Sarcopenia is defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. Ageing greatly contributes to sarcopenia as may many other factors such as cancer or androgen deprivation therapies (ADT).
African American men have a higher burden of prostate cancer compared with other populations. We sought to determine if they experience disparities in access to prostate cancer clinical trials.
We created a database of all US counties by linking prostate cancer clinical trial data with county-level socioeconomic, demographic, and health-care facility data derived from several external data sources.
Acute and late toxicity was analysed for prostate cancer patients with bilateral hip prostheses, who received fixed field intensity modulated radiotherapy (IMRT). The aims were (1) to establish whether toxicity rates differed from those of a control group with normal hips, (2) to develop a volumetric modulated arc therapy (VMAT) approach for patients with prostheses and (3) to compare doses to bladder and rectum for the control group, prostheses group and VMAT replans for the prostheses group.
For men with an elevated prostate-specific antigen (PSA), there is a strong evidence for prostate MRI to assess the risk of clinically significant prostate cancer (CSPC) and guide targeted-biopsy interventions.
Although the feasibility of transperineal biopsy under local anesthesia has been demonstrated, little is known regarding the application of MRI/ultrasound software fusion targeted biopsy for transperineal biopsy under local anesthesia.
Androgen deprivation, which can be accomplished via drug treatment using gonadotropin-releasing hormone (GnRH) agonists, antiandrogens, or both combined, is widely used in the treatment of prostate cancer. Androgen deprivation therapy (ADT) can delay cancer progression and be life-prolonging. As with almost all cancer treatments, ADT comes with side effects and one of the most concerning is the possibility of accelerated brain aging and cognitive decline. Patients and their friends and family may notice diminished memory, attention, and information processing. This is thought to be related to the neuroprotective supportive role that testosterone plays in the healthy brain. It enhances synaptic plasticity, improves mitochondrial function, and is anti-inflammatory. Reducing androgens to castration levels may mean loss of this protection.
Metastasis has classically been considered a binary state, which has heavily influenced treatment paradigms to favor systemic therapy. Recently, mounting evidence suggests metastasis is a spectrum of disease rather than a simple binary entity resulting in the notion of a potentially curable low-volume metastatic state with metastasis-directed local therapy. Significant efforts have been underway to categorize patients with metastatic castration-sensitive prostate cancer (mCSPC) by splitting disease into high- and low-volume states for treatment and risk stratification purposes. As investigators attempt to accurately categorize these patients, several definitions of disease volume have been proposed and applied in various clinical trials. Broadly, these can be separated into numeric/location-centric (ie CHAARTED and STAMPEDE) or enumeration only (i.e. Oligometastatic ≤3 or ≤5) definitions.
We have previously demonstrated that clinical data alone is insufficient to fully capture the heterogeneity exhibited by this patient population and that tumor genomics plays a key role across this spectrum of disease. We, therefore, aimed to evaluate this commonly used definition of disease burden in the context of patients with CSPC who underwent next-generation sequencing of their tumor.
Patients were classified into biochemically recurrent, “low-volume”, and “high-volume” metastatic disease utilizing four definitions. Patients classified as biochemical recurrence (BCR) had a rising PSA following definitive therapy to the primary tumor without any radiographic evidence of gross metastatic disease at last follow-up. The four definitions in our analysis included those from CHAARTED (high volume: visceral metastasis or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis), modified STAMPEDE (high volume: visceral metastasis or ≥4 bone lesions), oligometastatic ≤3 (high volume: greater than 3 metastases irrespective of location), and oligometastatic ≤5 (high volume: greater than 5 metastases irrespective of location).
We identified that all of these definitions were similarly effective at stratifying patients by clinical outcome (radiographic progression-free survival, time to castration resistance, and overall survival) (Figure). High volume disease was associated with significantly worse outcomes within all definitions. We also noted the underlying genetic makeup of tumors was similar across all definitions and increasing rates of driver mutations were identified across the spectrum of disease within all four definitions. Interestingly, patients with low-volume disease and TP53 mutations had clinical course more akin to patients with high-volume disease suggesting its ability to provide prognostic information. Finally, patients with discordant classifications (high volume by one definition but low by another) also appeared to have a more aggressive clinical course similar to those with high volume disease.
These findings demonstrate the similarities of four commonly utilized definitions of mCSPC in terms of patient classifications, clinical outcomes, and incidence of pathogenic driver mutations across the spectrum of disease. Future work is needed to further refine risk stratification by incorporating timing of disease (metachronous vs synchronous), and tumor genomics.
Written by: Matthew P Deek, Philip Sutera, Kim Van Der Eecken, Amar U Kishan, Anis Hamid, Emily Grist, Gerhardt Attard, Tamara Lotan, Adrianna A Mendes, Channing J Paller, Michael A Carducci, Ashley Ross, Hao Wang, Ken Pienta, Felix Y Feng, Emmanuel S Antonarakis, Piet Ost, Daniel Y Song, Stephen Greco, Curtiland Deville, Theodore DeWeese, Phuoc T Tran
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Departments of Pathology and human structure and repair, University of Ghent, Ghent, Belgium., Department of Radiation Oncology, UCLA, Los Angeles, CA, USA., Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Department of Oncology, UCL Cancer Institute, London, UK., Division of Molecular Pathology, The Institute of Cancer Research, London, UK., Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, Northwestern University, Chicago, IL, USA., Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Departments of Radiation Oncology, Medicine and Urology, UCSF, San Francisco, CA, USA., Department of Radiation Oncology, Iridium Network, Antwerp, Belgium and Department of human structure and repair, Ghent University, Ghent, Belgium.
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Aim: To assess homologous recombination repair mutation (HRRm) testing patterns in metastatic castration-resistant prostate cancer. Methods: A point-in-time, international survey conducted January-August 2020.
The role of endogenous testosterone in de novo prostate cancer pathogenesis in humans remains unclear. The effect of testosterone on the tumor genome is not explored. To explore the correlation between perioperative testosterone level on genomic risk score in a cohort of men who underwent radical prostatectomy.
Cloquet's node, located at the junction between the deep inguinal nodes and the external iliac chain, is easily accessible and commonly excised during pelvic lymph node dissection for prostate cancer.