scholarly journals Neoadjuvant Chemohormonal Therapy before Radical Prostatectomy for Japanese Patients with High-Risk Localized Prostate Cancer

2021 ◽  
Vol 9 (2) ◽  
pp. 24
Author(s):  
Takeshi Sasaki ◽  
Kouhei Nishikawa ◽  
Manabu Kato ◽  
Satoru Masui ◽  
Yuko Yoshio ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Progression Free Survival ◽  
Japanese Patients ◽  
High Rate ◽  
Localized Prostate Cancer ◽  
Treatment Modalities ◽  
Chemohormonal Therapy ◽  
Significant Difference

Background: Radical prostatectomy (RP) is the standard treatment in patients with high-risk prostate cancer (PCa). However, there is a high rate of recurrence, and new approaches are required to improve surgical efficacy. Here, we evaluated the feasibility and safety of neoadjuvant chemohormonal therapy (NCHT) before RP for Japanese patients with high-risk localized prostate cancer (PCa). Methods: From February 2009 to April 2016, 21 high-risk patients were enrolled in this prospective study. Patients were treated with docetaxel (70 mg/m2) every four weeks for three cycles and luteinizing hormone-releasing hormone agonist. Patients with grade 3–4 toxicities had 25% dose reductions for the following course. Results: Median follow-up was 88.6 months. The dose of docetaxel was reduced in 13 patients. The estimated five-year biochemical progression-free survival (bPFS) rate was 57.1%. National Comprehensive Cancer Network criteria (high-risk, but not very high-risk (nVHR) versus VHR) was associated with bPFS (p = 0.03). Five-year bPFS rates in the nVHR and VHR groups were 76.9% and 25.0%, respectively. There was a significant difference in bPFS between the nVHR and VHR groups (p = 0.023) by Kaplan–Meier analysis. Conclusions: Although our study included a small number of cases, at least in our exploration, NCHT was safe and feasible. However, more extensive treatment modalities are needed to improve outcomes, especially in VHR patients.

scholarly journals Meta-analysis of studies comparing oncologic outcomes of radical prostatectomy and brachytherapy for localized prostate cancer

2017 ◽  
Vol 9 (11) ◽  
pp. 241-250 ◽  
Author(s):  
Gabriele Cozzi ◽  
Gennaro Musi ◽  
Roberto Bianchi ◽  
Danilo Bottero ◽  
Antonio Brescia ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Oncologic Outcomes ◽  
High Risk Patients ◽  
Cochrane Reviews ◽  
Statistical Heterogeneity ◽  
Significant Difference ◽  
Risk Patients

Background: The aim of this study was to compare oncologic outcomes of radical prostatectomy (RP) with brachytherapy (BT). Methods: A literature review was conducted according to the ‘Preferred reporting items for systematic reviews and meta-analyses’ (PRISMA) statement. We included studies reporting comparative oncologic outcomes of RP versus BT for localized prostate cancer (PCa). From each comparative study, we extracted the study design, the number and features of the included patients, and the oncologic outcomes expressed as all-cause mortality (ACM), PCa-specific mortality (PCSM) or, when the former were unavailable, as biochemical recurrence (BCR). All of the data retrieved from the selected studies were recorded in an electronic database. Cumulative analysis was conducted using the Review Manager version 5.3 software, designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was tested using the Chi-square test. Results: Our cumulative analysis did not show any significant difference in terms of BCR, ACM or PCSM rates between the RP and BT cohorts. Only three studies reported risk-stratified outcomes of intermediate- and high-risk patients, which are the most prone to treatment failure. Conclusions: our analysis suggested that RP and BT may have similar oncologic outcomes. However, the analysis included a limited number of studies, and most of them were retrospective, making it impossible to derive any definitive conclusion, especially for intermediate- and high-risk patients. In this scenario, appropriate urologic counseling remains of utmost importance.

The impact of Gleason pattern 4 ratio on recurrence following radical prostatectomy in Japanese patients with prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 114-114
Author(s):  
Masashi Kato
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Japanese Patients ◽  
Gleason Grade ◽  
Gleason Pattern ◽  
Significant Difference ◽  
Psa Progression ◽  
The Impact

114 Background: The 2014 International Society of Urological Pathology (ISUP) classified the Gleason grade into five groups and the Gleason score (GS) 7 was divided into groups 2 (GS3+4) and 3 (GS4+3). The ISUP recommended recording the Gleason pattern (GP) 4 ratio. However, no data are available on Japanese patients, and no studies have reported any difference between GS3+3 and a part of GS3+4. In this study, we evaluated the effect of the GP 4 ratio on recurrence following radical prostatectomy in Japanese patients with prostate cancer and revealed the equivalent between GS3+3 and part of GS3+4. Methods: We retrospectively evaluated 1,000 patients with prostate cancer who underwent radical prostatectomy at the author’s affiliated hospitals between 2005 and 2013. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014. Recurrence following radical prostatectomy was defined according to American Urological Association guidelines. The endpoint was defined as an increase in prostate-specific antigen (PSA) level. Results: Median patient age was 67 years (range, 42–77 years). Median serum PSA level was 6.8 ng/mL (range, 0.4–82 ng/mL). Median follow-up period was 59 months (range, 0.2–134 months). PSA progression was observed in 13.9% of pT2, 39.5% of pT3a, and 59.5% of pT3b. There were 164 group 1 cases (GS6), 484 group 2 (GS3+4), 212 group 3 (GS4+3), 39 group 4 (GS8), and 95 group 5 (GS9–10) cases. PSA progression-free survival was significantly different among the five groups (log rank; P = 0.0001). A significant difference was observed among the four groups with regard to the proportion by which the GP4 ratio increased (P = 0.0001) when groups 2 and 3 were divided by the GP4 ratio ( < 20%, 236 cases; 20–50%, 240 cases; 51–80%, 188 cases; and 81–100%, 17 cases). On the other hand, no difference was detected between GS3+3 and GS3+4 (GS4 < 20%) (P = 0.481). Conclusions: An increase in the GP4 ratio was correlated with PSA progression following radical prostatectomy in Japanese patients with prostate cancer. In addition, no difference was observed between GS3+3 and GS3+4 (GP4 < 20%), and GS3+4 (GP4 < 20%) patients may be an indication for active surveillance.

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