Sentinel lymph node biopsy: What cancer patients should know

Prostate Cancer Biochemical Recurrence Risk Predicted By Inflammation

The degree of inflammation in prostate biopsy cores may help predict biochemical recurrence risk after radical prostatectomy (RP) for prostate cancer, investigators reported at the European Association of Urology's 2024 congress (EAU24) in Paris, France.

At a single institution, investigators stratified 595 patients by tumor grade and prostatic inflammation score (PIS) at biopsy into 3 groups. PIS type 1 indicated grade 0-1 with no or scattered inflammatory cells without nodules in the biopsy core. PIS type 2 reflected grade 2-3 disease and interstitial inflammatory cell infiltrate in lymphoid nodules only. PIS type 3 indicated prostate cancer of any grade and interstitial infiltration of inflammatory cells with glandular disruption.

At 5 years after RP, biochemical recurrence-free survival rates were higher in men with more inflammation: 80%, 90%, and 95% for patients with PIS 1, PIS 2 and PIS 3, respectively.

The biochemical recurrence-free survival rates were 60% and 80% lower for patients with PIS 2 and 3, respectively, compared with PIS 1, at multivariable cox regression analysis, after adjustment for age, Gleason Score, clinical stage, and PSA at diagnosis, Francesco Guzzi, MD, of the Hospital of Foggia in Foggia, Italy, and colleagues reported in a poster presentation. Biochemical recurrence was defined as a PSA rise to 0.2 ng/mL or higher following surgery.

The PIS 1 group was younger and had lower prostate volumes compared with the other groups.

"Peritumoral inflammation assessed by the prostate inflammation score in prostate biopsy cores is associated with biochemical recurrence after RP and may represent a readily available parameter to improve prediction of aggressiveness of prostate cancer," according to Dr Guzzi's team. The PIS is based on a 1997 study from Jacques Irani, et al, published in The Journal of Urology.

References:

Guzzi F, Falagario UG, Fanelli A, et al. Peritumoral inflammation in prostate biopsy core predict biochemical recurrence after active treatment for prostate cancer. Presented at: EAU24, Paris, France, April 5-8. Poster A0298.

Irani J, Levillain P, Goujon JM, Bon D, Dore B, Aubert J. Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol. 1997;157:1301-1303.

Prostate Cancer Recurrence Risk Higher During Active Surveillance Era

Biochemical recurrence (BCR) of prostate cancer after radical prostatectomy increased in the active surveillance (AS) era, driven by a higher-risk case mix and increased BCR risk among high-risk patients, according to recent study findings.

Investigators led by Timothy J. Daskivich, MD, MSHPM, of Cedars-Sinai Medical Center in Los Angeles, California, sampled 6682 patients who underwent radical prostatectomy for clinically localized tumors from 2000 to 2017, with 3492 (52%) and 3190 (48%) having surgery before and after 2010 (pre-AS and AS eras, respectively).

"BCR risk has increased in the AS era, with 40% of men experiencing BCR at 8-years after RP, an increase from the traditionally quoted 33% at 10-years from historical reference," Dr Daskivich's team reported in Urologic Oncology.

BCR risk was a significant 15% higher in the AS era compared with before, but this effect was eliminated after correcting for tumor risk, "suggesting that differences in tumor risk between eras mediated the change."

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It is imperative to clearly communicate these contemporary risks of BCR to patients so that they can most accurately understand the outcomes with definitive treatment and can therefore make better-informed shared decisions regarding treatment options

Compared with the pre-AS era, BCR risk among patients with favorable and unfavorable intermediate-risk prostate cancer was a significant 24% and 22% lower in the AS era, but was a significant 22% higher among patients with high-risk prostate cancer, the investigators reported.

The 8-year risks of BCR in the post-2010 era were 21%, 25%, 41%, and 60% for low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively.

"It is imperative to clearly communicate these contemporary risks of BCR to patients so that they can most accurately understand the outcomes with definitive treatment and can therefore make better-informed shared decisions regarding treatment options," the investigators concluded.

This article originally appeared on Renal and Urology News

Castration 'An Unfortunate Term' For Key Part Of Prostate Cancer Treatment

An expert explains the necessity of managing patients' testosterone levels while treating prostate cancer.

Treatments for prostate cancer and its side effects affect patients' long-term quality of life.

When treating patients with prostate cancer, controlling testosterone levels in the body is key, as one expert explained.

"Testosterone is the fuel for prostate cancer cells – it's what gives the cancer the signals to grow and spread and do the things that cancers do," explained Dr. Atish Choudhury, a genitourinary medical oncologist and the chair of the Gelb Center for Translational Research at Dana-Farber Cancer Institute in Boston. "So, lowering the level of testosterone in the body is the primary way that we treat prostate cancer because that then deprives the cancer of its fuel, and starts the process of killing cancer and putting some of the cancer cells to sleep as well."

Doctors, Choudhury explained, give patients drugs to lower testosterone in conjunction with radiation treatments.

"There have been multiple clinical trials that have shown that it basically makes the radiation more effective at killing the cancer more completely than if the testosterone stays at its normal levels," he said.

However, Choudhury acknowledged that "castration," is a loaded term, used in this context to refer to the chemical lowering of a patient's testosterone.

"Castration is a very unfortunate term that is used to describe the process of lowering levels of testosterone in the body, and it's been associated with actual surgical castration, which was a treatment that we used for prostate cancer previously, where you actually remove a man's testes and decrease the level of testosterone in that way. That was actually a very effective way to treat advanced prostate cancers," Choudhury said. "Here, we're using hormone mimics or hormone blockers to lower the level of testosterone in the body.

"And so, it can certainly have many of the same sorts of side effects as what a surgical castration might in terms of the hormonal changes, but here those side effects are intended to be quite temporary, to make the radiation work as well as possible. And then we would then allow the testosterone to recover back to normal levels, and then the side effects should eventually then wear off."

Those side effects, Choudhury said, include an expected reduction in both sexual interest and sexual function as the testosterone is lowered — although, as he noted, occasional patients still retain some libido and are able to achieve erections while their testosterone levels are low.

"The other side effects are very similar to what women might go through during menopause, which is a sudden hormonal change in them – so can certainly lead to things like fatigue, hot flashes, moodiness and achiness.

"But some of the concerning symptoms with long-term low testosterone is it can lead to weight gain, it can lead to metabolic changes, like increasing blood sugar and blood cholesterol, decreasing muscle mass and decreasing bone mass. That's why it's very important that after the treatment is done, we want the testosterone to recover back to the normal range, so people are not having to deal with those sorts of long-term side effects."

These treatments and their accompanying unfortunate side effects, Choudhury explained, are in the interest of patients' long-term quality of life.

"There is a trade-off when we use hormonal treatments with radiation to make it work as well as possible and lead to side effects that are going to worsen short-term quality of life," he said. "It's all with the intention of decreasing the risk of a recurrence that can lead to bigger quality of life issues down the line. So, we have to think about quality of life in the short term, but also over the course of the patient's remaining life expectancy."

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