Our aim was to assess the heterogeneity of high-risk (HR) prostate cancer managed with high-dose external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT).
We identified 547 patients who were treated with modern EBRT from 1997 to 2013, of whom 98% received ADT.
We analyzed biochemical relapse-free survival (bRFS) and distant metastases-free survival (DMFS).
Median EBRT dose was 74 Gy, and median ADT duration was 8 months. At 5 years, the DMFS was 85%. On multivariate analysis, significant predictors of shorter bRFS were biopsy Gleason score (bGS) of 8 to 10, higher prostate-specific antigen (PSA) level, shorter duration of ADT and lower radiation dose while predictors of shorter DMFS were bGS of 8 to 10, higher PSA level, and lower radiation dose. We identified an unfavorable high-risk (UHR) group of with 2-3 HR factors based on 2015 National Comprehensive Cancer Network (NCCN) criteria and a favorable high-risk (FHR) group, with 1 HR feature. Comparing very-HR prostate cancer, UHR & FHR, 5 year bRFS rates were 58.2%, 66.2%, and 69.2%, and 5 year DMFS rates were 78.4%, 81.2%, and 88.0%.
Patients with multiple HR factors have worse outcome than patients with 1 HR factor. Future studies should account for this heterogeneity in HR prostate cancer.
Go “Beyond the Abstract” - Read an article commentary written by the author
BMC urology. 2017 Aug 01*** epublish ***
Daniel N Cagney, Mary Dunne, Carmel O'Shea, Marie Finn, Emma Noone, Martina Sheehan, Lesley McDonagh, Lydia O'Sullivan, Pierre Thirion, John Armstrong
Department of Radiation Oncology, St. Luke's Radiation Oncology Network, Highfield Road Rathgar, Dublin, Ireland. ., Department of Radiation Oncology, St. Luke's Radiation Oncology Network, Highfield Road Rathgar, Dublin, Ireland.