An emerging treatment option for men with recurrent prostate cancer after radiation therapy – Harvard Health Blog


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Prostate cancer is often a multifocal disease, which means that many tumors can be located in different parts of the gland at the same time. However, not all of these tumors are an equal problem. It is increasingly believed that the tumor with the most aggressive feature – called an index lesion – dictates how a man’s cancer is generally likely to behave. This concept led to the emergence of a new treatment option. Called a partial adenoidectomy (PGA), as well as focal therapy, it entails treating only the lesion of the index and surrounding tissues, rather than surgically removing the prostate or treating the entire gland by other methods. Emerging evidence suggests that PGA effectively controls prostate cancer, but with fewer complications such as urinary incontinence.

In February, researchers posted it at the Memorial Sloan Kettering Cancer Center (MSKCC) in New York the findings It could pave the way for a focal treatment for men with recurrent prostate cancer. Focus especially on men whose cancer has recurred on average three to four years after the initial radiation treatment.

Their findings, although preliminary, suggest that MRI and biopsy results could allow clinicians to select patients with recurrent prostate cancer who might be eligible for PGA. The research was led by Dr Gregory Chesnot, MSKCC Urologist.

During their study, Chesnot and colleagues identified 77 men who were treated for recurrent prostate cancer at MSKCC between 2000 and 2014. All men were initially given radiation for prostate cancer with the intent to treat the disease, but the cancer was suffering from prostate cancer. is back. At that point, the prostate was surgically removed. Then, sections of their tumors were pinned onto slides for pathologist review, and then stored.

By looking at these slices with advanced tools, Chesnut’s team was able to pinpoint the location of individual tumors in each of the prostates in men. The team also had access to preoperative information showing that 15 of the men were candidates for PGA according to current criteria. For PGA to be considered, men need a treatable indicator lesion and the absence of highly aggressive cancer cells outside the vicinity of this tumor, according to biopsy and MRI results.

What the results showed

What Chesnut and colleagues wanted to know was whether pre-operative results for men were consistent with tumor details in the surgically removed prostate. And this turned out to be the case. The men truly had treatable index lesions without another aggressive cancer, which means that biopsy and MRI results accurately predicted PGA eligibility. Moreover, six additional men were found to be eligible for PGA based on tumor segment analysis, although preoperative and MRI evidence indicated otherwise.

Given this, the authors concluded that 21 of the 77 men, or 27% overall, developed recurrent prostate cancer that was susceptible to PGA.

While the results are promising, the authors also caution that due to the small number of men evaluated and other study limitations, they are currently unable to recommend PGA as a treatment for recurrent prostate cancer outside of clinical trials.

“The authors addressed a very important problem that has no easy answers, which is what should be done about recurrent or persistent prostate cancer after radiotherapy,” says Dr. Mark Garnick, professor of medicine at Gorman Brothers University at Harvard Medical School, Beth Israel Deaconess Medical Center, editor of Dar Harvard Health Publishing Annual Report on Prostate Diseases, And editor-in-chief HarvardProstateKnowledge.org.

“The radical prostatectomy procedure to remove the prostate after radiotherapy is a complex procedure associated with potentially serious side effects on the urinary system. Alternatives that can help eliminate persistent cancer in the irradiated gland, and thus reduce side effects, represent an important progress. You should rest assured of these results. New men who have undergone PGA say that aggressive prostate cancer will not be left untreated.Results are also important because patients can be offered a second chance to remove residual or recurrent cancer without having to undergo surgical removal of the prostate that has already been treated with radiation. Further studies should be explored. This results in greater numbers of patients. “

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