External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-sta...External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging(MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI(mp MRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrastenhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpM RI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decisionmaking for EBRT. mpM RI is also being used in salvageradiotherapy(SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence-pelvic(local, nodal, or bone) or distant-in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpM RI in detecting local recurrences-even in patients with low PSA levels(0.3-0.5 ng/m L)-and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpM RI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.展开更多
Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the resu...Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases： PubMed, Embase, and Web of Science using the following terms in ＂All fields＂： ＂salvage radiation therapy,＂ ＂salvage IMRT, S-IMRT, salvage radiotherapy, SRT, radical prostatectomy,＂ ＂RP, biochemical recurrence,＂ ＂BCR,＂ ＂biochemical relapse.＂ Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score （GS） 〉7 （odds ratio [OR]： 3.82; 95% confidence interval [CI]： 2.60-5.64） and pathological tumor （pT） stage 〉3a （OR： 1.82; 95% Ch 1.36-2.42） were positively correlated with BCR. However, SRT combined with androgen deprivation therapy （ADT） （OR： 0.63; 95% CI： 0.44-0.90） and radiation therapy （RT） dose 〉64 Gy （OR： 0.35; 95% CI： 0.19-0.64） were negatively correlated with BCR. Perineural invasion （OR： 2.64; 95% CI： 1.11-6.26）, preoperative prostate-specific antigen （PSA） 〉10 ng m1-1 （OR： 1.36; 95% CI： 0.94-1.96）, positive surgical margin （OR： 0.92; 95% Ch 0.7-1.19）, and seminal vesicle involvement （SVI） （OR： 1.09; 95% Ch. 0.83-1.43） had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.展开更多
Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR)...Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR) following radical prostatectomy(Rad P). This study aims to assess the detection rate of ^(68)Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography(PSMA-PET/CT) for diagnosis of clinical recurrence and as a treatment decision making tool in Asian patients with BCR post-Rad P.Methods: ^(68)Ga PSMA-PET and CT body with/without bone scan [conventional workup(CWU)] were performed in 55 Asian patients with BCR within 36 months post-Rad P. Two blinded reviewers assessed the images. Detection rates of ^(68)Ga PSMAPET/CT were evaluated, and impact on management was reviewed by comparison with CWU.Results: Median time to BCR post-Rad P was 8.1 months. Detection rate for ^(68)Ga PSMA-PET/CT was 80%(44/55). A positive scan was significantly associated with increasing prostate-specific antigen(PSA) level [odds ratio(OR) = 1.13(95% CI 1.05–1.30), P =0.017], but not with higher Gleason grade or shorter PSA doubling time. Compared to CWU, ^(68)Ga PSMA-PET/CT detected an additional 106 lesions in 33/44 patients with a positive scan, resulting in a change in management in 25/44(56.8%) patients: 10 to hormonal therapy(HT) and whole pelvis radiotherapy(RT) in addition to bed RT, and 15 to palliative HT alone.Conclusions: In the present report, we demonstrated the diagnostic and treatment decision utility of ^(68)Ga PSMA-PET/CT in Asian men with rapid BCR. Detection of small volume nodal and systemic recurrences at low PSA levels(< 1.0 ng/mL) highlights the role of the tool in assigning patients to treatment intensification with HT-RT or palliative HT in polymetastatic disease.展开更多
The indication for salvage radiotherapy(RT)(SRT)in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen(PSA)levels at the time of biochemical recurrence.Although th...The indication for salvage radiotherapy(RT)(SRT)in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen(PSA)levels at the time of biochemical recurrence.Although there are clear criteria(pT3-pT4 disease and/or positive margins)for the use of adjuvant radiotherapy,no specific clinical or tumour-related criteria have yet been defined for SRT.In retrospective series,5-year biochemical progression-free survival(PFS)ranges from 35%-85%,depending on the PSA level at the start of RT.Two phase 3 trials have compared SRT with and without androgen deprivation therapy(ADT),finding that combined treatment(SRT+ADT)improves both PFS and overall survival.Similar to adjuvant RT,the indication for ADT is based on tumour-related factors such as PSA levels,tumour stage,and surgical margins.The number of patients referred to radiation oncology departments for SRT continues to rise.In the present article,we define the clinical,therapeutic,and tumour-related factors that we believe should be evaluated before prescribing SRT.In addition,we propose a decision algorithm to determine whether the patient is fit for SRT.This algorithm will help to identify patients in whom radiotherapy is likely to improve survival without significantly worsening quality of life.展开更多
文摘External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging(MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI(mp MRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrastenhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpM RI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decisionmaking for EBRT. mpM RI is also being used in salvageradiotherapy(SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence-pelvic(local, nodal, or bone) or distant-in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpM RI in detecting local recurrences-even in patients with low PSA levels(0.3-0.5 ng/m L)-and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpM RI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
文摘Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases： PubMed, Embase, and Web of Science using the following terms in ＂All fields＂： ＂salvage radiation therapy,＂ ＂salvage IMRT, S-IMRT, salvage radiotherapy, SRT, radical prostatectomy,＂ ＂RP, biochemical recurrence,＂ ＂BCR,＂ ＂biochemical relapse.＂ Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score （GS） 〉7 （odds ratio [OR]： 3.82; 95% confidence interval [CI]： 2.60-5.64） and pathological tumor （pT） stage 〉3a （OR： 1.82; 95% Ch 1.36-2.42） were positively correlated with BCR. However, SRT combined with androgen deprivation therapy （ADT） （OR： 0.63; 95% CI： 0.44-0.90） and radiation therapy （RT） dose 〉64 Gy （OR： 0.35; 95% CI： 0.19-0.64） were negatively correlated with BCR. Perineural invasion （OR： 2.64; 95% CI： 1.11-6.26）, preoperative prostate-specific antigen （PSA） 〉10 ng m1-1 （OR： 1.36; 95% CI： 0.94-1.96）, positive surgical margin （OR： 0.92; 95% Ch 0.7-1.19）, and seminal vesicle involvement （SVI） （OR： 1.09; 95% Ch. 0.83-1.43） had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.
基金supported in part by Varian, Paolo Alto, CA through a structured research agreementsupported by the National Medical Research Council Singapore Clinician-Scientist Award (Grant No. NMRC/CSA/0027/ 2018)the Duke-NUS Oncology Academic Program Proton Research Program
文摘Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR) following radical prostatectomy(Rad P). This study aims to assess the detection rate of ^(68)Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography(PSMA-PET/CT) for diagnosis of clinical recurrence and as a treatment decision making tool in Asian patients with BCR post-Rad P.Methods: ^(68)Ga PSMA-PET and CT body with/without bone scan [conventional workup(CWU)] were performed in 55 Asian patients with BCR within 36 months post-Rad P. Two blinded reviewers assessed the images. Detection rates of ^(68)Ga PSMAPET/CT were evaluated, and impact on management was reviewed by comparison with CWU.Results: Median time to BCR post-Rad P was 8.1 months. Detection rate for ^(68)Ga PSMA-PET/CT was 80%(44/55). A positive scan was significantly associated with increasing prostate-specific antigen(PSA) level [odds ratio(OR) = 1.13(95% CI 1.05–1.30), P =0.017], but not with higher Gleason grade or shorter PSA doubling time. Compared to CWU, ^(68)Ga PSMA-PET/CT detected an additional 106 lesions in 33/44 patients with a positive scan, resulting in a change in management in 25/44(56.8%) patients: 10 to hormonal therapy(HT) and whole pelvis radiotherapy(RT) in addition to bed RT, and 15 to palliative HT alone.Conclusions: In the present report, we demonstrated the diagnostic and treatment decision utility of ^(68)Ga PSMA-PET/CT in Asian men with rapid BCR. Detection of small volume nodal and systemic recurrences at low PSA levels(< 1.0 ng/mL) highlights the role of the tool in assigning patients to treatment intensification with HT-RT or palliative HT in polymetastatic disease.
文摘The indication for salvage radiotherapy(RT)(SRT)in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen(PSA)levels at the time of biochemical recurrence.Although there are clear criteria(pT3-pT4 disease and/or positive margins)for the use of adjuvant radiotherapy,no specific clinical or tumour-related criteria have yet been defined for SRT.In retrospective series,5-year biochemical progression-free survival(PFS)ranges from 35%-85%,depending on the PSA level at the start of RT.Two phase 3 trials have compared SRT with and without androgen deprivation therapy(ADT),finding that combined treatment(SRT+ADT)improves both PFS and overall survival.Similar to adjuvant RT,the indication for ADT is based on tumour-related factors such as PSA levels,tumour stage,and surgical margins.The number of patients referred to radiation oncology departments for SRT continues to rise.In the present article,we define the clinical,therapeutic,and tumour-related factors that we believe should be evaluated before prescribing SRT.In addition,we propose a decision algorithm to determine whether the patient is fit for SRT.This algorithm will help to identify patients in whom radiotherapy is likely to improve survival without significantly worsening quality of life.
