Prostatectomía radical citorreductora comparado a no realizar tratamiento local en pacientes con cáncer de próstata metastásico / Cytoreductive radical prostatectomy versus no local treatment in patients with metastatic prostate cancer

Introducción El cáncer de próstata es uno de los cánceres más frecuentes en Chile, con 8157 nuevos casos en 2020. A nivel mundial, 5 a 10% de los hombres presentan metástasis al diagnóstico, y la terapia de deprivación androgénica con o sin quimioterapia es el estándar de cuidado para estos pacientes. El uso de tratamiento local en este contexto tiene una recomendación formal debido a la falta de evi-dencia de alta calidad. Algunos estudios retrospectivos han intentado dilucidar el beneficio de la cirugía sobre el tumor primario en el contexto de la enfermedad metastásica, ya que se ha demostrado que es un tratamiento local eficaz para otras neoplasias metastá-sicas. A pesar de estos esfuerzos, el beneficio de la prostatectomía radical citorreductora como tratamiento local en estos pacientes sigue sin estar claro. Métodos Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, que se mantiene mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE y Cochrane, entre otras. Se extrajeron los datos de las revisiones sistemáticas, se volvieron a analizar los datos de los estudios primarios, se realizó un metanálisis y se generó una tabla de resumen de resultados utilizando el enfoque GRADE. Resultados y conclusiones Se identificaron 12 revisiones sistemáticas, que incluían siete estudios primarios en total, ninguno de los cuales era un ensayo alea-torizado controlado. Sólo seis de esos siete estudios primarios se utilizaron en el resumen de resultados. A pesar de la falta de evi-dencia de alta calidad, los resultados de este resumen muestran los beneficios de realizar la cirugía en el tumor primario en términos de mortalidad por cualquier causas, mortalidad específica por cáncer y progresión de la enfermedad. También se observó un bene-ficio potencial en las complicaciones locales relacionadas con la progresión del tumor primario, lo que apoya la realización de esta intervención en pacientes con enfermedad metastásica. La ausencia de recomendaciones formales subraya la necesidad de evaluar los beneficios de la cirugía caso por caso, presentando la evidencia disponibles a los pacientes para un proceso de toma de decisiones compartido, teniendo en cuenta las futuras complicaciones locales que podrían ser difíciles de manejar.

Introduction Prostate cancer is one of the most frequent cancers in Chile, with 8157 new cases in 2020. Worldwide, 5 to 10% of men have metastatic disease at diagnosis, and androgen deprivation therapy with or without chemotherapy is the standard of care for these patients. The use of local treatment in this setting has no formal recommendation due to the lack of high- quality evidence. Some retrospective studies have sought to elucidate the benefit of surgery on the primary tumor in the setting of metastatic disease since it has been proven to be an effective local treatment for other metastatic malignant diseases. Despite these efforts, the benefit of cytoreductive radical prostatectomy as local treatment in these patients remains unclear. Methods We searched Epistemonikos, the largest database of systematic reviews in health, which is main-tained by screening multiple information sources, including MEDLINE, EMBASE, and Cochrane, among others. We extracted data from systematic reviews, reanalyzed data from primary studies, conducted a meta- analysis, and generated a summary results table using the GRADE approach. Results and conclusions We identified 12 systematic reviews, including seven studies in total, none of which was a trial. Only six of those seven primary studies were used in the results summary. Despite the lack of high- quality evidence, the results summary shows the benefits of performing surgery on the primary tumor in terms of all- cause mortality, cancer- specific mortality, and disease progression. There was also a potential benefit in local complications related to the progression of the prima-ry tumor, supporting the implementation of this intervention in patients with metastatic disease. The absence of formal recommendations highlights the need to evaluate the benefits of surgery on a case- by- case basis, presenting the available evidence to patients for a shared decision- making process and considering future local complications that could be difficult to manage.

The efficacy analysis of moderately hypofractionated IMRT combined with androgen deprivation therapy for locally advanced prostate cancer / 中华放射医学与防护杂志

Objective:To investigate the efficacy and adverse reactions of moderately hypofractionated intensity modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) for locally advanced prostate cancer (LAPC).Methods:This study retrospectively analyzed the medical records of 40 LAPC patients who were admitted in The Second Hospital of Dalian Medical University during 2014-2020. The planning gross target volume (PGTV) dose for prostate gland and seminal vesicle gland was 64.8-70.0 Gy/25-28 f, 2.4-2.8 Gy/f and the dose of PGTVnd in 20 cases with positive pelvic lymph nodes was 60.0-64.4 Gy/25-28 f, 2.3-2.4 Gy/f. The dose of planning target volume (PTV) for the drainage area of pelvic lymph nodes was 45.0-50.4 Gy/25-28 f. The enrolled patients were treated with long-term ADT, including neoadjuvant, simultaneous, and adjuvant therapies. The efficacy and adverse reactions were evaluated. The prognostic factors affecting the biochemical failure-free survival (BFFS) were analyzed.Results:The median follow-up time was 31 months. The 2- and 3-year overall survival (OS) rates were 100% and 96.9%, respectively. The 1-, 2-, and 3-year BFFS rates were 90%, 76.8% and 72%, respectively. The 1-, 2-, and 3-year distant metastasis-free survival (DMFS) rates were 92.2%, 82.8% and 75.1%, respectively. Gleason (GS) score ( χ2=10.00, P < 0.05) and adjacent tissue invasion ( χ2=8.85, P<0.05) were prognostic factors related to BFFS for LAPC. Adjacent tissue invasion and GS 9-10 were independent poor prognostic factors. The incidence of acute urinary adverse reaction and rectal injury (grade≥2) was 7.5% and 20%, respectively. The incidence of late urinary adverse reaction and rectal injury (grade≥2) was 12.5% and 17.5%, respectively. Adverse reactions at grade 3-4 did not occur. Conclusions:The moderately hypofractionated IMRT combined with ADT is feasible for LAPC treatment, achieving satisfactory survival effects. 70 Gy/25-28 f, 2.5-2.8 Gy/f is a safe and effective moderate hypofraction scheme. Adjacent tissue invasion and GS score are prognostic factors related to BFFS for LAPC.

A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone杛eleasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix)

Luteinizing hormone杛eleasing hormone agonist (LHRH?A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate?specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long?term follow?up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single?step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH?A in patients with preexisting CVD. There is considerable long?term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long?term follow?up.

Application prospect of palliative transurethral prostatectomy in the treatment of advanced prostate cancer complicated with lower urinary tract symptoms / 中华泌尿外科杂志

Prostate cancer has become the most common malignant disease in male. Due to development of therapy methods, the overall survive rate of advanced prostate cancer has been improved significantly. The demands for higher quality of life are impending in advanced prostate cancer patient. With the progression of prostate cancer, about 1/3 to 2/3 of patients will suffer from moderate to severe lower urinary tract symptoms. Severe lower urinary tract symptoms can lead to negative effects on treatment and quality of life. However, there is no standard treatment for lower urinary tract symptoms in advanced prostate cancer patients. This article reviews the clinical application of palliative transurethral resection of prostate in patients with advanced prostate cancer.

Identifying the role of apolipoprotein A-I in prostate cancer / 亚洲男科学杂志(英文版)

Although localized prostate cancer (PCa) can be cured by prostatectomy and radiotherapy, the development of effective therapeutic approaches for advanced prostate cancer, including castration-resistant PCa (CRPC) and neuroendocrine PCa (NEPC), is lagging far behind. Identifying a novel prognostic and diagnostic biomarker for early diagnosis and intervention is an urgent clinical need. Here, we report that apolipoprotein A-I (ApoA-I), the major component of high-density lipoprotein (HDL), is upregulated in PCa based on both bioinformatics and experimental evidence. The fact that advanced PCa shows strong ApoA-I expression reflects its potential role in driving therapeutic resistance and disease progression by reprogramming the lipid metabolic network of tumor cells. Molecularly, ApoA-I is regulated by MYC, a frequently amplified oncogene in late-stage PCa. Altogether, our findings have revealed a novel indicator to predict prognosis and recurrence, which would benefit patients who are prone to progress to metastasis or even NEPC, which is the lethal subtype of PCa.

Relación entre la terapia hormonal en cáncer de próstata avanzado e incidencia del síndrome metabólico y eventos cardiovasculares: Estudio prospectivo en el Hospital San Borja Arriarán (HSBA) / Relationship between hormonal therapy in advanced prostate cancer and incidence of metabolic syndrome and cardiovascular events: Prospective study at the San Borja Arriarán Hospital (HSBA)

La terapia hormonal con deprivación de andrógenos constituye un pilar fundamental en el manejo del cáncer de próstata avanzado y metastásico, sin embargo, se han descrito diversos efectos adversos. Dentro de ellos, los de mayor relevancia por su morbimortalidad asociada, son el desarrollo del síndrome metabólico y eventos cardiovasculares. En Latinoamérica no existen estudios prospectivos que evalúen esta relación. MATERIALES Y MÉTODOS: Se diseñó un estudio prospectivo. Se seleccionaron 87 pacientes del HSBA con diagnóstico de cáncer de próstata avanzado o metastásico, que iniciaron terapia hormonal entre abril de 2016 y abril de 2017. Se registraron datos clínicos: Presión Arterial, Circunferencia abdominal, Índice de Masa Corporal; y datos de laboratorio: Colesterol total, HDL, LDL, Glicemia en Ayunas, Insulinemia Basal y Testosterona Total. El registro de datos fue al inicio y a los 6 meses de iniciada la hormonoterapia. Para el análisis estadístico de las variables registradas se utilizó el test t de Student y Wilcoxon según la distribución de las variables, con una significancia estadística de p<0.05 y el programa SPSS 22.0. Se contó con el consentimiento informado de cada paciente y aprobación del comité de ética. RESULTADOS: El promedio de edad de los pacientes evaluados fue de 74.3 años. De los 87 pacientes, un total de 67 presentaron antecedentes de factores de riesgo cardiovascular (FRCV); 42 era sólo hipertensos, 4 eran sólo diabéticos, y 42 presentaban ambas patologías. De las variables a evaluar, no se evidenciaron diferencias significativas en parámetros clínicos ni de laboratorio en los distintos tiempos. Ningún paciente en el período de estudio desarrolló algún evento cardiovascular. DISCUSIÓN: Se realizó un estudio prospectivo en pacientes con cáncer de próstata del HSBA que recibieron terapia hormonal. Se evaluó la incidencia del síndrome metabólico, tanto en parámetros clínicos y de laboratorio. En nuestra serie no encontramos un aumento estadísticamente significativo en la incidencia de síndrome metabólico, resultado acorde con un estudio retrospectivo realizado en nuestro centro. Por otro lado, estudios internacionales europeos y norteamericanos notifican que la hormonoterapia sí produce aumento en la incidencia del síndrome metabólico y con ello, aumento del riesgo de eventos cardiovasculares. Hacen falta más estudios de tipo prospectivos y de mayor seguimiento para poder confirmar nuestra hipótesis. (AU)

INTRODUCTION: Androgen deprivation therapy is a fundamental pillar in the management of advanced and metastatic prostate cancer, however, several adverse effects have been described. Among them, the most relevant for their associated morbidity and mortality are the development of metabolic syndrome and cardiovascular events. In Latin America there are no prospective studies that evaluate this relationship. METHODOLOGY: A prospective study was designed. A total of 87 HSBA patients with diagnosis of advanced or metastatic prostate cancer were selected, who initiated hormonal therapy between April 2016 and April 2017. Clinical data were recorded: Blood Pressure, Abdominal Circumference, Body Mass Index; and laboratory data: Total cholesterol, HDL, LDL, glycemia, basal insulinemic and Total Testosterone. Data recording was at the beginning and at 6 months after the start of therapy. For the statistical analysis the Student t test and Wilcoxon were used according to the distribution of the variables, with a statistical significance of p <0.05 and with the software SPSS 22.0. We had the informed consent of each patient and approval of the ethics committee. RESULTS: The average age of the patients evaluated was 74.3 years. Of the 87 patients, a total of 67 had a history of cardiovascular risk factors (CVRF); 42 was only hypertensive, 4 were diabetic only, and 42 had both pathologies. Of the variables to be evaluated, there were no significant differences in clinical or laboratory parameters at different times. No patient in the study period developed any cardiovascular event. DISCUSSION: A prospective study was conducted in patients with prostate cancer of HSBA who received hormonal therapy. The incidence of metabolic syndrome was evaluated, both in clinical and laboratory parameters. In our series, we did not find a statistically significant increase in the incidence of metabolic syndrome, a result consistent with a retrospective study conducted in our center. On the other hand, European and North American international studies report that hormone therapy does produce an increase in the incidence of the metabolic syndrome and with it, an increased risk of cardiovascular events. More prospective and longer follow-up studies are needed to confirm our hypothesis (AU)

PI3K/p110β-specific inhibitors in castration-resistant prostate cancer / 中华男科学杂志

Advanced prostate cancer, especially at the castration-resistant stage, remains incurable clinically and, therefore, urgently requires new therapeutics for the patients. PI3K is a family of critical cell signal transduction molecules and their over-activation is an important factor in cancer development and progression. It has been demonstrated that class IA PI3K p110 is drastically overexpressed in prostate cancer and involved in androgen receptor-mediated gene expression and castration-resistant progression and regarded as a potential therapeutic target for prostate cancer. Several p110-specific inhibitors have been reported recently and two of them, GSK2636771 and AZD8186, are being tested in clinical trials.

Expressions of ERK and p-ERK in advanced prostate cancer / 中华男科学杂志

Objective@#To investigate the expressions of extracellular signal-regulated kinase (ERK) and p-ERK in benign and malignant prostate tissues, and whether it can be used as a marker for the prognosis of advanced prostate cancer (PCa).@*METHODS@#Using immunohistochemical Envision, we detected the expressions of ERK1/2 and p-ERK1/2 in 20 cases of benign prostatic hyperplasia (BPH) and 40 cases of advanced PCa and analyzed their correlation with PCa metastasis, Gleason score, PSA level, and prognosis.@*RESULTS@#The expression of ERK1/2 was remarkably higher in the advanced PCa than in the BPH cases (82.5% vs 55%, P5 yr, and survival ≤ 5 yr groups were 61.9%, 89.5%, 57.9%, and 90.5%, respectively, with statistically significant differences among these groups (P<0.05).@*CONCLUSIONS@#ERK1/2 and p-ERK1/2 proteins are highly expressed in advanced PCa and p-ERK1/2 is associated with the metastasis and prognosis of advanced PCa.

Safety of neoadjuvant chemo-hormonal therapy by the combination of docetaxel and maximal androgen blockage for locally advanced prostate cancer / 上海交通大学学报（医学版）

Objective· To evaluate the safety of neoadjuvant therapy which was constituted by docetaxel based systemic chemotherapy and maximal androgen blockage for patients with locally advanced prostate cancer and to summarize the related adverse events and clinical managements.Methods· From June 2015 to February 2017,the clinical data of 55 patients undergoing neoadjuvant chemotherapy combined with complete androgen deprivation were retrospectively reviewed.The patients were given docetaxel and prednisone as DP regimen every 3 weeks and LHRH analogues with bicalutamide as maximal androgen deprivation for a total of 4 cycles.All treatment-related adverse events were observed and then recorded.Results· Two cases with liver function impairment after 2 cycles of treatment were withdrawn from the study.No severe allergic reactions occurred during neoadjuvant therapy.The most common adverse events were hematologic toxicity,while 23.6％ of patients had grade Ⅲ-Ⅳ neutropenia,and about 12.7％ had anemia.Due to a relatively short course of treatment,the skin or mucous damage,peripheral neurotoxicity and fluid retention were rare.However,hot flash,male breast development as well as erectile dysfunction were very frequently observed due to maximal androgen deprivation.The majority of these adverse events were relieved by symptomatic and supportive treatment.Conclusion · After strict selection,4 cycles of neoadjuvant chemotherapy combined with total androgen blockade could be well tolerated by the patients with high-risk locally advanced prostate cancer.Even though the adverse events were controllable,they still need to be closely monitored during treatment in order to reduce the incidence.In addition,the very low testosterone level associated endocrinal metabolic disorders caused by complete androgen deprivation were also of great concern.

Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy, and their combination

Locally advanced prostate cancer (LAPC) is defined as histologically proven T3–4 prostatic adenocarcinoma. In this review, we define the individual roles of radiotherapy (RT), short-term (ST-) and long-term (LT-) androgen deprivation therapy (ADT), and their combination in multimodal therapy for LAPC. Despite limitations in comparing the clinical outcomes among published papers, in the present study, a trend of 10-year clinical outcomes was roughly estimated by calculating the average rates weighted by the cohort number. With RT alone, the following rates were estimated: 87% biochemical failure, 34% local failure (LF), 48% distant metastasis (DM), 38% overall survival (OS), and 27% disease-specific mortality (DSM). Those associated with ADT alone were 74% BCF, 54% OS, and 25% DSM, which appeared to be better than those of RT alone. The addition of ADT to RT produced a notable local and systemic effect, regardless of ST- or LT-ADT. The LF rate decreased from 34% with RT alone to 21% with ST-ADT and further to 15% with LT-ADT. The DM and DSM rates also showed a similar trend among RT alone, RT+ST-ADT, and RT+LT-ADT. The combination of RT+LT-ADT resulted in the best long-term clinical outcomes, indicating that both RT and ADT are important parts of multimodal therapy.

Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy, and their combination

Locally advanced prostate cancer (LAPC) is defined as histologically proven T3–4 prostatic adenocarcinoma. In this review, we define the individual roles of radiotherapy (RT), short-term (ST-) and long-term (LT-) androgen deprivation therapy (ADT), and their combination in multimodal therapy for LAPC. Despite limitations in comparing the clinical outcomes among published papers, in the present study, a trend of 10-year clinical outcomes was roughly estimated by calculating the average rates weighted by the cohort number. With RT alone, the following rates were estimated: 87% biochemical failure, 34% local failure (LF), 48% distant metastasis (DM), 38% overall survival (OS), and 27% disease-specific mortality (DSM). Those associated with ADT alone were 74% BCF, 54% OS, and 25% DSM, which appeared to be better than those of RT alone. The addition of ADT to RT produced a notable local and systemic effect, regardless of ST- or LT-ADT. The LF rate decreased from 34% with RT alone to 21% with ST-ADT and further to 15% with LT-ADT. The DM and DSM rates also showed a similar trend among RT alone, RT+ST-ADT, and RT+LT-ADT. The combination of RT+LT-ADT resulted in the best long-term clinical outcomes, indicating that both RT and ADT are important parts of multimodal therapy.

Comparison of life quality between surgical castration and drug castration in advanced prostate cancer / 中国生化药物杂志

Objective To explore the effects of surgical castration and intermittent androgen blockade (IAB) in patients with advanced prostate cancer.Methods 115 cases of advanced prostate cancer were selected including 48 cases with drug castration receiving IAB and 67 cases with surgical castration.Before the treatment, 6 months and 1 years after the treatment, the quality of life of the two groups was investigated by the quality of life questionnaire (EORTC QLQ-C30 +QLQ-PR25).Results Compared with before treatment, the general health status of the patients in the drug castration group and the surgical castration group were significantly improved (P<0.01), the whole body and the local pain were relieved (P<0.01) and the micturition symptoms were controlled ( P<0.01 ).The overall quality of life of drug castration group and surgical castration group were significantly decreased (P<0.05), and the degree of sexual function was particularly affected (P<0.01), but the body function of patients in drug castration group restored to a certain extent in drug castration group after 1 year’s treatment(P<0.01), while the quality of life in patients of surgical castration did not reverse.Conclusion Both of surgical castration and androgen deprivation therapy can reduce the quality of life of patients with advanced prostate cancer, but the adverse effects of drug treatment on the quality of life can be recovered in treatment intermission.

Clinical Study onZhibai Dihuang Decoction Combined with Endocrine Therapy in Treating Kidney-yin Deficiency Type of Advanced Prostate Cancer / 中国中医药信息杂志

Objective To observe the clinical efficacy ofZhibai Dihuang Decoction combined with endocrine therapy for kidney-yin deficiency type of advanced prostate cancer and its influence on patient symptoms of hot flashes.Methods Totally 72 cases of advanced prostate cancer patients were randomly divided into the combined group (36 cases) and the control group (36 cases). Patients in the control group were treated with endocrine therapy, while patients in the combined group were additionally treated byZhibai Dihuang Decoction. After 12 weeks of treatment, serum prostate specific antigen (PSA), the international prostate symptom score (I-PSS), the clinical symptoms score, the number of cases of hot flashes and safety index before and after treatment were observed. Results In the course of treatment, the control group and the combined group each had 1 case lost to follow up. PSA and I-PSS in the two groups significantly decreased after treatment (P<0.01). The total efficiency rate of TCM syndrome was 94.3% (33/35) in the combined group, while it was 57.1% (20/35) in the control group, with significant difference (P<0.01). After treatment, the incidence of hot flushes was reduced after treatment in the combined group, but the control group increased, with significant difference (P<0.01). No adverse reaction was found in the two groups.ConclusionZhibai Dihuang Decoction combined with endocrine therapy is more effective than endocrine therapy alone, which can reduce the symptoms of hot flashes.

Genomic predictors for treatment of late stage prostate cancer / 亚洲男科学杂志(英文版)

In spite of the development of new treatments for late stage prostate cancer, significant challenges persist to match individuals with effective targeted therapies. Genomic classification using high-throughput sequencing technologies has the potential to achieve this goal and make precision medicine a reality in the management of men with castrate-resistant prostate cancer. This chapter reviews some of the most recent studies that have resulted in significant progress in determining the landscape of somatic genomic alterations in this cohort and, more importantly, have provided clinically actionable information that could guide treatment decisions. This chapter reviews the current understanding of common alterations such as alterations of the androgen receptor and PTEN pathway, as well as ETS gene fusions and the growing importance of PARP inhibition. It also reviews recent studies that characterize the evolution to neuroendocrine tumors, which is becoming an increasingly important clinical problem. Finally, this chapter reviews recent innovative studies that characterize the compelling evolutionary history of lethal prostate cancer evidenced by polyclonal seeding and interclonal cooperation between metastasis and the importance of tumor clone dynamics measured serially in response to treatment. The genomic landscape of late stage prostate cancer is becoming better defined, and the prospect for assigning clinically actionable data to inform rationale treatment for individuals with this disease is becoming a reality.

Rationale of Surgery in Locally Advanced and Oligometastatic Prostate Cancer

There is no clear consensus for the best treatment of men with locally advanced prostate cancer. As a first step, radiation therapy or primary hormone therapy or radical prostatectomy with extended pelvic lymph node dissection is used. But it seems impossible to have a good oncologic result with single treatment modality. Traditionally, external beam radiation therapy with adjuvant hormone therapy is most preferred treatment method in locally advanced prostate cancer and radical prostatectomy has not been routinely used because of high rates of margin positive and lymph node metastasis. But, recently published articles showed that surgery in multimodal setting is effective treatment modality and not inferior to radiation therapy in oncologic outcomes. Perioperative morbidities of surgery and incontinence rates are similar to surgery of organ confined diseases, and patients with primary radiotherapy seem to have high rate of lower urinary tract symptoms and radiation related complications compared with radical prostatectomy with adjuvant radiotherapy. There is still controversy in regard to performing surgery for locally advanced prostate cancer. We review the studies with surgery in locally advanced prostate cancer and compare with radiation therapy in multimodal setting, and review the studies with surgery in oligometastatic prostate cancer.

The clinical efficacy of the therapy scheme of green light photoselective vaporization combined testicular resection plus anti-androgen on advanced prostate cancer and bladder outlet obstruction / 中国综合临床

Objective To evaluate the clinical efficacy of green light photoselective vaporization(PVP)combined testicular resection plus anti-androgen treatment on advanced prostate cancer and bladder outlet obstruction.Methods Twenty cases with PVP of advanced prostate cancer and bladder outlet obstruction were selected as our subjects,who underwent PVP testicular resection plus anti-androgen treatment.The clinical information was recorded.Results All patients were succeed through surgery.Maximum urinary flow rate (MFR) at the pre-operation was (2.0 ± 1.0) ml/s,and increased to (14.0 ± 4.5) ml/s after operation.Serum prostate specific antigen (PSA) was decreased from the preoperative (176.5 ± 160.5) μg/L to (2.0 ± 1.0)μg/L International prostate symptom score (IPSS) was from (25.0 ± 5.0) down to (8.0 ± 1.0) points.The quality of life (QOL) score was (4.0 ± 2.0) at pre-operation,higher than after operation (1.0 ± 1.0)points.There were significant differences between preoperative and postoperative (t =9.502,7.371,5.328,8.350,P ＜0.05).Every patient was followed up from 3 to 18 months.The improvements regarding of clinical symptoms were seen including voiding,and all patients survived with tumor.Conclusion Advanced prostate cancer associate with bladder outlet obstruction.The therapy plan of PVP joint testicular resection plus antiandrogen is proved to improve symptoms of urethral obstruction and patient quality of life.

Tratamiento con dietilestilbestrol en pacientes refractarios a la castración por análogos LH- RH / Treatment with diethylstilbestrol in patients who had failed to androgen deprivation by lhrh agonists

Introducción: El objeto de este trabajo clínico es estudiar la eficacia de la administración de Dietilestilbestrol (DES) oral en pacientes con cáncer de próstata avanzado y que han presentado refractariedad al tratamiento con análogos LH-RH y además evaluar los efectos colaterales atribuibles a su uso. Material y métodos: Entre Noviembre de 2010 y Mayo de 2012 se ingresaron en forma consecutiva al estudio 15 pacientes con cáncer prostático avanzado, refractarios a manejo con análogos LH-RH. Edad promedio de los pacientes 69,4 años .Rango 57-80. Se registró el tipo de tratamiento realizado, detallando el manejo hormonal previo al que fueron sometidos. Se consideró refractariedad a los análogos, la detección de 2 alzas consecutivas del APE durante la administración de éstos. Se indicó a los pacientes 1mg. de DES al día. La evaluación del tratamiento se hizo cada 30 días con determinación de APE y registro de efectos colaterales. Resultados: De los 15 pacientes, 8 (53,3 por ciento) disminuyeron su APE inicial, 6 de ellos (40 por ciento) lo hicieron en más de un 50 por ciento de su valor y 2 (13,3 por ciento) disminuyeron el APE pero en menos de un 50 por ciento. 7 pacientes (46,6 por ciento) no disminuyeron su valor de APE y fueron considerados como fracasos. Como efectos colaterales del tratamiento tuvimos 13 pacientes (86,6 por ciento) que presentaron hipersensibilidad de los pezones, pero solo 2 requirieron tratamiento sintomático. 4 pacientes (26,6 por ciento) desarrollaron ginecomastia leve a moderada y no tuvimos ninguna complicación cardiovascular en los 15 pacientes estudiados. Conclusión: Consideramos de acuerdo a nuestros resultados que el DES oral es efectivo como tratamiento en los pacientes que han fallado o son refractarios a la deprivación androgénica por análogos LH-RH, con una baja morbilidad, buena aceptación de los pacientes y de muy bajo costo.

Introduction: The object of this clinical trial is to study the effectiveness of the administration of Diethylstilbestrol (DES) oral in patients with advanced cancer of prostate and that has presented resistance to the treatment with analogs LH-RH and in addition to evaluate the collateral effects attributable to its use. Material and methods: Between November of 2010 and May of 2012 15 patients with advanced prostate cancer, refractory to handling with analogs LH-RH entered themselves in consecutive form the study. Age average of the patients 69, 4 years, Rank 57-80. The type of made treatment was registered, detailing previous the hormonal handling which they were put under. Resistance to the analogs, the detection of 2 consecutive rises of the PSA was considered during the administration of this one. 1 mg. was indicated to the patients of DES to the day. The evaluation of the treatment was made every 30 days with determination of PSA and registry of collateral effects. Results: Of the 15 patients, 8 (53,3 percent) diminished their initial PSA, 5 of them (40 percent)did in more of a 50 percent of their value and 2 (13,3 percent) diminished the PSA but in less of a 50 percent. 7 patients (46,6 percent) did not diminished their value of PSA and were considered like failures. As collateral effects of the treatment we had 13 patients (86,6 percent) who presented hypersensitivity of the nipples, but single 2 required symptomatic treatment, 4 patients (26,6 percent) developed ginecomastia weighs moderate and we did not have any cardiovascular complication in the 15 studied patients. Conclusion: We considered according to our results that the oral DES is effective like treatment in the patients who have failed or ar refractory to the androgenic deprivation by analogs LH-RH, with a low morbidity, good acceptance of the patients and very low cost.

Meta-analysis of randomized trials of prostate specific antigen progression and death rate in patients with locally advanced prostate cancer / 中华泌尿外科杂志

Objective To verify the best treatment strategy in reducing prostate specific antigen (PSA) progression and death rate in patients with locally advanced prostate cancer by a meta-analysis. Methods The literature search strategy was followed according to the Collaborative Review Group search strategy. Published data of randomized clinical trials comparing radical prostatectomy (RP) plus adjuvant therapy to either RP alone or other treatment were analyzed. Both fixed effect model and randomized effect model were applied and odds ratio (OR) with its 95% confidence interval (95% CI) was also used as the effect size 'estimate. Results Eight clinical trials were chosen with total in-volved cases of 3826. There were 5 trials compared post radical prostatectomy plus adjuvant hormonal therapy with radical prostatectomy alone. PSA progression was used as the indicator of progression and the combined OR was 0.86 (95%CI 0.48-1.56). There were 3 trails compared the combination of radical prostateetomy with hormonal therapy and radical prostatectomy alone. Disease specific death rate was used as the evaluating criteria and the OR was 0.72(95%CI,0.51-1.02). Conclusion RP plus adjuvant hormonal therapy can reduce PSA progression of patients with locally advanced pros-tate cancer, but it has no significant effect on disease specific death rate.

The Gleason Score and the Change of Serum PSA after Maximum Androgen Blocking in Patients with Metastatic Prostate Cancer / 대한비뇨기과학회지

The prostate specific antigen(PSA) has the most available clinical value in monitoring the disease status and treatment response, especially in patients with advanced metastatic adenocarcinoma of prostate. Between March 1992 and May 1994, 22 patients with newly diagnosed metastatic prostate cancer received gonadotropin-releasing hormone analogue monthly and antiandrogen daily. The 15 patients whose serum PSA levels were normalized within the first 3 months had serum PSA level of 71.3+/-22.7 ng/ml at the time of diagnosis and their Gleason score was 6.2+/-1.3. The other 7 whose serum PSA levels were not normalized even after hormonal treatment, had 75.6+/-39.1 ng/ml of serum PSA level at the time of diagnosis and their Gleason score was 8.71+/-0.98. There was not signifcantly different in PSA levels but in Gleason scores between the two groups at diagnosis. So the serum PSA level of patients with low Gleason score have a tendency to be normalized within 3 months of hormonal treatment. And we suggest that the normalization of serum PSA level after 3 months treatment might be the earliest and most highly correlated predictor of response or prognosis.