Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications .
PATIENT SUMMARY In men with a rise in their PSA levels after prior local treatment for prostate cancer only , it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on the treatment of relapsing , metastatic , and castration-resistant prostate cancer ( CRPC ) .
EVIDENCE SYNTHESIS Relapse after local therapy is defined by a rising prostate-specific antigen ( PSA ) level > 0.2ng/ml following radical prostatectomy ( RP ) and > 2ng/ml above the nadir after radiation therapy ( RT ) .
And rogen deprivation therapy ( ADT ) remains the basis for treatment of men with metastatic prostate cancer ( PCa ) .
Level 1 evidence for the treatment of metastatic CRPC ( mCRPC ) includes , abiraterone acetate plus prednisone ( AA/P ) , enzalutamide , radium 223 ( Ra 223 ) , docetaxel at 75 mg/m2 every 3 wk and sipuleucel-T. Cabazitaxel , AA/P , enzalutamide , and radium are approved for second-line treatment of CRPC following docetaxel .
CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly .
Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography.
BACKGROUND The management of patients with clinical recurrence of prostate cancer after radical prostatectomy ( RP ) remains challenging . OBJECTIVE To determine whether the removal of positive lymph nodes at [11C]choline positron emission tomography/computed tomography ( PET/CT ) scan may have an impact on the prognosis of patients with biochemical recurrence ( BCR ) and nodal recurrence after RP . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve analysis of 72 patients affected by BCR after RP associated with a nodal pathologic [11C]choline PET/CT scan . INTERVENTION Patients underwent salvage lymph node dissection ( LND ) . MEASUREMENTS Biochemical response ( BR ) to treatment was defined as prostate-specific antigen ( PSA ) < 0.2 ng/ml at 40 d after salvage LND . Kaplan-Meier and Cox regression analyses addressed time to and predictors of clinical recurrence ( CR ) after salvage LND , respectively . RESULTS AND LIMITATIONS Overall , 56.9 % of patients achieved BR . Mean and median follow-up after LND were 39.4 and 39.8 mo , respectively . The 5-yr BCR-free survival rate was 19 % . Preoperative PSA < 4 ng/ml ( hazard ratio [ HR ] : 0.12 ; p = 0.005 ) , time to BCR < 24 mo ( HR : 7.52 ; p = 0.005 ) , and negative lymph nodes at previous RP ( HR : 0.19 ; p=0.04 ) represented independent predictors of BR . Overall , 5-yr CR-free and cancer-specific survival were 34 % and 75 % , respectively . At multivariable analyses , only PSA > 4 ng/ml ( HR : 2.13 ; p=0.03 ) and the presence of retroperitoneal uptake at PET/CT scan ( HR=2.92 ; p=0.004 ) represented independent preoperative predictors of CR . Similarly , the presence of pathologic nodes in the retroperitoneum ( HR : 2.78 ; p=0.02 ) , higher number of positive lymph nodes ( HR : 1.04 ; p=0.006 ) , and complete BR to salvage LND ( HR : 0.31 ; p=0.002 ) represented postoperative independent predictors of CR . Main limitations consisted of the lack of a control group and the heterogeneity of patients included in the analyses . CONCLUSIONS Salvage LND is feasible in patients with BCR after RP and nodal pathologic uptake at [11C]choline PET/CT scan . Biochemical response after surgery can be achieved in a consistent proportion of patients . Although most patients invariably progressed to BCR after surgery at longer follow-up , 35 % of patients showed the absence of CR at 5 yr
Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications .
PATIENT SUMMARY In men with a rise in their PSA levels after prior local treatment for prostate cancer only , it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on the treatment of relapsing , metastatic , and castration-resistant prostate cancer ( CRPC ) .
EVIDENCE SYNTHESIS Relapse after local therapy is defined by a rising prostate-specific antigen ( PSA ) level > 0.2ng/ml following radical prostatectomy ( RP ) and > 2ng/ml above the nadir after radiation therapy ( RT ) .
And rogen deprivation therapy ( ADT ) remains the basis for treatment of men with metastatic prostate cancer ( PCa ) .
Level 1 evidence for the treatment of metastatic CRPC ( mCRPC ) includes , abiraterone acetate plus prednisone ( AA/P ) , enzalutamide , radium 223 ( Ra 223 ) , docetaxel at 75 mg/m2 every 3 wk and sipuleucel-T. Cabazitaxel , AA/P , enzalutamide , and radium are approved for second-line treatment of CRPC following docetaxel .
CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly .