The natural history of radiorecurrent high-risk prostate cancer (HRPCa) is not well-described. To better understand its clinical course, we evaluated rates of distant metastases (DM) and prostate cancer-specific mortality (PCSM) in a cohort of 978 men with radiorecurrent HRPCa who previously received either external beam radiation therapy (EBRT, n = 654, 67%) or EBRT + brachytherapy (EBRT + BT, n = 324, 33%) across 15 institutions from 1997 to 2015.
In men who did not die, median follow-up after treatment was 8.9 yr and median follow-up after biochemical recurrence (BCR) was 3.7 yr. Local and systemic therapy salvage, respectively, were delivered to 21 and 390 men after EBRT, and eight and 103 men after EBRT + BT. Overall, 435 men developed DM, and 248 were detected within 1 yr of BCR. Measured from time of recurrence, 5-yr DM rates were 50% and 34% after EBRT and EBRT + BT, respectively. Measured from BCR, 5-yr PCSM rates were 27% and 29%, respectively. Interval to BCR was independently associated with DM (p < 0.001) and PCSM (p < 0.001). These data suggest that radiorecurrent HRPCa has an aggressive natural history and that DM is clinically evident early after BCR. These findings underscore the importance of further investigations into upfront risk assessment and prompt systemic evaluation upon recurrence in HRPCa. PATIENT SUMMARY: High-risk prostate cancer that recurs after radiation therapy is an aggressive disease entity and spreads to other parts of the body (metastases). Some 60% of metastases occur within 1 yr. Approximately 30% of these patients die from their prostate cancer.
European urology. 2021 May 10 [Epub ahead of print]
Rebecca G Philipson, Tahmineh Romero, Jessica K Wong, Bradley J Stish, Robert T Dess, Daniel E Spratt, Avinash Pilar, Chandana Reddy, Trude B Wedde, Wolfgang A Lilleby, Ryan Fiano, Gregory S Merrick, Richard G Stock, D Jeffrey Demanes, Brian J Moran, Michelle Braccioforte, Phuoc T Tran, Santiago Martin, Rafael Martinez-Monge, Daniel J Krauss, Eyad I Abu-Isa, Luca Valle, Natalie Chong, Thomas M Pisansky, C Richard Choo, Daniel Y Song, Stephen Greco, Curtiland Deville, Todd McNutt, Theodore L DeWeese, Ashley E Ross, Jay P Ciezki, Derya Tilki, R Jeffrey Karnes, Eric A Klein, Jeffrey J Tosoian, Paul C Boutros, Nicholas G Nickols, Prashant Bhat, David Shabsovich, Jesus E Juarez, Patrick A Kupelian, Matthew B Rettig, Alejandro Berlin, Jonathan D Tward, Brian J Davis, Robert E Reiter, Michael L Steinberg, David Elashoff, Eric M Horwitz, Rahul D Tendulkar, Amar U Kishan
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA., UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA., Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA., Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada., Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA., Oslo University Hospital, Oslo, Norway., Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, USA., Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., California Endocurietherapy Cancer Center, Oakland, CA, USA., Chicago Prostate Cancer Center, Westmont, IL, USA., Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Radiation Oncology, Clínica Universidad de Navarra and Program in Solid Tumors, CIMA- University of Navarra, Pamplona, Spain., Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Urology and Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Urology, University of California Los Angeles, Los Angeles, CA, USA., Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA., David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA., Department of Medical Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Medical Oncology, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA., Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada., Department of Radiotherapy Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA., Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33985797