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Treatment Intensification in Localized Prostate Cancer: What Route with What...
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Treatment Intensification in Localized Prostate Cancer: What Route with What Car?

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 8220

Special Issue Editors

Dr. Paul Sargos

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Guest Editor
Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
Interests: prostate cancer; radiotherapy; bladder cancer
Dr. Igor Latorzeff

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Guest Editor
Department of Radiotherapy, Clinique Pasteur, Toulouse, France
Interests: prostate cancer; radiotherapy; bladder cancer
Dr. Vedang Murthy

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Guest Editor
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
Interests: prostate SBRT; bladder preservation; pelvic radiotherapy

Special Issue Information

Dear Colleagues,

For patients with prostate cancer (PCa) treated with radiotherapy, support for intensification with abiraterone and androgen deprivation therapy (ADT) is the new standard of care based on the STAMPEDE trial. Nevertheless, appropriately intensified radiotherapy could be complementary or even an alternative to systemic intensification for selected patients. Evidence from contemporary randomized trials in highrisk prostate cancer shows that the intensification of prostate radiotherapy—via brachytherapy (ASCENDE-RT), intraprostatic boost (FLAME), or elective pelvic irradiation (POPRT)—results in 5 yr metastasis-free survival (MFS) of 90–95% with ADT alone. Results from ongoing trials evaluating the same strategy in the post-operative setting are awaited. The aim of this Topic Issue is to review evidence regarding treatment intensification in localized PCa, describing rationale, oncological outcomes, tolerance and perspectives.

Dr. Paul Sargos
Dr. Igor Latorzeff
Dr. Vedang Murthy
Guest Editors

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Keywords

  • prostate cancer
  • hormonal treatment
  • radiotherapy
  • pelvic radiotherapy
  • brachytherapy
  • post-operative radiotherapy

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Published Papers (4 papers)

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Research

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10 pages, 1063 KiB  
Article
Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy
by Felix Preisser, Reha-Baris Incesu, Pawel Rajwa, Marcin Chlosta, Mohamed Ahmed, Andre Luis Abreu, Giovanni Cacciamani, Luis Ribeiro, Alexander Kretschmer, Thilo Westhofen, Joseph A. Smith, Markus Graefen, Giorgio Calleris, Yannic Raskin, Paolo Gontero, Steven Joniau, Rafael Sanchez-Salas, Shahrokh F. Shariat, Inderbir Gill, Robert Jeffrey Karnes, Paul Cathcart, Henk Van Der Poel, Giancarlo Marra and Derya Tilkiadd Show full author list remove Hide full author list
Cancers 2023, 15(12), 3123; https://doi.org/10.3390/cancers15123123 - 9 Jun 2023
Cited by 1 | Viewed by 1360
Abstract
Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node [...] Read more.
Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI. Full article
(This article belongs to the Special Issue Treatment Intensification in Localized Prostate Cancer: What Route with What Car?)
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Review

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16 pages, 963 KiB  
Review
Treatment and Staging Intensification Strategies Associated with Radical Prostatectomy for High-Risk Prostate Cancer: Efficacy Evaluation and Exploration of Novel Approaches
by Giuseppe Reitano, Tommaso Ceccato, Simone Botti, Martina Bruniera, Salvatore Carrozza, Eleonora Bovolenta, Gianmarco Randazzo, Davide Minardi, Lorenzo Ruggera, Mario Gardi, Giacomo Novara, Fabrizio Dal Moro and Fabio Zattoni
Cancers 2024, 16(13), 2465; https://doi.org/10.3390/cancers16132465 - 5 Jul 2024
Viewed by 1178
Abstract
The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a [...] Read more.
The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a paradigm shift towards more aggressive treatment strategies, also guided by new imaging modalities like positron emission tomography using prostate-specific membrane antigen (PSMA-PET). Despite the benefits, treatment intensification raises concerns regarding increased side effects. This review synthesizes the latest evidence on perioperative treatment intensification and de-escalation for high-risk localized and locally advanced PCa patients eligible for surgery. Through a non-systematic literature review conducted via PubMed, Scopus, Web of Science, and ClinicalTrials.gov, we explored various dimensions of perioperative treatments, including neoadjuvant systemic therapies, adjuvant therapies, and the role of novel diagnostic technologies. Emerging evidence provides more support for neoadjuvant systemic therapies. Preliminary results from studies suggest the potential for treatments traditionally reserved for metastatic PCa to show apparent benefit in a non-metastatic setting. The role of adjuvant treatments remains debated, particularly the use of androgen deprivation therapy (ADT) and adjuvant radiotherapy in patients at higher risk of biochemical recurrence. The potential role of radio-guided PSMA lymph node dissection emerges as a cutting-edge approach, offering a targeted method for eradicating disease with greater precision. Innovations such as artificial intelligence and machine learning are potential game-changers, offering new avenues for personalized treatment and improved prognostication. The intensification of surgical treatment in high-risk PCa patients is a dynamic and evolving field, underscored by the integration of traditional and novel therapeutic approaches. As evidence continues to emerge, these strategies will refine patient selection, enhance treatment efficacy, and mitigate the risk of progression, although with an attentive consideration of the associated side effects. Full article
(This article belongs to the Special Issue Treatment Intensification in Localized Prostate Cancer: What Route with What Car?)
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27 pages, 1096 KiB  
Review
Review of Current Treatment Intensification Strategies for Prostate Cancer Patients
by Sobia Wasim, Jieun Park, Seungyoon Nam and Jaehong Kim
Cancers 2023, 15(23), 5615; https://doi.org/10.3390/cancers15235615 - 28 Nov 2023
Cited by 4 | Viewed by 2932
Abstract
Prostate cancer (PCa) used to be one of the most common nondermatologic cancers in men that can be treated only with surgery. However, a revolutionary breakthrough came in the 1980s with the introduction of long-acting luteinizing hormone-releasing hormone (LHRH) agonists for the curative [...] Read more.
Prostate cancer (PCa) used to be one of the most common nondermatologic cancers in men that can be treated only with surgery. However, a revolutionary breakthrough came in the 1980s with the introduction of long-acting luteinizing hormone-releasing hormone (LHRH) agonists for the curative treatment of PCa. This paradigm shift contributed to the combined use of androgen deprivation therapy (ADT), chemotherapy, and radiotherapy for the treatment. The latest data highlight the use of treatment intensification (TI), i.e., combined use of radiotherapy (RT) and hormonal or drug treatments, for localized or locally advanced PCa. Indeed, the results of combined modality treatments have shown a reduction in disease-specific mortality and improved overall survival. Although TI seems promising, more research studies are warranted to confirm its efficacy. This review summarizes the latest available outcome results of pivotal trials and clinical studies on the efficacy of TI. Full article
(This article belongs to the Special Issue Treatment Intensification in Localized Prostate Cancer: What Route with What Car?)
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Other

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16 pages, 392 KiB  
Systematic Review
Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies
by Eliodoro Faiella, Domiziana Santucci, Giulia D’Amone, Vincenzo Cirimele, Daniele Vertulli, Amalia Bruno, Bruno Beomonte Zobel and Rosario Francesco Grasso
Cancers 2024, 16(4), 765; https://doi.org/10.3390/cancers16040765 - 13 Feb 2024
Cited by 5 | Viewed by 2030
Abstract
Background: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the [...] Read more.
Background: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. Methods: Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. Results: Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. Conclusions: The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa. Full article
(This article belongs to the Special Issue Treatment Intensification in Localized Prostate Cancer: What Route with What Car?)
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