Overall survival outcomes with the use of adjuvant chemotherapy, radiation therapy and hormone therapy in high-risk, very-high-risk and node-positive prostate cancer post radical prostatectomy: A NCDB analysis.

118 Background: Phase III trials have not consistently demonstrated overall survival (OS) advantage of adjuvant radiation therapy (ART) in prostate cancer (PC) with high risk/very high risk features after radical prostatectomy (RP). Adjuvant hormone therapy (AHT) in PC after RP improved OS in patients with positive lymph nodes (pLNs). We report an observational study on the impact of AHT to ART in NCCN defined high-risk/very high risk (Group 1), and adjuvant chemotherapy (ACT) to AHT in pLNs (group 2) post RP on OS. Methods: We conducted a retrospective study of PC patients (group 1 and group 2) who underwent RP and/or pelvic lymph node dissection. OS was calculated using Kaplan Meier analysis. Group 1 compared ART+AHT vs ART and Group 2 AHT+ ACT vs AHT within 16 weeks of RP. Multivariate analysis was performed with Cox proportional hazard regression model to adjust for different variables. Results: Out of 1,390,357 PC patients reported in NCDB (2004-2015) 182,653 and 11,972 met our inclusion criteria for Group 1 and Group 2 respectively. 3.37% of Group 1 received ART and/or AHT. 19.81% of Group 2 received AHT and/or ACT. Patients who received ART + AHT were more likely to be older, Non-Hispanic white, more likely to have pT4, and have higher prostate specific antigen (PSA) and Gleason scores (GS). Patients who received AHT+ACT were more likely to be younger, with private insurance, and lower Charlson-Deyo Score (CDCC) score. Five and seven year OS with adjusted hazard ratio (aHR) among Group 1 and Group 2 are depicted in table. Conclusions: No statistically significant difference in OS was seen among respective treatment groups. Limitations that exist with this registry based study include lack of randomization, differences in surgical and radiation techniques, duration and choices of ACT and AHT.[Table: see text]

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Survival after Radical Prostatectomy vs. Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer

The Journal of Urology ◽

10.1097/ju.0000000000002250 ◽

2021 ◽

Author(s):

Francesco Chierigo ◽

Mike Wenzel ◽

Christoph Würnschimmel ◽

Rocco Simone Flammia ◽

Benedikt Horlemann ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

High Risk ◽

Radical Prostatectomy ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Very High

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High-Grade Prostate Cancer: Favorable Results in the Modern Era Regardless of Initial Treatment

ISRN Oncology ◽

10.5402/2012/596029 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Emma H. Ramahi ◽

Gregory P. Swanson ◽

Matthew W. Jackson ◽

Fei Du ◽

Joseph W. Basler

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Hormone Therapy ◽

Specific Antigen ◽

High Grade ◽

Cancer Specific Survival ◽

Free Survival ◽

Modern Era

Purpose. We performed a retrospective study to determine the outcome of a modern cohort of patients with high-grade (Gleason score ≥ 8) prostate cancer treated with radical prostatectomy, radiation therapy, or hormone therapy. Methods. We identified 404 patients in the South Texas Veteran’s Healthcare System Tumor Registry diagnosed with high grade prostate cancer between 1998 and 2008. Mean follow-up was years. End points were biochemical failure-free survival, overall survival, metastasis-free survival, and cancer-specific survival. Results. 5-year overall survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 88.9%, 76.3%, and 58.9%, respectively. 5-year metastasis-free survival for patients undergoing radical prostatectomy, radiation therapy, and hormone therapy was 96.8%, 96.6%, and 88.4%, respectively, and 5-year cancer-specific survival was 97.2%, 100%, and 89.9%, respectively. Patients with a Gleason score of 10 and pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year biochemical failure-free and cancer-specific survival. Patients with a pretreatment prostate-specific antigen > 20 ng/mL had decreased 5-year overall survival. Discussion. Even for patients with high-grade disease, the outcome is not as dire in the modern era regardless of primary treatment modality chosen. While there is room for improvement, we should not have a nihilistic impression of how these patients will respond to treatment.

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Outcomes of combined radiotherapy in high-risk prostate cancer

Malignant tumours ◽

10.18027/2224-5057-2019-9-4-32-40 ◽

2020 ◽

Vol 9 (4) ◽

pp. 32-40

Author(s):

A. V. Potapova ◽

I. A. Gladilina ◽

A. V. Petrovsky ◽

V. A. Chernyaev ◽

V. N. Sholokhov ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Total Dose ◽

Hormone Therapy ◽

Disease Progression ◽

Response To Treatment ◽

External Beam ◽

Group 2 ◽

Group 1

Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques.Purpose. The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them.Materials and methods. 53 patients with PC received 125I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied.Results. Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps.Conclusion. EBT using 125I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.

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The value of transperineal prostate apical zone biopsy in predicting urethral or apical margin status after radical prostatectomy in prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.127 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 127-127

Author(s):

Jindong Dai ◽

Pengfei Shen

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Hormone Therapy ◽

Occurrence Rate ◽

Adjuvant Hormone Therapy ◽

High Risk Prostate Cancer ◽

Positive Biopsy ◽

Risk Prostate Cancer ◽

Very High

127 Background: To investigate potential preoperative predictors of positive surgical margin (PSM) after radical prostatectomy, and how to reduce the possibility of urethral or apical PSM with positive biopsy cores in the apical zone of prostate (AZP). Methods: 531 patients who had radical prostatectomy during 2010-2017 in West China hospital was enrolled. The logistic regression was used to assess the preoperative factors associated with PSM. 399 patients with high/very high risk prostate cancer were recognized by National comprehensive cancer Network guidelines and 339 patients were reported positive biopsy cores in the AZP. Results: The overall PSM rate of all patients was about 30.1% (160/531) and 117 of them were reported urethral or apical PSM. The occurrence rate of urethral or apical PSM in patients with positive cores in AZP was obviously higher than that in total group (p = 0.022). We further found that the addition of positive AZP to a standard multivariable model could significantly increase the predictive value of urethral or apical PSM (p = 0.016) in different groups. The analysis also showed that neo-adjuvant hormone therapy was an independent protective factor for urethral or apical PSM in positive AZP patients, but not all patients. Conclusions: This is the first study to investigate the necessity of getting cores in the apical zone by transperineal prostate biopsy to predict the possibility of apical or urethral PSM. In clinical practice, neo-adjuvant hormone therapy should be given when patients with AZP(+) to reduce the presence of PSM, especially patients with high/very high risk prostate cancer.

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