Mohamed Jalloh1, Michael S Leapman2, Janet E Cowan3, Katsuto Shinohara2, Kirsten L Greene2, Mack Roach4, Albert J Chang4, June M Chan5, Jeffry P Simko2, Peter R Carroll6. 1. Department of Urology, University of California-San Francisco, San Francisco, California; Service d'Urologie-Andrologie, Hopital General de Grand Yoff, Dakar, Senegal. 2. Department of Urology, University of California-San Francisco, San Francisco, California; University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California. 3. Department of Urology, University of California-San Francisco, San Francisco, California. 4. Department of Radiation Oncology, University of California-San Francisco, San Francisco, California; University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California. 5. Department of Urology, University of California-San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California. 6. Department of Urology, University of California-San Francisco, San Francisco, California; University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California. Electronic address: pcarroll@urology.ucsf.edu.
Abstract
PURPOSE: Little is known about patterns of local failure following radiation therapy for prostate cancer. We aimed to characterize post-radiation biopsy findings, including the treatment effect and the zonal distribution of recurrent disease after radiation therapy, in men experiencing biochemical recurrence. MATERIALS AND METHODS: We identified patients who received post-radiation biopsy in the setting of biochemical recurrence following primary radiation for localized disease. Histological post-radiation biopsy results were categorized by the absence of tumor, demonstration of radiation treatment effect, failure (recurrent cancer) or a combination of treatment effect and failure. We described patterns of histological failure and compared them to the diagnostic biopsy findings. RESULTS: A total of 284 men underwent mapped post-radiation biopsy for biochemical recurrence. Mean age at initial diagnosis was 63 years and median prostate specific antigen was 8.2 ng/ml. Of the men 33%, 32% and 35% were classified at low, intermediate and high risk based on clinical CAPRA (Cancer of the Prostate Risk Assessment) categories. Median time to post-radiation biopsy was 61 months after treatment. Findings were negative in 4% of cases while we noted a treatment effect in 31%, failure in 45% and a combination in 20%. Failure rates were similar across sextants. Of 140 patients with mapped pretreatment and posttreatment biopsies 4% demonstrated cancer in a new location previously identified as negative. Gleason upgrading occurred in 43% of cases with 85% upgraded to 4 + 3 or higher. CONCLUSIONS: Men with rising prostate specific antigen after radiotherapy for prostate cancer most often experience recurrence in dominant tumor sites. Whether failure is due to inadequate targeting, dosing or intrinsic radiation resistance remains unknown to our knowledge. Further study is warranted.
PURPOSE: Little is known about patterns of local failure following radiation therapy for prostate cancer. We aimed to characterize post-radiation biopsy findings, including the treatment effect and the zonal distribution of recurrent disease after radiation therapy, in men experiencing biochemical recurrence. MATERIALS AND METHODS: We identified patients who received post-radiation biopsy in the setting of biochemical recurrence following primary radiation for localized disease. Histological post-radiation biopsy results were categorized by the absence of tumor, demonstration of radiation treatment effect, failure (recurrent cancer) or a combination of treatment effect and failure. We described patterns of histological failure and compared them to the diagnostic biopsy findings. RESULTS: A total of 284 men underwent mapped post-radiation biopsy for biochemical recurrence. Mean age at initial diagnosis was 63 years and median prostate specific antigen was 8.2 ng/ml. Of the men 33%, 32% and 35% were classified at low, intermediate and high risk based on clinical CAPRA (Cancer of the Prostate Risk Assessment) categories. Median time to post-radiation biopsy was 61 months after treatment. Findings were negative in 4% of cases while we noted a treatment effect in 31%, failure in 45% and a combination in 20%. Failure rates were similar across sextants. Of 140 patients with mapped pretreatment and posttreatment biopsies 4% demonstrated cancer in a new location previously identified as negative. Gleason upgrading occurred in 43% of cases with 85% upgraded to 4 + 3 or higher. CONCLUSIONS:Men with rising prostate specific antigen after radiotherapy for prostate cancer most often experience recurrence in dominant tumor sites. Whether failure is due to inadequate targeting, dosing or intrinsic radiation resistance remains unknown to our knowledge. Further study is warranted.
Authors: Giancarlo Marra; Taimur T Shah; Daniele D'Agate; Alessandro Marquis; Giorgio Calleris; Luca Lunelli; Claudia Filippini; Marco Oderda; Marco Gatti; Massimo Valerio; Rafael Sanchez-Salas; Alberto Bossi; Juan Gomez-Rivas; Francesca Conte; Desiree Deandreis; Olivier Cussenot; Umberto Ricardi; Paolo Gontero Journal: Front Surg Date: 2022-06-07
Authors: Shyama U Tetar; Anna M E Bruynzeel; Lisa Verweij; Omar Bohoudi; Berend J Slotman; Tezontl Rosario; Miguel A Palacios; Frank J Lagerwaard Journal: Phys Imaging Radiat Oncol Date: 2022-07-03
Authors: Francesca V Mertan; Matthew D Greer; Sam Borofsky; Ismail M Kabakus; Maria J Merino; Bradford J Wood; Peter A Pinto; Peter L Choyke; Baris Turkbey Journal: Top Magn Reson Imaging Date: 2016-06
Authors: Hecong Qin; Vickie Zhang; Robert A Bok; Romelyn Delos Santos; J Adam Cunha; I-Chow Hsu; Justin Delos Santos Bs; Jessie E Lee; Subramaniam Sukumar; Peder E Z Larson; Daniel B Vigneron; David M Wilson; Renuka Sriram; John Kurhanewicz Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-25 Impact factor: 7.038
Authors: Kelli A Connolly; Brian A Belt; Nathania M Figueroa; Aditi Murthy; Ankit Patel; Minsoo Kim; Edith M Lord; David C Linehan; Scott A Gerber Journal: Oncotarget Date: 2016-12-27
Authors: T T Shah; M Peters; A Kanthabalan; N McCartan; Y Fatola; J van der Voort van Zyp; M van Vulpen; A Freeman; C M Moore; M Arya; M Emberton; H U Ahmed Journal: Prostate Cancer Prostatic Dis Date: 2016-07-19 Impact factor: 5.554