Adding GS>7 and pretreatment PSA>20 makes 6.8 times failure

[JimmyToowong]

UroToday - Long-term results after high-dose radiotherapy and adjuvant hormones in prostate cancer: How curable is high-risk disease?

Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain.

To analyze long-term outcome and prognostic factors for high-risk prostate cancer defined by National Comprehensive Cancer Network criteria treated with high-dose radiotherapy and androgen deprivation in a single institution.

A total of 306 patients treated between 1995 and 2007 in a radiation dose-escalation program fulfilled the National Comprehensive Cancer Network high-risk criteria. Median International Commission on Radiation Units and Measurements radiation dose was 78 Gy (range, 66.0-84.1 Gy). Long-term androgen deprivation (LTAD) was administered in 231 patients, short-term androgen deprivation (STAD) in 59 patients, and no hormones in 16 patients. The Phoenix (nadir plus 2 ng/mL) consensus definition was used for biochemical control. Multivariate analysis was performed to determine the independent prognostic impact of clinical and treatment factors. Median follow-up time was 64 months (range, 24-171 months).

The actuarial overall survival at 5 and 10 years was 95.7% and 89.8%, respectively, and the corresponding biochemical disease-free survival (bDFS) was 89.5% and 67.2%, respectively. Fourteen patients (4.6%) developed distant metastasis. Multivariate analysis showed that Gleason score >7 (p = 0.001), pretreatment prostate-specific antigen (PSA) level >20 ng/mL (p = 0.037), higher radiation dose (p = 0.005), and the use of adjuvant LTAD vs. STAD (p = 0.011) were independent prognostic factors affecting bDFS in high-risk disease. The 5-year bDFS for patients treated with LTAD plus radiotherapy dose >78 Gy was 97%.

For high-risk patients the present series showed that the use of LTAD in conjunction with higher doses (>78 Gy) of radiotherapy was associated with improved biochemical tumor control. We observed that the presence of Gleason sum >7 and pretreatment PSA level >20 ng/mL in the same patient represents a 6.8 times higher risk of PSA failure. These men could be considered for clinical trials with addition of novel agents.

Written by:

Zapatero A, García-Vicente F, Martín de Vidales C, Cruz Conde A, Ibáñez Y, Fernández I, Rabadán M. [1]

Reference: Int J Radiat Oncol Biol Phys. 2010 Oct 5. Epub ahead of print.

doi: 10.1016/j.ijrobp.2010.07.1975

PubMed Abstract[2]

PMID: 20932659 Forum: Primary hormone therapy Title: Adding GS>7 and pretreatment PSA>20 makes 6.8 times treatment failure risk

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