Posted 6/23/2011 6:47 PM (GMT -7)
Hi K2, - Following are a few Study Abstracts comparing ART to SRT results. - John@newPCa (aka) az4peaks
A multi-institutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy
• Tom Budiharto , Christiaan Perneel, Karin Haustermans, Sara Junius, Bertrand Tombal, Pierre Scalliet, Laurette Renard, Evelyne Lerut, Kris Vekemans, Steven Joniau, Hendrik Van Poppel
Received 7 January 2010; received in revised form 7 July 2010; accepted 7 July 2010. published online 15 October 2010.
Background and purpose
In men with adverse pathology at the time of radical prostatectomy (RP), the most appropriate timing to administer radiotherapy (RT) remains a subject for debate. To determine whether salvage radiotherapy (SRT) upon early prostate-specific antigen (PSA) relapse is equivalent to immediate adjuvant radiotherapy (ART) post RP.
Material and methods
130 patients receiving ART and 89 receiving SRT were identified. All had an undetectable PSA after RP. Homogeneous subgroups were built based on the status (±) of lymphatic invasion (LVI) and surgical margins (SM), to allow a comparison of ART and SRT. Biochemical disease-free survival (bDFS) was calculated from the date of surgery and from the end of RT. The multivariate analysis was performed using the Cox Proportional hazard model.
In the SM−/LVI− and SM+/LVI− groups, SRT was a significant predictor of a decreased bDFS from the date of surgery, while in the SM+/LVI+ group, there was a trend towards significance. From the end of RT, SRT was also a significant predictor of a decreased bDFS in three patient groups: SM−/LVI−, SM+/LVI− and SM+/LVI+. Gleason score >7 showed to be another factor on multivariate analysis associated with decreased bDFS in the SM−/LVI− group, from the date of surgery and end of RT. Preoperative PSA was a significant predictor in the SM−/LVI− group from the date of RP only.
Immediate ART post RP for patients with high risk features in the prostatectomy specimen significantly reduces bDFS after RP compared with early SRT upon PSA relapse.
Disease-specific survival outcomes in lymph node-positive patients with prostate cancer treated with radiotherapy.
J Clin Oncol 29: 2011 (suppl 7; abstr 182)
G. Crehange, V. K. Weinberg, A. Izaguirre, C. C. Hsu, I. J. Hsu, A. R. Gottschalk, K. Shinohara, P. Carroll, M. Roach III; Radiation Oncology, University of California, San Francisco, San Francisco, CA; University of California, San Francisco, San Francisco, CA
Background: Involvement of regional lymph nodes (LN+) at the time of prostate cancer (PCa) diagnosis is widely regarded as an adverse prognostic factor associated with poor outcome. No commonly utilized treatment, composed of any combination of androgen ablation, surgery and radiation, has proven to be superior for survival. This study will evaluate the clinical survival outcomes of patients (pts) with newly diagnosed LN+ PCa at the University of California San Francisco (UCSF). Methods: All newly diagnosed LN+ PCa pts treated with External Beam Radiation Therapy (EBRT) as primary therapy or after surgery, each with and without androgen ablation between 1987 and 2009 were included. All pts had confirmed pathologic or radiologic LN+ whereas none had evidence of metastases on the work up. Cause Specific Survival (CSS), Disease Free survival (DFS) and biochemical control were measured from the start of treatment. PSA failure was determined by the Phoenix definition after EBRT and by a confirmed PSA >1 ng/mL following RP+EBRT. Results: A retrospective analysis identified 91 pts with LN+ at the time of diagnosis (75.8% high risk pts) with disease follow-up. Thirty-four (37%) were managed with exclusive EBRT alone (eRT), 18 pts (20%) with a combination of radical prostatectomy (RP) and adjuvant EBRT (RP+aRT) and 39 pts (43%) were treated with a combination of RP + salvage RT (RP+sRT). Overall 78% of patients also received hormone therapy (HT): 74.0% with eRT, 89% with RP+aRT and 79% with RP+sRT. The 10 years CSS estimates was 89% for eRT, 0% after RP+aRT and 88% after RP+sRT. The 10 years DFS estimates was 33% for eRT, 0% after RP+aRT and 75% after RP+sRT. Among pts remaining disease free the median follow-up is 38 mos for eRT, 26 mos for RP+aRT and 64 mos for RP+sRT. The last PSA for these patients was <0.1 for 85% of all patients which included 47% following eRT, 100% after RP+aRT and 97% after RP+sRT. There were 7 deaths due to PCa occurring between 5 and 73 mos from the start of EBRT.
Conclusions: The results of the current analysis indicate that some pts with LN+ from PCa have prolonged disease free outcomes; and for these men, aggressive treatment may be appropriate.
Monday, May 16, 2011 8:00 AM-10:00 AM
Prostate Cancer: Advanced Moderated Poster Source of Funding: none 706: ADJUVANT RADIOTHERAPY LEADS TO SUPERIOR BIOCHEMICAL RECURRENCE FREE SURVIVAL COMPARED TO EARLY SALVAGE RADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED PROSTATE CANCER: RESULTS OF A MATCHED-CONTROLLED MULTI-INSTITUTIONAL ANALYSIS.
Tom Budiharto Steven Joniau Umberto Capitanio Cesare Cozzarini Karin Haustermans Bertrand Tombal Nadia Di Muzio Patrizio Rigatti Francesco Montorsi Hein Van Poppel Milan, Italy
INTRODUCTION AND OBJECTIVES: Prospective randomized trials have shown a significant benefit of adjuvant RT (aRT) in presence of positive surgical margins (SM) or locally advanced prostate cancer (PCa). This analysis aimed at comparing the effect of aRT vs early salvage RT (eSRT) on biochemical recurrence (BCR) free survival in a large multi-institutional cohort of men undergoing radical prostatectomy (RP), pelvic lymph node dissection and subsequent aRT or eSRT METHODS: In a study population of 515 patients treated with RP and either aRT or eSRT at three tertiary care centres, 420 pT2-4 R0-R1 pN0 patients (81.5%) who received either immediate aRT with undetectable PSA after surgery (n=313, 74.5%) or eSRT (defined as RT administered with a PSA value
Mean follow-up was 78.5 months (median 76.7; range: 4.8- 188 months). In the overall patient population (n=515), 2, 5 and 8-years BCR free survival rates were 95.4, 84.7 and 78.1%, and 88, 65.4 and 44.6% in patients treated with aRT and sRT, respectively (p
This study demonstrated that eSRT has a detrimental effect on BCR free survival as compared to aRT
Urology. 2008 Dec;72(6):1298-302; discussion 1302-4. Epub 2008 Jul 30.
A multi-institutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer.
Trabulsi EJ, Valicenti RK, Hanlon AL, Pisansky TM, Sandler HM, Kuban DA, Catton CN, Michalski JM, Zelefsky MJ, Kupelian PA, Lin DW, Anscher MS, Slawin KM, Roehrborn CG, Forman JD, Liauw SL, Kestin LL, DeWeese TL, Scardino PT, Stephenson AJ, Pollack A.
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure.
Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery.
A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, SRT and Gleason score >or=8 were independent predictors of diminished FFBF. From the date of surgery, Gleason score >or=8 was a significant predictor of FFBF.
Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score >or=8 was the only factor on multivariate analysis associated with metastasic progression.
PMID: 18672274 [PubMed - indexed for MEDLINE]