Longer ADT for very high risk

[JimmyToowong]

Int J Radiat Oncol Biol Phys. 2011 Jun 4. [Epub ahead of print]

Continued Benefit to Androgen Deprivation Therapy for Prostate Cancer Patients Treated with Dose-Escalated Radiation Therapy Across Multiple Definitions of High-Risk Disease.

Stenmark MH, Blas K, Halverson S, Sandler HM, Feng FY, Hamstra DA.

Source

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.

Abstract

PURPOSE:

To analyze prognostic factors in patients with high-risk prostate cancer treated with dose-escalated external-beam radiation therapy (EBRT) and androgen deprivation (ADT).

METHODS AND MATERIALS:

Between 1998 and 2008 at the University of Michigan Medical Center, 718 men were consecutively treated with EBRT to at least 75 Gy. Seven definitions of high-risk prostate cancer, applying to 11-33% of patients, were evaluated. Biochemical failure (BF), salvage ADT use, metastatic progression, and prostate cancer-specific mortality (PCSM) were estimated by the Kaplan-Meier method and Cox proportional hazards regression.

RESULTS:

Each high-risk definition was associated with increased BF (hazard ratio (HR) 2.8-3.9, p < 0.0001), salvage ADT use (HR 3.9-6.3, p < 0.0001), metastasis (HR 3.7-6.6, p < 0.0001), and PCSM (HR 3.7-16.2, p < 0.0001). Furthermore, an increasing number of high-risk features predicted worse outcome. Adjuvant ADT yielded significant reductions in both metastases (HR 0.19-0.38, p < 0.001) and PCSM (HR 0.38-0.50, p < 0.05) for all high-risk definitions (with the exception of clinical Stage T3-4 disease) but improved BF only for those with elevated Gleason scores (p < 0.03, HR 0.25-0.48). When treated with ADT and dose-escalated EBRT, patients with Gleason scores 8 to 10, without other high-risk features, had 8-year freedom from BF of 74%, freedom from distant metastases of 93%, and cause-specific survival of 92%, with salvage ADT used in 16% of patients.

CONCLUSION:

Adjuvant ADT results in a significant improvement in clinical progression and PCSM across multiple definitions of high-risk disease even with dose-escalated EBRT. There is a subset of patients, characterized by multiple high-risk features or the presence of Gleason Pattern 5, who remain at significant risk for metastasis and PCSM despite current treatment.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID: 21645976 Forum: Very high risk Title: Longer ADT for very high risk

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