PET-Guided Radiation Boosts Post-Postatectomy Outcomes

Image-guided radiotherapy with the advanced PET radiotracer fluciclovine (Axumin) reduced treatment failure rates in men with recurrent prostate cancer following surgery, a single-institution randomized study found.

Failure-free survival at 3 years improved from 63.0% for those assigned to standard imaging to 75.5% among those whose treatment decisions were also guided by fluciclovine PET (P=0.003), reported Ashesh Jani, MD, of Winship Cancer Institute of Emory University in Atlanta.

At 4 years, failure-free survival rates were 51.2% versus 75.5%, respectively (P<0.001), according to findings presented at the virtual American Society for Radiation Oncology (ASTRO) annual meeting.

The decision to offer radiation after prostatectomy for patients with recurrent prostate cancer is complex and failure rates are high, Jani explained. Conventional imaging has significant limitations and more accurate radiation therapy decision-making and treatment planning is needed.

“The study is unique,” he said, noting that randomized imaging studies with a cancer-control endpoint are rare. “But also, we had hardwired the post-PET treatment decisions into the protocol.”

In the investigational arm, patients received the following based on their PET results:

  • Extra-pelvic uptake (no radiation)
  • Pelvic uptake (45.0-50.4 Gy to the pelvis, 64.8-70.2 Gy to prostate bed)
  • Prostate bed-only uptake (radiation to prostate bed)
  • No uptake (radiation to prostate bed)

“The improved failure-free survival rate at 3 years is very impressive. [It’s] very hard to improve hard cancer endpoints to that degree,” said press briefing moderator Sue Yom, MD, of the University of California San Francisco.

“It’s important to understand the relationship between advanced imaging and advanced radiation,” she said. “The use of higher precision, image-guided therapies in radiation oncology offers the possibility of improving radiation planning and improving cancer control and symptoms in patients.”

Fluciclovine (18F) was approved in 2016 for use with PET imaging to help diagnose recurrence in men with treated prostate cancer and rising PSA levels, and is recommended by National Comprehensive Cancer Network guidelines. It binds to prostate-specific membrane antigen, a marker expressed by prostate cancer cells.

“But it is not used for radiation treatment planning,” said Yom. “So this study gives us data to make that case.”

From 2012 to 2019, EMPIRE-1 (Emory Molecular Prostate Imaging for Radiotherapy Enhancement) randomized 165 patients with recurrent prostate adenocarcinoma post-prostatectomy 1:1 to radiotherapy based on standard imaging or radiotherapy based on standard imaging plus fluciclovine PET/CT.

In the study arm, findings on PET changed treatment planning in about 35% of cases, Jani noted.

For inclusion, patients needed a negative CT and bone scan, but detectable PSA, and were stratified by PSA levels (<2.0 vs ≥2.0 ng/mL), adverse pathology (positive margins, extracapsular extension, seminal vesicle invasion, or nodal involvement), and use of androgen deprivation therapy.

The study’s primary outcome was failure-free survival at 3 years, with treatment failure defined as persistent PSA, a PSA increase greater than 0.2 ng/mL from nadir plus a second increase, findings on imaging or rectal exam, or the start of systemic therapy.

Physician-assessed adverse events were similar between the two study arms, “suggesting that treatment to

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Exercise boosts physical, mental well-being of older cancer survivors

Active older adults — cancer survivors included — are in better physical and mental health than their sedentary peers, a new study finds.

More regular moderate to vigorous physical activity and less sedentary time improve the mental and physical health of older cancer survivors and older people without a cancer diagnosis, say researchers from the American Cancer Society.

“The findings reinforce the importance of moving more and sitting less for both physical and mental health, no matter your age or history of cancer,” study co-author Dr. Erika Rees-Punia said.

“This is especially relevant now as so many of us, particularly cancer survivors, may be staying home to avoid COVID-19 exposure, and may be feeling a little isolated or down,” Rees-Punia added in a cancer society news release.

For the study, the research team analyzed aerobic and muscle-strengthening activities, sitting time and mental and physical health of nearly 78,000 people who took part in the society’s Cancer Prevention Study II Nutrition Cohort.

The researchers found clinically meaningful differences in mental and physical health between the most and least active, and the least and most sedentary.

They say the findings support the importance of regular exercise and less sitting time as a way to improve quality of life for older men and women.

The American Cancer Society physical activity guidelines recommend that adults get 150 to 300 minutes of moderate-intensity activity or 75 to 150 minutes of vigorous-intensity a week. They also advise limiting sedentary behaviors like screen time.

“A simple walk or other physical activity that you enjoy may be good for your mind and body,” Rees-Punia said.

The report was published this week in the journal Cancer.

More information

For more on exercise and health, visit the U.S. Centers for Disease Control and Prevention.

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Non-Invasive Prostate Cancer Test Boosts Early Treatment


For years, men with an elevated PSA had two options: adopt a wait-and-see approach, or, to find out with certainty whether they had cancer, get a biopsy, a painful procedure where a physician puts a needle through the wall of the rectum and into the prostate. It also carries risk of bleeding or infection.

Instead, Ripken’s urologist, Ronald Tutrone Jr., chief of the Division of Urology at the Greater Baltimore Medical Center, recommended the ExoDx Prostate Test, a newer, simple urine test that looks for genetic changes indicating prostate cancer. When that test came back elevated, Ripken went ahead with a biopsy that indeed revealed he had prostate cancer. He underwent successful surgery in March, and is now in remission.

Ripken feels fortunate his cancer was caught in the early stages, and that he was able to get the ExoDX Prostate Test. “Without it I might have decided to simply watch my PSA levels for a while, and the cancer might have spread.”

For more than thirty years, the PSA has been the gold standard when it comes to detecting prostate cancer. But it’s also had its share of controversy. “There have been concerns that a positive PSA test has led to overdiagnosis and overtreatment,” says James Wysock, M.D., a urologic oncologist and assistant professor of urology at NYU Grossman School of Medicine in New York City. In men with PSA levels in the 4.0 to 10 range, biopsy confirms cancer about 25 percent of the time. This means that the remaining 75 percent would have to undergo a procedure that’s painful, anxiety-producing, and carries risks including infection and bleeding. And even if the test successfully picks up cancer, Wysock adds, many prostate cancers grow so slowly that they will not cause harm during a man’s lifetime. But to be on the safe side, many men opt for treatment, which carries risk of side effects such as incontinence and impotence.

Now, not only can several new blood and urine tests more accurately measure your risk for prostate cancer, they can also detect how aggressive your cancer is, so that both you and your doctor can come up with a targeted treatment. “Not all prostate cancers need to be treated — we can sometimes do what’s known as active surveillance, where you’re monitored over time to see if your levels rise,” explains Wysock.

The ExoDx, which has been available since 2017, works by checking a man’s urine for specific prostate cancer biomarkers that would indicate tumor cell growth. If the test comes back with a score under 15.6, it’s considered low risk or benign. Anything higher could indicate cancer. Ripken’s score was 45.

Similar specific tests to diagnose prostate cancer have been available for close to a decade. Two of the earliest ones were the Prostate Health Index (PHI), FDA approved in 2012, and the 4Kscore test, approved in 2015. These both combine the results of different types of PSA to get an overall score that reflects the chance a man

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Prehospital Plasma Boosts Survival in Traumatic Brain Injury

Prehospital plasma, administered soon after injury, appears to improve survival for patients with traumatic brain injury (TBI), results of a new analysis suggest.

Administration of prehospital plasma demonstrated a strong survival benefit and was associated with a 45% lower risk for mortality in TBI patients, Danielle S. Gruen, PhD, and colleagues write in their report, published online October 15 in JAMA Network Open.

The finding is from a post hoc secondary analysis of a prespecified subgroup from the Prehospital Air Medical Plasma (PAMPer) randomized clinical trial, published in 2018 in The New England Journal of Medicine.

PAMPer studied the safety and efficacy of prehospital administration of thawed plasma in injured patients at risk for hemorrhagic shock. It included 501 patients; 230 received prehospital plasma, and 271 received standard-care resuscitation that did not include prehospital plasma administration.

Results showed that mortality at 30 days, the trial’s primary endpoint, was significantly lower in the plasma group than in the standard-care group (23.2% vs 33.0%; P = .03).

The current analysis explored the association between prehospital plasma resuscitation and survival in a subgroup of 166 patients with TBI. Of these, 74 patients received prehospital plasma, and 92 received standard care.



Dr Jason Sperry

“If you give prehospital plasma to injured patients, there is a survival benefit, as PAMPer showed, and the current study demonstrates that the signal is strongest in patients who have traumatic brain injury,” senior author Jason L. Sperry, MD, MPH, professor of surgery and critical care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, told Medscape Medical News.

“We think that giving plasma as soon as possible improves survival via several mechanisms,” he said. “These include volume expansion to restore perfusion, an alteration in the inflammatory response, a reduction in endothelial injury, and the prevention or mitigation of coagulopathy.”

The median age of the patients with TBI was 43 years (range, 25 – 60 years). Brain injury was shown on CT imaging. Most patients with TBI were men (n = 125, 75.3%), and all had blunt trauma injuries. The median Injury Severity Score was 29 (interquartile range [IQR], 22 – 38).

Patients with TBI were more severely injured than those without TBI, and the incidence of prehospital intubation was higher for those patients. In addition, they were more likely to receive in-hospital vasopressors, the length of stay in the intensive care unit was longer, they spent more days on mechanical ventilation, and 24-hour mortality rates (P = .001) and 30-day mortality rates (P = < .001) were higher.

Except for the plasma intervention, there were no significant differences in fluid administration during transport to the hospital. However, in-hospital transfusion requirements differed between the two groups. Patients with TBI who were treated with prehospital plasma received less crystalloid fluid, vasopressors, and packed red blood cells in the first 24 hours.

In addition, for patients with TBI who received prehospital plasma, international normalized ratios were lower (median, 1.20 [IQR, 1.10 – 1.40] vs 1.40 [IQR 1.20 – 1.80]).

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How Physical Fitness Training Boosts Resilience by Meeting Targets

Exercise not only rejuvenates healthy mind and body but also helps in fulfilling the targets of individual in several working fields. Fitness freaks who are indulged in different activities always prefer to take proper training from an instructor who can make them perfect in different categories like sports, jobs (Army, Navy) and different martial arts like Judo, Kung fu, and Karate. They seek the assistance of trainer because it is hard for them to set such objectives themselves.

Physical fitness training improves your performance in several categories of work. Intense workout and athletic body with resilience are essential for fields like army, police, navy, airlines and sports. Fitness guidance or training may help to fulfill one's target in those platforms.

Psychological Benefits of the Workout

Research has shown that exercise not only builds your body but also handles stress and anxiety. Physically active people have a lower rate of depression and other psychological issues. Some of the psychometric benefits of workouts are highlighted below:

  • Workouts can improve your mood.
  • Reduces symptoms or risk of depression and protects you from illness like hypertension and other mental disorders.
  • Sharpens the decision-making capacity of an individual.
  • Rejuvenates the power of endurance and increase inner solace.

Physical Benefit of Exercise

There are multiple benefits of physical activity if done in a correct way. Advantages of workouts are as follows:

  • Exercise controls weight and gives a proper shape of your body by balancing the Body Mass Index.
  • Health issues like diabetes, metabolic syndrome, high blood pressure, cholesterol, heart disease etc can be controlled by physical activities.
  • Fitness activity helps in strengthening muscles, bones, and joints.
  • It increases the chance of living longer.
  • Workout also helps to overcome insomnia and provide good sleep.

Physical Fitness Training Goals

Everyone has the idea about the benefits of a workout but few people are acquainted with the side affect of wrong exercise, which can be the major reason for multiple health issues or injuries. If you do not take proper guidance of a professional fitness instructor then it may be hard to meet the fitness goals. Following are the guidelines suggested by the fitness gurus:

  • They set up regular workouts.
  • Instructors always try to guide their clients through important steps and techniques to prevent injury while training.
  • Fitness trainers make their clients strong in the specific platforms of working by scheduling the appropriate workouts for their jobs or other activities.
  • For beginners, some steps are designed by the trainers so that the trainee does not feel difficulty in a workout routine.
  • Fitness instructors do not give overtraining, which may harm a beginner.
  • They suggest you follow a balanced diet chart according to the BMI of your body.
  • They make you start exercise with warm up and stretching.

Indulging in various types of physical activities may not offer fruitful result if you do not take professional guidance. Therefore, lessons provided by physical fitness training can be beneficial and help to reach the target in a specific time and boosts resilience …

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