Evaluation of biochemical recurrence in patients with high-risk prostate cancer treated with radical prostatectomy and radiotherapy plus androgen deprivation therapy

Abstract

ObjectiveThe aim of this study was to evaluate the biochemical recurrence (BCR) in patients with high-risk prostate cancer (PCa) treated with radical prostatectomy (RP) or radiotherapy (RT) plus androgen deprivation therapy (ADT).MethodsSubjects were patients with National Comprehensive Cancer Network-defined high-risk PCa treated with either RP or RT plus ADT. We calculated BCR-free survival in patients with those treatments and evaluated risk factor against BCR.ResultsA total of 114 patients, 71 RP and 43 RT plus ADT, were evaluated. A total of 59 and 20.9% of patients experienced BCR in the RP and RT treatment groups, respectively. The 5-year BCR-free survival probabilities improved significantly for patients who received RT compared to those who received RP (81.3 vs 37.3%, P<0.001). According to the number of risk factors, 59.2% of patients in the RP and 51.2% of patients in the RT treatment groups were classified with one risk factor (P<0.014). The 5-year BCR-free survival probabilities for patients treated with RP were 46.6 and 21.7% for one and multiple risk factors, respectively (P=0.008). On univariate analysis, only the number of risk factors had a significant impact on the risk of BCR. Meanwhile, there were no significant differences in the 5-year BCR-free survival probabilities between one and multiple risk factors in patients treated with RT.ConclusionAmong patients treated with RP, a marked heterogeneity existed in the oncological outcomes. Based on these findings, the number of risk factors should be emphasized to decide the optimal treatments for patients with high-risk PCa.

The role of radical prostatectomy and definitive external beam radiotherapy in combined treatment for high-risk prostate cancer: a systematic review and meta-analysis

“…Ten studies 15 16 17 19 21 22 24 25 27 28 provided data of EBRT modality, such as conventional EBRT, three dimensional conformal radiation therapy, and intensity modulated radiation therapy. Radiation dosage was only mentioned in 15 15 16 17 18 19 20 21 22 23 24 25 27 28 29 31 of 17 studies and mostly ranged from 60 to 80 gray (Gy, J kg −1 ). In addition, considerable variability was found in the use of adjuvant or salvage therapies, regardless of the modality or duration.…”

“…Of the 17 studies included, 16 were retrospective 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 and one was a RCT. 15 The RCT scored three out of five points (considered as high quality) according to the Jadad Scale.…”

“…Eight studies 16 17 18 20 21 25 27 30 with a total of 3701 patients were involved in the assessment. Meta-analysis showed that the patients might benefit from EBRT-based treatment with a lower risk of biochemical failure ( Figure 2a ).…”

Comparison on efficacy of radical prostatectomy versus external beam radiotherapy for the treatment of localized prostate cancer

“…Among the 12 studies, patients of four cohorts [ 11 – 14 ] were treated with 3DCRT or RP, three studies [ 4 , 15 , 16 ] provided eligible data limited to IMRT, and other articles [ 17 – 21 ] contained both 3DCRT and IMRT. The radiation dose ranged from 70 Gy to 86.4 Gy, and patients treated with EBRT were mostly older than those who received RP.…”

“…Treatment-related toxicity should also be assessed. Among the included articles, two studies [ 15 , 21 ] reported the adverse events of EBRT, which mostly consisted of diarrhea, anal pain and urinary frequency. Another studies [ 13 ] compared the health-related quality of life and functional outcomes of patients treated with RP or EBRT.…”