Abstract
BackgroundOur 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).MethodsWe 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).ResultsMedian 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%.ConclusionPatients with multiple HR factors have worse outcome than patients with 1 HR factor. Future studies should account for this heterogeneity in HR prostate cancer.
Highlights
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)
The median EBRT dose to the planning target volume was 74 Gy in 2Gy/ fraction biologically equivalent doses, and intensitymodulated RT (IMRT) was used with 21% of all patients
We found that a high GS of 8 to 10, higher prostatespecific antigen (PSA) level and lower radiation dose were significant predictors of shorter distant metastases-free survival (DMFS) on multivariate analyses
Summary
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). Patients with multiple intermediate risk factors (for example, a bGS of 7 and PSA of 10–20 ng/ml) may be considered for management similar to patients with high-risk disease [2, 3] This risk stratification scheme was originally based on biochemical outcomes of patients treated with standard. This combination has shown improvement in rates of biochemical failure and distant metastases compared to standard dose radiation alone [4,5,6,7,8] It remains unclear whether the original high-risk definition based on biochemical outcomes remains applicable to patients treated in this manner for more clinically relevant endpoints of distant metastases and prostate cancerspecific mortality
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