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Latest & greatest articles for prostate cancer
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Oral Relugolix for Androgen-Deprivation Therapy in Advanced ProstateCancer. Injectable luteinizing hormone-releasing hormone agonists (e.g., leuprolide) are the standard agents for achieving androgen deprivation for prostatecancer despite the initial testosterone surge and delay in therapeutic effect. The efficacy and safety of relugolix, an oral gonadotropin-releasing hormone antagonist, as compared with those of leuprolide are not known.In this phase 3 trial, we randomly assigned patients (...) with advanced prostatecancer, in a 2:1 ratio, to receive relugolix (120 mg orally once daily) or leuprolide (injections every 3 months) for 48 weeks. The primary end point was sustained testosterone suppression to castrate levels (<50 ng per deciliter) through 48 weeks. Secondary end points included noninferiority with respect to the primary end point, castrate levels of testosterone on day 4, and profound castrate levels (<20 ng per deciliter) on day 15. Testosterone recovery was evaluated in a subgroup
Enzalutamide and Survival in Nonmetastatic, Castration-Resistant ProstateCancer. Preliminary trial results showed that enzalutamide significantly improved metastasis-free survival among men who had nonmetastatic, castration-resistant prostatecancer and rapidly increasing prostate-specific antigen (PSA) levels while taking androgen-deprivation therapy. Results from the final analysis of overall survival have not yet been reported.In this double-blind, phase 3 trial, men with nonmetastatic (...) , castration-resistant prostatecancer (defined on the basis of conventional imaging and a PSA doubling time of ≤10 months) who were continuing to receive androgen-deprivation therapy were randomly assigned (in a 2:1 ratio) to receive enzalutamide at a dose of 160 mg or placebo once daily. Overall survival was assessed with a group sequential testing procedure and an O'Brien-Fleming-type alpha-spending function.As of October 15, 2019, a total of 288 of 933 patients (31%) in the enzalutamide group and 178
The Oral Gonadotropin-releasing Hormone Receptor Antagonist Relugolix as Neoadjuvant/Adjuvant Androgen Deprivation Therapy to External Beam Radiotherapy in Patients with Localised Intermediate-risk ProstateCancer: A Randomised, Open-label, Parallel-group The Oral Gonadotropin-releasing Hormone Receptor Antagonist Relugolix as Neoadjuvant/Adjuvant Androgen Deprivation Therapy to External Beam Radiotherapy in Patients With Localised Intermediate-risk ProstateCancer: A Randomised, Open-label (...) Gonadotropin-releasing Hormone Receptor Antagonist Relugolix as Neoadjuvant/Adjuvant Androgen Deprivation Therapy to External Beam Radiotherapy in Patients With Localised Intermediate-risk ProstateCancer: A Randomised, Open-label, Parallel-group Phase 2 Trial , , , , , , , , , , , , , , Affiliations Expand Affiliations 1 The Institute of Cancer Research and Royal Marsden Hospital, London, UK. Electronic address: email@example.com. 2 Urology San Antonio, San Antonio, TX, USA. 3 21st Century
of malignanttumors. UICC International Union Against Cancer. 8th edn. 2017. 73. Cooperberg, M.R., et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol, 2005. 173: 1938. 74. Epstein, J.I., et al. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of ProstaticCarcinoma. Am J Surg Pathol, 2005. 29: 1228 (...) as predictors for prostatecancer. J Clin Oncol, 2009. 27: 398. 133. Stephan, C., et al. The influence of prostate volume on the ratio of free to total prostate specific antigen in serum of patients with prostatecarcinoma and benign prostate hyperplasia. Cancer, 1997. 79: 104. 134. Catalona, W.J., et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostatecancer from benign prostaticdisease: a prospective multicenter clinical trial. JAMA, 1998. 279: 1542. 135
be offered as an alternative to conventional fractionation. The task force strongly encourages that these patients be treated as part of a clinical trial or multi-institutional registry. Comment: There is additional RCT evidence to support the recommendation of KQ3B that may increase the quality of evidence for the use of ultrahypofractionation in intermediate-risk disease from low to at least moderate . ENDORSED with comment KQ3C: In men with high-risk prostatecancer receiving EBRT, the task force (...) with the recommendations for information purposes. Guideline Endorsement 3-22 Section 2: Endorsement Methods Overview – April 28, 2020 Page 5 Selection of Guidelines The Radiation Treatment Program, Disease Pathway Management, Ontario GU Cancers Advisory Committee, GU disease site group (DSG) chairs reviewed the ASTRO, ASCO, and AUA evidence-based guideline on hypofractionated radiation therapy for localized prostatecancer and accepted it as potentially useful and relevant to guide practice in Ontario. Assessment
, randomised study, we recruited men with biopsy-proven prostatecancer and high-risk features at ten hospitals in Australia. Patients were randomly assigned to conventional imaging with CT and bone scanning or gallium-68 PSMA-11 PET-CT. First-line imaging was done within 21 days following randomisation. Patients crossed over unless three or more distant metastases were identified. The primary outcome was accuracy of first-line imaging for identifying either pelvic nodal or distant-metastatic disease (...) Prostate-specific membrane antigen PET-CT in patients with high-risk prostatecancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Conventional imaging using CT and bone scan has insufficient sensitivity when staging men with high-risk localised prostatecancer. We aimed to investigate whether novel imaging using prostate-specific membrane antigen (PSMA) PET-CT might improve accuracy and affect management.In this multicentre, two-arm
trial conducted at the US Department of Veterans Affairs and National Cancer Institute sites. The participants were men (n=731) ≤75yr of age with localized prostatecancer, prostate-specific antigen (PSA) <50ng/ml, life expectancy ≥10yr, and medically fit for surgery. Intervention: Radical prostatectomy versus observation. Outcome measurements and statistical analysis: All-cause mortality was assessed in the entire cohort and patient and tumor subgroups. Intention-to-treat analysis was conducted (...) with intermediate-risk disease although not in men with high-risk disease. Patient summary: In this randomized study, we evaluated death from any cause in men with early prostatecancer treated with either surgery or observation. Overall, surgery may provide small very long-term reductions in death from any cause and increases in years of life gained. Absolute effects were much smaller in men with low-risk disease, but were greater in men with intermediate-risk disease although not in men with high-risk disease
was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%).Among patients with MRI-visible lesions, combined biopsy led to more detection of all prostatecancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower (...) MRI-Targeted, Systematic, and Combined Biopsy for ProstateCancer Diagnosis. The use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostatecancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostatecancer in men with MRI-visible lesions.Men with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary
MBS items to cover the urological component and radiation oncology component of LDR-BT for use as a boost to EBRT in patients with high- intermediate and high-risk prostatecancer. The proposed MBS item descriptors are summarised in Table 1. 4 Table 1 Applicant proposed MBS item descriptor Category 3 – Therapeutic procedures PROSTATE, radioactive seed implantation (radiation oncology component), using transrectal ultrasound guidance, for localised (non-metastatic) prostaticmalignancy classified (...) (urological component), using transrectal ultrasound guidance, for localised (non-metastatic) prostaticmalignancy classified as high-intermediate risk (defined as having a prostate specific antigen (PSA) of 10-20 ng/ml and a Gleason score of 7 and a tumour classified as T2b-c) or high risk (defined as having a PSA of greater than 20 ng/ml and/or a Gleason score of 8-10 and/or a tumour classified as T3). It is recommended the procedure only be performed as ‘boost’ treatment, in addition to external beam
Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized ProstateCancer: A Phase III Randomized Controlled Trial Dose-escalated radiotherapy (RT) with androgen-deprivation therapy (ADT) is a standard definitive treatment of localized prostatecancer (LPCa). The optimal sequencing of these therapies is unclear. Our phase III trial compared neoadjuvant versus concurrent initiation of ADT in combination with dose-escalated prostate RT (PRT).Patients with newly (...) diagnosed LPCa with Gleason score ≤ 7, clinical stage T1b to T3a, and prostate-specific antigen < 30 ng/mL were randomly allocated to neoadjuvant and concurrent ADT for 6 months starting 4 months before RT (neoadjuvant group) or concurrent and adjuvant ADT for 6 months starting simultaneously with RT (concurrent group). The primary end point was biochemical relapse-free survival (bRFS). Stratified log-rank test was used to compare bRFS and overall survival (OS). Incidence of grade ≥ 3 late RT-related
Veterans Affairs Cooperative Studies Program Study #553: Chemotherapy After Prostatectomy for High-risk ProstateCarcinoma: A Phase III Randomized Study The Veterans Affairs Cooperative Studies Program study #553 was designed to evaluate the efficacy of adjuvant chemotherapy added to the standard of care (SOC) for patients who are at high risk for relapse after prostatectomy.To test whether addition of chemotherapy to surgery for high-risk prostatecancer improves progression-free survival (PFS (...) ).Eligible patients after prostatectomy were randomized to the SOC group with observation or to the chemotherapy group with docetaxel and prednisone administered every 3 wk for six cycles. Randomization was stratified for prostate-specific antigen, Gleason, tumor stage, and surgical margin status.The primary endpoint was PFS. Secondary endpoints included overall, prostatecancer-specific, and metastasis-free survival, and time to androgen deprivation therapy.A total of 298 of the planned 636 patients
prognostic models and enhanced prebiopsy imaging are mandatory. An essential consideration when implementing any tissue-based biomarker study in prostatecancer is that tissue-based molecular testing is dependent on the site of collection within the primary tumor and tumor content, and is significantly influenced by the heterogeneity of the disease. , , For the purpose of improving prognostic value, it is of paramount importance to select the areas that are characterized by the most aggressive disease (...) . were Expert Panel co-chairs. Abstract Section: PURPOSE This guideline provides recommendations for available tissue-based prostatecancer biomarkers geared toward patient selection for active surveillance, identification of clinically significant disease, choice of postprostatectomy adjuvant versus salvage radiotherapy, and to address emerging questions such as the relative value of tissue biomarkers compared with magnetic resonance imaging. METHODS An ASCO multidisciplinary Expert Panel
Apalutamide (Erleada) - non-metastatic castration-resistant prostatecancer (NM-CRPC) Published 10 February 2020 Statement of advice SMC2268 apalutamide 60mg film-coated tablets (Erleada®) Janssen-Cilag Ltd 10 January 2020 ADVICE: in the absence of a submission from the holder of the marketing authorisation apalutamide (Erleada®) is not recommended for use within NHSScotland. Indication under review: In adult men for the treatment of non-metastatic castration-resistant prostatecancer (NM-CRPC (...) ) who are at high risk of developing metastatic disease. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines Consortium and was arrived at after careful consideration and evaluation of the available evidence
for ProstateCancer guideline. This guideline included recommendations across a relatively broad clinical spectrum within prostatecancer. Topics addressed ranged from management of osteoporotic fracture risk in nonmetastatic disease to management of men with castration-resistant prostatecancer metastatic to bone. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS The Bone Health and Bone-Targeted (...) -targeted therapies for prostatecancer. The CCO practice recommendations are drawn from data provided by randomized controlled trials (RCT) and systematic reviews of bone-targeted therapies in men with prostatecancer in a variety of settings. Relevant clinical risks range from osteoporotic fractures associated with androgen-deprivation therapy (ADT) to morbidity and death as a result of progression of bone-metastatic castration-resistant disease. In this document, the ASCO Expert Panel (Appendix