Re: Importance of Local Control in Early-Stage Prostate Cancer: Outcomes of Patients with Positive Post-Radiation Therapy Biopsy Results Treated in RTOG 9408
| Autor: | Samir Narayan, Mark H. Leibenhaut, Jeff M. Michalski, William U. Shipley, Kenneth L. Zeitzer, Howard M. Sandler, Susan Chafe, Viroon Donavanik, Christopher U. Jones, Luis Souhami, Jean Paul Bahary, David G. McGowan, Elizabeth Gore, Javier F. Torres-Roca, Daniel J. Krauss, Chen Hu |
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| Rok vydání: | 2016 |
| Předmět: |
Oncology
Male Cancer Research Prostate biopsy Stage prostate cancer medicine.medical_treatment Biopsy 030232 urology & nephrology Androgen suppression Flutamide Gonadotropin-Releasing Hormone Prostate cancer chemistry.chemical_compound 0302 clinical medicine Prostate Aged 80 and over Radiation medicine.diagnostic_test Androgen Antagonists Hazard ratio Middle Aged Combined Modality Therapy medicine.anatomical_structure Treatment Outcome Adenocarcinoma Post-radiation medicine.medical_specialty Urology Disease-Free Survival Article 03 medical and health sciences Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Aged Neoplasm Staging business.industry Prostatic Neoplasms Prostate-Specific Antigen medicine.disease Surgery Radiation therapy chemistry Neoplasm Grading Neoplasm Recurrence Local business |
| Zdroj: | The Journal of urology. 195(2) |
| ISSN: | 1527-3792 |
| Popis: | Purpose The purpose of this study was to assess the association between positive post-radiation therapy (RT) biopsy results and subsequent clinical outcomes in males with localized prostate cancer. Methods and Materials Radiation Therapy Oncology Group study 94-08 analyzed 1979 males with prostate cancer, stage T1b-T2b and prostate-specific antigen concentrations of ≤20 ng/dL, to investigate whether 4 months of total androgen suppression (TAS) added to RT improved survival compared to RT alone. Patients randomized to receive TAS received flutamide with luteinizing hormone releasing hormone (LHRH) agonist. According to protocol, patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years after RT completion. Statistical analysis was performed to evaluate the impact of positive post-RT biopsy results on clinical outcomes. Results A total of 831 patients underwent post-RT biopsy, 398 were treated with RT alone and 433 with RT plus TAS. Patients with positive post-RT biopsy results had higher rates of biochemical failure (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.3-2.1) and distant metastasis (HR = 2.4; 95% CI = 1.3-4.4) and inferior disease-specific survival (HR = 3.8; 95% CI = 1.9-7.5). Positive biopsy results remained predictive of such outcomes after correction for potential confounders such as Gleason score, tumor stage, and TAS administration. Prior TAS therapy did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy results. Patients with Gleason score ≥7 with a positive biopsy result additionally had inferior overall survival compared to those with a negative biopsy result (HR = 1.56; 95% CI = 1.04-2.35). Conclusions Positive post-RT biopsy is associated with increased rates of distant metastases and inferior disease-specific survival in patients treated with definitive RT and was associated with inferior overall survival in patients with high-grade tumors. |
| Databáze: | OpenAIRE |
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