Evaluation of the prognostic nutritional index for the prognosis of Chinese patients with high/extremely high-risk prostate cancer after radical prostatectomy

BACKGROUND The incidence of prostate cancer(PCa)is on the rise in China.The risk level of patients with PCa is associated with disease-free survival rate at 10 years after radical prostatectomy.Predicting prognosis in advance according to the degree of risk can provide a reference for patients,especially treatment options and postoperative adjuvant treatment measures for high-risk/extremely high-risk patients.AIM To explore the predictive value of the prognostic nutritional index(PNI)for biological recurrence in Chinese patients with high/extremely high-risk PCa after radical prostatectomy.METHODS The biochemical test results and clinical data of 193 patients who underwent radical prostatectomy for the first time from January 2015 to December 2020 were retrospectively collected.The PNI value of peripheral blood within 1 wk before surgery was calculated,and during the follow-up period,prostate-specific antigen≥0.2 ng/mL was considered to have biological recurrence.The receiver operating characteristic(ROC)curve was used to calculate the optimal critical value and area under the curve(AUC)of the patients.According to the critical value,the progression-free survival of the high PNI group and low PNI group was compared.The independent influencing factors of the patients’prognosis were obtained by the Cox proportional hazards regression model.RESULTS The non-biological recurrence rates at 1,3,and 5 years were 92.02%,84.05%,and 74.85%,respectively.The optimal critical value for PNI to predict biological recurrence was 46.23,and the AUC was 0.789(95%confidence interval:0.651-0.860;P<0.001).The sensitivity and specificity were 82.93%and 62.30%,respectively.In accordance with the optimal critical value of the ROC curve(46.23),193 patients were further divided into a high PNI group(PNI≤46.23,n=108)and low PNI group(PNI>46.23,n=85).The incidence of postoperative complications in the high PNI group was lower than that in the low PNI group(21.18%vs 38.96%).Kaplan-Meier survival analysis showed that the overall survival rate at 5 years in the low PNI group was 87.96%(13/108),which was lower than that in the high PNI group(61.18%,33/85;P<0.05).Low PNI[hazard ratio(HR)=1.74;P=0.003]and positive incisal margin status(HR=2.14;P=0.001)were independent predictors of biological recurrence in patients with high/extremely high-risk PCa.CONCLUSION The PNI has predictive value for the prognosis of patients with high/extremely high-risk PCa,and is an independent prognostic factor.Patients with low PNI value have a shorter time of nonbiological recurrence after prostatectomy.It is expected that the combined prediction of other clinicopathological data will further improve the accuracy and guide postoperative adjuvant therapy to improve the quality of prognosis.

Image-Guided Radiotherapy Dose Escalation in Intermediate and High Risk Cancer Prostate Patients and Its Effect on Treatment Toxicity

Purpose: To study the effect of escalating radiation dose;in intermediate and high risk prostate cancer patients;via online image-guidance on acute toxicities. Patients and Methods: thirty-eight prostate cancer patients were treated by using simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) with online image guided correction via kilo voltage cone beam computed tomography (KV-CBCT)/electronic portal imaging device (EPID) of trans-rectal ultrasound (TRUS)-inserted intraprostatic gold fiduciary markers. High-risk patients received a median dose of 80.5 Gy to prostate and 56 Gy to pelvic nodes in 35 fractions over 7 weeks. Intermediate-risk patients received a similar prostate dose over the same overall treatment time. Acute toxicity (bladder, rectal and bowel symptoms) was reported once weekly during the radiation course and up to 3 months from the end of the radiation course. Results: The image guided (IG)-IMRT allows escalating the radiation dose delivered to the prostate through minimizing the margin of setup error to less than 0.5 cm with subsequent sparing of nearby organs at risk. Out of thirty-eight patients, no patient developed >grade 1 acute rectal toxicity, 7.9% of patients experienced grade 3 urinary toxicity and there was no reported small intestinal toxicity. Conclusion: Escalating the radiation dose more than 80 Gy in intermediate and high risk prostate cancer patients was safe and not associated with grade 3 - 4 RTOG toxicity when guided by online verification of intra-prostatic fiducial markers.

Performance of^(18)F‑DCFPyL PET/CT in Primary Prostate Cancer Diagnosis,Gleason Grading and D'Amico Classifcation:A Radiomics‑Based Study

This study aimed to investigate the performance of^(18)F-DCFPyL positron emission tomography/computerized tomography(PET/CT)models for predicting benign-vs-malignancy,high pathological grade(Gleason score>7),and clinical D'Amico classifcation with machine learning.The study included 138 patients with treatment-naïve prostate cancer presenting positive^(18)F-DCFPyL scans.The primary lesions were delineated on PET images,followed by the extraction of tumor-to-backgroundbased general and higher-order textural features by applying fve diferent binning approaches.Three layer-machine learning approaches were used to identify relevant in vivo features and patient characteristics and their relative weights for predicting high-risk malignant disease.The weighted features were integrated and implemented to establish individual predictive models for malignancy(Mm),high path-risk lesions(by Gleason score)(Mgs),and high clinical risk disease(by amico)(Mamico).The established models were validated in a Monte Carlo cross-validation scheme.In patients with all primary prostate cancer,the highest areas under the curve for our models were calculated.The performance of established models as revealed by the Monte Carlo cross-validation presenting as the area under the receiver operator characteristic curve(AUC):0.97 for Mm,AUC:0.73 for Mgs,AUC:0.82 for Mamico.Our study demonstrated the clinical potential of^(18)F-DCFPyL PET/CT radiomics in distinguishing malignant from benign prostate tumors,and high-risk tumors,without biopsy sampling.And in vivo^(18)F-DCFPyL PET/CT can be considered a noninvasive tool for virtual biopsy for personalized treatment management.

Neoadjuvant hormone therapy for patients with high-risk prostate cancer:a systematic review and meta-analysis

This study aimed to identify the pathological outcomes and survival benefits of neoadjuvant hormone therapy(NHT)combined with radical prostatectomy(RP)and radiotherapy(RT)administered to patients with high-risk prostate cancer(HRPCa).We searched PubMed,Embase,and the Cochrane Library for studies comparing NHT plus RP or RT with RP or RT alone,administered to patients with HRPCa.We used a random-effects model to compute risk estimates with 95%confidence intervals(CIs)and quantified heterogeneity using the I2 statistic.Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity.We selected 16 studies.NHT before RP significantly decreased lymph node involvement(risk ratio[RR]=0.69,95%CI:0.56–0.87)and increased the rates of pathological downstaging(RR=2.62,95%CI:1.22–5.61)and organ-confinement(RR=2.24,95%CI:1.54–3.25),but did not improve overall survival and biochemical progression-free survival(bPFS).The administration of NHT before RT to patients with HRPCa was associated with significant benefits for cancer-specific survival(hazard ratio[HR]=0.51,95%CI:0.39–0.68),disease-free survival(HR=0.51,95%CI:0.44–0.60),and bPFS(HR=0.54,95%CI:0.46–0.64).Short-term NHT combined with RT administered to patients with HRPCa conferred significant improvements.Although the advantage of local control was observed when NHT was administered before RP,there was no significant survival benefit associated with HRPCa.Therefore,short-term NHT combined with RT is recommended for implementation in standard clinical practice but not for patients who undergo RP.

Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy, primary results of study CU 1005

The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU 1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival （P = 0.004） compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.