Expanded risk groups help determine which prostate radiotherapy sub-group may benefit from adjuvant androgen deprivation therapy.

Matthew Beasley,Scott G Williams,Tom Pickles,Bcca Prostate Outcomes Unit

doi:10.1186/1748-717x-3-8

Matthew Beasley, Scott G Williams + Show 2 more

Open Access

https://doi.org/10.1186/1748-717x-3-8

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Abstract

PurposeTo assess whether an expanded (five level) risk stratification system can be used to identify the sub-group of intermediate risk patients with prostate cancer who benefit from combining androgen deprivation therapy (ADT) with external beam radiotherapy (EBRT).Materials and methodsUsing a previously validated 5-risk group schema, a prospective non-randomized data set of 1423 men treated at the British Columbia Cancer Agency was assessed for the primary end point of biochemical control (bNED) with the RTOG-ASTRO "Phoenix" definition (lowest PSA to date + 2 ng/mL), both with and without adjuvant ADT. The median follow-up was 5 years.ResultsThere was no bNED benefit for ADT in the low or low intermediate groups but there was a statistically significant bNED benefit in the high intermediate, high and extreme risk groups. The 5-year bNED rates with and without ADT were 70% and 73% respectively for the low intermediate group (p = non-significant) and 72% and 58% respectively for the high intermediate group (p = 0.002).ConclusionThere appears to be no advantage to ADT where the Gleason score is 6 or less and PSA is 15 or less. ADT is beneficial in patients treated to standard dose radiation with Gleason 6 disease and a PSA greater than 15 or where the Gleason score is 7 or higher.

Highlights

Androgen deprivation therapy (ADT) has a proven role in the treatment of metastatic prostate cancer
Patient characteristics by expanded and National Comprehensive Cancer Network (NCCN) risk groups are shown in table 2
The Kaplan-Meier survival curves for biochemical control by NCCN risk groups are presented in figure 1

Summary

Introduction

Androgen deprivation therapy (ADT) has a proven role in the treatment of metastatic prostate cancer. Some groups of patients undergoing external beam radiotherapy (EBRT) for localized prostate cancer benefit from adjuvant ADT. An EORTC trial randomized patients with T1–2 high grade or T3–4 N0–1 prostate cancer to either radiotherapy alone or with 3 years of ADT and showed an improved overall survival at 5 years[1]. Radiation Oncology Group 96.01 trial randomized patients with T2b-T4 N0 disease to radiotherapy alone or with 3 or 6 months ADT. There was an improvement in disease free survival for both ADT arms compared to EBRT alone [2]. Sub-division of prostate cancer patients into risk groups can be used to guide management decisions based on their risk of relapse. The National Comprehensive Cancer (page number not for citation purposes)

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