Differences in failure-free survival after salvage radiotherapy guided by conventional imaging versus 18F-fluciclovine PET/CT in postprostatectomy patients : a post hoc substratification analysis of the EMPIRE-1 trial

Please read abstract in the article.The National Institutes of Health and Blue Earth Diagnostics.http://jnm.snmjournals.orghj2023Nuclear Medicin

Making Transnational Intimacies: Intergenerational Relationships in Chinese-Western Families in Beijing

In this study, we explore intergenerational relationships in Chinese-Western transnational families. Our argument draws on 28 life story interviews with Chinese middle-class professionals and their Western partners in Beijing. In the context of their living arrangements in Beijing, many of these couples had close ties with their Chinese parents or in-laws, in some cases living together under the same roof. We draw on our participants' interview narratives to ask how their culturally situated, sometimes disparate, understandings of intimacy shaped their relationships with their parents or in-laws. In this context, our analysis focuses on the ways in which our participants negotiated understandings and practices in their families. We conceptualise our participants' transnational families as an individualised intimate space, within which meanings of family, filial piety, and marriage cannot be taken for granted and require an ongoing process of reflexive negotiation to become and remain mutually acceptable. With this study, we seek to add to academic debates about parent-child relationships and filial piety in Chinese society. While there is a sizeable literature on this subject matter, the ways in which the quickly growing number of transnational marriages in China may rework intergenerational relationships remain poorly understood

Dose Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Suppression for Intermediate Risk Prostate Cancer: Outcomes From the NRG Oncology/RTOG 0815 Randomized Trial

Purpose/Objective(s): Androgen suppression can improve outcomes when added to radiotherapy (RT) for intermediate risk prostate cancer, but no study to date has reported its utility in the context of contemporary, dose-escalated RT. Herein, the clinical outcomes of a phase III prospective trial evaluating the utility of total androgen suppression (TAS) combined with dose-escalated RT for patients with intermediate risk prostate cancer are reported. Materials/Methods: Eligible patients had intermediate risk prostate cancer defined as harboring ≥ 1 of the following risk factors: clinical stage T2b-T2c, Gleason score 7, or PSA value \u3e 10 and ≤ 20 ng/mL. Patients with all three risk factors and ≥ 50% of biopsy cores positive were ineligible. After stratification by number of intermediate risk factors (single vs. multiple), RT boost modality, and baseline comorbidity (ACE-27 comorbidity index ≥ vs. \u3c grade 2), patients were randomized to dose-escalated RT alone (Arm 1) or combined with TAS (Arm 2) consisting of LHRH agonist/antagonist in combination with oral antiandrogen for a duration of 6 months. Permitted RT modalities were external beam radiotherapy (EBRT) alone to total dose 79.2 Gy or EBRT (45 Gy) combined with LDR or HDR brachytherapy boost. Pelvic nodal RT was not permitted. Under a 1-sided significance level of 0.025 and 85% power, the study was designed to detect an improvement in the 5-year overall survival rate from 90% (Arm 1) to 93.3% (Arm 2). Patient reported quality of life outcomes were collected and are reported in another abstract. Results: The study completed its accrual objective. Between 2009 and 2016, 1538 patients were randomized. There were 750 eligible patients on Arm 1 and 742 on Arm 2 comprising the modified intent-to-treat population. 67% had a single intermediate risk factor. 88% were treated with EBRT with the remainder receiving EBRT plus brachytherapy boost. 33% had an ACE-27 score ≥ grade 2. With a median follow up of 6.2 years, 219 deaths occurred, 119 in Arm 1 and 100 in Arm 2, yielding 5-year overall survival estimates of 90% vs. 91%, respectively [HR 0.85 (95% CI 0.65-1.11); P = 0.22]. 193 patients experienced PSA failure, 125 in Arm 1 and 68 in Arm 2 [HR 0.52 (0.39-0.70); P \u3c 0.001]. 35 patients developed distant metastases, 28 in Arm 1 and 7 in Arm 2 [HR 0.25 (0.11-0.57); P \u3c 0.001]. 11 deaths were attributed to prostate cancer, 10 in Arm 1 and 1 in Arm 2 [HR 0.10 (0.01-0.80); P = 0.007]. One hundred three acute grade ≥ 3 adverse events occurred, 17 (2.3%) in Arm 1 and 86 (17.5%) in Arm 2 (P \u3c 0.001). The cumulative incidence of late grade ≥ 3 adverse events was 16.2% in Arm 1 and 17.5% in Arm 2 (P = 0.27). Conclusion: While the addition of TAS to dose-escalated RT did not improve overall survival for men with intermediate risk prostate cancer, significant improvements in rates of metastases, deaths due to prostate cancer, and PSA failures support the continued use of combination dose-escalated RT and TAS. Benefits will need to be weighed against the increased risk of adverse events and the patient reported outcomes analysis

Treatment Patterns and Overall Survival Outcomes Among Patients Aged 80 yr or Older with High-risk Prostate Cancer

Background: Elderly patients diagnosed with high-risk prostate cancer (PCa) present a therapeutic dilemma of balancing treatment of a potentially lethal malignancy with overtreatment of a cancer that may not threaten life expectancy. Objective: To investigate treatment patterns and overall survival outcomes in this group of patients. Design setting and participants: A retrospective cohort study was conducted. We queried the National Cancer Database for high-risk PCa in patients aged 80 yr or older diagnosed during 2004-2016. Intervention: Eligible patients underwent no treatment following biopsy (ie, observation), androgen deprivation therapy (ADT) alone, radiation therapy (RT) alone, RT + ADT, or surgery. Outcome measurements and statistical analysis: Kaplan-Meier, log rank, and multivariate Cox proportional hazard regression was performed to compare overall survival (OS). Results and limitations: A total of 19 920 men were eligible for analysis, and the most common treatment approach was RT + ADT (7401 patients; 37.2%). Observation and ADT alone declined over time (59.3% in 2004 vs 47.5% in 2016). There was no observed difference in OS between observation and ADT alone (adjusted hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.99-1.09; = 0.105). Definitive local treatment was associated with improved OS compared with ADT alone (RT alone, HR 0.54, 95% CI, 0.50-0.59, \u3c 0.0001; ADT + RT, HR 0.48, 95% CI, 0.46-0.50, \u3c 0.0001; surgery, HR 0.50, 95% CI, 0.42-0.59, \u3c 0.0001). Conclusions: This analysis demonstrates that the use of definitive local therapy, including surgery or RT ± ADT, is increasing and is associated with a 50% reduction in overall mortality compared with observation or ADT alone. While prospective validation is warranted, elderly men with high-risk disease eligible for definitive management should be counseled on the risks, including a possible compromise in OS, with deferring definitive management. Patient summary: Elderly men are more often diagnosed with higher-risk prostate cancer but are less likely to receive curative treatment options than younger men. Our analysis demonstrates that for men ≥80 yr of age with high-risk prostate cancer, definitive local therapy, including surgery or radiation therapy and/or androgen deprivation therapy, is associated with a 50% reduction in overall mortality compared with observation or androgen deprivation therapy alone. We therefore recommend that life expectancy (ie, physiologic age) be taken into account, over chronologic age, and that elderly men with good life expectancy (eg, \u3e5 yr; minimal comorbidity) should be offered definitive, life-prolonging therapy

Impact of 18F-fluciclovine PET/CT findings on failure-free survival in biochemical recurrence of prostate cancer following salvage radiation therapy

Please read abstract in the article.The EMPIRE-1 trial received funding from the National Institutes of Health/National Cancer Institute (R01 CA16918), Blue Earth Diagnostics, Ltd., and the Winship Cancer Institute of Emory University.http://journals.lww.com/nuclearmed/pages/default.aspx2023-12-14Nuclear Medicin