Guide Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies

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While there are challenges with our current approaches, especially with regard to imaging this disease, we seem to be standing on a precipice with regard to both imaging and biomarkers that will soon take us to a new level in our ability, to not only monitor treatment response, but also to enable us to choose the most appropriate treatment. Knowing when not to treat prostate cancer is just as important as knowing which treatment to choose and we are developing tools that will aid us in choosing the right path for our patients.

Bethesda, MD. Clinical practice guidelines in oncology: prostate cancer.

Alberta Provincial Genitourinary Tumour Team. Prostate cancer. Thompson I. Guideline for the management of clinically localized prostate cancer: update. J Urol. Heidenreich A. Guidelines on Prostate Cancer. Eur Urol. Systematic Review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer an EORTC study : a phase III randomized trial. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol J Clin Oncol.

Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med.

Controversies in proton therapy for prostate cancer

Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group Adjuvant therapy with sodium clodronate in locally advanced and metastatic prostate cancer: long-term overall survival results from the MRC PR04 and PR05 randomised controlled trials. Lancet Oncol. A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma.

J Natl Canc Inst. Smith MR. Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer. Lipton A. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal randomized phase III trials. Eur J Can. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer.

Multinational, double-blind, phase III study of prednisone and either satraplatin or placebo in patients with castrate-refractory prostate cancer progressing after prior chemotherapy: the SPARC trial. Sipuleucel-T immunotherapy for castration-resistant prostate cancer.

Dicki GJ. Strontium and samarium therapy for bone metastases from prostate carcinoma. Australas Radiol. Parker C. A feasibility study of cryotherapy followed by radical prostatectomy for locally advanced prostate cancer. Third-generation cryotherapy for prostate cancer in the UK: a prospective study of the early outcomes in primary and recurrent disease. BJU Int. Focal therapy for prostate cancer: possibilities and limitations. Cryotherapy for localised prostate cancer.

Cochrane Database Syst Rev. High-intensity focused ultrasound therapy for clinically localized prostate cancer. Prostate Cancer Prostatic Dis. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Int J Urol. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study.

Hinyokika Kiyo. Multi-parametric MRI-directed focal salvage permanent interstitial brachytherapy for locally recurrent adenocarcinoma of the prostate: a novel approach. J Cancer. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study.

Gowardhan B, Greene D. Salvage cryotherapy: is there a role for focal therapy? J Endourol. A multicenter prospective development study evaluating focal therapy using high intensity focused ultrasound for localized prostate cancer: the INDEX study. Contemp Clin Trials. Natural history of progression after PSA elevation following radical prostatectomy. Definitions of biochemical failure that best predict clinical failure in patients with prostate cancer treated with external beam radiation alone: a multi-institutional pooled analysis.

Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. Assessment of response to therapy in advanced breast cancer. Br J Cancer. WHO handbook for reporting results of cancer treatment. J Natl Cancer Inst. Eur J Cancer. Bone imaging in metastatic breast cancer.

Tumour response interpretation with new tumour response criteria vs the World Healt Orgnisation criteria in patients with bone-only metastatic breast cancer. Br J Canc. A prospective study of bone tumor response assessment in metastatic breast cancer. Clin Breast Cancer. J Nucl Med. Strontium Metastron versus external beam radiotherapy in patients with painful bony metastases secondary to prostatic cancer: preliminary report of a multicenter trial.

Semin Oncol. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. Prostate-specific antigen kinetics during follow-up are an unreliable trigger for intervention in a prostate cancer surveillance program. Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Psychosocial aspects of active surveillance. Curr Opin Urol.

General application of the National Institute for Health and Clinical Excellence NICE guidance for active surveillance for men with prostate cancer is not appropriate in unscreened populations.

Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. Stage T prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Long-term outcome of patients with prostate cancer and pathologic seminal vesicle invasion pT3b : Effect of adjuvant radiotherapy. Prog- nostic significance of surgical margins in radical prostatectomy specimens.

Disease recurrence and progression in unrelated pathologic stage T3 prostate cancer: selecting the patient for adju- vant therapy. Postop- erative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomized controlled trial EORTC trial Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow-up of a randomized clinical trial. Prognostic significance of lymphovascular invasion in radical prostatectomy specimens.

Lymphovascular invasion is a pathologic feature of biologically aggressive disease in patients treated with radical prostatectomy. Prognostic impact of lymphovascular invasion in radical prostatectomy specimens.

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Recommendations for the reporting of prostate carcinoma. Human Pathology. Risk of prostate carcinoma death in patients with lymph node metastasis. Immediate hormonal therapy vs. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy.


Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendaions for standard in the reporting of surgical outcomes. Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Moul JW. Prostate specific antigen only progression of prostate cancer.

King CR. Adjuvant versus salvage radiotherapy for high-riskprostate cancer patients. Semin Radiat Oncol. The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Stephenson A. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. Identifying appropriate patients for early salvage radiotherapy after prostatectomy. Outcomes in patients with Gleason score prostate cancer: relation to preoperative PSA level.

Benign prostate glands at the bladder neck margin in robotic vs. BJU International. Does benign prostatic tissue contribute to measurable PSA levels after radical prostatectomy? Immunohistochemical labeling for prostate specific antigen in non-prostatic tissues. Pathol Res Pract. PSA immunoreactivity in a Parotid Oncocytoma: A diagnostic pitfall in discriminating primary parotid neoplasms from metastatic prostate cancer.

Diagnostic Cytopathology. Detection of prostate specific antigen in pancrease and salivary glands: a potential impact on prstate cancer overestimation. J Urology. The expression of prostate-specific antigen in invasive breast carcinoma and its relationship with routin clinicopathologic parameter. Adv Biomed Res. Consensus statement guidelines for PSA following radiation therapy. PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Radiotherapy for localized prostate carcinomaThe correlation of pretreatment prostate specific antigen and nadir prostate specific antigen with outcome as assessed by systematic biopsy and serum prostate specific antigen.

DeWitt K. D, Sandler H. M, Weinberg V. What does postradiotherapy PSA nadir tell us about freedom from PSA failure and progression-free survival in patients with low and intermediate-risk localized prostate cancer? Hanlon A. L, Diratzouian H, Hanks G. Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. The relationship between biochemical failure and time to nadir in patients treated with external beam therapy for T1-T3 prostate carcinoma. Radiother Oncol. Cavanaugh S. X, Kupelian P. A, Fuller C. Early prostate-specific antigen PSA kinetics following prostate carcinoma radiotherapy: Prognostic value of a time-and-PSA threshold model.

Defining biochemical cure for prostate carcinoma patients treated with external beam radiation therapy. Critz FA. Time to achieve a prostate specific antigen nadir of 0. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation.

Ellis DS. Cryosurgery as primary treatment for localized prostate cancer: a community hospital experience. Single center experience with third generation cryosurgery for management of organ confined prostate cancer: critical evaluation of short term outcomes, complications, and patient quality of life. Targeted cryoablation of the prostate: seven year outcomes in the primary treatment of prostate cancer. Comparison of biochemical failure definitions for predicting local cancer recurrence following cryoablation of the prostate. The Prostate. Pickles T.

An analysis of men treated for prostate cancer with external beam or brachytherapy with or without adjuvant androgen deprivation therapy. Permanent I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence. Radiat Oncol.

Prostate-specific antigen progression predicts overall survival in patients with metastatic prostate cancer: data from Southwest Oncology Group trials Intergroup Study and Design and end points of clinical trials testosterone: recommendations of the postate cancer clinical trials working group. Cell Stem Cell. Hum Pathol. Imaging metastatic bone disease from carcinoma of the prostate. The flare phenomenon on radionuclide bone scan in metastatic prostate cancer. Am J Roentgenol. Weber G. Enzymology of cancer cells. Bouchelouche K, Oher P. Imaging in prostate cancer staging: present role and future perspectives.

Urol Int. Biomarkers in cancer staging, prognosis and treatment selection. Nat Rev Cancer. DD3: a new prostate-specific gene, highly overexpressed in prostate cancer. Cancer Res. Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance. The glutathione S-transferase sugergene family: regulation of GST and the contribution of the isoenzymes to cancer chemoprotection and drug resistance.

Crit Rev Biochem Mol Biol. GSTP1 hypermethylation as a molecular marker in the diagnosis of prostatic cancer: is there a correlation with clinical stage, gleason grade, PSA value or age? Eur J Med Res. Measurement of serum prostate-specific membrane antigen, a new prognostic marker for prostate cancer. Expression of the prostate specific membrane antigen.

Screening for prostatic carcinoma with prostate specific antigen. Metabolomic profiles delineate potential role for sarcosine in prostate cancer progression. Couzin J. Metabolite in urine may point to high-risk prostate cancer. Natural history of early, localized prostate cancer. Overdiagnosis due to prostate-specific antigen screening: lessons from U. A population model of prostate cancer incidence. Stat Med. How good is MRI at detecting and characterising cancer within the prostate? Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology.

Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging-clinicopathologic study. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. Prostate cancer: apparent diffusion coefficient map with T2-weighted images for detection—a multireader study. Dynamic contrast-enhanced magnetic resonance imaging DCE-MRI is a useful modality for the precise detection and staging of early prostate cancer. Dynamic contrast enhanced MRI in prostate cancer.

Eur J Radiol. Acta Radiologica. Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer.

Clin Radiol. If ignored, variations in RBE may potentially place patients at higher risk for toxicity than photon radiation depending on the beam angles chosen, intrafraction motion, and target location Some authors have called for the use of anterior beam orientations when treating prostate cancer so that the distal end of the spread-out Bragg peak is deposited on the peripheral zone of the prostate where most prostate cancers are found.

The potentially higher RBE in this location could theoretically aid in tumor control A few prospective and retrospective cohort studies have been published documenting the safety and efficacy of PT Table 1 13 - In general, the studies have shown that PT minimizes the risk for major toxicity despite the use of dose escalation. In a study including patients treated to moderate doses of radiation therapy, Slater et al. Two cases of late grade 3 rectal bleeding and a case of grade 3 bowel obstruction requiring a colostomy were observed.

Fourteen patients developed late grade 3 GU toxicity. Mendenhall et al. The median follow-up was 5. The same group of authors published an update of outcomes for a larger series of patients treated on the aforementioned protocols and enrolled on an outcomes-tracking protocol between to Per the outcome-tracking protocol, the investigators collected patient-reported QOL and toxicity follow-up information prospectively. The 5-year rates of grade 3 GU and GI toxicity were 2. Nihei et al. With a median follow-up of 3. Finally, Pugh et al.

Only a single patient experienced a grade 3 GI toxicity and no episodes of grade 3 GU toxicity were reported. For example, Vora et al. Patients were treated to a median dose of The median follow-up was for 7. Additionally, Spratt et al. The median dose delivered to the prostate was A few retrospective comparisons have been published evaluating toxicity and patient-reported QOL for patients treated with photon or proton beam radiation.

The results have been mixed with some studies finding that PT reduces the risk for acute side effects of radiation therapy, as well as bowel frequency and urgency in comparison to photon based radiation, while other studies suggest that PT yields equivalent or worse outcomes. For example, Gray et al. Hoppe et al.

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Fang et al. Patients in each group were retrospectively matched based on risk group, age, and prior GU and GI comorbidities. Sheets et al.

In a propensity score-adjusted analysis, patients treated with PT did not differ in the risk for erectile dysfunction or urinary incontinence when compared to patients treated with IMRT. Yu et al. Patients treated with PT were matched to a subset of patients with similar socioeconomic and clinical characteristics who were treated with IMRT.

The risk for GI toxicity was not significantly different at any time during follow-up; by 12 months GU toxicity rates were also not significantly different between the two groups. Not only will you broaden your understanding of the basic biology of disease processes, you'll also access updated treatment algorithms, information on techniques, and state-of-the-art modalities.

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Stanford Radiation Oncologist Explains Radiation Therapy Treatment for Prostate Cancer

Disease Sites chapters summarize the most important issues on the opening page and include a full-color format, liberal use of tables and figures, a closing section with a discussion of controversies and problems, and a treatment algorithm that reflects the treatment approach of the authors. Chapters have been edited for scientific accuracy, organization, format, and adequacy of outcome data such as disease control, survival, and treatment tolerance.

Allows you to examine the therapeutic management of specific disease sites based on single-modality and combined-modality approaches. Features an emphasis on providing workup and treatment algorithms for each major disease process, as well as the coverage of molecular biology and its relevance to individual diseases. New Associate Editor, Dr. Andrea Ng, offers her unique perspectives to the Lymphoma and Hematologic Malignancies section. Key Points are summarized at the beginning of each disease-site chapter, mirroring the template headings and highlighting essential information and outcomes.

Treatment algorithms and techniques, together with discussions of controversies and problems, reflect the treatment approaches employed by the authors. Disease Site Overviews allow each section editor to give a unique perspective on important issues, while online updates to Disease Site chapters ensure your knowledge is current. Disease Site chapters feature updated information on disease management and outcomes. Thirty all-new anatomy drawings increase your visual understanding.

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Comparative studies of different approaches are reviewed, and aspects of patient assessment, examined. The prevention and treatment of disease recurrences are also addressed. Further sections consider related conditions, other treatment options, and future pathways for research.

This book should be read by all who treat or conduct research into Dupuytren disease. It is based on presentations delivered at the International Conference on Dupuytren Disease, held in Groningen, the Netherlands, which was designed to promote a coordinated global response to the disease involving patients, scientists, and clinicians. It provides a quick reference to the key issues in cancer nursing, and a concise and systematic account of all of the main areas of cancer nursing practice.

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Prostate Cancer Treatment (PDQ®)

Written by experienced nurses, the book is laid out to enable quick access to precise, targeted information on the vast majority of potential clinical scenarios. Stereotactic Radiosurgery for Prostate Cancer Hardcover, 1st ed. The rationale, selection criteria, and treatment planning for prostate SBRT are explained. Important imaging and anatomic considerations are discussed, and detailed consideration devoted to organ motion and tumor tracking during SBRT.

Outcomes of therapy are then examined, with thorough appraisal of side effect profiles and quality of life impacts.

Prostate Cancer: Types of Treatment |

Clear guidance is provided on how to deliver the therapy in a way that minimizes the risk of long-term urinary and rectal toxicities. Stereotactic radiosurgery for prostate cancer is an increasingly used form of treatment. Retrospective investigations have demonstrated the safe application of high-dose treatments, with 5-year results comparable to those achieved with protracted external beam radiotherapy.

Prospective studies are underway comparing SBRT with more traditional forms of image-guided and intensity-modulated radiotherapy. In offering in-depth guidance on safe delivery of prostate SBRT, this book will be of value for students of radiation oncology, more experienced practitioners, and medical physicists.

Progress and controversies: Radiation therapy for prostate cancer

The aim is to provide the advanced clinician with an up-to-date evidence-based reference that will assist in the delivery of enhanced patient care in daily practice. Traditional multi-week fractionation schedules were established at a time when the inclusion of relatively large amounts of normal tissue was unavoidable owing to the lack of accurate target localization during treatment.

Such schedules are time and resource consuming, difficult for patients, and expensive. Nevertheless, acceptance of alternate fractionation strategies has been slow in some countries. The paradigm is, however, changing as evidence accumulates to demonstrate improved local control, equivalence of tolerance, or both.

In documenting these alternate strategies, this book will be of value for radiation oncologists, medical physicists, and oncologists worldwide. Washington, Dennis T. Welcome to Loot. Checkout Your Cart Price. Status Available to order On special 38 New releases 3 Recent releases 8.