OncologyResidual Prostate Cancer After Radiotherapy: A Study of Radical Cystoprostatectomy Specimens
Section snippets
Material and Methods
We performed a retrospective review of the Fox Chase Cancer Center tumor registry to identify patients having undergone RT for localized CaP with curative intent, who subsequently required RCP for bladder pathology from January 1990 to June 2007. Eligible patients received either definitive brachytherapy or external beam radiation and subsequently underwent RCP for a non-CaP–related disease at a later date. Patients undergoing radical retropubic prostatectomy followed by adjuvant or salvage
Results
We identified a total of 21 patients meeting our inclusion criteria (Table 1). The median age at diagnosis of prostate cancer was 71 years (mean, 69 years; range, 54 to 80 years). Initial PSA at the time of diagnosis of prostate cancer was 9.0 ng/mL (mean, 14.5 ng/mL; range, 3.13 to 80 ng/mL). The median Gleason score at time of diagnosis was 6 (range, 5 to 9). A total of 19% (4 of 21) had definitive brachytherapy, whereas 81% (17 of 21) had undergone external beam RT. The median dose of
Discussion
The ability of post-treatment surveillance to detect disease recurrence and/or persistence is critical in assessing treatment success and the planning of salvage therapy. Our study suggests that PSA alone does not accurately assess CaP activity in patients after RT. We observed that PSA before RCP was not significantly different between patients with and without histologically residual CaP in RCP specimens after definitive RT. Furthermore, 50% of patients had active CaP at the time of RCP
Conclusions
Prostate cancer disease surveillance after RT based on PSA does not capture all patients with recurrent or persistent disease. The true incidence of active CaP after RT in prior series may have been underestimated as a result of the sampling error associated with transrectal biopsy. The current series demonstrates 50% of RCP specimens containing active CaP despite meeting the Phoenix definition of biochemical success. Identification and development of novel methods in monitoring CaP disease
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2021, Journal of Vascular and Interventional RadiologyCitation Excerpt :Despite advances in RT delivery, biochemical recurrence continues to affect up to 60% of patients (4). In fact, up to 89% of patients with biochemical freedom from disease have residual prostate cancer, detected by pathologic examination, suggesting that PSA testing may be insufficient to detect residual disease (22). Further dose escalation to provide improved oncologic control is limited by the surrounding tissues’ toxicities.
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2015, Journal of UrologyBladder wall recurrence of prostate cancer after high-dose-rate brachytherapy
2015, BrachytherapyCitation Excerpt :In particular, 30% of patients with residual tumor 1 year after radiation ultimately convert to no evidence of disease without further intervention (12). Some data suggest that PRB may be prognostic for outcome 24–36 months after radiation, but viable prostate cancer is found in half of radical cystoprostatectomy specimens in men who remain biochemically controlled 5 years after treatment (13). As such, PRB is only informative in select scenarios and was not undertaken in this case given the early, overt evidence of tumor recurrence within the bladder.
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2014, Journal of UrologyCitation Excerpt :Median PSA in our series was 0.6 ng/ml and only 24% of men had PSA greater than 2 ng/ml. In prior series median PSA was 1 ng/ml in patients with residual PCa.9 Together these data suggest that PCa after RT may not be detected only by increased PSA.
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2010, European UrologyCitation Excerpt :Although the Gleason score has not been developed for the evaluation of post-RT PCa, we have confirmed that it is one of the decisive preoperative parameters for postsurgical success. It has also been identified as a positive prognostic marker in recent clinical studies evaluating the predictability of biochemical progression-free survival after RT and the therapeutic success of salvage brachytherapy for the treatment of locally recurrent PCa after EBRT [38–40]. In our series, previous seed implantation, <50% positive biopsy cores involved with cancer, and a PSA DT >12 mo were significantly associated with the presence of organ-confined, margin- and lymph node–negative PCa.
Critical review of use of radiation as initial treatment for localized prostate cancer
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