Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy
Andrew J. Stephenson,Peter T. Scardino,Michael W. Kattan,Thomas M. Pisansky,Kevin M. Slawin,Eric A. Klein,Mitchell S. Anscher,Jeff M. Michalski,Howard M. Sandler,Daniel W. Lin,Jeffrey D. Forman,Michael J. Zelefsky,Larry L. Kestin,Claus G. Roehrborn,Charles Catton,Theodore L. DeWeese,Stanley L. Liauw,Richard K. Valicenti,Deborah A. Kuban,Alan Pollack +19 more
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Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence, which should prove valuable for medical decision making for patients with a rising PSA level.Abstract:
Purpose An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients. Results The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P .001), prostatectomy Gleason grade (P .001), PSA doubling time (P .001), surgical margins (P .001), androgen-deprivation therapy before or during SRT (P .001), and lymph node metastasis (P .019). The resultant nomogram was internally validated and had a concordance index of 0.69. Conclusion Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level. J Clin Oncol 25:2035-2041. © 2007 by American Society of Clinical Oncologyread more
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EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent—Update 2013
Axel Heidenreich,Patrick J. Bastian,Joaquim Bellmunt,Michel Bolla,Steven Joniau,Theodor van der Kwast,Malcolm David Mason,Vsevolod Matveev,Thomas Wiegel,Filiberto Zattoni,Nicolas Mottet +10 more
TL;DR: Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa, and watchful waiting is a treatment alternative to androgen-deprivation therapy (ADT), with equivalent oncologic efficacy.
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Nomograms in oncology: more than meets the eye
TL;DR: This work provides a systematic, practical approach to evaluating and comprehending nomogram-derived prognoses, with particular emphasis on clarifying common misconceptions and highlighting limitations.
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Clinical practice guidelines in oncology
William J. Gradishar,Benjamin O. Anderson,Ron Balassanian,Sarah L. Blair,Harold J. Burstein,Amy E. Cyr,Anthony D. Elias,William B. Farrar,Andres Forero,Sharon H. Giordano,Matthew P. Goetz,Lori J. Goldstein,Steven J. Isakoff,Janice A. Lyons,P. Kelly Marcom,Ingrid A. Mayer,Beryl McCormick,Meena S. Moran,Ruth O'Regan,Sameer A. Patel,Lori J. Pierce,Elizabeth C. Reed,Kilian E. Salerno,Lee S. Schwartzberg,Amy Sitapati,Karen L. Smith,Mary Lou Smith,Hatem Soliman,George Somlo,Melinda L. Telli,John H. Ward,Rashmi Kumar,Dorothy A. Shead +32 more
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
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EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer ☆
Nicolas Mottet,Joaquim Bellmunt,Michel Bolla,Steven Joniau,Malcolm David Mason,Vsevolod Matveev,Hans-Peter Schmid,Theo van der Kwast,Thomas Wiegel,Filiberto Zattoni,Axel Heidenreich +10 more
TL;DR: A summary of the 2010 version of the EAU guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC) summarise the most recent findings and put them into clinical practice.
Journal ArticleDOI
Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical Trial
Ian M. Thompson,Catherine M. Tangen,Jorge Paradelo,M. Scott Lucia,Gary J. Miller,Dean A. Troyer,Edward M. Messing,Jeffrey D. Forman,Joseph L. Chin,Gregory P. Swanson,Edith D. Canby-Hagino,E. David Crawford +11 more
TL;DR: Adjuvant radiotherapy after radical prostatectomy for a man with pT3N0M0 prostate cancer significantly reduces the risk of metastasis and increases survival.
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