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[PMID]:29192092
[Au] Autor:den Heijer M; Bakker A; Gooren L
[Ad] Endereço:Department of internal medicine, VU Medical Center, Amsterdam, Netherlands m.denheijer@vumc.nl.
[Ti] Título:Long term hormonal treatment for transgender people.
[So] Source:BMJ;359:j5027, 2017 11 30.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Terapia de Reposição Hormonal/efeitos adversos
Terapia de Reposição Hormonal/utilização
Policitemia/induzido quimicamente
Pessoas Transgênero/psicologia
Trombose Venosa/induzido quimicamente
[Mh] Termos MeSH secundário: Adulto
Assistência ao Convalescente
Idoso
Antagonistas de Androgênios/farmacologia
Estrogênios/administração & dosagem
Estrogênios/farmacologia
Feminino
Disforia de Gênero/psicologia
Guias como Assunto
Seres Humanos
Masculino
Policitemia/complicações
Fatores de Risco
Testosterona/administração & dosagem
Testosterona/farmacologia
Tempo
Trombose Venosa/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Estrogens); 3XMK78S47O (Testosterone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5027


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[PMID]:28749017
[Au] Autor:Ong WL; Foroudi F; Evans S; Millar J
[Ad] Endereço:Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Vic., Australia.
[Ti] Título:Large institutional variations in use of androgen deprivation therapy with definitive radiotherapy in a population-based cohort of men with intermediate- and high-risk prostate cancer.
[So] Source:BJU Int;120 Suppl 3:35-42, 2017 11.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the pattern of use of androgen deprivation therapy (ADT) with definitive radiotherapy (RT) in men with prostate cancer (PCa) in a population-based study in Australia. PATIENTS AND METHODS: This is a prospective cohort of men with intermediate- and high-risk PCa, captured in the population-based Prostate Cancer Outcome Registry Victoria, who were treated with definitive prostate RT between January 2010 and December 2015. The primary outcome of interest was ADT utilization. Chi-squared test for trend was used to evaluate the temporal trend in the use of ADT over the study period. Multivariate logistic regressions were used to evaluate the effects of patient-, tumour- and treatment-related factors, and treatment institutions (public/ private and metropolitan/ regional) on the likelihood of ADT utilization. RESULTS: A total of 1806 men were included in the study, 199 of whom (11%) had favourable National Comprehensive Cancer Network (NCCN) intermediate-risk disease (i.e. only one intermediate-risk feature, primary Gleason grade 3, and <50% biopsy core involved), 687 (38%) had unfavourable NCCN intermediate-risk disease, and 920 (51%) had high-risk disease. Of the 1806 men, 1155 (64%) received ADT with RT. Men with NCCN high-risk PCa (84%) were more likely to have ADT than men with favourable NCCN intermediate-risk (32%) and unfavourable NCCN intermediate-risk (46%) PCa (P < 0.001). Men treated in public institutions (66%, vs 47% in private institutions; P < 0.001) and regional centres (78%, vs 59% in metropolitan institutions; P < 0.001) were more likely to receive ADT. There was a trend towards an increase in ADT utilization from 50% in 2010 to 64% in 2015 (P < 0.001). In multivariate analyses (adjusting for age, tumour-related factors, year of treatment and use of brachytherapy boost), treatment institution (public and regional) remained independently associated with increased likelihood of ADT utilization. Men with intermediate-risk PCa treated in regional and public institutions were 2.7 times (95% confidence interval [CI] 1.9-3.9; P < 0.001) and 2.8 times (95% CI 1.4-5.3; P = 0.002), more likely to receive ADT with RT, respectively, while men with high-risk PCa treated in regional and public institutions were 3.1 times (95% CI 1.7-5.7; P < 0.001) and 3.0 times (95% CI 1.7-5.4; P < 0.001), more likely to receive ADT with RT, respectively. CONCLUSION: This is the largest Australasian contemporary series reporting on the pattern of use of ADT with definitive prostate RT. While there was an increasing trend towards use of ADT over time, ADT still appeared to be underutilized in certain groups of patients who may benefit from ADT, with approximately one in five men with high-risk and one in two with unfavourable intermediate-risk PCa not receiving ADT with RT. There was notable variation in the use of ADT between public vs private and metropolitan vs regional institutions.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Neoplasias da Próstata
[Mh] Termos MeSH secundário: Idoso
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/epidemiologia
Neoplasias da Próstata/radioterapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Androgen Antagonists)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13969


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[PMID]:28450658
[Au] Autor:Rahman F; Rahardjo HE; Ariwicaksono SC; Hafizar H; Sembiring MGA; Andika R; Patandung R; Hidianingsih S; Hotasi SL
[Ad] Endereço:Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. rahman.fakhri@gmail.com.
[Ti] Título:The Role of Docetaxel in Non-Castrate Resistant Metastatic Prostate Cancer: An Evidence-based Case Report.
[So] Source:Acta Med Indones;49(1):74-78, 2017 Jan.
[Is] ISSN:0125-9326
[Cp] País de publicação:Indonesia
[La] Idioma:eng
[Ab] Resumo:AIM: to learn the role of docetaxel in non-castrate resistant prostate cancer patient. METHODS: literature search was conducted to find relevant study comparing the combination of docetaxel and androgen deprivation therapy (ADT) to ADT alone in non-castrate resistant prostate cancer using PubMed, Cohrane Library, Proquest, EBSCO, and Scopus database. Quality assessment of studies was done using Bond University Rapid Critical Appraisal of a Systematic Review. RESULTS: we found 494 studies from literature search, but only two studies were included in final selection. Based on validity assessment, we chose one study to be discussed further. This study showed that combination of docetaxel and ADT is better than ADT alone in regards of overall survival (HR 0.64; 95% CI 0.55, 0.75; p<0.0001; NNT=3), biochemical progression free survival (HR 0.63; 95% CI 0.57, 0.69; p<0.0001; NNT=2) and clinical progression free survival (HR 0.73; 95% CI 0.64, 0.84; p<0.0001; NNT=2). Benefit of docetaxel and ADT combination was especially seen in high volume disease (HR 0.67; 95% CI 0.54, 0.83; p=0.0003; NNT=3). CONCLUSION: addition of docetaxel into ADT has beneficial effects in terms of overall survival and progression free survival in patients with non-castrate resistant metastatic prostate cancer.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Antineoplásicos/uso terapêutico
Neoplasias da Próstata/tratamento farmacológico
Taxoides/uso terapêutico
[Mh] Termos MeSH secundário: Intervalo Livre de Doença
Quimioterapia Combinada
Seres Humanos
Masculino
Meia-Idade
Metástase Neoplásica
Neoplasias da Próstata/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Antineoplastic Agents); 0 (Taxoids); 15H5577CQD (docetaxel)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:28463150
[Au] Autor:Gay HA; Sanda MG; Liu J; Wu N; Hamstra DA; Wei JT; Dunn RL; Klein EA; Sandler HM; Saigal CS; Litwin MS; Kuban DA; Hembroff L; Regan MM; Chang P; Michalski JM; Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium
[Ad] Endereço:Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: hiramgay@wustl.edu.
[Ti] Título:External Beam Radiation Therapy or Brachytherapy With or Without Short-course Neoadjuvant Androgen Deprivation Therapy: Results of a Multicenter, Prospective Study of Quality of Life.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):304-317, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The long-term effects of neoadjuvant androgen deprivation therapy (NADT) with radiation therapy on participant-reported health-related quality of life (HRQOL) have not been characterized in prospective multicenter studies. We evaluated HRQOL for 2 years among participants undergoing radiation therapy (RT) with or without NADT for newly diagnosed, early-stage prostate cancer. METHODS AND MATERIALS: We analyzed longitudinal cohort data from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium to ascertain the HRQOL trajectory of men receiving NADT with external beam RT (EBRT) or brachytherapy. HRQOL was measured using the expanded prostate cancer index composite 26-item questionnaire at 2, 6, 12, and 24 months after the initiation of NADT. We used the χ or Fisher exact test to compare the shift in percentages between groups that did or did not receive NADT. Analyses were conducted at the 2-sided 5% significance level. RESULTS: For subjects receiving EBRT, questions regarding the ability to have an erection, ability to reach an orgasm, quality of erections, frequency of erections, ability to function sexually, and lack of energy were in a significantly worse dichotomized category for the patients receiving NADT. Comparing the baseline versus 24-month outcomes, 24%, 23%, and 30% of participants receiving EBRT plus NADT shifted to the worse dichotomized category for the ability to reach an orgasm, quality of erections, and ability to function sexually compared with 14%, 13%, and 16% in the EBRT group, respectively. CONCLUSIONS: Compared with baseline, at 2 years, participants receiving NADT plus EBRT compared with EBRT alone had worse HRQOL, as measured by the ability to reach orgasm, quality of erections, and ability to function sexually. However, no difference was found in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, depression, lack of energy, or change in body weight. The improved survival in intermediate- and high-risk patients receiving NADT and EBRT necessitates pretreatment counseling of the HRQOL effect of NADT and EBRT.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/efeitos adversos
Braquiterapia/efeitos adversos
Terapia Neoadjuvante/efeitos adversos
Orgasmo
Ereção Peniana
Neoplasias da Próstata/terapia
Qualidade de Vida
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Antagonistas de Androgênios/uso terapêutico
Peso Corporal/efeitos dos fármacos
Peso Corporal/efeitos da radiação
Braquiterapia/métodos
Braquiterapia/estatística & dados numéricos
Mama/efeitos dos fármacos
Mama/efeitos da radiação
Distribuição de Qui-Quadrado
Terapia Combinada/efeitos adversos
Terapia Combinada/métodos
Terapia Combinada/estatística & dados numéricos
Depressão/etiologia
Disfunção Erétil/etiologia
Fadiga/etiologia
Fogachos/etiologia
Seres Humanos
Masculino
Meia-Idade
Terapia Neoadjuvante/métodos
Terapia Neoadjuvante/estatística & dados numéricos
Orgasmo/efeitos dos fármacos
Orgasmo/efeitos da radiação
Ereção Peniana/efeitos dos fármacos
Ereção Peniana/efeitos da radiação
Estudos Prospectivos
Antígeno Prostático Específico/sangue
Neoplasias da Próstata/sangue
Neoplasias da Próstata/patologia
Inquéritos e Questionários
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Androgen Antagonists); EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28463152
[Au] Autor:Yang DD; Muralidhar V; Mahal BA; Labe SA; Nezolosky MD; Vastola ME; King MT; Martin NE; Orio PF; Choueiri TK; Trinh QD; Spratt DE; Hoffman KE; Feng FY; Nguyen PL
[Ad] Endereço:Harvard Medical School, Boston, Massachusetts.
[Ti] Título:National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):338-343, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. METHODS AND MATERIALS: Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. RESULTS: Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. CONCLUSIONS: ADT use in low-risk prostate cancer has declined nationally but may remain an issue of concern in certain populations and regions.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Neoplasias da Próstata/tratamento farmacológico
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/estatística & dados numéricos
Centros Médicos Acadêmicos/tendências
Adulto
Idoso
Idoso de 80 Anos ou mais
Braquiterapia/utilização
Institutos de Câncer/estatística & dados numéricos
Institutos de Câncer/tendências
Centros Comunitários de Saúde/estatística & dados numéricos
Centros Comunitários de Saúde/tendências
Crioterapia/utilização
Bases de Dados Factuais/estatística & dados numéricos
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
National Cancer Institute (U.S.)/estatística & dados numéricos
Gradação de Tumores
Modelos de Riscos Proporcionais
Prostatectomia/utilização
Neoplasias da Próstata/epidemiologia
Neoplasias da Próstata/radioterapia
Neoplasias da Próstata/cirurgia
Radioterapia/utilização
Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Androgen Antagonists)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28463149
[Au] Autor:Lawton CAF; Lin X; Hanks GE; Lepor H; Grignon DJ; Brereton HD; Bedi M; Rosenthal SA; Zeitzer KL; Venkatesan VM; Horwitz EM; Pisansky TM; Kim H; Parliament MB; Rabinovitch R; Roach M; Kwok Y; Dignam JJ; Sandler HM
[Ad] Endereço:Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: clawton@mcw.edu.
[Ti] Título:Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-Term Update of NRG Oncology RTOG 9202.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):296-303, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Trial RTOG 9202 was a phase 3 randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease. METHODS AND MATERIALS: Men (N=1554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate-specific antigen (PSA) <150 ng/mL and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short-term ADT (STAD: 4 months of flutamide 250 mg 3 times per day and goserelin 3.6 mg per month) and definitive RT versus long-term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin). RESULTS: Among 1520 protocol-eligible and evaluable patients, the median follow-up time for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease-free survival (29% relative reduction in failure rate, P<.0001), local progression (46% relative reduction, P=.02), distant metastases (36% relative reduction, P<.0001), disease-specific survival (30% relative reduction, P=.003), and overall survival (12% relative reduction, P=.03). Other-cause mortality (non-prostate cancer) did not differ (5% relative reduction, P=.48). CONCLUSIONS: LTAD and RT is superior to STAD and RT for the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate and should be considered the standard of care.
[Mh] Termos MeSH primário: Adenocarcinoma/terapia
Antagonistas de Androgênios/uso terapêutico
Neoplasias da Próstata/terapia
[Mh] Termos MeSH secundário: Adenocarcinoma/sangue
Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Adulto
Idoso
Idoso de 80 Anos ou mais
Antagonistas de Androgênios/administração & dosagem
Antagonistas de Androgênios/efeitos adversos
Terapia Combinada/efeitos adversos
Terapia Combinada/métodos
Terapia Combinada/estatística & dados numéricos
Intervalo Livre de Doença
Flutamida/administração & dosagem
Flutamida/efeitos adversos
Flutamida/uso terapêutico
Seguimentos
Gosserrelina/administração & dosagem
Gosserrelina/efeitos adversos
Gosserrelina/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Antígeno Prostático Específico/sangue
Neoplasias da Próstata/sangue
Neoplasias da Próstata/mortalidade
Neoplasias da Próstata/patologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Androgen Antagonists); 0F65R8P09N (Goserelin); 76W6J0943E (Flutamide); EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29412780
[Au] Autor:Sartor O; de Bono JS
[Ad] Endereço:From Tulane Medical School, New Orleans (O.S.); and the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London (J.S.B.).
[Ti] Título:Metastatic Prostate Cancer.
[So] Source:N Engl J Med;378(7):645-657, 2018 02 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/patologia
[Mh] Termos MeSH secundário: Androstenos/uso terapêutico
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Biomarcadores Tumorais
Resistência a Medicamentos Antineoplásicos/genética
Seres Humanos
Masculino
Mutação
Metástase Neoplásica/diagnóstico
Metástase Neoplásica/tratamento farmacológico
Neoplasias da Próstata/genética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Androstenes); 0 (Biomarkers, Tumor); G819A456D0 (abiraterone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180208
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMra1701695


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[PMID]:27771243
[Au] Autor:Spratt DE; Soni PD; McLaughlin PW; Merrick GS; Stock RG; Blasko JC; Zelefsky MJ
[Ad] Endereço:Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
[Ti] Título:American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer.
[So] Source:Brachytherapy;16(1):1-12, 2017 Jan - Feb.
[Is] ISSN:1873-1449
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. METHODS AND MATERIALS: The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. RESULTS: At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. CONCLUSIONS: Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers.
[Mh] Termos MeSH primário: Braquiterapia/métodos
Neoplasias da Próstata/radioterapia
[Mh] Termos MeSH secundário: Comitês Consultivos
Antagonistas de Androgênios/uso terapêutico
Terapia Combinada
Intervalo Livre de Doença
Seres Humanos
Masculino
Antígeno Prostático Específico/sangue
Neoplasias da Próstata/sangue
Neoplasias da Próstata/tratamento farmacológico
Radioterapia (Especialidade)
Radioterapia/métodos
Estudos Retrospectivos
Sociedades Médicas
Taxa de Sobrevida
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Androgen Antagonists); EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29254781
[Au] Autor:Yang DD; Muralidhar V; Mahal BA; Nguyen PL; Devlin PM; King MT; Orio PF
[Ad] Endereço:Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Lack of Apparent Survival Benefit With Use of Androgen Deprivation Therapy in Patients With High-risk Prostate Cancer Receiving Combined External Beam Radiation Therapy and Brachytherapy.
[So] Source:Int J Radiat Oncol Biol Phys;100(1):53-58, 2018 Jan 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Although level 1 evidence has demonstrated a survival benefit from the addition of androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) for patients with high-risk prostate cancer, the benefits of ADT with combined EBRT and brachytherapy for high-risk patients are unclear. We examined the association between ADT and overall survival in a national cohort of high-risk patients treated with EBRT with or without brachytherapy. METHODS AND MATERIALS: We identified 46,325 men in the National Cancer Database with a diagnosis of high-risk prostate cancer (Gleason score 8-10, clinical stage T3-T4, or prostate-specific antigen >20 ng/mL) who were treated with EBRT with or without brachytherapy and ADT from 2004 through 2011. Multivariable Cox regression analysis adjusting for sociodemographic and clinicopathologic factors was used to identify the association between ADT and overall survival. RESULTS: The median follow-up period was 48.6 and 59.2 months for patients treated with EBRT only and combined modality RT, respectively. ADT was associated with an improvement in overall survival for the 85.0% (39,361) of the study cohort who underwent EBRT alone (adjusted hazard ratio 0.91, P=.001) but not for patients treated with combined modality RT (adjusted hazard ratio 1.05, P=.496), with a significant interaction (P =.036). CONCLUSIONS: In contrast to the known survival benefit when ADT is given with EBRT, our results suggest that ADT might not improve survival for high-risk patients who undergo combined EBRT and brachytherapy. Given the significant adverse effects of ADT, in particular, with long-term therapy, a randomized controlled trial of combined EBRT and brachytherapy with or without ADT for select high-risk patients using a noninferiority design should be undertaken.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/efeitos adversos
Braquiterapia/mortalidade
Neoplasias da Próstata/mortalidade
Neoplasias da Próstata/radioterapia
[Mh] Termos MeSH secundário: Idoso
Terapia Combinada/métodos
Terapia Combinada/mortalidade
Bases de Dados Factuais/estatística & dados numéricos
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Gradação de Tumores
Estadiamento de Neoplasias
Antígeno Prostático Específico/sangue
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); EC 3.4.21.77 (Prostate-Specific Antigen)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


  10 / 9681 MEDLINE  
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[PMID]:29187457
[Au] Autor:Chen MY; Chen YY; Tsai HT; Tzai TS; Chen MC; Tsai YS
[Ad] Endereço:Department of Urology, Madou Sin-Lau Hospital, Sin-Lau Medical Foundation, the Presbyterian Church in Taiwan, Tainan, Taiwan, R.O.C.
[Ti] Título:Transdermal Delivery of Luteinizing Hormone-releasing Hormone with Chitosan Microneedles: A Promising Tool for Androgen Deprivation Therapy.
[So] Source:Anticancer Res;37(12):6791-6797, 2017 12.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:Long-term administration of luteinizing hormone-releasing hormone analogs (LHRHa) is the main type of androgen-deprivation therapy (ADT) for lethal prostate cancer. A fully insertable microneedle system, composed of embeddable chitosan microneedles and a dissolvable polyvinyl alcohol/polyvinyl pyrrolidone supporting array, was developed for sustained delivery of LHRHa to the skin. A porcine cadaver skin test showed that chitosan microneedles can be fully embedded within the skin and microneedle-created micropores reseal within 7 days. The measured LHRHa loading amount was 73.3±2.8 µg per microneedle patch. After applying goserelin-containing microneedles to mice, serum LH levels increased initially and then declined below baseline at day 7. In contrast, serum testosterone levels increased to reach a peak at day 14 and then declined to a castration level at day 21. Additionally, such a castration level was maintained for 2 weeks. Therefore, transdermal delivery of goserelin with embeddable chitosan microneedles can produce a castrated state in mice. Such a system is a promising, feasible means of delivering ADT.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/administração & dosagem
Quitosana/química
Sistemas de Liberação de Medicamentos/métodos
Hormônio Liberador de Gonadotropina/administração & dosagem
Agulhas
[Mh] Termos MeSH secundário: Administração Cutânea
Antagonistas de Androgênios/química
Antagonistas de Androgênios/farmacocinética
Animais
Antineoplásicos Hormonais/administração & dosagem
Antineoplásicos Hormonais/química
Antineoplásicos Hormonais/farmacocinética
Hormônio Liberador de Gonadotropina/química
Hormônio Liberador de Gonadotropina/farmacocinética
Gosserrelina/administração & dosagem
Gosserrelina/química
Gosserrelina/farmacocinética
Seres Humanos
Hormônio Luteinizante/sangue
Masculino
Camundongos Endogâmicos ICR
Pele/metabolismo
Suínos
Testosterona/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Antineoplastic Agents, Hormonal); 0F65R8P09N (Goserelin); 33515-09-2 (Gonadotropin-Releasing Hormone); 3XMK78S47O (Testosterone); 9002-67-9 (Luteinizing Hormone); 9012-76-4 (Chitosan)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE



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