Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespec...Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespecific membrane antigen positron emission tomography(PSMA-PET/CT)imaging have prompted growing interest in personalized,risk-adapted management strategies.This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists’practices in managing IR-PC,focusing on RT and imaging modalities to identify trends for personalized treatments.Methods:A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer(PC)cases annually.The 22-item questionnaire covered IR-PC management aspects such as risk stratification,imaging preferences,androgen deprivation therapy(ADT)use and duration,RT techniques,and treatment combinations.Anonymous responses were analyzed using descriptive statistics.Results:Thirty radiation oncologists participated,57%with over 20 years of experience.The median annual number of PC cases treated was 130.For risk stratification,43% followed the National Comprehensive Cancer Network(NCCN)guidelines,while 30%used the D’Amico classification.Imaging preferences revealed 47% favored PSMA-PET/CT.External beam RT was universally preferred,with 60% adopting ultra-hypofractionation.ADT was used by 97%,with 73% recommending it for unfavorable IR-PC cases.Short-term ADT(4–6 months)was the standard,administered concurrently with RT by 57%.Cardiovascular status influenced decisions for 97% of respondents,while 37% also considered patient age,preferences,and sexual health.Conclusions:This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey,marked by selective PSMA-PET/CT use,tailored ADT,and evolving radiotherapy practices.The findings underscore the importance of multidisciplinary collaboration—particularly between urologists and radiation oncologists—to optimize imaging integration and treatment outcomes.展开更多
Objective:To investigate the association of persistently elevated prostate-specific antigen(PSA)after radical prostatectomy(RP)with clinicopathological features and long-term oncological prognosis for the development ...Objective:To investigate the association of persistently elevated prostate-specific antigen(PSA)after radical prostatectomy(RP)with clinicopathological features and long-term oncological prognosis for the development of a potential management strategy.Methods:A systematic literature search was performed using PubMed and Web of Science up to June 2021 to identify the eligible studies focusing on understanding the impact of persistent PSA in patients who underwent RP for localized prostate cancer.Meta-analyses were performed on parameters with available information.Results:A total of 32 RP studies were identified,of which 11 included 26719 patients with consecutive cohorts and the remaining 21 comprised 24177 patients with cohorts carrying specific restrictions.Of the 11 studies with consecutive cohorts,the incidence of persistent PSA varied between 3.1%and 34.6%with a median of 11.0%.Meta-analyses revealed patients with persistent PSA consistently showed unfavorable clinicopathological features and a more than 3.5-fold risk of poorer biochemical recurrence,metastasis,and prostate cancer-specific mortality prognosis independently,when compared to patients with undetectable PSA.Similarly,cases with persistent PSA in different specific patient cohorts with a higher risk of prostate cancer also showed a trend of worse outcomes.Conclusion:We found that the frequency of persistent PSA was about 11.0%in consecutive RP cohorts.Persistent PSA was significantly associated with unfavorable clinicopathological characteristics and worse oncological outcomes.Patients with persistent PSA after RP may benefit from early salvage treatment to delay or prevent biochemical recurrence,improving oncological outcomes for these patients.Further prospective randomized controlled trials are warranted to understand optimal systemic therapy in these patients.展开更多
Currently,there is growing interest regarding prostatespecific antigen(PSA) and the cardiovascular system.Increased PSA serum levels have been reported after prolonged cardiopulmonary resuscitation,cardiac surgery,ext...Currently,there is growing interest regarding prostatespecific antigen(PSA) and the cardiovascular system.Increased PSA serum levels have been reported after prolonged cardiopulmonary resuscitation,cardiac surgery,extracorporeal cardiopulmonary bypass,acute myocardial infarction(AMI) and coronary artery stenting.The possible role of PSA in cardiac events has been questioned due to the finding of PSA decrease during AMI and by the correlation of variation in PSA levels with coronary lesions and occurrence of major adverse cardiac events.Complexed PSA forms and uncomplexed PSA forms are observed in the bloodstream but the increasing formation of irreversible bound PSA seems to be a crucial finding during AMI.Large studies need to be carried out to confirm these preliminary results and to elucidate unclear aspects.These findings present many potential directions for future research including the role of uncomplexed forms of PSA,the possible distribution of PSA in the heart,the relative expression levels in heart disease states,the mode of expression regulation and other potential specific substrates.The journey of PSA investigation could be longer than initially expected.展开更多
Since Xing et al[1]first proposed radical prostatectomy(RP)without preoperative biopsy for patients with highly suspicious prostate cancer identified by multiparametric magnetic resonance imaging(mpMRI)and prostatespe...Since Xing et al[1]first proposed radical prostatectomy(RP)without preoperative biopsy for patients with highly suspicious prostate cancer identified by multiparametric magnetic resonance imaging(mpMRI)and prostatespecific membrane antigen(PSMA)positron emission tomography(PET)in 2019,several original articles have reported attempts in this direction by various independent teams.Despite sparking widespread debate,these articles and discussions have provided new insights into the diagnostic and treatment paradigms for prostate cancer.展开更多
文摘Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespecific membrane antigen positron emission tomography(PSMA-PET/CT)imaging have prompted growing interest in personalized,risk-adapted management strategies.This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists’practices in managing IR-PC,focusing on RT and imaging modalities to identify trends for personalized treatments.Methods:A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer(PC)cases annually.The 22-item questionnaire covered IR-PC management aspects such as risk stratification,imaging preferences,androgen deprivation therapy(ADT)use and duration,RT techniques,and treatment combinations.Anonymous responses were analyzed using descriptive statistics.Results:Thirty radiation oncologists participated,57%with over 20 years of experience.The median annual number of PC cases treated was 130.For risk stratification,43% followed the National Comprehensive Cancer Network(NCCN)guidelines,while 30%used the D’Amico classification.Imaging preferences revealed 47% favored PSMA-PET/CT.External beam RT was universally preferred,with 60% adopting ultra-hypofractionation.ADT was used by 97%,with 73% recommending it for unfavorable IR-PC cases.Short-term ADT(4–6 months)was the standard,administered concurrently with RT by 57%.Cardiovascular status influenced decisions for 97% of respondents,while 37% also considered patient age,preferences,and sexual health.Conclusions:This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey,marked by selective PSMA-PET/CT use,tailored ADT,and evolving radiotherapy practices.The findings underscore the importance of multidisciplinary collaboration—particularly between urologists and radiation oncologists—to optimize imaging integration and treatment outcomes.
文摘Objective:To investigate the association of persistently elevated prostate-specific antigen(PSA)after radical prostatectomy(RP)with clinicopathological features and long-term oncological prognosis for the development of a potential management strategy.Methods:A systematic literature search was performed using PubMed and Web of Science up to June 2021 to identify the eligible studies focusing on understanding the impact of persistent PSA in patients who underwent RP for localized prostate cancer.Meta-analyses were performed on parameters with available information.Results:A total of 32 RP studies were identified,of which 11 included 26719 patients with consecutive cohorts and the remaining 21 comprised 24177 patients with cohorts carrying specific restrictions.Of the 11 studies with consecutive cohorts,the incidence of persistent PSA varied between 3.1%and 34.6%with a median of 11.0%.Meta-analyses revealed patients with persistent PSA consistently showed unfavorable clinicopathological features and a more than 3.5-fold risk of poorer biochemical recurrence,metastasis,and prostate cancer-specific mortality prognosis independently,when compared to patients with undetectable PSA.Similarly,cases with persistent PSA in different specific patient cohorts with a higher risk of prostate cancer also showed a trend of worse outcomes.Conclusion:We found that the frequency of persistent PSA was about 11.0%in consecutive RP cohorts.Persistent PSA was significantly associated with unfavorable clinicopathological characteristics and worse oncological outcomes.Patients with persistent PSA after RP may benefit from early salvage treatment to delay or prevent biochemical recurrence,improving oncological outcomes for these patients.Further prospective randomized controlled trials are warranted to understand optimal systemic therapy in these patients.
文摘Currently,there is growing interest regarding prostatespecific antigen(PSA) and the cardiovascular system.Increased PSA serum levels have been reported after prolonged cardiopulmonary resuscitation,cardiac surgery,extracorporeal cardiopulmonary bypass,acute myocardial infarction(AMI) and coronary artery stenting.The possible role of PSA in cardiac events has been questioned due to the finding of PSA decrease during AMI and by the correlation of variation in PSA levels with coronary lesions and occurrence of major adverse cardiac events.Complexed PSA forms and uncomplexed PSA forms are observed in the bloodstream but the increasing formation of irreversible bound PSA seems to be a crucial finding during AMI.Large studies need to be carried out to confirm these preliminary results and to elucidate unclear aspects.These findings present many potential directions for future research including the role of uncomplexed forms of PSA,the possible distribution of PSA in the heart,the relative expression levels in heart disease states,the mode of expression regulation and other potential specific substrates.The journey of PSA investigation could be longer than initially expected.
文摘Since Xing et al[1]first proposed radical prostatectomy(RP)without preoperative biopsy for patients with highly suspicious prostate cancer identified by multiparametric magnetic resonance imaging(mpMRI)and prostatespecific membrane antigen(PSMA)positron emission tomography(PET)in 2019,several original articles have reported attempts in this direction by various independent teams.Despite sparking widespread debate,these articles and discussions have provided new insights into the diagnostic and treatment paradigms for prostate cancer.
