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03-01-2024 | Prostate Cancer

Approach to Patients with High-Risk Localized Prostate Cancer: Radiation Oncology Perspective

Authors: Sophia C. Kamran, MD, Neha Vapiwala, MD

Published in: Current Treatment Options in Oncology | Issue 1/2024

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Opinion statement

High-risk localized prostate cancer is a challenging clinical entity to treat, with heterogeneous responses to an evolving array of multidisciplinary treatment approaches. In addition, this disease state is growing in incidence due to a variety of factors, including shifting recommendations that discouraged routine prostate cancer screening. Current guidelines now incorporate an informed decision-making process for prostate cancer screening and evaluation. More work is underway to improve targeted screening for certain at-risk populations and to implement greater personalization in the use of diagnostic tools. Once diagnosed with high-risk localized disease, a multimodality treatment paradigm is warranted. Radiation—in its various forms and combinations—plays a large and continually evolving role in the management of high-risk prostate cancer, yet treatment outcomes are still suboptimal. There is a growing need to improve upon current treatment approaches, and better personalize a particular treatment recommendation based on both tumor and patient characteristics, as well as patient preference and goals of therapy. Given that treatment generally requires more than one therapy, there are notable implications on long-term quality of life, especially with respect to overlapping and cumulative side effects of local and systemic therapies, respectively. The desire for aggressive therapy to optimize cancer control outcomes must be weighed against the risk of morbidities and overtreatment and discussed with each patient so that an informed decision about treatment and care can be determined. High-level evidence to support treatment recommendations, where available, is critical for a data-driven and tailored approach to address all goals of care.
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go back to reference • Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet (London, England). 2020;395(10231):1208–16. This trial sought to understand whether PSMA PET-CT improved accuracy of staging and affected management in men with high-risk prostate cancer, randomizing 302 men to either Ga-68 PSMA PET-CT or conventional imaging with CT abdomen/pelvis + bone scan. Subjects then went on to have crossover imaging unless three or more distant metastases were found. In those who received PSMA PET-CT as 1stst line imaging, the PET-CT resulted in a change of treatment management in 28% of patients (compared to 15% of patients with conventional imaging, p=0.008). Among patients who underwent second-line imaging, management changed occurred in 5% following conventional imaging and 27% of patients following PSMA PET-CT.CrossRefPubMed • Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet (London, England). 2020;395(10231):1208–16. This trial sought to understand whether PSMA PET-CT improved accuracy of staging and affected management in men with high-risk prostate cancer, randomizing 302 men to either Ga-68 PSMA PET-CT or conventional imaging with CT abdomen/pelvis + bone scan. Subjects then went on to have crossover imaging unless three or more distant metastases were found. In those who received PSMA PET-CT as 1stst line imaging, the PET-CT resulted in a change of treatment management in 28% of patients (compared to 15% of patients with conventional imaging, p=0.008). Among patients who underwent second-line imaging, management changed occurred in 5% following conventional imaging and 27% of patients following PSMA PET-CT.CrossRefPubMed
Metadata
Title
Approach to Patients with High-Risk Localized Prostate Cancer: Radiation Oncology Perspective
Authors
Sophia C. Kamran, MD
Neha Vapiwala, MD
Publication date
03-01-2024
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 1/2024
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-023-01163-3

ASH 2024 Annual Meeting Coverage

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Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

In this webinar, Professor Martin Dreyling and an esteemed international panel of CAR T-cell therapy experts discuss the latest data on the safety, efficacy, and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL.

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Chaired by: Prof. Martin Dreyling
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