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Title: Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam

Abstract

Purpose: To determine cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in high-risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and July 2002, 204 patients with high-risk prostate cancer (Gleason score {>=}8 or prostate-specific antigen [PSA] >20 ng/mL or clinical stage {>=}T2c) underwent brachytherapy. Median follow-up was 7.0 years. The bPFS was defined by a PSA {<=}0.40 ng/mL after nadir. Multiple clinical, treatment, and dosimetric parameters were evaluated for the impact on survival. Results: The 10-year CSS, bPFS, and OS were 88.9%, 86.6%, and 68.6%, respectively. A statistically significant difference in bPFS was discerned between hormone naive, ADT {<=}6 months, and ADT >6 month cohorts (79.7% vs. 95.% vs. 89.9%, p = 0.032). Androgen deprivation therapy (ADT) did not impact CSS or OS. For bPFS patients, the median posttreatment PSA was <0.04 ng/mL. A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS, whereas percent positive biopsies and duration of ADT best predicted for bPFS. The OS was best predicted by Gleason score and diabetes. Thirty-eight patients have died, with 26 of the deaths from cardiovascular/pulmonary disease or second malignancy. Eleven patients havemore » died of metastatic prostate cancer. Conclusions: The ADT improved 10-year bPFS without statistical impact on CSS or OS. Death as a result of cardiovascular/pulmonary disease and second malignancies were more than twice as common as prostate cancer deaths. Strategies to improve cardiovascular health should positively impact OS.« less

Authors:
 [1];  [2];  [3];  [2];  [4];  [2];  [5];  [2]
  1. Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States). E-mail: gmerrick@urologicresearchinstitute.org
  2. Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)
  3. Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States)
  4. (United States)
  5. Department of Pathology, Wheeling Hospital, Wheeling, WV (United States)
Publication Date:
OSTI Identifier:
20951612
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.11.046; PII: S0360-3016(06)03606-6; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANDROGENS; ANTIGENS; BEAMS; BIOPSY; BRACHYTHERAPY; CARCINOMAS; DEATH; HEALTH HAZARDS; METASTASES; PATIENTS; PROSTATE; REGRESSION ANALYSIS

Citation Formats

Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Galbreath, Robert W., Ohio University Eastern, St. Clairsville, OH, Allen, Zachariah A., Adamovich, Edward, and Lief, Jonathan. Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.11.046.
Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Galbreath, Robert W., Ohio University Eastern, St. Clairsville, OH, Allen, Zachariah A., Adamovich, Edward, & Lief, Jonathan. Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam. United States. doi:10.1016/j.ijrobp.2006.11.046.
Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Galbreath, Robert W., Ohio University Eastern, St. Clairsville, OH, Allen, Zachariah A., Adamovich, Edward, and Lief, Jonathan. Tue . "Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam". United States. doi:10.1016/j.ijrobp.2006.11.046.
@article{osti_20951612,
title = {Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam},
author = {Merrick, Gregory S. and Butler, Wayne M. and Wallner, Kent E. and Galbreath, Robert W. and Ohio University Eastern, St. Clairsville, OH and Allen, Zachariah A. and Adamovich, Edward and Lief, Jonathan},
abstractNote = {Purpose: To determine cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in high-risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and July 2002, 204 patients with high-risk prostate cancer (Gleason score {>=}8 or prostate-specific antigen [PSA] >20 ng/mL or clinical stage {>=}T2c) underwent brachytherapy. Median follow-up was 7.0 years. The bPFS was defined by a PSA {<=}0.40 ng/mL after nadir. Multiple clinical, treatment, and dosimetric parameters were evaluated for the impact on survival. Results: The 10-year CSS, bPFS, and OS were 88.9%, 86.6%, and 68.6%, respectively. A statistically significant difference in bPFS was discerned between hormone naive, ADT {<=}6 months, and ADT >6 month cohorts (79.7% vs. 95.% vs. 89.9%, p = 0.032). Androgen deprivation therapy (ADT) did not impact CSS or OS. For bPFS patients, the median posttreatment PSA was <0.04 ng/mL. A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS, whereas percent positive biopsies and duration of ADT best predicted for bPFS. The OS was best predicted by Gleason score and diabetes. Thirty-eight patients have died, with 26 of the deaths from cardiovascular/pulmonary disease or second malignancy. Eleven patients have died of metastatic prostate cancer. Conclusions: The ADT improved 10-year bPFS without statistical impact on CSS or OS. Death as a result of cardiovascular/pulmonary disease and second malignancies were more than twice as common as prostate cancer deaths. Strategies to improve cardiovascular health should positively impact OS.},
doi = {10.1016/j.ijrobp.2006.11.046},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 68,
place = {United States},
year = {Tue May 01 00:00:00 EDT 2007},
month = {Tue May 01 00:00:00 EDT 2007}
}