Long-term outcome of a phase II trial using immunomodulatory in situ gene therapy in combination with intensity-modulated radiotherapy with or without hormonal therapy in the treatment of prostate cancer
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Objective To analyze the epidemiology information of prostate cancer from three centers of Bejing,Shanghai,Guangzhou,and to reflect the current situation of prostate cancer in China,and to analyze the information of 272 patients with advanced prostate cancer who received hormonal therapy to find the prognostic factors of hormone therapy.Methods Collect the information of 525 patients with prostate cancer from three centers.Two hundred and seventy-two cases of advanced prostate cancer with full information were selected from the 525 cases to analyze the prognostic factors of hormone therapy.Results Three hundred and fifty-seven cases(68.0%)had advanced disease at diagnosis and 80.2% patients received hormone therapy as the main therapy.Prognostic analysis indicared that Gleason score, bone metastasis and prostate specific antigen nadir were independent prognostic factors of progression-free survival time.Conclusions In this report,most patients are advanced prostate cancer at diagnose,and hormonal therapy is the main therapy.Gleason score,bone metastasis,prostate specific antigen nadir are independent prognostic factors of advanced prostate cancer after hormone therapy.
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Prostate cancer; Epidemiology; Hormonal therapy; Prognosis
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The selection of therapies for breast cancer is today based on prognostic features (chemotherapy, radiotherapy), hormone receptor status (hormonal therapy) and HER-2 status (trastuzumab therapy). HER-2, p53 and BCL-2 are tumour-related proteins that have the potential to further improve individualisation of patient management, by predicting response to chemotherapy, hormonal therapy and radiotherapy.This paper reviews the rationale for the use of these proteins as predictive factors, as well as the published literature addressing the use of each one to predict response to hormonal therapy, chemotherapy and radiotherapy.HER-2, p53 and BCL-2 remain inadequately assessed as predictive factors in breast cancer. HER-2 evaluation is required for the selection of patients for trastuzumab (Herceptin) therapy, as trials of this therapy have been limited to HER-2 overexpressors. HER-2 overexpression may be predictive of resistance to hormonal therapy. Anthracyclines are effective therapy for breast cancer regardless of HER-2 status, but patients whose tumours overexpress HER-2 appear to receive the greatest relative benefit from this therapy. Studies of HER-2 as a predictor of response to CMF and to radiotherapy are inconclusive at this time. No data yet exist to support the use of p53 or BCL-2 as predictive factors in the therapy of breast cancer.At this point in time, there is inadequate evidence to support the use of HER-2, p53 or BCL-2 to guide the selection of hormonal therapy, chemotherapy or radiotherapy for breast cancer.
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4708 Background: To determine the histological effect of prolonged hormonal therapy on prostate cancer, we evaluated radical prostatectomy specimen after androgen ablation therapy. Methods: From January 2001 to December 2003, 36 patients underwent retropubic radical prostatectomy after several periods of hormonal therapy. The median period of hormonal therapy was 8 months (2 to 74 months) and 5 patients were given more than 3 years. Results: Seven of 36 patients (19.4%) had no residual cancer (pT0) in radical prostatectomy specimen. Periods of hormonal treatment of these patients were 6, 7, 8, 8, 16, 40, and 44 months, respectively. In the patient who was given the hormonal treatment for 74 months, only a small amount of degenerated, but viable cancer cells remained and this tumor was considered to be insignificant. Six of 7 tumors with pT0 were cT1c. There were no significant relationship between the histological effect and PSA level at diagnosis, however PSA level of all patients with pT0, except one, decreased less than 0.1 ng/ml before radical surgery. Tumors with high Gleason’s score, those received longer duration of hormonal treatment and those treated with a combined androgen blockade had a tendency to response to hormonal treatment well. Conclusions: In patients with localized prostate cancer whose PSA level kept less than 0.1 ng/ml for more than 3 years by androgen ablation, there was no significant cancer in surgical specimen. Theses findings suggest that some patients with localized prostate cancer may be cured by prolonged hormonal therapy alone. No significant financial relationships to disclose.
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Abstract Systemic therapy has historically been the backbone of treatment for patients with metastatic disease. However, recent evidence suggests metastasis-directed therapy in those with oligometastatic disease (≤5 lesions) may improve progression-free and overall survival. Within prostate cancer–specific cohorts, metastasis-directed therapy also appears to delay the time to initiation of androgen deprivation therapy while also generally being associated with a mild toxicity profile and has thus garnered interest as a means to delay systemic therapy. Here we review the evidence surrounding the use of radiation therapy to metastatic sites in patients with metastatic hormone-sensitive prostate cancer.
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Abstract
Objectives. Transrectal ultrasonography (TRUS) was used in previously untreated men with prostate cancer undergoing hormonal therapy to provide objective observations on the decrease in prostate size and to assess the usefulness of prostate size in estimating treatment response. Methods. In this retrospecive study, 31 patients with previously untreated prostate cancer (Stage T1c to D2) who received hormonal therapy (flutamide, n=18; flutamide plus castration, n=13) were followed with serial estimations of prostate size by TRUS and by serum prostate-specific antigen (PSA). Results. In both treatment groups, the major decreases in prostate size were noted within the first 6 months of therapy, whereas further follow-up examinations failed to show statistically significant changes. Prostate size decreased by 48% in men treated with flutamide, whereas those treated with flutamide plus castration showed a statistically significant greater decrease, mean of 56% (P ≤0.01). Six patients (33%) in the flutamide group and 5 (38%) men in the total androgen deprivation group ultimately failed therapy as indicated by a rising PSA level. Only 55% (n = 6) of the patients who progressed showed an increase in prostate size. Conclusions. Total androgen deprivation in comparison to flutamide alone caused a larger reduction in prostate size. As a marker of hormonal failure, a rising PSA was more sensitive than an increase in prostate size.Flutamide
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Giving radiotherapy in addition to hormone therapy improves survival in older men with locally advanced prostate cancer when compared with the commonly used approach of using only hormonal treatment in this age group, an analysis of US data has shown.
Researchers compared the effectiveness of androgen deprivation therapy and radiotherapy with that of hormonal treatment alone in 31 541 men who had had prostate cancer diagnosed …
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Objective
To study the relationship between changes in prostate volume and neoadjuvant hormone therapy (NHT) duration in prostate cancer radiotherapy.
Methods
Fifty patients with prostate cancer who received NHT were enrolled in the study continuously. The diameters along the x-, y-, and z-axes of the prostate were measured, and the volume of prostate was calculated weekly during radiotherapy. The relationship of prostate volume reduction with NHT duration, prostate volume before radiotherapy, and prostate cancer risk groups was analyzed during radiotherapy.
Results
The prostate volume in all patients decreased after radiotherapy. Patients with short NHT duration had larger changes in prostate volume and diameters than those with long NHT duration. Compared with those with a large prostate volume, patients with a normal prostate volume had larger changes in prostate volume and diameters long three axes after 7 weeks of radiotherapy, shorter NHT duration before radiotherapy, and lower risk of prostate cancer. In patients with low-and medium-risk prostate cancer, the prostate volumes were significantly reduced to 68.10% and 78.70%, respectively, of those before radiotherapy after no more than 4 months of NHT (P=0.002), but remained similar after more than 4 months of NHT. In patients with high-risk and more severe prostate cancer, the prostate volumes were significantly reduced to 76.59% and 85.46%, respectively, of those before radiotherapy after no more than 6 months of NHT (P=0.001), but remained similar after more than 6 months of NHT.
Conclusions
The changes in prostate volume and diameters along three axes during radiotherapy become smaller with longer NHT duration. Patients with low-or medium-risk prostate cancer have slight changes in prostate volume after more than 4 months of NHT, while patients with high-risk or locally advanced prostate cancer have slight changes in prostate volume after more than 6 months of NHT.
Key words:
Prostate neoplasms/radiotherapy; Prostate neoplasms/neoadjuvant hormone therapy; Prostate volume
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From September 2003 to December 2005, 188 patients who visited our hospital and allied institutions for the purpose of prostate brachytherapy were administrated hormonal therapy for volume reductions before brachytherapy. The pretreatment and posttreatment of prostate volume using a transrectal ultrasound volumetric study and the types and duration of hormonal therapy were analyzed. We administered 91 patients with Luteinizing hormone-releasing hormone (LH-RH) agonist, 49 patients with anti-androgen (bicaltamide/flutamide), and 48 patients with maximum androgen blockade (MAB). The duration of the hormonal therapy was 1-3 months for 49 patients, 4-6 months for 59 patients, 7-9 months for 40 patients, 10-12 months for 32 patients, and over 13 months for 8 patients. Before the initiation of hormonal therapy, the mean prostate volume was 35.12 ml (11.04-78.71 ml), and the average of prostate volume before and after hormonal therapy was 36.79 ml and 24.79 ml, respectively (a 32.4% reduction). The prostate volume reduction rate was 32.0% for the LH-RH agonist only, 18.1% for the anti-androgen only and 41.2% for the MAB. No statistically significant difference was observed for the duration of hormonal therapy between 3 groups. A three-month course of the neoadjuvant LH-RH agonist indicated a sufficient volume reduction effectiveness for a large prostate volume.
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