Zeitschriftenartikel: „Biochemical Recurrence“

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Narita, Shintaro, Koji Mitsuzuka, Takahiro Yoneyama, Sadafumi Kawamura, Yoichi Arai, Chikara Ohyama, Tatsuo Tochigi, Takuhiro Yamaguchi und Tomonori Habuchi. „Impact of body mass index on clinicopathologic outcome and biochemical recurrence after radical prostatectomy in 1,257 Japanese patients with prostate cancer.“ Journal of Clinical Oncology 31, Nr. 6_suppl (20.02.2013): 176. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.176.

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176 Background: To determine the impact of body mass index (BMI) on the clinicopathological characteristics and biochemical recurrence of prostate cancer (PCa) after radical prostatectomy (RP) in Japanese men. Methods: The medical records of 1,257 men with PCa treated by radical prostatectomy without neoadjuvant therapy at four medical centers between 2001 and 2009 were retrospectively reviewed. Patients were categorized into four groups using the WHO BMI classification and recommended BMI quartiles. Associations of the various BMI categories with clinicopathological characteristics and biochemical recurrences were statistically evaluated. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of >0.2 ng/ml. Results: Of the 1,257 patients, 230 (18.1%) experienced biochemical recurrence during the median follow-up period of 49 months. The median BMI was 23.8 kg/m2, and 1.4% patients were underweight, 65.4% were of normal weight, 30.9% were overweight, and 2.4% were obese (WHO classification). Preoperative PSA levels and PSA density (PSAD) were significantly higher in the underweight group than in the other groups. Pathological characteristics did not differ significantly among BMI categories. As per the WHO classification and quartile categories, biochemical recurrence rate was comparable among the BMI groups. After adjusting for other pre- and perioperative covariables, multivariate Cox proportional hazards analysis revealed that a high BMI did not have an independent impact on biochemical recurrence-free survival. Conclusions: Underweight Japanese PCa patients who underwent radical prostatectomy had higher preoperative PSA levels and PSAD. However, high BMI was not associated with increased biochemical recurrence rate.

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Moul, Judd W. „Biochemical recurrence of prostate cancer“. Current Problems in Cancer 27, Nr. 5 (September 2003): 243–72. http://dx.doi.org/10.1016/s0147-0272(03)00032-1.

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Amling, Christopher L. „Biochemical Recurrence after Localized Treatment“. Urologic Clinics of North America 33, Nr. 2 (Mai 2006): 147–59. http://dx.doi.org/10.1016/j.ucl.2005.12.002.

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Sidaway, Peter. „Proteomic assay predicts biochemical recurrence“. Nature Reviews Urology 13, Nr. 12 (25.10.2016): 695. http://dx.doi.org/10.1038/nrurol.2016.215.

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Michalet, Morgan, Olivier Riou, Jeremy Cottet-Moine, Florence Castan, Sophie Gourgou, Simon Valdenaire, Pierre Debuire et al. „Magnetic Resonance-Guided Reirradiation for Local Recurrence within the Prostate or in the Prostate Bed: One-Year Clinical Results of a Prospective Registry Study“. Cancers 14, Nr. 8 (12.04.2022): 1943. http://dx.doi.org/10.3390/cancers14081943.

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Around 33% of patients treated by EBRT or brachytherapy will present a biochemical recurrence. SBRT is a new option for the treatment of patients with local-only recurrence. MRgRT seems to be interesting for the treatment of these recurrences. This article presents the one-year late tolerance and biochemical recurrence-free survival results of a prospective registry study. Patients with intraprostatic (or in the prostate bed) recurrence were treated with 5 to 9 fractions (median dose of 30 Gy in 5 fractions) with the MRIdian® system. PSA level and toxicities were evaluated before treatment and at three, six and 12 months after treatment. Thirty-seven patients with a median age of 74.5 years old were treated between 21 October 2019 and 7 December 2020. Acute tolerance was excellent with no grade >2 toxicities. Twelve months after treatment, we observed an increase of grade 1–2 dysuria (46% vs. 13% before treatment) and grade 1 polyuria (73% vs. 7%). The six, nine and 12-months biochemical-recurrence free survival were 97.3%, 86.5% and 65.0%. Fifteen patients (40%) presented a biochemical recurrence. Nine of these 15 patients (60%) had a persistent disease within the treated volume. In conclusion, MRgRT is safe and has promising survival results.

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Pendharkar, Arjun V., Eric S. Sussman, Allen L. Ho, Melanie G. Hayden Gephart und Laurence Katznelson. „Cushing's disease: predicting long-term remission after surgical treatment“. Neurosurgical Focus 38, Nr. 2 (Februar 2015): E13. http://dx.doi.org/10.3171/2014.10.focus14682.

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Cushing's disease (CD) is a state of excess glucocorticoid production resulting from an adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma. The gold-standard treatment for CD is transsphenoidal adenomectomy. In the hands of an experienced neurosurgeon, gross-total resection is possible in the majority of ACTH-secreting pituitary adenomas, with early postoperative remission rates ranging from 67% to 95%. In contrast to the strong data in support of resection, the clinical course of postsurgical persistent or recurrent disease remains unclear. There is significant variability in recurrence rates, with reports as high as 36% with a mean time to recurrence of 15–50 months. It is therefore important to develop biochemical criteria that define postsurgical remission and that may provide prognosis for long-term recurrence. Despite the use of a number of biochemical assessments, there is debate regarding the accuracy of these tests in predicting recurrence. Here, the authors review the various biochemical criteria and assess their utility in predicting CD recurrence after resection.

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Lages, Paulo Sergio, Luciano Prado Junior, Leonardo Prado und Luciana Lages. „Experience of a single Brazilian center on PSMA-PET in biochemical recurrence in patients with prostate cancer.“ Journal of Clinical Oncology 37, Nr. 7_suppl (01.03.2019): 134. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.134.

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134 Background: Biochemical recurrence in prostate cancer is a common event, and we have data showing that PSMA-PET may guide therapy when it happens. Objectives: Verify the sensibility of PSMA-PET on biochemically recurrent prostate cancer and correlate it with PSA level and Gleason score. Methods: From October 2015 to August 2018, 547 PSMA-PET (68Ga-PSMA) was performed to evaluate prostate cancer individuals. 276 patients had already been treated from prostate cancer and were in biochemical recurrence. From these patients, 122 had information regarding Gleason Score. Results: From the 276 patients, we found 216 positive exams (78.3%). What we can see, and according to the present data we already have, is that the positivity rises with increasing PSA level. Conclusions: PSMA-PET is a useful strategy for planning treatment in patients with biochemical recurrent prostate cancer. The sensibility varies according to PSA level and Gleason Score. An interest thing observed is that the sensibility for Gleason 3+4 is similar to Gleason 3+3 and the sensibility for Gleason 4+3 is similar to 4+4, showing that the Gleason 7 disease has different behaviors, as previous shown in other trials. This dataset reinforces the importance of incorporating PSMA-PET in clinical practice.[Table: see text][Table: see text][Table: see text]

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Luker, Gary D. „Imaging Biochemical Recurrence in Prostate Cancer“. Radiology: Imaging Cancer 3, Nr. 4 (01.07.2021): e219015. http://dx.doi.org/10.1148/rycan.2021219015.

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Simon, Nicholas I., Chris Parker, Thomas A. Hope und Channing J. Paller. „Best Approaches and Updates for Prostate Cancer Biochemical Recurrence“. American Society of Clinical Oncology Educational Book, Nr. 42 (April 2022): 1–8. http://dx.doi.org/10.1200/edbk_351033.

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Biochemical recurrence develops in almost one-third of men with prostate cancer after treatment with local therapy. There are numerous options for management, including surveillance, salvage radiation, androgen deprivation therapy (ADT), and clinical trials. This article reviews the current approaches to radiation therapy, ADT, and molecular imaging in men with biochemically recurrent prostate cancer. First, radiation therapy, including selection of field, dose, and use of concurrent antiandrogen therapy, is reviewed. Next, molecular imaging is addressed, including prostate-specific membrane antigen PET imaging and its increased sensitivity in identifying sites of disease. Finally, the factors associated with starting ADT are explored, and the data supporting intermittent over continuous ADT are reviewed. Lastly, the use of prostate-specific membrane antigen PET imaging and its potential role influencing therapy are discussed.

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Trock, B., M. Han, E. B. Humphreys, A. W. Partin, M. A. Eisenberger und P. C. Walsh. „Survival following early hormone therapy for men with rapid PSA doubling time within 2 years following radical prostatectomy“. Journal of Clinical Oncology 27, Nr. 15_suppl (20.05.2009): 5065. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.5065.

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5065 Background: Early hormonal therapy has been used in the salvage setting for men with biochemical recurrence following radical prostatectomy (RP), but no studies to date have been able to evaluate whether such treatment prolongs survival. We examined the impact of salvage hormonal therapy on overall survival (OS) in a cohort with long-term follow-up, and attempted to identify the subgroup most likely to benefit. Methods: Retrospective analysis of a cohort of 488 men undergoing RP at Johns Hopkins Hospital from 1982–2004, who experienced biochemical recurrence and received no salvage therapy (n = 386) or salvage hormonal therapy (n = 102); no one received adjuvant therapy. Survival was defined from biochemical recurrence to death from all causes, and analyzed with proportional hazards models with time-dependent covariates. Results: With median follow-up of 6 years after recurrence and 9 years after RP, there were 143 deaths (29%), including 105 from prostate cancer. After adjusting for PSA doubling time (PSADT), RP Gleason score, and year of surgery, hormonal therapy did not significantly improve OS for all men, compared to no salvage therapy: hazard ratio (HR) = 0.72 (95% confidence interval (CI): 0.45–1.17), p = 0.187. However, when restricted to men with early recurrence, i.e. within 2 years of RP, and with a rapid PSADT<6 months, hormonal therapy was associated with a large, significant improvement in OS: HR = 0.25 (95% CI: 0.08–0.71), p = 0.0095. This subgroup comprised 22% of the cohort. In contrast, there was no benefit of salvage hormonal therapy in men with early recurrence and PSADT>6 months: HR = 1.96 (95% CI: 0.89–4.31), p = 0.093, nor those who recurred more than 2 years after RP, regardless of PSADT. Conclusions: This study suggests that early salvage hormonal therapy may significantly and substantially prolong overall survival in the subgroup of men who experience an early biochemical recurrence with a rapid PSADT. These results are consistent with early recurrences being indicative of metastatic disease, while later recurrences are more likely to represent local recurrence. If validated, these results may provide useful stratification criteria for clinical trials. No significant financial relationships to disclose.

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Shahabi, Ahva, Raj Satkunasivam, Inderbir S. Gill, Gary Lieskovsky, Sia Daneshmand, Jacek K. Pinski und Mariana C. Stern. „Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era“. Canadian Urological Association Journal 10, Nr. 1-2 (14.01.2016): 17. http://dx.doi.org/10.5489/cuaj.3163.

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Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients.Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy).Results: The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage.Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP.

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Ward, John F., und Judd W. Moul. „Biochemical recurrence after definitive prostate cancer therapy. Part I: Defining and localizing biochemical recurrence of prostate cancer*“. Current Opinion in Urology 15, Nr. 3 (Mai 2005): 181–86. http://dx.doi.org/10.1097/01.mou.0000165552.79416.11.

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Ward, John F., und Judd W. Moul. „Biochemical recurrence after definitive prostate cancer therapy. Part II: Treatment strategies for biochemical recurrence of prostate cancer*“. Current Opinion in Urology 15, Nr. 3 (Mai 2005): 187–95. http://dx.doi.org/10.1097/01.mou.0000165553.17534.e3.

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Schweizer, Michael Thomas, Xian C. Zhou, Hao Wang, Ting Yang, Farah Shaukat, Mario A. Eisenberger und Emmanuel S. Antonarakis. „Association of metastasis-free survival (MFS) with overall survival (OS) in men with PSA-recurrent prostate cancer treated with deferred androgen-deprivation therapy.“ Journal of Clinical Oncology 31, Nr. 6_suppl (20.02.2013): 109. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.109.

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109 Background: To support the hypothesis that metastases are a significant clinical event, we aimed to explore the association between MFS with OS in men with biochemically-recurrent prostate cancer. Methods: This is a retrospective analysis of 450 men treated at a single institution between July 1981 and July 2010 with biochemical recurrence following prostatectomy, of which 140 (31%) developed subsequent metastases. In all patients, androgen deprivation therapy was deferred until after the development of radiographic metastases. Univariate and multivariable Cox regression models were developed to investigate factors influencing OS. Results: The median time from biochemical recurrence to metastasis (i.e. MFS) was 10.2 y (95% CI, 7.6–14.0 y), and the median time from first metastasis to death (i.e. OS) was 6.6 y (95% CI, 5.8–8.4 y). Using multivariable Cox regressions, we identified 4 variables that were independently prognostic for OS (Table): MFS (≤3 vs >3 y; P=0.009), number of metastases (≤3 vs ≥4; P=0.001), painful metastases (present vs absent; P<0.001), and ECOG performance status (0 vs ≥1; P=0.001). The concordance index reflecting the association between MFS and OS was 0.67. Conclusions: After adjusting for other prognostic variables, MFS was independently associated with OS in men with biochemically-recurrent prostate cancer. While this observation requires prospective validation, it suggests that MFS may be a reasonable endpoint in future clinical trials. [Table: see text]

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Pfisterer, Wolfgang K., Ronald A. Nieman, Adrienne C. Scheck, Stephen W. Coons, Robert F. Spetzler und Mark C. Preul. „Using ex vivo proton magnetic resonance spectroscopy to reveal associations between biochemical and biological features of meningiomas“. Neurosurgical Focus 28, Nr. 1 (Januar 2010): E12. http://dx.doi.org/10.3171/2009.11.focus09216.

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Object The goal in this study was to determine if proton (1H) MR spectroscopy can differentiate meningioma grade and is associated with interpretations of biological behavior; the study was performed using ex vivo high-resolution spectra indicating metabolic characteristics. Methods Sixty-eight resected tissue samples of meningiomas were examined using ex vivo 1H MR spectroscopy. Of these meningiomas, 46 were WHO Grade I, 14 were WHO Grade II, and 8 were WHO Grade III. Fifty-nine were primary meningiomas and 9 were recurrences. Invasion of adjacent tissue (dura mater, bone, venous sinus, brain) was found in 32 cases. Thirty-nine meningiomas did not rapidly recur (as defined by expansion on MR imaging within a 5-year follow-up period), whereas rapid recurrence was confirmed in 24 meningiomas, and follow-up status was unknown in 5 cases. Results The absolute concentrations of total alanine and creatine were decreased in high-grade compared with low-grade meningiomas, as was the ratio of glycine to alanine (all p < 0.05). Additionally, alanine and the glycine/alanine ratio distinguished between primary and recurrent meningiomas (all p < 0.05). Finally, the absolute concentrations of alanine and creatine, and the glycine/alanine and choline/glutamate ratios were associated with rapid recurrence (p < 0.05). Conclusions . These data indicate that meningioma tissue can be characterized by metabolic parameters that are not typically identified by histopathological analysis alone. Creatine, glycine, and alanine may be used as markers of meningioma grade, recurrence, and the likelihood of rapid recurrence. These data validate a previous study of a separate group of Grade I meningiomas.

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Tağcı, Süleyman, Cüneyt Özden, Yalçın Kızılkan, Samet Şenel, Doruk Demirel, Binhan Kağan Aktaş, Cevdet Serkan Gökkaya und Süleyman Bulut. „The relationship between the CAPRA-S and the time of biochemical recurrence following radical prostatectomy“. Yeni Üroloji Dergisi 16, Nr. 3 (22.10.2021): 254–61. http://dx.doi.org/10.33719/yud.2021;16-3-908452.

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Objective: In this study, we aimed to evaluate the relationship between biochemical recurrence time and the “cancer of the prostate risk assessment post-surgery” score (CAPRA-S) after radical prostatectomy (RP). Material and Methods: Retrospective evaluation was made of the records of 328 patients applied with RP for a diagnosis of clinically localized prostate cancer. The patients were separated into groups according to the CAPRA-S score determined according to the preoperative PSA level and pathological characteristics of the RP specimen and the biochemical recurrence time after RP. Results: The mean follow-up period was 76.9±34.5 months. Biochemical recurrence was determined in 23.2% (n:69) of the cases, as early recurrence in 71% (n:49) and late in 29% (n:20). According to the CAPRA-S score, 186 (62.4%) patients were classified as low risk, 66 (22.1%) as moderate risk, and 46 (15%) as high risk. The 3 and 5-year BRFS rates of all the patients were 88.9% and 81.8% respectively. Patients with a low CAPRA-S score were determined to have a statistically significantly higher 3 and 5-year BRFS rate than patients in the moderate and high groups. Early biochemical recurrence after RP was statistically significantly correlated only with lymph node involvement (OR: 2.42, 95% CI: 1.07-5.47, p=0.03). Conclusion: This study showed that the CAPRA-S score, which is effective in predicting the risk of biochemical recurrence after RP, was not effective in predicting the time of biochemical recurrence after RP. Keywords: Biochemical recurrence, CAPRA-S score, prostate cancer, radical prostatectomy

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Guliev, F. A. „Predictors of biochemical recurrence of prostate cancer“. Kazan medical journal 98, Nr. 6 (15.12.2017): 890–94. http://dx.doi.org/10.17750/kmj2017-890.

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Aim. To study the role of postoperative parameters in predicting the probability of development of biochemical recurrence in patients with prostate cancer with low pre-operative risk of its progression. Methods. 95 patients who underwent radical prostatectomy, were included in the study, the average age being 59.5±0.7 (44-76) years. The average levels of total and free prostate-specific antigen were 5.8±0.2 (1.71-9.9) and 1.03±0.07 (0.2-3.6) ng/ml respectively. Biochemical recurrence was defined as the level of prostate-specific antigen higher than 0.2 ng/ml after radical prostatectomy. Results. 8 (8.4%) patients during the follow-up period were diagnosed with biochemical recurrence. The average period to biochemical recurrence development was 45.8±6.7 (24-84) months. Pathomorphological examination revealed presence of tumor cells at surgical margin in 18 (18.9%) cases. Biochemical recurrence was diagnosed in 5 out of 77 (6.5%) patients with negative surgical margins and in 3 out of 18 (1.7%) patients with positive surgical margins. In our study, no correlation between the state of surgical margin and biochemical recurrence development was revealed (χ2=1.958; р=0.162). In the study group postoperative Gleason score was not prognostically significant as well (р=0.294). The average tumor volume in resected material was 11.8±1.0% (1-55%) of prostate volume (мм3). Extraprostatic extension was diagnosed in 10 (10.5%) cases. Results of univariate dispersion analysis of postoperative parameters revealed prognostic significance of tumor volume in removed specimen (р=0.007) and extracapsular extension (р=0.027). Conclusion. In our study we determined that tumor volume and extracapsular extention are independent risk factors for biochemical recurrence in prostate cancer patients with low pre-operative risk of disease progression.

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Loeb, Stacy, Yasin Folkvaljon, David Robinson, Thorsten Schlomm, Hans Garmo und Pär Stattin. „Phosphodiesterase type 5 inhibitors (PDE5i) and prostate cancer recurrence.“ Journal of Clinical Oncology 34, Nr. 2_suppl (10.01.2016): 55. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.55.

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55 Background: Phosphodiesterase type 5 inhibitors are commonly used for management of erectile dysfunction after prostate cancer (CaP) treatment. Single-institution studies have reported conflicting data on PDE5i use and recurrence after radical prostatectomy (RP). We re-evaluated the association between PDE5i use after RP and RT with biochemical recurrence in a nationwide, population-based registry. Methods: We performed a nested case-control study using data from the National Prostate Cancer Register of Sweden (including >98% prostate cancer cases nationwide), linked to the national Prescribed Drug Register. Among men with localized CaP who underwent primary RT or RP from 2006-2007 with 5 years of follow-up, we identified those with biochemical recurrence (n=293 cases). For each case, we identified 20 controls who were recurrence-free at the event date of the index case, using incidence density sampling stratified by age and treatment (n=5,767 controls). Multivariable conditional logistic regression was used to examine the relationship between overall PDE5i use and cumulative pill number with biochemical recurrence. Results: Among men treated by RT, PDE5i were not associated with BCR (OR 0.97, 95% CI 0.48-1.94), adjusting for marital status, education, income, PSA, clinical stage, Gleason score, and proportion of positive biopsies. As shown in the table, PDE5i were not associated with biochemical recurrence after RP adjusting for clinical features (OR 0.79, 95% CI 0.60-1.05), or with additional adjustment for surgical pathology (OR 0.83, 95% CI 0.62-1.10). Men whose cumulative number of PDE5i pills was above the median had a slightly lower risk of biochemical recurrence in the clinical model, and no difference in risk of biochemical recurrence after adjustment for RP features. Conclusions: Our results from a population-based setting suggest against an increased risk of biochemical recurrence among men using PDE5i after CaP treatment. [Table: see text]

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Favorito, Luciano A. „Radical Prostatectomy: Biochemical recurrence and prognostic factors“. International braz j urol 39, Nr. 6 (Dezember 2013): 765–67. http://dx.doi.org/10.1590/s1677-5538.ibju.2013.06.01.

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Carvalho*, João, Pedro Nunes, João Lima, Vasco Quaresma, Rodolfo Silva, Edgar Silva, Paula Soeiro et al. „PD54-09 BIOCHEMICAL RECURRENCE OF PROSTATE CANCER“. Journal of Urology 203 (April 2020): e1107. http://dx.doi.org/10.1097/ju.0000000000000956.09.

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Molitierno, Joseph, Aubrey Evans, James L. Mohler, Eric Wallen, Dominic Moore und Raj S. Pruthi. „Characterization of Biochemical Recurrence after Radical Prostatectomy“. Urologia Internationalis 77, Nr. 2 (2006): 130–34. http://dx.doi.org/10.1159/000093906.

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Alled Comín, L., C. Laria Font, J. Pérez Pausin, R. Escó Barón, C. Velilla Millán und M. López Mata. „Biochemical recurrence-free survival after prostate cancer“. Reports of Practical Oncology & Radiotherapy 18 (Juni 2013): S395. http://dx.doi.org/10.1016/j.rpor.2013.03.653.

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Franca, Carlos Antônio da Silva, Sérgio Lannes Vieira, Antonio Carlos Pires Carvalho, Antonio Jose Serrano Bernabe und Antonio Belmiro Rodrigues Campbell Penna. „Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherapy“. Radiologia Brasileira 47, Nr. 2 (April 2014): 89–93. http://dx.doi.org/10.1590/s0100-39842014000200010.

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Objective To evaluate the relationship between two year PSA nadir (PSAn) after brachytherapy and biochemical recurrence rates in prostate cancer patients. Materials and Methods In the period from January 1998 to August 2007, 120 patients were treated with iodine-125 brachytherapy alone. The results analysis was based on the definition of biochemical recurrence according to the Phoenix Consensus. Results Biochemical control was observed in 86 patients (71.7%), and biochemical recurrence, in 34 (28.3%). Mean PSAn was 0.53 ng/ml. The mean follow-up was 98 months. The patients were divided into two groups: group 1, with two year PSAn < 0.5 ng/ml after brachytherapy (74 patients; 61.7%), and group 2, with two year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%). Group 1 presented biochemical recurrence in 15 patients (20.3%), and group 2, in 19 patients (43.2%) (p < 0.02). The analysis of biochemical disease-free survival at seven years, stratified by the two groups, showed values of 80% and 64% (p < 0.02), respectively. Conclusion Levels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly correlated with a poor prognosis. This fact may help to identify patients at risk for disease recurrence.

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Choe, Jung Wan, Jae Min Lee, Jong Jin Hyun und Hong Sik Lee. „Analysis on Microbial Profiles & Components of Bile in Patients with Recurrent CBD Stones after Endoscopic CBD Stone Removal: A Preliminary Study“. Journal of Clinical Medicine 10, Nr. 15 (27.07.2021): 3303. http://dx.doi.org/10.3390/jcm10153303.

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Background/Aim: Common bile duct (CBD) stone recurrence after endoscopic treatment is a major concern as a late complication. Biliary bacterial factors and biochemical factors determine the path of gallstone formation. The aim of this preliminary study was to investigate the microbial profile and components of bile in patients with and without recurrent CBD stones after endoscopic CBD stone removal. Methods: Among patients who had undergone an initial endoscopic procedure for the removal of CBD stones and were followed up for >2 years, 11 patients who experienced at least two CBD stone recurrences, six months after endoscopic retrograde cholangiopancreatography (ERCP), were categorized into the recurrence group. Nine patients without CBD recurrence events were matched. Results: Polymicrobial infections are generally seen in all patients who have biliary sphincteroplasty. Microbial richness, measured by the numbers of operational taxonomic units (OTUs), was reduced in the recurrence group. The microbial evenness was also significantly lower than in the non-recurrence group. The overall microbial communities in the recurrence group deviated from the non-recurrence group. Infection with bacteria exhibiting β-glucuronidase activity was more frequent in the recurrence group, but there was no statistical significance. In an analysis of the bile components, the bile acid concentration was higher in the non-recurrence group than in the recurrence group. However, the other metabolites were not significantly different. Conclusions: Microbiota dysbiosis and altered bacterial community assembly in bile duct and decreased bile acid in bile juice were associated with recurrence of bile duct stone.

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Alumkal, J. J., Z. Zhang, E. B. Humphreys, C. Bennett, L. A. Mangold, M. A. Carducci, A. W. Partin, E. Garrett-Mayer, A. M. DeMarzo und J. G. Herman. „The impact of DNA methylation on the identification of recurrent prostate cancer“. Journal of Clinical Oncology 25, Nr. 18_suppl (20.06.2007): 21086. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.21086.

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21086 Purpose: Biochemical (PSA) recurrence of prostate cancer following radical prostatectomy remains a major problem. Better biomarkers are needed to identify high and low-risk patients. DNA methylation of promoter regions leads to gene silencing in many cancers. In this study, we assessed the impact of changes in DNA methylation on biochemical recurrence in men with prostate cancer. Methods: We examined the methylation status of fifteen genes using MSP (Methylation Specific PCR) on tissue samples from 151 patients with clinically localized prostate cancer for whom at least five years of follow-up after prostatectomy was available. Results: In a multivariable logistic regression analysis, extra capsular penetration, high Gleason score, and involvement of the lymph nodes, seminal vesicles, or surgical margin were associated with an increased risk of recurrence. In addition, samples with methylation of 2 specific genes involved in cell-cell adhesion and apoptosis were associated with biochemical recurrence with an odds ratio of 5.64 (95% CI=1.47–21.7, p=0.012) compared to samples without methylation of both of these genes. The methylation status of these 2 genes had a higher sensitivity (72.3%; 95% CI=57–84.4%) for detecting recurrences than all the clinico-pathological variables (p<0.02) except extra-capsular penetration (p=0.346). The methylation status of these 2 genes had a similar negative predictive value (79.0%; 95% CI=66.8–88.3%) as the individual clinico-pathological variables examined. Conclusion: DNA Methylation of specific genes is independently associated with an increased risk of biochemical recurrence after radical prostatectomy even one considers the prognostic clinico-pathologic variables used in the clinic today. Our findings should be validated on another larger group of patients with prostate cancer who have undergone radical prosatetectomies. No significant financial relationships to disclose.

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Metser, Ur, Claudia Ortega, Douglas Hussey, Rosanna Chan, Alejandro Berlin, Antonio Finelli und Patrick Veit-Haibach. „18F-DCFPyL (PSMA) PET in the Management of Men with Biochemical Failure after Primary Therapy: Initial Clinical Experience of an Academic Cancer Center“. Current Oncology 28, Nr. 5 (25.08.2021): 3251–58. http://dx.doi.org/10.3390/curroncol28050282.

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Purpose: To describe the initial experience of an academic center using 18F-DCFPyL PET in managing men with recurrent prostate cancer. Materials & Methods: This prospective, single-arm IRB-approved study included men with biochemical failure after primary therapy for prostate cancer and negative/equivocal CT and bone scintigraphy who were candidates for salvage therapy, as determined by a multidisciplinary panel of experts. 18F-DCFPyL PET was assessed for the presence and extent of recurrence: local, oligometastatic (≤4), or extensive. Post-PET management and clinical outcome, including PSA response, was documented. For patients who received PET-directed ablative therapies, response was categorized as “complete” if PSA became undetectable or “favorable” if PSA decreased ≥50%. Results: Forty-seven men with biochemical failure after radical prostatectomy (n = 29), primary radiotherapy (n = 15) or focal tumor ablation (n = 3) were included. PET was positive in (43/47) 91.5%, including local recurrence in (9/47) 19.2%; oligometastatic disease in (16/47) 34%; and extensive metastatic disease in (18/47) 38.3%. PET-directed focal ablative therapies without systemic therapy were given to (13/29) 44.8% of patients without extensive metastases on PET with a mean PSA response of 69% (median, 74.5%; range: 35–100). Favorable biochemical response was observed in (10/13) 76.9% of patients with limited recurrence on PET, and in 23.1% (3/13), there was complete response. Conclusion: 18F-DCFPyL PET was positive in >90% of patients with biochemical failure. For those with limited recurrence, PSMA PET-directed local ablative therapies resulted in favorable outcome in more than 3 in 4 patients, and in nearly a quarter of them, there was complete biochemical response.

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Nasser, Nicola Joseph, Victoria Chernyak, Shalom Kalnicki und Jonathan Klein. „Predictors of prostate bed nodule on MRI in patients with rising PSA after radical prostatectomy.“ Journal of Clinical Oncology 37, Nr. 7_suppl (01.03.2019): 122. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.122.

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122 Background: Radical prostatectomy (RP) is a common treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to rule out metastatic disease and pelvic MRI to detect local recurrence in the prostate bed. We analyzed disease characteristics and demographic data of patients with rising PSA after RP to determine correlation with MRI-detected cancer recurrence. Methods: Using Clinical Looking Glass, an institutional data registry query tool, we identified all MRI scans performed at our institution between January 2013 and January 2018 to evaluate for the presence of prostate cancer after RP due to rising prostate specific antigen (PSA) levels. Using Chi-square testing, we analyzed PSA levels, pathologic disease characteristics, time from surgery to biochemical failure, and patient demographic characteristics as predictors of local recurrence detected by pelvic MRI. Results: We identified 64 patients who underwent MRI for rising PSA and had complete clinical and pathological data available. A prostate bed nodule compatible with local recurrence was found in 17 patients (27%). Thirty-six patients (56%) had no evidence of tumor in the prostate bed or pelvis. Eleven patients (17%) had a suspicious lesion which could represent scarring, retained seminal vesicle or recurrent cancer. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p = 0.04) with African-American patients having 82% lower chance of MRI-detected tumor recurrence compared with White patients (p = 0.045). No other characteristic was significantly associated with MRI-detected recurrence including prostate cancer risk group, Gleason score, extra-capsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI. Conclusions: African-American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with white patients. This data may support a higher propensity toward microscopic metastatic disease at the time of biochemical failure in this population.

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Gadzinski, Adam J., Kirsten L. Greene, Peter Carroll, Charles J. Ryan, Felix Y. Feng und Tom Hope. „Detection of prostate cancer lesions using Gallium-68 PSMA-11 PET in men with biochemical recurrence following radical prostatectomy.“ Journal of Clinical Oncology 36, Nr. 6_suppl (20.02.2018): 236. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.236.

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236 Background: Conventional imaging techniques infrequently detect the site of prostate cancer disease in men with biochemical recurrence following radical prostatectomy (RP). We examine the use of Gallium-68 Prostate-Specific Membrane Antigen (PSMA) positron emission tomography (PET) to determine the site of disease recurrence in these men. Methods: We retrospectively reviewed men with persistently detectable prostate specific antigen (PSA) and those with formal biochemical recurrence (PSA ≥ 0.2 ng/mL) following RP who underwent PSMA PET scan under our institution's prospective trials (NCT02918357 & NCT02611882). We assessed the location of detected recurrences, and examined the distribution of recurrence location (prostate bed, pelvic lymph nodes (LN), and extra-pelvic disease) according to PSA at time of PET scan. Results: One hundred and fifty-eight men underwent PSMA PET after RP, 46% of men had previously undergone either adjuvant or salvage radiation therapy. Eleven men (7%) had the scan for persistently detectable PSA < 0.2 and 93% of men had biochemical recurrence. At time of RP, 66% of men had ≥pT3a disease, 40% had positive surgical margins, and 18% had positive lymph nodes. Gleason grade at RP was ≤3+3 in 5% of men, 3+4 in 27%, 4+3 in 32% and ≥4+4 in 36%. Overall, 77% of men had a lesion detectable on PSMA PET. Men with higher PSA at time of scan had a higher prevalence of lesions, with all men PSA > 6.0 having at least one lesion on PSMA PET (Table). Overall, we found extra-pelvic lesions in 44% of all men, and 58% of men with PSA ≥ 1.0. These are areas not typically covered by salvage radiation fields. Conclusions: PSMA PET detects lesions in a high proportion of men with biochemical recurrence following RP, with many lesions outside of the pelvis. This may facilitate more precise targeting of treatment areas for these patients. Clinical trial information: NCT02918357. Clinical trial information: NCT02611882. [Table: see text]

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Steiner, E., O. Eicher, J. Sagemüller, M. Schmidt, H. Pilch, B. Tanner, J. G. Hengstler, M. Hofmann und P. G. Knapstein. „Multivariate independent prognostic factors in endometrial carcinoma: A clinicopathologic study in 181 patients“. International Journal of Gynecologic Cancer 13, Nr. 2 (Februar 2003): 197–203. http://dx.doi.org/10.1136/ijgc-00009577-200303000-00017.

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The aim of this study was to evaluate the biologic outcome of endometrial carcinomas as compared to clinical and pathologic parameters and to identify multivariate independent prognostic factors. Charts were abstracted from patients with endometrial carcinoma from 1985 to 1995. Data on clinicopathologic variables, adjuvant treatment, site of recurrence, and survival were collected. χ2 test was used to test association between variables. Kaplan-Maier method was used for survival analysis and Cox proportional hazards model for multiple regression analysis. Univariate analysis revealed that FIGO stage, tumor grade, depth of myometrial invasion, biochemical analysis of progesterone receptor status, age, additional diabetes mellitus, lymph node metastasis, and type of tumor were significantly associated with the overall-survival. For disease-free interval, FIGO stage, tumor grade, depth of myometrial invasion, biochemical analysis of progesterone receptor status, lymph node metastasis, and type of tumor were also significantly associated. Multivariate analysis revealed that FIGO stage, tumor grading, tumor type, depth of myometrial invasion, and biochemically measured progesterone receptor status were associated significantly with overall survival. A significant correlation as independent prognostic factors were also seen for recurrence free interval for FIGO stage, tumor grade, and biochemical progesterone receptor status. In multivariate statistical analysis we identified FIGO stage, tumor type, tumor grade, biochemical analysis of progesterone receptor status, and depth of myometrial invasion as independent prognostic factors for overall survival, and FIGO stage, biochemical analysis of progesterone receptor status, and tumor grade as independent prognostic factors for recurrence-free interval.

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Braun, Leah T., German Rubinstein, Stephanie Zopp, Frederick Vogel, Christine Schmid-Tannwald, Montserrat Pazos Escudero, Jürgen Honegger, Roland Ladurner und Martin Reincke. „Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment“. Endocrine 70, Nr. 2 (02.08.2020): 218–31. http://dx.doi.org/10.1007/s12020-020-02432-z.

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Abstract Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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Hsieh, Chun-Yu, Ying-Erh Chou, Chia-Yen Lin, Shian-Shiang Wang, Ming-Hsien Chien, Chih-Hsin Tang, Jian-Cheng Lin, Yu-Ching Wen und Shun-Fa Yang. „Impact of Matrix Metalloproteinase-11 Gene Polymorphisms on Biochemical Recurrence and Clinicopathological Characteristics of Prostate Cancer“. International Journal of Environmental Research and Public Health 17, Nr. 22 (19.11.2020): 8603. http://dx.doi.org/10.3390/ijerph17228603.

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Prostate cancer is among the most common malignant tumors worldwide. Matrix metalloproteinase (MMP)-11 is involved in extracellular matrix degradation and remodeling and plays an essential role in cancer development and metastasis. This study investigated the association of MMP-11 polymorphisms with the clinicopathological characteristics and biochemical recurrence of prostate cancer. Five single-nucleotide polymorphisms (SNPs) of the MMP-11 were analyzed in 578 patients with prostate cancer through real-time polymerase chain reaction analysis. A prostate-specific antigen level of >10 ng/mL, Gleason grade groups 4 + 5, advanced tumor stage, lymph node metastasis, invasion, and high-risk D’Amico classification were significantly associated with biochemical recurrence in the patients (p < 0.001). MMP-11 rs131451 “TC + CC” polymorphic variants were associated with advanced clinical stage (T stage; p = 0.007) and high-risk D’Amico classification (p = 0.015) in patients with biochemical recurrence. These findings demonstrate that MMP-11 polymorphisms were not associated with prostate cancer susceptibility; however, the rs131451 polymorphic variant was associated with late-stage tumors and high-risk D’Amico classification in prostate cancer patients with biochemical recurrence. Thus, the MMP-11 SNP rs131451 may contribute to the tumor development in prostate cancer patients with biochemical recurrence.

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Sooriakumaran, P., M. John, A. Srivastava, Y. El-Douaihy, S. Grover, D. Bhagat, S. Rajan, R. Leung und A. Tewari. „Nomograms to predict 3-year biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy based on preoperative and perioperative variables of 774 patients.“ Journal of Clinical Oncology 29, Nr. 7_suppl (01.03.2011): 115. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.115.

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115 Background: Predictors of biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical recurrence. Methods: 774 patients with at least 3 year follow up had undergone RALP by a single surgeon at our institution. Biochemcial recurrence was defined as a postoperative PSA >0.2 ng/ml. Multivariable logistic regression models were used to develop the biochemical recurrence predictive nomograms: nomogram 1- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion; nomogram 2- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion, nerve sparing, positive surgical margins (none, unifocal, or multifocal). The predictive accuracy of the models was assessed in terms of discrimination and calibration. Results: Both nomograms discriminated well between patients that recurred and those that did not (bootstrap corrected c-indices of 0.766 and 0.806 for nomograms 1 and 2 respectively). Nomogram 1 was well calibrated, but nomogram 2 over- predicted the probability of biochemical recurrence in patients at >30% risk. Conclusions: Our nomogram based on age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, and perineural invasion on preoperative biopsy has a good predictive ability to differentiate between RALP-treated patients that biochemically recur by 3 years from those that do not. Adding nerve sparing and surgical margin status further improved discriminatory ability but at the expense of over-prediction for patients at high risk. These nomograms may be used to guide the use of nerve sparing and the management of positive margins in men undergoing RALP for clinically localized prostate cancer. No significant financial relationships to disclose.

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Perennec, Tanguy, Loig Vaugier, Alain Toledano, Nathaniel Scher, Astrid Thomin, Yoann Pointreau, Guillaume Janoray, Renaud De Crevoisier und Stéphane Supiot. „Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study“. Cancers 13, Nr. 17 (27.08.2021): 4339. http://dx.doi.org/10.3390/cancers13174339.

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Prostate cancer recurrence in patients previously treated with radical prostatectomy and radiation therapy is challenging. Re-irradiation could be an option, but data regarding efficacy and safety are lacking. We retrospectively evaluated salvage re-irradiation for local recurrence after prostatectomy and external beam radiation therapy. We collected data from 48 patients who underwent salvage reirradiation with stereotactic radiation therapy for local prostate cancer recurrence in the prostatic bed at four French centers. Fifteen patients (31%) were on androgen deprivation therapy during stereotactic radiotherapy. Biochemical response and relapse-free survival were analyzed, and post-treatment toxicities were assessed according to the Common Terminology of Adverse Events criteria. Five patients had grade 3 late bladder toxicity (cystitis), three had grade 3 late incontinence, and one had grade 3 late chronic pain. At three months, 83% of patients had a positive biochemical response. The median follow-up was 22 months. At the end of the follow-up, 21 patients (43%) had a biochemical relapse. The median time to biologic relapse was 27 months. The biochemical relapse rates at 1 and 2 years were 80% and 52%, respectively. In conclusion, salvage re-irradiation for recurrent prostate cancer in the prostate bed may generate significant toxicity rates, and a prospective study with appropriate patient selection is needed to evaluate its effectiveness.

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Yuan, Yong, Qiang Zhang, Chaofan Xie und Tao Wu. „Effect of Salvage Radiotherapy and Endocrine Therapy on Patients with Biochemical Recurrence After Prostate Cancer Operation— a Meta‑Analysis“. American Journal of Men's Health 15, Nr. 3 (Mai 2021): 155798832110248. http://dx.doi.org/10.1177/15579883211024881.

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Context: Several studies reported the application of androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. Objective: To perform a systematic review and meta-analysis evaluating of endocrine therapy and radiotherapy in patients with biochemical recurrence after prostate cancer surgery. The primary end point was biochemical progression-free survival (bPFS). Secondary end point was overall survival (OS). Methods: A systematic review of PubMed/Medline, Embase, and Cochrane databases to identify relevant studies published in English up to March 2020. Twelve studies were selected for inclusion. Results: There were 11 studies included in the present study. Including two randomized controlled trials and nine cohort studies. The meta-analysis shows a significant bPFS benefit from androgen deprivation therapy and radiotherapy in patients with biochemical recurrence after prostate cancer operation. (hazard ratio [HR]: 0.57; 95% confidence interval CI, 0.52–0.63; p < .001). For patients with GS < 7 and low-risk patients, combined treatment can have a benefit for BPFs (HR: 0.53; 95% CI, 0.37–0.76; HR: 0.58; 95% CI, 0.36–0.93). Androgen deprivation therapy and radiotherapy in patients with biochemical recurrence was associated with a slightly OS improvement (HR: 0.73; 95% CI, 0.57–0.93; p = 0.01). Conclusions: Compared with salvage radiotherapy alone, This meta-analysis shows a significant bPFS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence after prostate cancer operation. And benefit more for high-risk groups. However, there was no significant benefit in group GS ≥ 8. It shows a slightly OS benefit from endocrine therapy combined with salvage radiotherapy in patients with biochemical recurrence.

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Hollon, Todd, Esteban Urias, Arjun Adapa, Neil Jairath, Akshay Save, Peter D. Canoll, Honglak Lee, Christian Freudiger und Daniel Orringer. „NIMG-69. RAPID INTRAOPERATIVE DIAGNOSIS OF GLIOMA RECURRENCE USING STIMULATED RAMAN HISTOLOGY AND DEEP NEURAL NETWORKS“. Neuro-Oncology 21, Supplement_6 (November 2019): vi177. http://dx.doi.org/10.1093/neuonc/noz175.738.

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Abstract Accurate intraoperative diagnosis of recurrence versus treatment effect (TE) is essential for determining the management of suspected recurrent gliomas. Cytologic and histoarchitectural changes related to chemoradiation overlap with common findings in recurrent tumors (e.g. atypia, abnormal vasculature, necrosis). Moreover, H&E tissue processing artifact complicates interpretation. Stimulated Raman histology (SRH) uses the intrinsic biochemical properties of fresh, unprocessed surgical specimens to provide rapid label-free digital histologic images. Here, we report an automated technique using deep convolutional neural networks (ConvNet) that differentiates recurrent glioma and TE in fresh surgical specimens imaged using SRH with equivalent accuracy and 10x faster (tissue-to-diagnosis, 2 minutes) than conventional methods. Our ConvNet, based on Google’s Inception-ResNet-v2 architecture, was first trained on 3.6 million SRH images from 441 patients with the most common brain tumor subtypes. To optimize the network for classifying glioma recurrence, we used cross-validation (CV) on 35 patients (24 recurrent, 9 TE) for model hyperparameter tuning and to identify an optimal probability threshold to classify recurrence. To perform rigorous model validation, we used a 50 patient external testing set to evaluate overall model accuracy. Over 5 iterations of CV, the mean held-out classification accuracy was 94.8% (range, 91.4 - 97.1%). Using ROC analysis, we found that a probability of recurrence greater than 25% was the optimal threshold to render a recurrence diagnosis for whole-slide SRH images. Using our external testing set, we achieved a classification accuracy of 96% (total 48/50; 30/30 recurrences, 18/20 TE). Moreover, our method effectively identifies regions of glioma recurrence in whole slide SRH at no additional computational cost. Our study demonstrates the feasibility of applying deep learning for intraoperative diagnosis of recurrent gliomas in SRH imaged tissues. In the future, ConvNets may ultimately be used to guide decision-making in the surgical care of recurrent gliomas, independent of conventional neuropathology resources.

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Ng, Chee Kwan, Naji J. Touma, Venu Chalasani, Madeleine Moussa, Donal B. Downey und Joseph L. Chin. „The pattern of prostate cancer local recurrence after radiation and salvage cryoablation“. Canadian Urological Association Journal 5, Nr. 6 (15.04.2013): 125. http://dx.doi.org/10.5489/cuaj.748.

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Objective: We assessed the pattern of local recurrence after salvagecryoablation of the prostate, and the impact of local recurrence onintermediate-term outcome.Methods: One hundred twenty-two patients who underwentsalvage cryoablation were studied after a mean follow-up of 56months. Serial prostate biopsy was carried out after cryoablation.The histopathology of prostate biopsies before and after cryoablationwere compared. The prognostic value of post-cryoablationbiopsy was assessed with the Cox regression method.Results: 23.1% of patients had a positive biopsy for prostate cancerfollowing salvage cryoablation. Most cancer recurrences occurredin the apex (51.5%), base (21.2%) and seminal vesicles (18.2%).The presence of cancer at the base of the prostate was found tobe a prognostic factor for eventual biochemical failure. Overall5-year biochemical disease-free survival (bDFS) was 28%, howeverpatients with cancer at the base of the prostate had a 5-yearbDFS of 0%.Conclusion: Cancer recurrences occurred in areas where aggressivefreezing was avoided as it might result in serious problems (e.g.,urethro-rectal fistula and incontinence). Post-cryoablation biopsiesand the location of persistent disease are of prognostic value.

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Manas, F. N. U., Suchetha Jagan und Barbara Mols-Kowalczewski. „PSUN15 Recurrence of Benign Pheochromocytoma“. Journal of the Endocrine Society 6, Supplement_1 (01.11.2022): A122. http://dx.doi.org/10.1210/jendso/bvac150.249.

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Abstract INTRODUCTION: Pheochromocytoma is a rare, usually benign, tumor of adrenal medulla. The prevalence is about 4.5-6.5%. The common presenting symptoms are headache, palpitations, diaphoresis, flushing, hypertension, and tachycardia. The high catecholamine levels can also result in arrhythmias, cardiomyopathy, stroke, and even death. It can also be asymptomatic and diagnosed as an adrenal incidentaloma on routine imaging. Due to its diverse and non-specific presentation, it is often called a great mimic in medicine. It is diagnosed both biochemically with plasma or urine metanephrines and by imaging (CT or MRI). The first line treatment is surgical resection of adrenal gland, adrenalectomy. Resected tumors should be pathologically confirmed for absence of malignancy. The recurrence of benign pheochromocytoma after adrenalectomy is rare. Recurrence rate following adrenalectomy is 6.5-16.5%. There are no identified predictors of recurrence but usually it occurs after 2-3 years. Annual imaging and biochemical testing for plasma and urinary metanephrines is recommended for early diagnosis of recurrence. CASE PRESENTATION: A middle aged female with past medical history of uncontrolled hypertension and uncontrolled diabetes mellitus underwent CT scan for abdominal pain, fatigue, and unintentional weight loss. She also complained of intermittent palpitations, chest heaviness, sweating, facial flushing, and headaches. Family history was negative for endocrinopathies or endocrine malignancies. CT showed 12 cm right adrenal mass. Plasma metanephrines were ordered given the imaging findings and they were elevated at more than 13000 pg/nl (normal < 60 pg/ml). All other adrenal hormones were within normal range. She was diagnosed with pheochromocytoma and underwent right adrenalectomy. The tumor was confirmed to be benign by histopathology. Post-surgery her symptoms resolved, and biochemical tests normalized with plasma metanephrine at 35 pg/ml. She presented again 4 years later with similar symptoms. Patient experienced palpitation and noted to have high blood pressure at home. She had also been experiencing flushing and having a sense of impending doom. On examination the patient was diaphoretic and review of systems was positive for heat intolerance, polydipsia and polyuria. EKG revealed sinus tachycardia and blood glucose was elevated. Labs revealed elevated plasma metanephrine and normetanephrine levels. Renin activity and plasma aldosterone levels were normal. CT scan confirmed soft tissue masses, 2. 0 x4. 0 cm posteriorly and 2. 0 x3.2cm laterally, in the pararenal space surrounding the right kidney, suggestive of local recurrence of pheochromocytoma. CONCLUSION: Even though rare, the recurrence of pheochromocytoma can occur, usually after 2-3 years. Annual imaging and biochemical testing is recommended to diagnose recurrent pheochromocytoma, especially in patients with large tumors (>5cm). Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

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Recek, Cestmir. „Hemodynamics-based treatment of varices: A therapeutic concept counteracting the intrinsic tendency of varicose veins to recur“. Phlebology: The Journal of Venous Disease 31, Nr. 10 (23.09.2016): 704–11. http://dx.doi.org/10.1177/0268355516664809.

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Varicose vein disease is characterized by tenacious tendency to recur. Measures recommended to prevent recurrences (flush ligation at the saphenofemoral junction, removal of incompetent great saphenous vein in the thigh, and insertion of mechanical barriers in the fossa ovalis) did not succeed in preventing recurrence. Reflux recurrence is triggered by the hemodynamic phenomenon called hemodynamic paradox. Abolition of saphenous reflux removes the hemodynamic disturbance of any degree of severity but at the same time it releases the pathological process leading to recurrent reflux. This process is induced by drainage of venous blood from incompetent superficial thigh veins into deep lower leg veins during calf pump activity, which evokes the development of ambulatory pressure gradient between the femoral vein and incompetent segments of the saphenous system in the thigh. The pressure gradient sets off biophysical and biochemical events inducing recurrent reflux. The designed therapeutic strategy consists of reliable abolition of saphenous reflux and of hindering the pathological drainage of venous blood at the knee level in order to preclude development of the hemodynamic preconditions for reflux recurrence. In this way, the dividing line of the ambulatory pressure gradient would be kept below the knee, as is the case with healthy people.

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Kraus, Ryan, Nathan Cheng, Lingyun Ji, Richard Lester Stephen Jennelle, Susan G. Groshen und Leslie Ballas. „The perineural invasion paradox: Is perineural invasion an independent prognostic indicator of biochemical recurrence risk in patients with pT2N0 prostate cancer?“ Journal of Clinical Oncology 36, Nr. 6_suppl (20.02.2018): 6. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.6.

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6 Background: Perineural invasion is a histologic feature present in approximately 19% of patients with prostate cancer. The prognostic significance of perineural invasion is controversial with recent studies yielding contradictory results. This study aims to assess whether perineural invasion on surgical pathology of patients with pT2N0 disease is an independent prognostic indicator of the risk of biochemical recurrence. Methods: We identified 201 patients with non-metastatic pT2N0 prostate cancer at our institution between 1/1/2008-12/31/2014. We reviewed the electronic medical record of these patients and identified whether the patient had biochemical recurrence (defined as PSA > 0.2 after surgery). A multivariable analysis was then performed using clinical and histological data for each patient to assess the association between perineural invasion and biochemical recurrence. Results: Of the 201 patients identified, 68.1% (137/201) had perineural invasion and 14% (28/201) had biochemical recurrence. Perineural invasion was associated with pT2c disease (p < 0.001), an increased number of positive cores on biopsy (p < 0.001), and a higher surgical Gleason score (p < 0.001). 19% of patients with perineural invasion had disease recurrence compared to 3.1% without perineural invasion (p = 0.001, Hazard ratio of 6.2). After performing a multivariable analysis and accounting for pathologic tumor staging and Gleason score, perineural invasion had a trend towards a significant association with recurrence (p = 0.085, Hazard ratio of 3.2). Conclusions: Perineural invasion may be an indicator of unfavorable histology such as a high Gleason score or more widespread disease rather than an independent prognostic indicator of the risk of biochemical recurrence.

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Verburg, Frederik, Uwe Mäder, Inge Grelle, Luca Giovanella, Christoph Reiners und Heribert Hänscheid. „Only a Rapid Complete Biochemical Remission After 131I-Therapy is Associated with an Unimpaired Life Expectancy in Differentiated Thyroid Cancer“. Hormone and Metabolic Research 49, Nr. 11 (November 2017): 860–68. http://dx.doi.org/10.1055/s-0043-119462.

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AbstractThe objective of the work was to investigate the relationship between thyroglobulin doubling time (TgDT) as a marker of speed of response to 131I-therapy and the differentiated thyroid cancer (DTC) recurrence rate, DTC specific mortality rate, and relative survival rate in a DTC population followed over a long period of time after 131I-therapy. From our database, data of 1354 patients were reviewed. TgDT could be calculated in 174 patients, however, 376 patients did not have sufficient Tg values available for TgDT calculation and 804 patients reached biochemical remission before a sufficient number of Tg measurements for TgDT calculation was acquired. Main outcome measures were recurrence-free, DTC specific, and relative survival rates. In patients<45 years, TgDT in multivariate analysis was identified as the solitary significant determinant of DTC specific and relative survival. In patients≥45 years of age at diagnosis, TgDT is an independent, but not the only determinant of recurrence free, DTC specific, and relative survival. Importantly, in this age group life expectancy is normal in patients reaching rapid biochemical remission (i. e., before TgDT can be calculated); it was reduced in patients with a negative TgDT, which normally is deemed a marker of response to therapy. Only DTC patients with a rapid biochemical remission have a very good prognosis with a normal life expectancy. If no rapid biochemical remission occurs, both biochemically progressive disease and a slower biochemical remission of disease are associated with a reduced prognosis, especially in older DTC patients.

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Fragkoulis, Charalampos, Ioannis Glykas, Lazaros Tzelves, Panagiotis Velissarios Stamatakos, Georgios Papadopoulos, Georgios Stathouros, Athanasios Dellis et al. „Clinical impact of ERG and PTEN status in prostate cancer patients underwent radical prostatectomy“. Archivio Italiano di Urologia e Andrologia 94, Nr. 4 (27.12.2022): 390–95. http://dx.doi.org/10.4081/aiua.2022.4.390.

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Objectives: Phosphate and tensin homolog gene (PTEN) acts as a regulator of PI3-KAkt molecular pathway. ETS Related gene (ERG), an oncogene located in chromosome 21q22.2, is involved in prostate cancer (PCa) by serine 2 (TMPRSS2), a protein encoded by TMPRSS2 gene. The aim of this study is to evaluate the clinical impact of PTEN loss and ERG rearrangement in terms of oncologic results in patients diagnosed with localized PCa who underwent radical prostatectomy. Materials and methods: Prospective data were collected from a total of 74 patients who underwent open radical retropubic prostatectomy for localized PCa and immunohistochemical study was performed in tissue samples. The primary antibodies for anti-ERG antibody as well as anti-PTEN antibody were obtained from DAKO. ERG was considered positive if at least 20% of the evaluated cells were stained at least with medium intensity. PTEN protein loss was considered when the intensity of cytoplasmic and nuclear staining was mild or entirely negative across > 10% of tumor cells. Results: Homogenous loss of PTEN was associated with higher clinical International Society of Urological Pathology (ISUP) grade (p = 0.018) while no statistical significant association was present regarding the presence of ERG rearrangement with either ISUPc or ISUPp. After a median follow up of 34 months, 24 patients developed biochemical recurrence. No statistical significant correlation of ERG status with biochemical recurrence was noted while PTEN was associated with biochemical recurrence development in a statistical significant way. Lastly the combination of PTEN loss with ERG rearrangement presence was detected more often in higher ISUPc and ISUPp as well as biochemical recurrence development, although in a non statistical significant way. Conclusions: Homogenous and heterogenous PTEN loss was associated with biochemical recurrence. No association of ERG and biochemical recurrence was noted. The combination of PTEN loss and ERG rearrangement presented a trend for higher ISUPc and ISUPp as well as biochemical recurrence but not in a statistical significant way.

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Solodkiy, V. A., A. Yu Pavlov, A. D. Tsybulskiy, A. G. Dzidzariya und A. S. Pchelintsev. „Salvage high dose-rate brachytherapy for local recurrence of prostate cancer after different types of radical treatment“. Cancer Urology 15, Nr. 2 (09.07.2019): 73–76. http://dx.doi.org/10.17650/1726-9776-2019-15-2-73-76.

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Objective: at the primary analysis of prostate cancer treatment referring to the patients who have experienced high dose rate brachytherapy after a confirmed locally recurrent tumor having been treated with diverse treatment modes.Materials and methods. The research includes 28 patients aged 53 to 78 years old (average age is 66 years old) with histologically verified prostate cancer recurrence. Within the period 2015–2017 all the patients got a salvage high dose rate brachytherapy in the Russian Scientific Center of Roentgenradiology. Brachytherapy was carried out as 2 fractions with the single tumor dose of 12.5 Gy. There was a two-week gap between fractions with the total tumor dose of 25 Gy. The follow-up period is 9 to 36 months.Results and conclusion. Overall biochemical free survival rate is 82.1 %. There are 5 people having a growing prostatic specific antigen (PSA) while the case follow-up. There is 1 case of a confirmed local tumor recurrence. Significant factors of the disease progression after salvage brachytherapy are: risk group, pretreatment PSA high, time line from the background therapy to biochemical recurrence uprise and PSA level if there’s prostate cancer recurrence after the background therapy.

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Zanatta, Danielle A., Reginaldo J. Andrade, Eduardo F. Pacagnan, Lucas W. München, Rosangela A. B. Assumpção, Vanesssa C. F. I. Mercante und Gustavo M. D. Simonetti. „Early stage prostate cancer: biochemical recurrence after treatment“. International braz j urol 40, Nr. 2 (April 2014): 137–45. http://dx.doi.org/10.1590/s1677-5538.ibju.2014.02.02.

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Terai, Akito, Yoshiyuki Matsui, Koji Yoshimura, Yoichi Arai und Yoshihiro Dodo. „Salvage radiotherapy for biochemical recurrence after radical prostatectomy“. BJU International 96, Nr. 7 (November 2005): 1009–13. http://dx.doi.org/10.1111/j.1464-410x.2005.05746.x.

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Zaorsky, Nicholas G., und Amar U. Kishan. „Salvage therapy at biochemical recurrence of prostate cancer“. Nature Reviews Urology 17, Nr. 4 (12.02.2020): 195–96. http://dx.doi.org/10.1038/s41585-020-0290-3.

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Reddy, C. A., J. P. Ciezki und E. A. Klein. „Clinical recurrence post-biochemical failure of prostate cancer.“ Journal of Clinical Oncology 29, Nr. 7_suppl (01.03.2011): 195. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.195.

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195 Background: The purpose of this study is to evaluate the role of salvage therapy (STx) after biochemical failure (bF) for prostate cancer (CaP) and to determine what factors are associated with the development of clinical recurrence (cR). Methods: From 1996-2009, 7,585 patients (pts) with CaP were treated with prostatectomy (RP), brachytherapy (PI), or external beam radiotherapy (RT). For RP patients (pts), bF was defined as a postoperative PSA >0.3 and for PI and RT pts the Phoenix definition was used. bF was documented in 927 pts. cR was defined as any image-based or pathological diagnosis of disease recurrence after bF. Cox proportional hazards regression was used to examine if the use of STx after bF, the time of bF, along with disease characteristics were associated with cR after bF. Results: The median follow-up after bF was 31months (mo; range: 0-131). Thirty percent of pts had a cR after bF, and the 5-year rate of cR free survival was 58%. STx within 1 year after bF (early) was given to 46% of pts, STx more than 1 year after bF (late) was given to 11% of pts, and 43% of pts did not receive STx. On univariate analysis, factors found to be significantly associated (p-value <0.05) with cR were a short interval between initial treatment and bF (bFTime), no use of STx, early initiation of STx, biopsy Gleason Score (bGS), clinical stage, older age at bF, the use of PI or RT, and increased frequency of PSA follow-up after bF (PSAfreq). In multivariable analysis, bFTime, no use of STx, early initiation of STx, bGS, the use of PI or RT, and PSAfreq remained significant. To better evaluate the effect the timing of initiation of STx had on the development of cR, a second analysis was preformed, limited to the 529 pts who did receive STx after bF. In multivariable analysis, early use of STx remained significant for cR (HR=2.09, 95%CI=1.24- 3.51). As a continuous variable, in a second multivariable analysis, delayed use of STx resulted in a reduced risk of developing cR (HR=0.98, 95%CI=0.96-1.00). Conclusions: This study suggests that while the use of STx after bF reduces the risk of subsequently developing cR, early use of STx after bF is not beneficial. Other factors such as the time interval between initial treatment and bF need to be evaluated when determining when to initiate STx after bF. No significant financial relationships to disclose.

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Carvajal, C., A. Gomez-Iturriaga, F. Casquero, E. Hortelano, J. Jaen, J. López, J. Cacicedo et al. „Salvage radiotherapy in biochemical recurrence after radical prostatectomy“. Reports of Practical Oncology & Radiotherapy 18 (Juni 2013): S333—S334. http://dx.doi.org/10.1016/j.rpor.2013.03.519.

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Kruser, Tim J., David F. Jarrard, Andrew K. Graf, Sean P. Hedican, David R. Paolone, John D. Wegenke, Glenn Liu, Heather M. Geye und Mark A. Ritter. „Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence“. Cancer 117, Nr. 12 (14.12.2010): 2629–36. http://dx.doi.org/10.1002/cncr.25824.

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Kim, Jae-Sung, Changhoon Song, Sung Kyu Hong, Seok-Soo Byun und Sang Eun Lee. „Metastasis free survival following salvage radiotherapy versus hormonal therapy alone in patients with biochemical recurrence after radical prostatectomy.“ Journal of Clinical Oncology 34, Nr. 2_suppl (10.01.2016): 130. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.130.

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130 Background: To describe metastasis-free survival (MFS) in patients with biochemical recurrence following radical prostatectomy (RP), and to define clinical prognostic factors for metastasis. Methods: From our institutional database, 1,408 patients underwent primary RP between 2005 and 2011. Of these, 267 patients who had biochemical recurrence (two consecutive PSA ≥ 0.2 ng/mL) and had post-biochemical recurrence follow-up greater than 12 months were used as the study cohort. As an initial management for biochemical recurrence, salvage radiotherapy (SRT) combined with or without androgen deprivation therapy (ADT) was administered to 186 patients, while 33 patients received salvage ADT alone. Remaining 48 patients had been observed without any treatments. We estimated MFS using the Kaplan–Meier method, and investigated factors influencing the risk of metastasis using Cox proportional hazards regression. Results: Median follow-up after RP was 6.0 years, and after biochemical recurrence was 4.2 years. At last follow-up, 28 of 267 patients (10.5%) had developed metastasis, while 5-year MFS rate was 88.6%. No one developed metastasis in patients under observation. SRT resulted in an improved 5-year MFS rate (89.3% vs. 76.7%; p =0.022) compared with salvage ADT alone. This inferiority of salvage ADT alone compared with salvage SRT was marginally significant in the multivariate analysis (hazard ratio [HR] 2.24; 95% confidence interval [CI] 0.93–5.36; p = 0.071). Gleason score ≥8 (HR 4.10; 95% CI 1.77–9.51; p = 0.001) and seminal vesicle invasion (HR 2.37; 95% CI 1.06–5.30; p = 0.036) were significantly associated with MFS in the multivariate analysis. Conclusions: In patients undergoing prostatectomy, MFS after biochemical recurrence is variable and is most strongly influenced by Gleason score and seminal vesicle invasion. These parameters serve to stratify patients into different risk groups with respect to metastatic progression. Salvage ADT alone should be used with caution with select patients.

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Valea, Ana, V. Muntean, Andra Morar, Mara Carsote, Cristina Căpățînă und Simoa Elena Albu. „RE-OPERATIVE SURGERY FOR RECURRENT PRIMARY HYPERPARATHYROIDISM ASSOCIATED WITH OLIGOMENORRHEA“. Journal of Surgical Sciences 2, Nr. 3 (01.07.2015): 140–43. http://dx.doi.org/10.33695/jss.v2i3.124.

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Recurrent primary hyperparathyroidism is characterized by typical symptoms and biochemical recurrence of hypercalcemia after more than 6 months of normal calcium levels after surgery. We report the case of a 39-year-old female patient presenting with menses disturbances who was diagnosed with primary hyperparathyroidism caused by a left inferior parathyroid adenoma at the age of 35. Postoperative 6-month follow-up showed normalization of biochemical and hormonal profiles, with significant improvement of clinical symptoms, dominated by muscle weakness, weight loss and oligomenorrhea. The 18-month follow-up showed elevated PTH and serum calcium levels. Imaging confirmed recurrence of primary hyperparathyroidism by highlighting a right upper parathyroid adenoma. Surgery was performed again and no major incident was seen. The particularity of this case consists in the recurrence of primary hyperparathyroidism in a young patient with no family history of the disease due to asynchronous parathyroid adenomas that were successfully removed in a female patient who in addition to classic complications such as calyceal microlithiasis and osteoporosis presented oligomenorrhea which was resolved spontaneously after the correction of hypercalcemia.

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