Two-years Postradiotherapy Biopsies: Lessons from MRC RT01 Trial

Autor: Antoine, Kass-Iliyya, Gordana, Jovic, Claire, Murphy, Cyril, Fisher, Isabel, Syndikus, Chakiath, Jose, Christopher D, Scrase, John D, Graham, David, Nicol, Matthew R, Sydes, David, Dearnaley
Rok vydání: 2017
Předmět:
Zdroj: European Urology
ISSN: 1873-7560
Popis: Background The importance of 2-yr postradiotherapy prostate biopsy status remains uncertain. Objective To assess the value of 2 year post treatment biopsies in a randomised trial of radiotherapy dose escalation. Design, setting, and participants Between 1998 and 2001, 843 men with localised prostate cancer were randomised to receive either control-64 Gy or escalated-74 Gy conformal radiotherapy (CFRT) in the MRC RT01 trial in combination with 3–6-mo neoadjuvant androgen deprivation therapy. Prostate biopsies were planned at 2 yr from start of CFRT in suitable men. Outcome measurements and statistical analysis Prostate biopsy results and prostate-specific antigen (PSA) levels performed at 2 yr post-CFRT were evaluated with long-term biochemical progression free survival (bPFS) and overall survival. Outcome measures were timed from the 2-yr biopsy using a landmark approach. Results and limitations A 2-yr biopsy was performed in 312/843 patients. One hundred and seventy-seven patients were included in the per-protocol group with median follow-up of 7.8 yr from biopsy. Median PSA at biopsy was 0.5 ng/ml. Sixty-four bPFS events were reported: 46/145 (32%) in patients with negative, 6/18 (33%) suspicious, and 12/14 (86%) positive biopsies. A positive biopsy was prognostic of worse bPFS, going forward, compared with negative and suspicious biopsies, hazard ratio (HR) = 4.81 (95% confidence interval [CI]: 2.50–9.26, p
Take Home Message Two-year postradiotherapy biopsy results from a randomised controlled trial indicate that routine biopsy is not indicated but biopsy should be used selectively to guide local salvage treatments in patients with unfavourable post-treatment prostate-specific antigen results.
Databáze: OpenAIRE
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