Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Background: The therapeutic standard for oligoprogressive prostate cancer resistant to castration is second-generation hormone therapy. This systemic treatment is expensive. There are oligoprogressive lesions accessible to radiotherapy. Objectives: To study the impact of radiotherapy of oligoprogressive lesions on the implementation of second generation hormone therapy. Patients and Methods: A retrospective study from 2012 to 2020 was carried out. All patients with oligoprogressive prostate cancer who had received radiotherapy on one or more lesions in progression were collated. Survival was calculated using the Kaplan-Meier method. Results: 8 patients were treated with stereotactic and conformational radiotherapy between August 2012 and August 2020 in the context of oligoprogressive prostate cancer resistant to castration. The median age at diagnosis of oligoprogression was 73 years with a median PSA level of 3.11 ng/ml. Nine lesions were diagnosed with PET scan PSMA. All the lesions were treated by radiotherapy with different regimens. After a median follow-up of 12.5 months, 7 patients showed a biochemical response to treatment with a median decrease in PSA of 67%. The median survival without clinical or biochemical progression was 7 months. The median survival without the need for further systemic treatment was 9 months. During the follow-up period, six patients received second-generation hormone therapy to treat their relapse, and the other two showed no clinical or biochemical relapse. Conclusion: Radiotherapy may be an alternative to delay the introduction of difficult-to-access second-generation hormone therapy in developing countries. A prospective study could validate this therapeutic approach.

Conformational Radiotherapy of Prostatic Adenocarcinoma at the Dalal Jamm Hospital, Senegal—(Retrospective Analysis of a Series of 62 Cases)

Aim: We endeavored to describe the epidemiological profile of prostatic cancer, and to evaluate its diagnostic and therapeutic aspects. Method: We conducted a descriptive retrospective study on the conformational radiotherapy of prostatic adenocarcinoma at the Dalal Jamm University Hospital, Senegal from June 2018 to December 2019. We included 62 consecutive patients. The average age of the patients was 68.9 years. The average consultation time was 7.6 months. Results: Symptom manifestation and high PSA triggered the diagnosis of cancer in 74.2% and 25.8% of patients, respectively. Symptoms: pollakiuria (72.3%), bone pain (8%) and erectile dysfunction (4.8%). The digital rectal examination: normal (33.8%), nodular (30.6%), induration (24.1%), and shielding (11.3%). The mean PSA level was 90.6 ng/ml. Histology: adenocarcinoma was the most common (98.6%). The Gleason score: <7 (45.1%), =7 (35.5%), and >7 (19.4%). The majority of patients were in the high-risk group (70.9%) and 7 patients (11.2%) were metastatic at diagnosis. Therapy: first radical prostatectomy (20.9%), first-line curative radiotherapy (67.8%), adjuvant (21%) and palliative radiotherapy in 7 patients (11.2%): patients having received palliative radiotherapy had an estimated decline in symptoms of 80%. Hormone therapy was performed in 88.8% of patients, with average duration of 12.5 months. After a mean follow-up of 15 months, 59 patients were alive, including 45 cases (81.8%) in complete remission;3 patients with metastasis at the first visit (having received palliative radiotherapy) died. Conclusion: The collected data show a profile of prostate cancer that is specific to the sub-Saharan context in which the discovery is still late. Also in comparison to developed countries, the therapeutic means necessary to fight against this cancer are limited, even though three-dimensional conformational radiotherapy remains an effective and essential treatment;this study provided fundamental data in the area of insufficient data/tools.

Curative 3D Conformal Radiotherapy of Non-Operated Prostate Adenocarcinoma at Pointe-a-Pitre University Hospital (Guadeloupe): About 29 Cases

Context: Technological advances have improved the toxicities of radiotherapy. We are evaluating the 3D technique in prostate cancer. Materials and Methods: Retrospective study from January 2015 to December 2015 with 29 files. Survival was calculated by Kaplan-Meier method. Results: We collected 29 patient records over the study period. The median age was 75 years with the following extremes: 54 years and 83 years. The median PSA level was 12 ng/ml with a range of 3.05 to 79 ng/ml. Gleason score analysis showed 6 patients (20.69%) with a score of 6 (3 + 3), 23 patients (79.31%) with a score of 7 including 12 patients (41.38%) with grade 3 and 11 patients (37.93%) with grade 4. The median dose delivered was 74 Gy, with a mean dose of 73.79 Gy and extremes of 70 Gy for the minimum and 76 Gy for the maximum. Hormone therapy was combined with radiotherapy in 17 patients (58.62%). Seven patients (24.14%) had grade 1 acute bladder toxicity and one patient (3.45%) had grade 2 acute toxicity. Late bladder toxicity was grade 1 in 5 patients (17.24%), grade 2 in 3 patients (10.34%) and grade 3 in 1 patient (3.45%). Late rectal toxicity, grade 2 in 3 patients (10.34%), grade 3 in 1 patient, was noted. Overall survival at 2 years was 100% and 89.65% at 5 years. Relapse-free survival at 2 years was 82.76% and 62.07% at 5 years. There were 3 deaths (10.34%) of which only one was related to prostate cancer. Conclusion: Radiotherapy, like surgery, is a fundamental option for the treatment of prostate cancers, particularly those that are locally advanced. It is gaining in importance with the improvement of techniques (IMRT, VMAT…) and new fractionations which contribute to the reduction of toxicities and the comfort of patients (shorter spread).

A Shoulder Mass Revealing a Metastatic Prostate Cancer

Introduction: A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radiotherapy and chemotherapy and androgen deprivation therapy (ADT). Observations: A 66 years old patient was referred for a painful right shoulder mass whose biopsy and pathological examination found a Gleason 8 (4 + 4) moderately differentiated adenocarcinoma. The PSA level was 508.52 ng/ml. The patient was treated with analgesic radiotherapy on the right shoulder and chemo-hormonal therapy. At 2 years follow-up, the disease was well controlled. Conclusion: A shoulder mass revealing metastatic prostate cancer is not common. Local treatment of the symptomatic metastasis while continuing chemotherapy and ADT improves the quality of life.

Kohonen’s Algorithm Applied to the Scintigraphic Image for an Aid in the Diagnosis of Prostate Cancer Metastasis

To partition the scintigraphic image, several methods are used, among which is Kohonen’s self-organizing map algorithm. The objective of this study was to perform an ascending hierarchical classification (HAC) on the results of the Kohonen self-organizing map. This makes it possible to carry out the second phase necessary for the elaboration of the classifier by grouping the neurons as well as possible into 3 classes then by reconstituting the scintigraphic image from the 3 classes. This partition proceeds by successive groups, thus merging at each iteration two subsets of neurons using a measure of similarity which is Ward’s method. In this method, the algorithm aggregates the nearest neurons into classes. This allows us to obtain a dendrogram that looks like a tree. And this one needs to be cut. And to have an adequate cut-off level, we have established the variation of the Davies Bouldin index as a function of the number of classes. The minimum value of this index gave the optimal number of classes which corresponded to 3 in the study. These three groups A, B, C have a variable intensity. This intensity can be high, it can be medium or low. The high, medium and low intensities corresponded respectively to metastases for class A, to degenerative or inflammatory phenomena for class B and to normal radiopharmaceutical uptake for class C. To confirm this strong suspicion, we performed reconstructions using a filter. And after this reconstruction, we had images like at the entrance. And for the interpretation of these images, we used a visual metric. This enabled us to note that for the interval [0 - 50[, the image is not contrasted and no lesion could be detected. Over the interval [50 - 200[, we observed the distribution of the radiopharmaceutical over the entire skeletal whole body. On this reconstruction interval, the visual metric shows hypofixation in the bladder and areas suspected of metastases. Over the interval [200 - 250[, we detected hyperfixations linked to degenerative, inflammatory or metastatic lesions. And finally, in the last interval, [250 - 252], we found regions that showed strong uptake (bladder, sternum, etc.). This capture is physiological. Apart from physiological hyperfixation, the other types of hyperfixation were considered metastatic according to the two nuclear scientists who interpreted these images. In total, the HAC allowed us to sub-classify the data into 3 groups which were subsequently reconstructed. And this reconstruction technique highlighted the periarticular metastases belonging to the class [250 - 252]. This allowed us to highlight the oligo-metastases and to carry out in most of these patients a radical prostatectomy.