Prostate Cancer

Expanding Active Surveillance Criteria for Low- and Intermediate-risk Prostate Cancer: Can We Accurately Predict the Risk of Misclassification for Patients Diagnosed by Multiparametric Magnetic Resonance Imaging-targeted Biopsy - Beyond the Abstract

Active surveillance (AS) is generally recognized as the preferred treatment option for low-risk prostate cancer (PCa) patients with excellent long-term oncologic outcomes, preserving quality of life and functional outcomes. Recent data have suggested expanding indication to highly selected favorable intermediate-risk PCa although associated with a higher risk of progression to locally advanced and metastatic disease. Defining optimal selection criteria remains a key issue. Recently Gandaglia et al., on behalf of the European Association of Urology-Young Academic Urologists Working Party on Prostate Cancer, and Lantz et al. developed multivariable models predicting the risk of adverse pathology (i.e., ISUP grade group≥3, non-organ confined disease and/or lymph node invasion) among patients operated by radical prostatectomy for low- and intermediate-risk PCa. We aimed to test these models in a set of 1062 low- and favorable intermediate-risk PCa patients diagnosed by multiparametric magnetic resonance imaging (MRI) and MRI-targeted biopsy using Trinity (Koelis®, La Tronche, France) system. We hypothesized that inclusion of radiological features into a novel model would improve patient selection. Performance was assessed using discrimination, calibration, and decision-curve-analysis (DCA).

How to read biparametric MRI in men with a clinical suspicious of prostate cancer: Pictorial review for beginners with public access to imaging, clinical and histopathological database.

Prostate Magnetic Resonance Imaging (MRI) is increasingly being used in men with a clinical suspicion of prostate cancer (PCa). Performing prostate MRI without the use of an intravenous contrast (IV) agent in men with a clinical suspicion of PCa can lead to reduced MRI scan time.

CDC Issues Key Clarification on Guideline for Prescribing Opioids for Chronic Pain

San Francisco, CA (UroToday.com) -- Agency Clarifies CDC Guideline Not Meant to Limit Access to Appropriate Pain Management for Individuals with Cancer, Sickle Cell Disease. The American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), and the National Comprehensive Cancer Network® (NCCN®) are pleased to acknowledge receipt of a key clarification from the Centers for Disease Control and Prevention (CDC) on prescribing opioids to manage pain from certain conditions. The clarification regarding CDC's Guideline for Prescribing Opioids for Chronic Pain----issued in a letter from the agency to ASCO, ASH, and NCCN----comes as a result of a collaborative effort by these organizations to clarify CDC's opioid prescribing guideline in order to ensure safe and appropriate access for cancer patients, cancer survivors, and individuals with sickle cell disease.

Overall Survival and Immune Responses with Sipuleucel-T and Enzalutamide: STRIDE Study

Background: STRIDE (NCT01981122) is the first study comparing concurrent (con) vs sequential (seq) enzalutamide (enz) with sipuleucel-T (sip-T) in patients (pts) with metastatic castration-resistant prostate cancer. Pts were followed until death or for 3 years.

Does Limited Pelvic Lymphadenectomy in Low-Risk Prostate Cancer Patients Affect Biochemical Recurrence?

ABSTRACT

Introduction: Several studies have reported a very low incidence of lymph node metastasis in D’Amico low-risk prostate cancer. As a result, omission of the pelvic lymphadenectomy (PLND) has become more common in this group. We evaluated whether omission of a PLND in these patients was associated with increased rates of 5-year biochemical recurrence (BCR).

Materials and Methods: The study population included 535 patients with prostate cancer clinical stage T1-2, Gleason 3 + 3, and PSA < 10 ng/mL. Patients were divided into 2 groups, those with a limited PLND (+PLND) at the time of prostatectomy (N = 139) and those without (–PLND) (N = 396). BCR was defined as PSA > 0.2 ng/mL at any time following surgery. Univariate and multivariate Cox proportional hazards analyses were applied to evaluate the association between the omission of PLND and BCR.

Results: Median follow-up was 43 months (range 0.4 to 194.8). The mean number of lymph nodes obtained at PLND was 6.2 (range 1 – 38). Of these, 122 men had BCR during follow-up. Men who had PLND had earlier surgery dates and were more likely to have had open prostatectomy. They were also associated with higher preop PSAs, fewer biopsy cores but a higher percent of positive cores, and higher maximum cancer in any 1 core. Kaplan-Meier analysis revealed similar survival curves for both groups (log-rank test P = 0.723). Using the univariate Cox proportional hazards analysis, omission of PLND was not associated with a higher risk of BCR when compared to +PLND. Preoperative PSA, year of surgery, procedure type, pathologic Gleason score and stage, as well as margin status were all significantly (P < 0.05) associated with the risk of BCR, while African American race approached significance (P = 0.062).

Conclusion: With a 43-month median follow-up, D’Amico low-risk prostate cancers are no more likely to develop BCR when limited PLND is omitted than those who undergo limited PLND. A potentially confounding variable might be the variability in the extent of PLND.

Joshua E. Logan, Bethany Barone Gibbs, Stephen B. Riggs, Robert W. Given, Michael D. Fabrizio, Paul F. Schellhammer, Raymond S. Lance

Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia

Submitted November 20, 2013 - Accepted for Publication November 28, 2013

KEYWORDS: Prostate cancer, pelvic lymph node dissection, PSA

CORRESPONDENCE: Joshua E. Logan, MD, Eastern Virginia Medical School, Norfolk, Virginia, United States ()

CITATION: UroToday Int J. 2013 December;6(6):art 73. http://dx.doi.org/10.3834/uij.1944-5784.2013.12.08

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Prostate Cancer

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