Radiation therapy with or without hormonal therapy for prostate carcinomafor prostate carcinoma

Abstract

Purpose : Radical prostatectomy and radiation therapy are the main methods of treat-ment for prostate cancer. The goal of this study is to evaluate the outcomes and prog-nostic factors for patients with prostate cancer treated with radiation therapy alone or combined radiation and hormonal therapy. Materials and Methods : From January 2000 through July 2004, there were 67 men diagnosed with prostate cancer and referred to radiation oncology for radiotherapy in our hospital. The median age of patients at the time of diagnosis was 75 years. The patho-logic types were all adenocarcinoma. The median of Gleason score was 6. According to staging system of AJCC 1997, forty patients (59.7%) were stage II (T1N0M0 AnyG, T2N0M0 AnyG), eighteen patients (26.9%) were stage III (T3N0M0 AnyG), and 9 patients (13.4%) were stage IV (T4N0M0 AnyG, AnyTN1M0 AnyG). Four patients (6.0%) did not finish the radiation therapy course and were lost to follow up. Among the 63 patients who finished the therapy course, thirty-seven patients (58.7%) received radio-therapy alone, and 26 patients (41.3%) received combinations of radiation and hormonal therapy. The method of radiotherapy was 3-D conformal radiation therapy (3DCRT), and the median dose of radiation therapy was 7200 cGy. The variables, such as age, PSA level before treatment, Gleason score, maximum of Gleason grade, stage, methods of treatment and dose of radiotherapy were analyzed with respect to their influence upon prognosis. Univariate and multivariate analyses were used. Univariate analysis using the log rank test and multivariate analysis using the Cox proportional hazards model were performed. Overall survival rate, disease-specific survival rate, survival rate without clini-cal failure and survival rate without biochemical failure were calculated with the method of Kaplan and Meier. Results : Two patients were lost to follow up after completion of radiotherapy. The medi-an of follow-up duration was 27.8 months (range from 4.3 to 65.0 months). Therefore, sixty-one patients entered the analysis of results. Five-year overall survival rate was 91.11%. Five-year survival rate without clinical failure was 70.15%. Five-year survival rate without biochemical failure was 56.50%. Five-year disease-specific survival rate was Purpose : Radical prostatectomy and radiation therapy are the main methods of treat-ment for prostate cancer. The goal of this study is to evaluate the outcomes and prog-nostic factors for patients with prostate cancer treated with radiation therapy alone or combined radiation and hormonal therapy. Materials and Methods : From January 2000 through July 2004, there were 67 men diagnosed with prostate cancer and referred to radiation oncology for radiotherapy in our hospital. The median age of patients at the time of diagnosis was 75 years. The patho-logic types were all adenocarcinoma. The median of Gleason score was 6. According to staging system of AJCC 1997, forty patients (59.7%) were stage II (T1N0M0 AnyG, T2N0M0 AnyG), eighteen patients (26.9%) were stage III (T3N0M0 AnyG), and 9 patients (13.4%) were stage IV (T4N0M0 AnyG, AnyTN1M0 AnyG). Four patients (6.0%) did not finish the radiation therapy course and were lost to follow up. Among the 63 patients who finished the therapy course, thirty-seven patients (58.7%) received radio-therapy alone, and 26 patients (41.3%) received combinations of radiation and hormonal therapy. The method of radiotherapy was 3-D conformal radiation therapy (3DCRT), and the median dose of radiation therapy was 7200 cGy. The variables, such as age, PSA level before treatment, Gleason score, maximum of Gleason grade, stage, methods of treatment and dose of radiotherapy were analyzed with respect to their influence upon prognosis. Univariate and multivariate analyses were used. Univariate analysis using the log rank test and multivariate analysis using the Cox proportional hazards model were performed. Overall survival rate, disease-specific survival rate, survival rate without clini-cal failure and survival rate without biochemical failure were calculated with the method of Kaplan and Meier. Results : Two patients were lost to follow up after completion of radiotherapy. The medi-an of follow-up duration was 27.8 months (range from 4.3 to 65.0 months). Therefore, sixty-one patients entered the analysis of results. Five-year overall survival rate was 91.11%. Five-year survival rate without clinical failure was 70.15%. Five-year survival rate without biochemical failure was 56.50%. Five-year disease-specific survival rate was 93.57%. In univariate analysis of 3-year survival , PSA level before treatment and maxi- mum of Gleason grade were significant predictors for survival rate without biochemical failure (p= 0.0046, 0.0481, respectively). Hormonal therapy was not a significant predic- tor for survival. Conclusion : In this study, patients who had higher initial PSA level or maximum of Gleason grade had worse outcome. More aggressive treatment may be considered for these patients.