The prognostic significance of the clinical T stage and Grade Group in patients with locally advanced prostate cancer treated via high-dose-rate brachytherapy and external beam radiation.

BACKGROUND: Although the optimal management of locally advanced prostate cancer (PCa) remains unclear, local definitive therapy, thus combined radiotherapy and androgen deprivation, is one option. We evaluated the long-term outcomes of patients with locally advanced PCa who underwent high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT). METHODS: We retrospectively analyzed 173 patients with locally advanced PCa (cT3a-4N0-1M0) who underwent HDR-BT and EBRT. We employed Cox's proportional hazards models to identify pre-treatment predictors of oncological outcomes. Treatment outcomes (biochemical recurrence-free survival [BCRFS], clinical progression-free survival [CPFS], and castration-resistant prostate cancer-free survival [CRPCFS] were compared according to the combination of the pre-treatment predictors. RESULTS: The 5-year BCRFS, CPFS, and CRPCFS rates were 78.5, 91.7, and 94.4% respectively; there were two PCa deaths. Multivariate analysis revealed that the clinical T stage (cT3b and cT4) and Grade Group (GG) 5 status were independent risk factors for poor BCRFS, CPFS, and CRPCFS. In the GG ≤ 4 group, the Kaplan-Meier curves for BCRFS, CPFS, and CRPCFS revealed excellent outcomes. However, in the GG5 group, patients with cT3b and cT4 PCa evidenced significantly poorer oncological outcomes than those with cT3a PCa. CONCLUSION: The clinical T stage and GG status were significantly prognostic of oncological outcomes in patients with locally advanced PCa. In patients of GG ≤ 4 PCa, HDR-BT was effective even in patients with cT3b or cT4 PCa. However, in patients with GG5 PCa, careful monitoring is essential, particularly of patients with cT3b or cT4 PCa.

A case of uncommon metastasis located posterior to the seminal vesicles in renal cell carcinoma.

Renal cell carcinoma (RCC) is known for its potential to metastasize to various sites but metastasis to the area posterior to the seminal vesicles is exceedingly rare. We present the case of a 44 year-old male patient with a history of clear cell RCC (ccRCC) who was found to have suspected metastases to the region posterior to the seminal vesicles and the greater omentum during follow-up after radical nephrectomy. The patient was classified as having a favorable risk according to the International Metastatic RCC Database Consortium criteria. Due to the rarity of this metastasis site, a treatment strategy combining immune-oncology therapy and tyrosine kinase inhibitors (IO-TKI) was initiated. This treatment led to significant reduction of the metastatic lesions, allowing for their complete removal via laparoscopic surgery. Pathologic examination confirmed that the metastatic lesions were consistent with primary ccRCC. No clinical progression was observed 2 months postoperatively. This case highlights the rare occurrence of ccRCC metastasizing posterior to the seminal vesicles and demonstrates the potential effectiveness of combined IO-TKI therapy followed by surgical resection in treating such atypical metastases.