with or without pelvic lymph node dissection is one of the main curative options for prostate cancer (PCa). However, approximately 20–30% patients subsequently experience a biochemical recurrence (BR) [1], defined as a rise in prostate specific antigen (PSA) with two sequential values ≥0.2 ng/mL [2]. For patients with adverse pathological features like high Gleason score, lymphovascular invasion, extracapsular extension, or positive surgical margins, the recurrence rate can reach as high as 40% [3]. The standard treatment for most patients with BR after RP is salvage radiotherapy (SRT) but the timing of SRT, total dose, benefit of combination with androgen deprivation therapy (ADT) or for pelvic lymph node irradiation remain a matter of debate. Furthermore, despite adjuvant radiotherapy (ART) after surgery, 40% of patients will ultimately develop a local recurrence (LR), highlighting the importance of an adequate radiation dose and definition of the clinical target volume (CTV). However, no consensus has yet been reached on the CTV definition, and to date, several different guidelines have been published to address the need for standardization of postoperative target delineation, including the Radiation Therapy Oncology Group (RTOG), the European Organisation for Research and Treatment of Cancer (EORTC) and the Faculty of Radiation Oncology Genito-Urinary Group (FROGG) consensus guidelines [4–8].
Adherence to guidelines for androgen deprivation therapy after radical prostatectomy: Swedish population-based study
Published in Scandinavian Journal of Urology, 2020
Magdalena Lycken, Linda Drevin, Hans Garmo, Anders Larsson, Ove Andrén, Lars Holmberg, Anna Bill-Axelson
Androgen deprivation therapy (ADT) delays progression in advanced prostate cancer, but the benefit of ADT at asymptomatic biochemical recurrence after radical prostatectomy remains controversial [1]. Early treatment with ADT has been found to delay progression to metastases among men with high-risk features [2]. However, only a minority of the men with biochemical recurrence experience progression to metastases and death from prostate cancer [3–8]. Overuse should be avoided since ADT has a range of adverse effects [9–14]. European guidelines state that treatment with ADT at biochemical recurrence following radical prostatectomy should be reserved for men with the highest risk of progression, defined by a short prostate-specific antigen doubling time (PSADT), or a high Gleason score, and a long life expectancy [15].
Switching from laparoscopic radical prostatectomy to robot assisted laparoscopic prostatectomy: comparing oncological outcomes and complications
Published in Scandinavian Journal of Urology, 2018
Ida Johnson, Fredrik Ottosson, Lien My Diep, Rolf Eigil Berg, Jon-Roar Hoff, Nicolai Wessel, Lars Magne Eri, Viktor Berge
1625 prostatectomies, 544 LRP and 1081 RALP operations, were performed from January 2003 to December of 2012. Clinical and pathological data were collected prospectively and entered into the institutional database (Biobank and Registry for Urological diseases). The patients were followed up at the outpatient clinic at our department, by the external referring urologists and by general practitioner. The database was handled according to guidelines issued by the Privacy Ombudsman and Regional Ethical Committee (REK 2013/1713). The follow-up protocol included serum PSA measurements every 3 months the first year, every 6 months the second and third years, and thereafter annually in the absence of increasing PSA. Biochemical recurrence was defined as serum PSA ≥0.2 ng/ml in at least two consecutive measurements. Recording of complications into the registry were done by our study nurses who regularly updated the database with information from the Electronic Patients Journal (EPJ) and information from other hospitals and primary physicians. Surgical and medical complications occurring within 90 days postoperatively were included. Operation time is measured as ‘skin to skin’ time.
Related Knowledge Centers
- Metastasis
- Surgery
- Cancer
- Prostate-Specific Antigen
- Prostate Cancer
- Signs & Symptoms