Humans ; Male ; Prostatic Neoplasms ; therapy

PURPOSE: Cryoablation is gaining acceptance as a primary treatment of localized metastatic urologic malignancies as well as a salvage therapy. Anecdotal clinical reports suggest that cryoablation can induce a systemic antitumor immune response, which has been confirmed in animal models also. MATERIALS AND METHODS: A review of the relevant literature was performed to suggest urologic applications of cryo-immunology. RESULTS: This article reviews the existing evidence regarding cryo-immunology and discusses the mechanisms for generation of an anti-tumor immune response. CONCLUSIONS: Our findings suggest combining cryoablation with other immunotherapeutic approaches to devise a cryo-immunotherapeutic strategy with potential to impact the progression of metastatic disease.
Cryosurgery ; Immunotherapy ; Kidney Neoplasms ; Models, Animal ; Prostatic Neoplasms ; Salvage Therapy

Research regarding the treatment of metastatic prostate cancer has been undergoing dramatic progress. Treatment of hormone-naïve metastatic prostate cancer includes surgical castration and medical castration that lowers androgen level in the blood using drugs. Although these androgen deprivation therapies are very effective, hormone-naïve metastatic prostate cancer finally leads to castration-resistant prostate cancer because resistance to surgical or medical castration occurs. The treatment at this stage includes not only docetaxel, but also new androgen synthesis inhibitor or androgen receptor inhibitors such as abiraterone or enzalutamide, new cytotoxic anticancer agents such as carbazitaxel, and radioisotope treatment such as radium-223. Recently, studies on the effect of chemotherapy on hormone-naïve metastatic prostate cancer before the development of castration-resistant prostate cancer have been actively published. As a result, various guidelines have recommended docetaxel as the first-line therapy for hormone-naïve metastatic prostate cancer. In this manuscript, we will summarize the basic concepts of androgen deprivation therapy for hormone-naïve metastatic prostate cancer and the main results of research on chemotherapy for hormone-naïve metastatic prostate cancer.
Antineoplastic Agents ; Castration ; Drug Therapy* ; Prostate* ; Prostatic Neoplasms* ; Receptors, Androgen

The management of advanced prostate cancer has evolved rapidly. Androgen deprivation therapy, through surgical or medical castration, is the cornerstone of first-line therapy for hormone-naive metastatic prostate cancer. Recently reported results of clinical trials have given answers to questions regarding the best therapeutic agents and strategies, and these have broadened the scope of evidence-based therapy in this field. Although hormone therapy is very effective, the majority of patients eventually develop resistance to hormonal manipulation, leading to so-called castration-resistant prostate cancer. For castration-resistant prostate cancer, docetaxel-based chemotherapy had been the only approved agent to show a survival benefit for several years. However, over the last five years, significant advances in the field have led to the approval of several new agents with different mechanisms of action, such as the new androgen pathway inhibitors abiraterone and enzalutamide, a new cytotoxic agent, cabazitaxel, and new bone-seeking agents such as radium-223, which have all been associated with improved quality of life and pain palliation and an increase in survival. Herein, recent developments in hormone therapy and chemotherapy for advanced prostate cancer are reviewed and some of the trials with important results are summarized. As treatment options have expanded and developed rapidly, the selection of the most appropriate agent and administration method through multidisciplinary management is much more important than simply giving newly approved agents to maximize the clinical outcome for patients with advanced, especially castration-resistant, prostate cancer.
Castration ; Drug Therapy* ; Humans ; Neoplasm Metastasis ; Prostatic Neoplasms* ; Quality of Life

Radiotherapy has an important role in the management of prostate cancer patients. It can be used as definitive treatment in place of surgery, postoperative adjuvant radiotherapy, or salvage treatment when recurrences develop after surgery. During definitive radiotherapy treatment, dose escalation can improve biochemical control but has not led to improved survival to date. Hypofractionated radiotherapy is applied for prostate cancer treatment, since prostate cancer has a low alpha/beta ratio. Contrary to theoretical expectations, hypofractionated treatment does not show improved therapeutic results and decreased toxicity, but it can reduce overall treatment time. Ongoing non-inferiority trials may assist in determining optimal hypofractionated treatment regimens. Adjuvant radiotherapy in patients with pathological T3 or positive resection margins can improve biochemical control and might increase overall survival. However, there is debate regarding the superiority of adjuvant radiotherapy over early salvage radiotherapy in high-risk patients after surgery. To address this issue, it will be necessary to wait for the results of current randomized trials.
Humans ; Prostatic Neoplasms* ; Proton Therapy ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence

Depth of prostate volume from the skin can vary due to intra-fractional and inter-fractional movements, which may result in dose reduction to the target volume. Therefore we evaluated the feasibility of automated depth determination-based adaptive proton therapy to minimize the effect of inter-fractional movements of the prostate. Based on the center of mass method, using three fiducial gold markers in the prostate target volume, we determined the differences between the planning and treatment stages in prostate target location. Thirty-eight images from 10 patients were used to assess the automated depth determination method, which was also compared with manually determined depth values. The mean differences in prostate target location for the left to right (LR) and superior to inferior (SI) directions were 0.9 mm and 2.3 mm, respectively, while the maximum discrepancies in location in individual patients were 3.3 mm and 7.2 mm, respectively. In the bilateral beam configuration, the difference in the LR direction represents the target depth changes from 0.7 mm to 3.3 mm in this study. We found that 42.1%, 26.3% and 2.6% of thirty-eight inspections showed greater than 1 mm, 2 mm and 3 mm depth differences, respectively, between the planning and treatment stages. Adaptive planning based on automated depth determination may be a solution for inter-fractional movements of the prostate in proton therapy since small depth changes of the target can significantly reduce target dose during proton treatment of prostate cancer patients.
Humans ; Prostate ; Prostatic Neoplasms ; Proton Therapy ; Protons ; Skin

Depth of prostate volume from the skin can vary due to intra-fractional and inter-fractional movements, which may result in dose reduction to the target volume. Therefore we evaluated the feasibility of automated depth determination-based adaptive proton therapy to minimize the effect of inter-fractional movements of the prostate. Based on the center of mass method, using three fiducial gold markers in the prostate target volume, we determined the differences between the planning and treatment stages in prostate target location. Thirty-eight images from 10 patients were used to assess the automated depth determination method, which was also compared with manually determined depth values. The mean differences in prostate target location for the left to right (LR) and superior to inferior (SI) directions were 0.9 mm and 2.3 mm, respectively, while the maximum discrepancies in location in individual patients were 3.3 mm and 7.2 mm, respectively. In the bilateral beam configuration, the difference in the LR direction represents the target depth changes from 0.7 mm to 3.3 mm in this study. We found that 42.1%, 26.3% and 2.6% of thirty-eight inspections showed greater than 1 mm, 2 mm and 3 mm depth differences, respectively, between the planning and treatment stages. Adaptive planning based on automated depth determination may be a solution for inter-fractional movements of the prostate in proton therapy since small depth changes of the target can significantly reduce target dose during proton treatment of prostate cancer patients.
Humans ; Prostate ; Prostatic Neoplasms ; Proton Therapy ; Protons ; Skin

No abstract available.
Cytosine Deaminase* ; Cytosine* ; Genetic Therapy* ; Osteocalcin* ; Prostate* ; Prostatic Neoplasms*

Eleven patients with advanced prostatic cancer who had received single agent chemotherapy with cyclophosphamide were evaluated. All patients had pathologically confirmed prostatic adenocarcinoma and were unresponsive to or in relapse after hormonal therapy. They were treated intravenously with 200mg/m2 cyclophosphamide daily for four days every four weeks. The National prostatic Cancer Project(NPCP) response criteria were used. so objective response included patients with complete or partial response as well as objectively stable disease as defined by NPCP response criteria. The response rate was 54.6 %. with three partial response(27.3 8 ) and three objectively stable disease(27.3) of the eleven patients. All the six patients with partial response and objectively stable disease lived longer than 4 year, whereas for the five patients with objective progression. only two patient lived longer than 1 year. Toxicity was mild and tolerable. Mild and asymptomatic cyclophosphamide-induced hyponatremia was observed in two patients and hemorrhagic cystitis of mild degree was observed in one patient Severe hematologic and gastrointestinal toxicities were not observed.
Adenocarcinoma ; Cyclophosphamide* ; Cystitis ; Drug Therapy* ; Humans ; Hyponatremia ; Prostatic Neoplasms* ; Recurrence

In some patients with prostate cancer and who manifest disease progression during maximal androgen blockade(MAB) therapy, discontinuation of antiandrogen treatment might result in a significant fall in the level of serum prostate-specific antigen(PSA), and this is often correlated with clinical improvement(antiandrogen withdrawal syndrome). However, a decline in the PSA level after the withdrawal of estramustine phosphate is extremely rare. We report here on a case of dramatic decline in the PSA level after withdrawal of estramustine phosphate in a patient with hormone refractory prostate cancer.
Disease Progression ; Drug Therapy ; Estramustine* ; Humans ; Prostate* ; Prostatic Neoplasms*