Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy

• Published in: BMC urology Vol. 17; no. 1; p. 60
• Main Authors: Cagney, Daniel N, Dunne, Mary, O'Shea, Carmel, Finn, Marie, Noone, Emma, Sheehan, Martina, McDonagh, Lesley, O'Sullivan, Lydia, Thirion, Pierre, Armstrong, John
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.08.2017; BioMed Central; BMC
• Subjects: Aged; Aged, 80 and over; Androgen Antagonists - therapeutic use; Androgen suppression therapy; Androgens; Antigens; Biopsy; Cancer therapies; Care and treatment; Clinical trials; Combined Modality Therapy; Gonadotropin-Releasing Hormone - agonists; Health aspects; Humans; Male; Metastases; Metastasis; Middle Aged; Mortality; Multivariate analysis; Patient outcomes; Prospective Studies; Prostate cancer; Prostate-specific antigen; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - radiotherapy; Radiation therapy; Radiotherapy; Radiotherapy Dosage; Risk Assessment; Risk factors; Survival; Urology; Ireland
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-017-0250-2

Our aim was to assess the heterogeneity of high-risk (HR) prostate cancer managed with high-dose external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT). We identified 547 patients who were treated with modern EBRT from 1997 to 2013, of whom 98% received ADT. We analyzed biochemical relapse-free survival (bRFS) and distant metastases-free survival (DMFS). Median EBRT dose was 74 Gy, and median ADT duration was 8 months. At 5 years, the DMFS was 85%. On multivariate analysis, significant predictors of shorter bRFS were biopsy Gleason score (bGS) of 8 to 10, higher prostate-specific antigen (PSA) level, shorter duration of ADT and lower radiation dose while predictors of shorter DMFS were bGS of 8 to 10, higher PSA level, and lower radiation dose. We identified an unfavorable high-risk (UHR) group of with 2-3 HR factors based on 2015 National Comprehensive Cancer Network (NCCN) criteria and a favorable high-risk (FHR) group, with 1 HR feature. Comparing very-HR prostate cancer, UHR & FHR, 5 year bRFS rates were 58.2%, 66.2%, and 69.2%, and 5 year DMFS rates were 78.4%, 81.2%, and 88.0%. Patients with multiple HR factors have worse outcome than patients with 1 HR factor. Future studies should account for this heterogeneity in HR prostate cancer.