Urology
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Randomized Controlled Trial Clinical Trial
Cancer and Leukemia Group B (CALGB) 90203: a randomized phase 3 study of radical prostatectomy alone versus estramustine and docetaxel before radical prostatectomy for patients with high-risk localized disease.
The purpose of The Cancer and Leukemia Group B (CALGB) 90203 trial is to determine which of 2 treatment strategies is superior in treating men with high-risk, clinically localized adenocarcinoma of the prostate (stage T1 to T3a NX M0), defined as a predicted probability < or =60% of remaining free from disease recurrence for 5 years after surgery. Patients with a > or =10-year life expectancy will be randomized to either radical prostatectomy (RP) alone versus estramustine and docetaxel before RP. Participants will be excluded if they have received prior therapy for prostate cancer (except transurethral resection of the prostate) or are judged not to be appropriate candidates for RP. ⋯ The trial will enroll approximately 700 men during a 48-month period. Patients will be observed for 84 months after study closure. The power to detect a 36% decrease in 5-year recurrence rates is 90%.
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There have been improvements in the outcome of patients with clinically localized prostate cancer treated by radical prostatectomy. However, some patients treated with radical prostatectomy will have clinical or biochemical progression. These men are at increased risk of dying of their disease. ⋯ Whether this additional multimodality therapy should be administered in the neoadjuvant or adjuvant setting remains controversial. Further, whether a patient at increased risk for progression after radical prostatectomy requires additional therapy before the development of documented progression remains controversial. This article reviews the potential multimodality approaches to prevent or delay recurrence of prostate cancer in patients undergoing surgical treatment for prostate cancer.
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Multiple oncologic treatment modalities are often integrated into the curative treatment approach for the patient with a newly established diagnosis of cancer. The combination of neoadjuvant and adjuvant therapies with radiotherapy for the care of the patient with prostate cancer is no exception. ⋯ The role of neoadjuvant and adjuvant therapies is under intense scrutiny as several randomized clinical trials seek to optimize the combination of androgen suppression, chemotherapy, and radiotherapy. The historical precedent for combining androgen suppression with radiotherapy is described, as are the results of prior definitive trials and ongoing studies in this setting.
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Hydropneumothorax (HPTX) is recognized as a potential complication of percutaneous nephrostolithotomy (PCNL), particularly with supracostal access. Postoperative chest radiography (CXR) is routinely used to evaluate the chest after PCNL. We prospectively compared the sensitivity of intraoperative chest fluoroscopy with immediate postoperative portable CXR and postoperative day 1 chest computed tomography (CT) for the detection of pleural fluid. ⋯ Intraoperative chest fluoroscopy during PCNL is sufficient to detect clinically significant HPTXs, and, therefore, routine postoperative CXRs are not necessary. However, a high index of suspicion based on clinical symptoms postoperatively should prompt chest imaging.
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To evaluate the disease and treatment-related factors for predicting biochemical freedom from recurrence (BFR) in patients with clinically localized prostate cancer undergoing permanent prostate brachytherapy. ⋯ The quality of permanent prostate brachytherapy as measured by the D(90) was the most significant predictor for BFR in this study cohort at 10 years. Furthermore, adding external beam radiotherapy and/or hormonal therapy as adjuvant therapies did not independently predict for BFR. Overall, the reported 10-year BFR rates in this study were favorable. Strategies for ensuring the best quality implant should be used and, when reporting brachytherapy outcomes, the implant quality should be noted.