Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up

Jason Robert Gee; John André Libertino

doi:doi:10.11648/j.ijcocr.20210603.14

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Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up

Jason Robert Gee, John André Libertino

Published in International Journal of Clinical Oncology and Cancer Research (Volume 6, Issue 3)

Received: 5 July 2021 Accepted: 19 July 2021 Published: 24 July 2021

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Abstract

High risk prostate cancer requires a multimodal approach to treatment. Surgery has played an increasing role for these patients although long-term follow-up and experience with neoadjuvant therapy, a basic tenet of cancer treatment, remains limited. Here we report our experience with neoadjuvant hormonal ablation followed by surgery and postoperative radiation with greater than 20-year follow-up. From 1990-2012, 82 patients with clinically organ-confined prostate cancer and 10 years median follow-up underwent multimodal therapy (MMT) consisting of neoadjuvant hormonal ablation followed by radical retropubic prostatectomy and postoperative radiation. High-risk prostate cancer was defined preoperatively as Gleason Score 8-10 or PSA>20. Patients with negative surgical margins were observed initially and treated with salvage XRT in the instance of recurrence. The MMT protocol was well tolerated in all 82 patients with no treatment-related discontinuation of therapy. Final surgical pathology revealed stage pT3-T4 in 58/82 (71%) and nodal involvement in 7/82 (9%). Distant metastatic disease was identified in 10/82 patients (12%). For patients undergoing MMT at 10, 15 and 20 years, cancer-specific survival was 78/82 (95%), 77 /82 (94%) and 77/82 (94%), overall survival was 68/82 (83%), 66/82 (80%) and 60/82 (73%), and biochemical recurrence was 61/82 (74%), 51/82 (62%) and 35/82 (43%). These findings establish the MMT protocol as an effective treatment strategy for high-risk prostate cancer with excellent long-term cancer-specific survival. Recurrence occurring primarily as a rising PSA as opposed to distant metastatic disease suggests limited morbidity as well among patients treated with this protocol.

Published in	International Journal of Clinical Oncology and Cancer Research (Volume 6, Issue 3)
DOI	10.11648/j.ijcocr.20210603.14
Page(s)	125-129
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Prostatic Neoplasms, Neoadjuvant Therapy, Prostatectomy, Radiation

References

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[9]	Horwitz EM, Bae K, Hanks GE, et al: Ten-year Follow-Up of Radiation Therapy Oncology Group Protocol 92-02: A Phase III Trial of the Duration of Elective Androgen Deprivation in Locally Advanced Prostate Cancer. J Clin Oncol 2008; 26: 2497.
[10]	Lewinshtein D, Teng B, Valencia A, et al: The Long-Term Outcomes After Radical Prostatectomy of Patients With Pathologic Gleason 8-10 Disease. Adv Urol 2012; 2012: 428098.
[11]	Soloway MS, Pareek K, Sharifi R, et al: Lupron Depot Neoadjuvant Prostate Cancer Study Group. Neoadjuvant androgen ablation before radical prostatectomy in cT2bNxMo prostate cancer: 5-year results. J Urol 2002; 167: 112.
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[13]	Bastian PJ, Boorjian SA, Bossi A, et al: High-risk prostate cancer: from definition to contemporary management. Eur Urol 2012; 61: 1096.
[14]	Kane CJ, Presti JC Jr. Amling CL, et al: Changing nature of high risk patients undergoing radical prostatectomy. J Urol 2007; 177: 113.
[15]	Moinzadeh A, Shunaigat AN and Libertino, JA: Urinary Incontinence After Radical Retropubic Prostatectomy: The Outcome of a Surgical Technique. BJU Int 2003; 92: 355.
[16]	McKay RR, Choueiri TK and Taplin ME: Rationale for and Review of Neoadjuvant Therapy Prior to Radical Prostatectomy for Patients with High-Risk Prostate Cancer. Drugs 2013; 73: 1417.
[17]	Antonelli A, Palumbo C, Veccia A, et al: Biological effect of neoadjuvant androgen-deprivation therapy assessed on specimens from radical prostatectomy: a systematic review. Minerva Urologica e Nefrologica 2018; 70: 370.
[18]	Eastham JA, Heller G, Halabi S et al. Cancer and Leukemia Group B 90203 (Alliance): Radical Prostatectomy With or Without Neoadjuvant Chemohormonal Therapy in Localized, High-Risk Prostate Cancer. J Clin Oncol. 2020; 38: 3042.

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APA Style

Jason Robert Gee, John André Libertino. (2021). Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. International Journal of Clinical Oncology and Cancer Research, 6(3), 125-129. https://doi.org/10.11648/j.ijcocr.20210603.14

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ACS Style

Jason Robert Gee; John André Libertino. Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. Int. J. Clin. Oncol. Cancer Res. 2021, 6(3), 125-129. doi: 10.11648/j.ijcocr.20210603.14

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AMA Style

Jason Robert Gee, John André Libertino. Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. Int J Clin Oncol Cancer Res. 2021;6(3):125-129. doi: 10.11648/j.ijcocr.20210603.14

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@article{10.11648/j.ijcocr.20210603.14,
  author = {Jason Robert Gee and John André Libertino},
  title = {Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up},
  journal = {International Journal of Clinical Oncology and Cancer Research},
  volume = {6},
  number = {3},
  pages = {125-129},
  doi = {10.11648/j.ijcocr.20210603.14},
  url = {https://doi.org/10.11648/j.ijcocr.20210603.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20210603.14},
  abstract = {High risk prostate cancer requires a multimodal approach to treatment. Surgery has played an increasing role for these patients although long-term follow-up and experience with neoadjuvant therapy, a basic tenet of cancer treatment, remains limited. Here we report our experience with neoadjuvant hormonal ablation followed by surgery and postoperative radiation with greater than 20-year follow-up. From 1990-2012, 82 patients with clinically organ-confined prostate cancer and 10 years median follow-up underwent multimodal therapy (MMT) consisting of neoadjuvant hormonal ablation followed by radical retropubic prostatectomy and postoperative radiation. High-risk prostate cancer was defined preoperatively as Gleason Score 8-10 or PSA>20. Patients with negative surgical margins were observed initially and treated with salvage XRT in the instance of recurrence. The MMT protocol was well tolerated in all 82 patients with no treatment-related discontinuation of therapy. Final surgical pathology revealed stage pT3-T4 in 58/82 (71%) and nodal involvement in 7/82 (9%). Distant metastatic disease was identified in 10/82 patients (12%). For patients undergoing MMT at 10, 15 and 20 years, cancer-specific survival was 78/82 (95%), 77 /82 (94%) and 77/82 (94%), overall survival was 68/82 (83%), 66/82 (80%) and 60/82 (73%), and biochemical recurrence was 61/82 (74%), 51/82 (62%) and 35/82 (43%). These findings establish the MMT protocol as an effective treatment strategy for high-risk prostate cancer with excellent long-term cancer-specific survival. Recurrence occurring primarily as a rising PSA as opposed to distant metastatic disease suggests limited morbidity as well among patients treated with this protocol.},
 year = {2021}
}

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TY - JOUR
T1 - Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up
AU - Jason Robert Gee
AU - John André Libertino
Y1 - 2021/07/24
PY - 2021
N1 - https://doi.org/10.11648/j.ijcocr.20210603.14
DO - 10.11648/j.ijcocr.20210603.14
T2 - International Journal of Clinical Oncology and Cancer Research
JF - International Journal of Clinical Oncology and Cancer Research
JO - International Journal of Clinical Oncology and Cancer Research
SP - 125
EP - 129
PB - Science Publishing Group
SN - 2578-9511
UR - https://doi.org/10.11648/j.ijcocr.20210603.14
AB - High risk prostate cancer requires a multimodal approach to treatment. Surgery has played an increasing role for these patients although long-term follow-up and experience with neoadjuvant therapy, a basic tenet of cancer treatment, remains limited. Here we report our experience with neoadjuvant hormonal ablation followed by surgery and postoperative radiation with greater than 20-year follow-up. From 1990-2012, 82 patients with clinically organ-confined prostate cancer and 10 years median follow-up underwent multimodal therapy (MMT) consisting of neoadjuvant hormonal ablation followed by radical retropubic prostatectomy and postoperative radiation. High-risk prostate cancer was defined preoperatively as Gleason Score 8-10 or PSA>20. Patients with negative surgical margins were observed initially and treated with salvage XRT in the instance of recurrence. The MMT protocol was well tolerated in all 82 patients with no treatment-related discontinuation of therapy. Final surgical pathology revealed stage pT3-T4 in 58/82 (71%) and nodal involvement in 7/82 (9%). Distant metastatic disease was identified in 10/82 patients (12%). For patients undergoing MMT at 10, 15 and 20 years, cancer-specific survival was 78/82 (95%), 77 /82 (94%) and 77/82 (94%), overall survival was 68/82 (83%), 66/82 (80%) and 60/82 (73%), and biochemical recurrence was 61/82 (74%), 51/82 (62%) and 35/82 (43%). These findings establish the MMT protocol as an effective treatment strategy for high-risk prostate cancer with excellent long-term cancer-specific survival. Recurrence occurring primarily as a rising PSA as opposed to distant metastatic disease suggests limited morbidity as well among patients treated with this protocol.
VL - 6
IS - 3
ER -

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Author Information

Jason Robert Gee

Emerson Urology Associates, Emerson Hospital, Tufts University School of Medicine, Concord, USA
John André Libertino

Emerson Urology Associates, Emerson Hospital, Tufts University School of Medicine, Concord, USA

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APA Style

Jason Robert Gee, John André Libertino. (2021). Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. International Journal of Clinical Oncology and Cancer Research, 6(3), 125-129. https://doi.org/10.11648/j.ijcocr.20210603.14

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ACS Style

Jason Robert Gee; John André Libertino. Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. Int. J. Clin. Oncol. Cancer Res. 2021, 6(3), 125-129. doi: 10.11648/j.ijcocr.20210603.14

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AMA Style

Jason Robert Gee, John André Libertino. Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up. Int J Clin Oncol Cancer Res. 2021;6(3):125-129. doi: 10.11648/j.ijcocr.20210603.14

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@article{10.11648/j.ijcocr.20210603.14,
  author = {Jason Robert Gee and John André Libertino},
  title = {Multimodal Therapy for Patients with High-Grade, High-Risk Prostate Cancer with Long-Term Follow-up},
  journal = {International Journal of Clinical Oncology and Cancer Research},
  volume = {6},
  number = {3},
  pages = {125-129},
  doi = {10.11648/j.ijcocr.20210603.14},
  url = {https://doi.org/10.11648/j.ijcocr.20210603.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20210603.14},
  abstract = {High risk prostate cancer requires a multimodal approach to treatment. Surgery has played an increasing role for these patients although long-term follow-up and experience with neoadjuvant therapy, a basic tenet of cancer treatment, remains limited. Here we report our experience with neoadjuvant hormonal ablation followed by surgery and postoperative radiation with greater than 20-year follow-up. From 1990-2012, 82 patients with clinically organ-confined prostate cancer and 10 years median follow-up underwent multimodal therapy (MMT) consisting of neoadjuvant hormonal ablation followed by radical retropubic prostatectomy and postoperative radiation. High-risk prostate cancer was defined preoperatively as Gleason Score 8-10 or PSA>20. Patients with negative surgical margins were observed initially and treated with salvage XRT in the instance of recurrence. The MMT protocol was well tolerated in all 82 patients with no treatment-related discontinuation of therapy. Final surgical pathology revealed stage pT3-T4 in 58/82 (71%) and nodal involvement in 7/82 (9%). Distant metastatic disease was identified in 10/82 patients (12%). For patients undergoing MMT at 10, 15 and 20 years, cancer-specific survival was 78/82 (95%), 77 /82 (94%) and 77/82 (94%), overall survival was 68/82 (83%), 66/82 (80%) and 60/82 (73%), and biochemical recurrence was 61/82 (74%), 51/82 (62%) and 35/82 (43%). These findings establish the MMT protocol as an effective treatment strategy for high-risk prostate cancer with excellent long-term cancer-specific survival. Recurrence occurring primarily as a rising PSA as opposed to distant metastatic disease suggests limited morbidity as well among patients treated with this protocol.},
 year = {2021}
}

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