Abstract
BackgroundTo assess the oncologic outcomes of radiation therapy (RT) combined with maximal androgen blockade (MAB) and prostate-specific antigen (PSA) kinetics in patients with localized, high-risk prostate carcinoma (PCa).MethodsThree-hundred twenty individuals with localized PCa who underwent RT + MAB in 2001–2015 were evaluated retrospectively. All patients had received 36 months of MAB therapy and 45 Gy of pelvic irradiation, plus a dose-escalated external beam radiation therapy (DE-EBRT) boost to 76~81 Gy (MAB + EBRT group), or a low-dose-rate prostate permanent brachytherapy (LDR-PPB) boost to 110 Gy with I-125 (MAB + EBRT + PPB group).ResultsFollow-up median is 90 months, ranging from 12 to 186 months; 117 (36.6%) and 203 (63.4%) cases underwent MAB + EBRT and MAB + EBRT + PPB, respectively. Multivariate Cox regression showed that the PPB regimen and PSA kinetics were positive indicators of oncologic outcomes. Compared with MAB + EBRT, MAB + EBRT + PPB remarkably improved PSA kinetics more pronouncedly: PSA nadir (1.3 ± 0.7 vs 0.11 ± 0.06 ng/mL); time of PSA decrease to nadir (7.5 ± 1.8 vs 3.2 ± 2.1 months); PSA doubling time (PSADT; 15.6 ± 4.2 vs 22.6 ± 6.1 months); decrease in PSA (84.6 ± 6.2% vs 95.8 ± 3.4%). Additionally, median times of several important oncologic events were prolonged in the MAB + EBRT + PPB group compared with the MAB + EBRT group: overall survival (OS; 12.3 vs 9.1 years, P < 0.001), biochemical recurrence-free survival (BRFS; 9.8 vs 6.5 years, P < 0.001), skeletal-related event (SRE; 10.4 vs 8.2 years, P < 0.001), and cytotoxic chemotherapy (CCT; 11.6 vs 8.8 years, P = 0.007).ConclusionMAB + EBRT + PPB is extremely effective in patients with localized, high-risk PCa, indicating that PPB may play a synergistic role in improving PSA kinetics and independently predicts oncologic outcomes.
Highlights
To assess the oncologic outcomes of radiation therapy (RT) combined with maximal androgen blockade (MAB) and prostate-specific antigen (PSA) kinetics in patients with localized, high-risk prostate carcinoma (PCa)
The results suggested that PSA outcomes are significantly favorable after brachytherapy in comparison with external beam radiation therapy (EBRT) in lowrisk cases, with the brachytherapy monotherapy achieving equivalent PSA outcomes compared to the EBRT and brachytherapy combination in individuals with intermediate-risk tumors
Univariate analysis indicated that age (P = 0.035, hazard ratio [HR] 5.812), gland volume (P = 0.006, HR 3.816), PPB addition (P = 0.007, HR 3.016), clinical stage (P < 0.001, HR 4.557), Gleason score (P = 0.001, HR 3.356), baseline PSA (P = 0.027, HR 1.558), Memorial Sloan-Kettering Risk Classification Standard score (P < 0.001, HR 7.658), PSA nadir (P < 0.001, HR 9. 473), time to PSA nadir (P = 0.012, HR 3.113), PSA doubling time (PSADT) (P = 0.042, HR 2.665), and PSA level reduction (P < 0.001, HR 13.463) were significant predictors of overall survival (OS) in patients with localized, high-risk PCa
Summary
To assess the oncologic outcomes of radiation therapy (RT) combined with maximal androgen blockade (MAB) and prostate-specific antigen (PSA) kinetics in patients with localized, high-risk prostate carcinoma (PCa). Most PCa patients, including those with high-risk disease, do not have metastatic tumors at diagnosis; local tumor resection could produce excellent long-term survival outcomes [1,2,3]. Because of excellent 15-year PSA outcomes [4], brachytherapy is routinely performed either as monotherapy in individuals with low-risk or low-/intermediate-risk cancer or in combination with external beam radiation therapy (EBRT) in those with high-risk tumors [5]. We evaluated the clinical benefit of the MAB + EBRT + PPB combination by assessing long-term survival outcomes and PSA kinetics in subjects with localized high risk
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
