Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer

A. J. Zurita, L. L. Pisters, X. Wang, P. Troncoso, P. Dieringer, J. F. Ward, J. W. Davis, C. A. Pettaway, C. J. Logothetis, L. C. Pagliaro

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.Methods:Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml-1 were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.Results:Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).Conclusions:Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.

Original languageEnglish (US)
Pages (from-to)276-280
Number of pages5
JournalProstate Cancer and Prostatic Diseases
Volume18
Issue number3
DOIs
StatePublished - Sep 14 2015
Externally publishedYes

Fingerprint

Prostatic Neoplasms
Lymph Nodes
Therapeutics
docetaxel
Neoplasm Metastasis
Prostatectomy
Treatment Failure
Androgens
Disease Progression
Neoplasms
Survival Rate
Recurrence
Survival

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

Cite this

Zurita, A. J., Pisters, L. L., Wang, X., Troncoso, P., Dieringer, P., Ward, J. F., ... Pagliaro, L. C. (2015). Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer. Prostate Cancer and Prostatic Diseases, 18(3), 276-280. https://doi.org/10.1038/pcan.2015.23

Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer. / Zurita, A. J.; Pisters, L. L.; Wang, X.; Troncoso, P.; Dieringer, P.; Ward, J. F.; Davis, J. W.; Pettaway, C. A.; Logothetis, C. J.; Pagliaro, L. C.

In: Prostate Cancer and Prostatic Diseases, Vol. 18, No. 3, 14.09.2015, p. 276-280.

Research output: Contribution to journalArticle

Zurita, AJ, Pisters, LL, Wang, X, Troncoso, P, Dieringer, P, Ward, JF, Davis, JW, Pettaway, CA, Logothetis, CJ & Pagliaro, LC 2015, 'Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer', Prostate Cancer and Prostatic Diseases, vol. 18, no. 3, pp. 276-280. https://doi.org/10.1038/pcan.2015.23
Zurita, A. J. ; Pisters, L. L. ; Wang, X. ; Troncoso, P. ; Dieringer, P. ; Ward, J. F. ; Davis, J. W. ; Pettaway, C. A. ; Logothetis, C. J. ; Pagliaro, L. C. / Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer. In: Prostate Cancer and Prostatic Diseases. 2015 ; Vol. 18, No. 3. pp. 276-280.
@article{8589ecbc07a64cad91247eb97606dccc,
title = "Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer",
abstract = "Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.Methods:Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml-1 were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.Results:Forty patients were enrolled and 39 were evaluable. Three patients (7.7{\%}) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67{\%}) completed surgery, and 13 (33{\%}) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).Conclusions:Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.",
author = "Zurita, {A. J.} and Pisters, {L. L.} and X. Wang and P. Troncoso and P. Dieringer and Ward, {J. F.} and Davis, {J. W.} and Pettaway, {C. A.} and Logothetis, {C. J.} and Pagliaro, {L. C.}",
year = "2015",
month = "9",
day = "14",
doi = "10.1038/pcan.2015.23",
language = "English (US)",
volume = "18",
pages = "276--280",
journal = "Prostate Cancer and Prostatic Diseases",
issn = "1365-7852",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer

AU - Zurita, A. J.

AU - Pisters, L. L.

AU - Wang, X.

AU - Troncoso, P.

AU - Dieringer, P.

AU - Ward, J. F.

AU - Davis, J. W.

AU - Pettaway, C. A.

AU - Logothetis, C. J.

AU - Pagliaro, L. C.

PY - 2015/9/14

Y1 - 2015/9/14

N2 - Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.Methods:Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml-1 were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.Results:Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).Conclusions:Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.

AB - Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival.Methods:Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml-1 were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy.Results:Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5).Conclusions:Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.

UR - http://www.scopus.com/inward/record.url?scp=84939153658&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939153658&partnerID=8YFLogxK

U2 - 10.1038/pcan.2015.23

DO - 10.1038/pcan.2015.23

M3 - Article

VL - 18

SP - 276

EP - 280

JO - Prostate Cancer and Prostatic Diseases

JF - Prostate Cancer and Prostatic Diseases

SN - 1365-7852

IS - 3

ER -