[Inventory] Recent research on prostate cancer treatment (10)

[1] Eur Urol: Combine high-dose rescue radiotherapy and hormone therapy to treat low-grade prostate cancer pelvic nodules

Eur Urol: Combine high-dose rescue radiotherapy and hormone therapy to treat pelvic nodules with low-grade recurrence of prostate cancer

The rare occurrence of recurrence of pelvic nodules in prostate cancer is a challenge for local rescue treatment
.

Androgen deprivation therapy (ADTs) is the main treatment for metastatic prostate cancer.

Recently, some researchers have evaluated the efficacy of ADT combined with rescue radiotherapy in the treatment of male patients with prostate cancer who have fewer recurrences of pelvic nodules
.

Researchers conducted an open-label phase II trial using fluorocholine positron emission tomography computed tomography to perform high-dose-intensity radiotherapy on patients with low-grade prostate cancer recurrence (5 or less) pelvic nodules Combined therapy with ADT (6 months)
.

The primary endpoint of the study is the 2-year progression-free survival, which is defined as two consecutive prostate-specific antigen levels higher than the level at the time of inclusion, as well as evidence of clinical progress according to RECIST 1.

Between August 2014 and July 2016, the researchers recruited 67 patients in 15 centers
.

Half of the patients had previously received prostate radiation therapy

In summary, the combination of high-dose rescue pelvic radiotherapy and ADT seems to prolong the tumor control of prostate cancer with less recurrence of pelvic nodules, and the toxicity is limited
.

After 3 years, nearly half of the patients were in complete remission

[2] Eur Urol Focus: No-clip robot-assisted radical prostatectomy and its impact on results

Eur Urol Focus: No-clip robot-assisted radical prostatectomy and its impact on results

When performing robot-assisted radical prostatectomy (RARP), the use of surgical clips for athermal dissection of the contralateral prostatic pedicle and ligation during pelvic lymph node dissection (PLND) have become the gold standard of the surgical procedure
.

The clip is used to prevent thermal damage to unmyelinated nerve fibers and lymph nodes

Recently, researchers have compared the oncology and functional results of a new clamp-free, lateral pedicle control, and PLND bipolar energy RARP (RARP-bi) technology with the standard band-clamped RARP technology (RARP-c)
.

The researchers conducted a retrospective study of 338 men who received RARP from July 2018 to March 2020
.

Surgery includes RARP-c and RARP-bi

A total of 144 (43%) and 194 (57%) men underwent RARP-bi and RARP-c operations, respectively
.

In general, there is no difference between the two methods in terms of function and oncology results

To sum up, although some people worry that using bipolar energy for prostatic pedicle dissection will increase the risk of nerve damage, the results of the study prove that the oncology and functional results of this technique are similar to the standard method of using surgical clips.
There are clips and The clipless technique also makes no difference in complications or lymph node formation
.

[3] Eur Urol: Comparison of the efficacy and safety of cabazitaxel and abiraterone or enzalutamide in elderly patients with metastatic castration-resistant prostate cancer

Eur Urol: Comparison of the efficacy and safety of cabazitaxel and abiraterone or enzalutamide in elderly patients with metastatic castration-resistant prostate cancer

In the CARD study (NCT02485691), the participating patients received docetaxel in the past and progressed ≤12 months after using alternative drugs (abiraterone/enzalutamide)
.

Compared with abiraterone/enzalutamide, cabazitaxel significantly improved the median radiological progression-free survival (rPFS) and overall survival (OS) of patients with metastatic castration-resistant prostate cancer (mCRPC)

Recently, in the CARD study, researchers have evaluated the efficacy of cabazitaxel and abiraterone/enzalutamide in patients ≥70 years old and <70 years old
.

mCRPC patients randomly receive cabazitaxel (25 mg/m2 + prednisone and granulocyte colony stimulating factor) and abiraterone (1000 mg + prednisone) or enzalutamide (160 mg) at a 1:1 ratio
.
According to pre-setting, the researchers analyzed rPFS (primary endpoint) and safety by age; the others were analyzed after the fact
.
The comparison of treatment groups adopts the stratified log-rank or Cochran-Mantel-Haenszel test
.

The study found that among 255 randomized patients, 135 were ≥70 years old (median 76 years old)
.
Compared with abiraterone/enzalutamide, cabazitaxel is in (8.
2 vs 4.
5 months; hazard ratio [HR]=0.
58; 95% confidence interval [CI]=0.
38-0.
89; p=0.
012) and <70 Patients aged (7.
4 vs 3.
2 months; HR=0.
47; 95%CI=0.
30-0.
74; p<0.
001) were able to significantly improve the median rPFS
.
In cabazitaxel and abiraterone/enzalutamide-treated patients ≥70 years of age, the median OS was 13.
9 months and 9.
4 months, respectively (HR=0.
66; 95%CI=0.
41-1.
06; p=0.
084) ; Patients under 70 years of age were 13.
6 months and 11.
8 months (HR=0.
66; 95%CI=0.
41-1.
08; p=0.
093)
.
Regardless of age, progression-free survival, prostate specific antigen, tumor and pain response are better in the treatment of cabazitaxel
.
Among patients ≥70 years of age who were treated with cabazitaxel and abiraterone/enzalutamide, the rates of treatment emergent adverse events (TEAEs) ≥3 were 58% and 49%, respectively, and those of patients <70 years old were respectively 48% and 42%
.
In patients ≥70 years of age, adverse cardiac events of abiraterone/enzalutamide were more frequent; adverse events of wheezing and diarrhea of ​​cabazitaxel were more frequent
.

In summary, compared with abiraterone/enzalutamide, cabazitaxel improves the treatment results of mCRPC patients after previous use of docetaxel and abiraterone/enzalutamide, and the efficacy is independent of age
.
TEAEs are more frequent in patients ≥70 years of age, and the safety of cabazitaxel is controllable in all age groups
.

[4] J Sex Med: Sildenafil citrate and the risk of biochemical recurrence in prostate cancer patients receiving radiotherapy: a post-mortem analysis of a randomized controlled trial

J Sex Med: Sildenafil Citrate and the Risk of Biochemical Recurrence in Prostate Cancer Patients Receiving Radiotherapy: A Post-mortem Analysis of a Randomized Controlled Trial

Sildenafil citrate has a protective effect on sexual function, but some evidence suggests that patients taking sildenafil after radical prostatectomy have an increased risk of biochemical recurrence (BCR)
.

Recently, researchers have evaluated whether sildenafil is associated with an increased risk of BCR in patients receiving prostate radiotherapy (RT)
.
They performed a secondary analysis of a randomized placebo-controlled trial (RPCT) that compared the results of sildenafil citrate with placebo during and after prostate RT
.

The research group consisted of prostate cancer patients who received radiotherapy at the researcher's institution
.
The researchers compared the results of sildenafil (50 mg per day) with placebo for 6 months, followed up for 24 months, and allowed for androgen blocking therapy (ADT)
.
The prognostic risk grouping of prostate cancer is not an exclusion criterion.
Most study participants have low or moderate risk of prostate cancer
.
Kaplan-Meier plot and log-rank test were used for statistical analysis
.

The researchers analyzed data from a total of 162 men
.
Among them, 9 men had insufficient PSA follow-up data, and the remaining 153 men were included in the final report
.
The median age of the participants was 61 years old
.
During a median follow-up of 8.
3 years (range: 3.
0-12.
2), 5/94 (5.
3%) and 2/59 (3.
4%) patients in the sildenafil and placebo groups had BCR, respectively
.
The 6-year BCR-free survival rate of all patients was 98.
8%, 98.
1% in the sildenafil group, and 100% in the placebo group
.
The 10-year BCR-free survival rate of all patients was 94.
4%, 95.
6% in the sildenafil group, and 92.
9% in the placebo group
.
By log-rank comparison, there was no difference in the BCR-free survival rate between the sildenafil group and the placebo group (P=0.
36)
.

In summary, the prevention of sildenafil citrate treatment and risk of biochemical recurrence of prostate cancer patients with radiation therapy does not matter
.
However, the study was unable to draw a clear negative conclusion
.
This analysis provides clinical decision-making evidence on the safety of using sildenafil during and after prostate RT
.
The advantage of the study lies in the prospective, randomized placebo-controlled trial, and the subjects' medication compliance is very high
.
However, the limitation of the study lies in the retrospective nature of the analysis.
Some patients used ADT and could not detect the difference in BCR between sildenafil and the placebo group
.

prevention

[5] J Sex Med: U.
S.
prostate cancer survivors use testosterone therapy

J Sex Med: Trends in U.
S.
prostate cancer survivors using testosterone therapy

At present, the prescribing model of testosterone therapy (TTh) in men with a history of prostate cancer (CaP) is not well elucidated
.

Recently, a researcher explained the demographics of men with a history of prostate cancer and the usage patterns of testosterone therapy in the United States
.

This is a retrospective study
.
The researchers managed diagnosis , procedures, pharmacy, and laboratory codes to identify male subjects with prostate cancer 40 years of age and older who underwent surgery or radiation therapy from 2003 to 2018, and they all received TTh
.
They also identified demographic and clinical factors, and reported time trends in TTh use
.

Management diagnosis

The main results of the study are the testosterone prescription rate of men with prostate cancer treated and related laboratory values ​​such as prostate-specific antigen (PSA) and pre-TTh testosterone levels
.

During the study period, a total of 126,374 men completed CaP treatment (42,515 operations, 75,186 radiotherapy, and 8673 both)
.
Among them, 3074 men (2.
4%) received testosterone therapy after CaP treatment
.
Compared with men who did not receive testosterone, men who received testosterone were younger, more likely to have erectile dysfunction, depression, and lower PSA values ​​before treatment
.
Depending on the type of CaP treatment, the median PSA before the start of TTh is 0-0.
2, and the median total testosterone is <300 ng/dL
.
TTh started at an average of 1.
5 years after radical prostatectomy and 2.
6 years after radiotherapy
.
The researchers observed that from the beginning of the study period, the TTh after CaP increased until it reached a peak of 4.
9% in 2013
.
After 2013, the rate declined year by year until it reached a plateau of about 1.
8%
.
Approximately one-third of men do not have a testosterone test before starting TTh
.

The study explains the trend of male testosterone prescription use after prostate cancer treatment, helps clinical decision-making, and provides evidence for improvement in the care of cancer survivors
.
The advantages of the research are the large sample size, long data coverage, and real-world analysis of testosterone prescription patterns across the United States
.
Limitations include reliance on insurance claims data, retrospective study design, and lack of other relevant clinical variables that may influence decisions about testosterone
.

In summary, the trend of testosterone prescriptions for prostate cancer patients in the United States shows that many men will use testosterone therapy after receiving prostate cancer treatment, and its indications and monitoring models are consistent with the general population
.

 

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