Acta clinica Croatica
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Acta clinica Croatica · Nov 2019
ReviewWHICH PATIENTS WILL BENEFIT MOST FROM DOCETAXEL ADDITION TO ANDROGEN DEPRIVATION THERAPY (ADT) IN METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER (MCSPC)?
Docetaxel improved the outcome of patients with mCSPC and became standard of care after CHAARTED, STAMPEDE arm C and GETUG-AFU 15 clinical trials and after subsequent meta-analysis. Patients with high-volume (CHAARTED definition) and high-risk (LATITUDE definition) disease, who have good performance status and are fit for chemotherapy, seem to benefit the most from addition of docetaxel to the androgen deprivation therapy. Results from TITAN trial with apalutamide showed the activity in the same setting. ⋯ We have direct evidence of overall survival benefit from abiraterone, apalutamide and enzalutamide for patients with high-volume disease who are not fit for chemotherapy, as well as for patients with low-volume disease. Clinical trials will show is there place for triple therapy in clinical practice. Before obtaining the results of new clinical trial results, physicians should base their treatment decision on risks and benefits of each current approach and consider the patient´s other health issues such as access, costs, patient and patient´s preferences.
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Acta clinica Croatica · Nov 2019
ReviewWHO SHOULD RECEIVE RADIOTHERAPY IN METASTATIC HORMONE-SENSITIVE PROSTATE CANCER?
The standard of treatment of metastatic hormone-sensitive prostate cancer (mHSPC) is androgen deprivation therapy (ADT) with docetaxel or abiraterone. However, numerous retrospective studies suggested outcome benefit of prostate radiotherapy. Small randomized trial (HORRAD) showed no overall survival (OS) benefit of the addition of prostate radiotherapy to ADT but there was a trend toward survival benefit in a low volume disease. ⋯ In addition, OS was significantly improved in patients with a low volume disease. In the absence of reliable molecular markers, the extent of metastatic disease has emerged as an important factor for treatment decision making. In this review, we summarize data from non-randomized as well as from randomized studies concerning prostate radiotherapy to contribute to the improvement of treatment tailoring for each individual patient with mHSPC in order to achieve the best possible treatment outcomes.
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Acta clinica Croatica · Nov 2019
ReviewWHICH PATIENTS SHOULD RECEIVE RADIOTHERAPY IN POSTOPERATIVE DISEASE RECURRENCE?
After radical prostatectomy (RP), up to 60% of patients with high-risk prostate cancer (PC), such as high Gleason score, extracapsular prostatic extension (ECE), positive margins, seminal vesicle involvement (SVI), will develop biochemical relapse and they will require further local treatment. Radiotherapy (RT) to the prostate bed has been used as adjuvant (ART) or salvage (SRT). ⋯ Only a few observational studies have compared RP patients who have received only RT with patients who have received RT with some form of hormonal therapy. A few of them have reported improved progression-free survival with addition of hormonal therapy to SRT, but benefit in overall survival (OS) is not yet known.
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The leading cause of death in patients with prostate cancer are cardiovascular diseases. Androgen deprivation therapy is the mainstay of treatment in prostate cancers. ⋯ It is important to point out that prostate cancer survivors have increased prevalence of coronary artery disease, cerebrovascular stroke, myocardial infarctions and cardiovascular mortality. Due to these reasons particular care on prevention and treatment of cardiovascular diseases should become a standard of care in patients with prostate cancer.
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Acta clinica Croatica · Nov 2019
Case ReportsMANAGEMENT OF LOCALLY ADVANCED, AGGRESSIVE PROSTATE CANCER - CASE REPORT.
Treatment of locally advanced prostate cancer (PC) represents a challenge before multidisciplinary team (MDT), typically includes not only local disease control but also systemic therapy and it should be tailored to each individual patient. We present a case of a 58-year-old man, whose PC presented itself as a locally advanced disease. Bearing in mind the patients' age, absence of comorbidities but also his preferences, MDT decided that the rational first step in almost imminent multimodal treatment should be radical prostatectomy (RP). ⋯ The therapy was well tolerated, although there was one episode of transitory radiation cystitis roughly one year after its completion. After 45 months of follow-up the patient is without signs of biochemical recurrence of PC, with fully restored testosterone level and good quality of life. The main task in advanced PC management, through multidisciplinary approach, is providing good oncological outcome while trying to reduce treatment morbidity and to maintain a good quality of life.