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Intermediate-risk localized prostate cancer in the PSA era: radiotherapeutic alternatives.
Urology. 2007 Mar; 69(3):541-6.U

Abstract

OBJECTIVES

To retrospectively compare the biochemical disease-free survival (BDFS) of patients treated with standard dose external beam radiotherapy (SD-EBRT), SD-EBRT plus androgen deprivation (AD), and brachytherapy-based treatment (brachytherapy with or without EBRT with or without AD).

METHODS

All 297 patients with intermediate-risk prostate cancer treated with these radiation-based treatments at our institution from August 1989 to June 2001 were included. Biochemical relapse was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, a prostate-specific antigen level of 1.5 ng/mL or greater and rising on two consecutive occasions (the "Bolla" definition), and the current prostate-specific antigen nadir plus 2 ng/mL with failure dated "at call" (the "Houston/Phoenix" definition). The number of patients treated with SD-EBRT, SD-EBRT plus AD, and brachytherapy-based treatment was 141, 84, and 72, respectively. The year of treatment was analyzed as a prognostic factor. The median follow-up was 32.3, 34.7, and 41.5 months for the ASTRO, Bolla, and Houston/Phoenix definitions, respectively.

RESULTS

The brachytherapy-based treatment resulted in improved BDFS compared with SD-EBRT (ASTRO definition, 5-year BDFS rate 88% +/- 5% versus 49% +/- 5%, P <0.01; Bolla definition, 88% +/- 8% versus 49% +/- 5%, P <0.01; Houston/Phoenix definition, 81% +/- 10% versus 64% +/- 5%, P = 0.01). SD-EBRT plus AD was superior to SD-EBRT alone using the Bolla definition (5-year BDFS 76% +/- 7% versus 49% +/- 5%, P <0.01) and the Houston/Phoenix definition (85% +/- 6% versus 64% +/- 5%, P = 0.01), but not using the ASTRO definition (P = 0.17). Multivariate analysis, including prostate-specific antigen, clinical stage, Gleason score, and year of treatment, demonstrated improved biochemical outcomes for brachytherapy-based treatment versus SD-EBRT (ASTRO, P <0.01; Bolla, P <0.01; and a trend toward significance with Houston/Phoenix, P = 0.07) and for the addition of AD to SD-EBRT (Bolla, P <0.01 and Houston/Phoenix, P = 0.03). The year of treatment trended toward significance (P = 0.077) on multivariate analysis using the ASTRO definition.

CONCLUSIONS

For patients with intermediate-risk prostate cancer, brachytherapy-based treatment and the addition of AD to SD-EBRT resulted in improved biochemical outcomes compared with the outcomes with SD-EBRT alone; however, these findings were dependent on the definition of biochemical failure used. The year of treatment may be an important prognostic factor in intermediate-risk prostate cancer.

Authors+Show Affiliations

Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17382161

Citation

Gondi, Vinai, et al. "Intermediate-risk Localized Prostate Cancer in the PSA Era: Radiotherapeutic Alternatives." Urology, vol. 69, no. 3, 2007, pp. 541-6.
Gondi V, Deutsch I, Mansukhani M, et al. Intermediate-risk localized prostate cancer in the PSA era: radiotherapeutic alternatives. Urology. 2007;69(3):541-6.
Gondi, V., Deutsch, I., Mansukhani, M., O'Toole, K. M., Shah, J. N., Schiff, P. B., Katz, A. E., Benson, M. C., Goluboff, E. T., & Ennis, R. D. (2007). Intermediate-risk localized prostate cancer in the PSA era: radiotherapeutic alternatives. Urology, 69(3), 541-6.
Gondi V, et al. Intermediate-risk Localized Prostate Cancer in the PSA Era: Radiotherapeutic Alternatives. Urology. 2007;69(3):541-6. PubMed PMID: 17382161.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermediate-risk localized prostate cancer in the PSA era: radiotherapeutic alternatives. AU - Gondi,Vinai, AU - Deutsch,Israel, AU - Mansukhani,Mahesh, AU - O'Toole,Kathleen M, AU - Shah,Jinesh N, AU - Schiff,Peter B, AU - Katz,Aaron E, AU - Benson,Mitchell C, AU - Goluboff,Erik T, AU - Ennis,Ronald D, PY - 2006/05/08/received PY - 2006/09/27/revised PY - 2006/12/13/accepted PY - 2007/3/27/pubmed PY - 2007/4/18/medline PY - 2007/3/27/entrez SP - 541 EP - 6 JF - Urology JO - Urology VL - 69 IS - 3 N2 - OBJECTIVES: To retrospectively compare the biochemical disease-free survival (BDFS) of patients treated with standard dose external beam radiotherapy (SD-EBRT), SD-EBRT plus androgen deprivation (AD), and brachytherapy-based treatment (brachytherapy with or without EBRT with or without AD). METHODS: All 297 patients with intermediate-risk prostate cancer treated with these radiation-based treatments at our institution from August 1989 to June 2001 were included. Biochemical relapse was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, a prostate-specific antigen level of 1.5 ng/mL or greater and rising on two consecutive occasions (the "Bolla" definition), and the current prostate-specific antigen nadir plus 2 ng/mL with failure dated "at call" (the "Houston/Phoenix" definition). The number of patients treated with SD-EBRT, SD-EBRT plus AD, and brachytherapy-based treatment was 141, 84, and 72, respectively. The year of treatment was analyzed as a prognostic factor. The median follow-up was 32.3, 34.7, and 41.5 months for the ASTRO, Bolla, and Houston/Phoenix definitions, respectively. RESULTS: The brachytherapy-based treatment resulted in improved BDFS compared with SD-EBRT (ASTRO definition, 5-year BDFS rate 88% +/- 5% versus 49% +/- 5%, P <0.01; Bolla definition, 88% +/- 8% versus 49% +/- 5%, P <0.01; Houston/Phoenix definition, 81% +/- 10% versus 64% +/- 5%, P = 0.01). SD-EBRT plus AD was superior to SD-EBRT alone using the Bolla definition (5-year BDFS 76% +/- 7% versus 49% +/- 5%, P <0.01) and the Houston/Phoenix definition (85% +/- 6% versus 64% +/- 5%, P = 0.01), but not using the ASTRO definition (P = 0.17). Multivariate analysis, including prostate-specific antigen, clinical stage, Gleason score, and year of treatment, demonstrated improved biochemical outcomes for brachytherapy-based treatment versus SD-EBRT (ASTRO, P <0.01; Bolla, P <0.01; and a trend toward significance with Houston/Phoenix, P = 0.07) and for the addition of AD to SD-EBRT (Bolla, P <0.01 and Houston/Phoenix, P = 0.03). The year of treatment trended toward significance (P = 0.077) on multivariate analysis using the ASTRO definition. CONCLUSIONS: For patients with intermediate-risk prostate cancer, brachytherapy-based treatment and the addition of AD to SD-EBRT resulted in improved biochemical outcomes compared with the outcomes with SD-EBRT alone; however, these findings were dependent on the definition of biochemical failure used. The year of treatment may be an important prognostic factor in intermediate-risk prostate cancer. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/17382161/Intermediate_risk_localized_prostate_cancer_in_the_PSA_era:_radiotherapeutic_alternatives_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(06)02639-2 DB - PRIME DP - Unbound Medicine ER -