Residual Prostate Cancer in Patients Treated With Endocrine Therapy With or Without Radical Radiotherapy: A Side Study of the SPCG-7 Randomized Trial
- Department of Oncology and Radiotherapy, St. Olav's Hospital, Trondheim University Hospital, Trondheim (Norway)
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (Norway)
- Department of Pathology and Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim (Norway)
- Department of Medical Biosciences/Pathology, Umea University Hospital, Umea (Sweden)
- Department of Urology, Stavanger University Hospital, Stavanger (Norway)
- Department of Urology, Malmoe University Hospital, UMAS (Sweden)
- Department of Radiation Sciences, Oncology, Umea University Hospital, Umea (Sweden)
- Department of Urology, St. Olav's Hospital, Trondheim University Hospital, Trondheim (Norway)
Purpose: The Scandinavian Prostate Cancer Group-7 randomized trial demonstrated a survival benefit of combined endocrine therapy and external-beam radiotherapy over endocrine therapy alone in patients with high-risk prostate cancer. In a subset of the study population, the incidence and clinical implications of residual prostate cancer in posttreatment prostate biopsy specimens was evaluated. Methods and Materials: Biopsy specimens were obtained from 120 of 875 men in the Scandinavian Prostate Cancer Group-7 study. Results: Biopsies were performed at median of 45 months follow-up. In 63 patients receiving endocrine treatment only and 57 patients receiving combined treatment, residual cancer was found in 66% (n = 41) and 22% (n = 12), respectively (p < 0.0001). The vast majority of residual tumors were poorly differentiated (Gleason score {>=}8). Endocrine therapy alone was predictive of residual prostate cancer: odds ratio 7.49 (3.18-17.7), p < 0.0001. In patients with positive vs. negative biopsy the incidences of clinical events were as follows: biochemical recurrence 74% vs. 27% (p < 0.0001), local progression 26% vs. 4.7% (p = 0.002), distant recurrence 17% vs. 9.4% (p = 0.27), clinical recurrence 36% vs. 13% (p = 0.006), cancer-specific death 19% vs. 9.7% (p = 0.025). In multivariable analysis, biochemical recurrence was significantly associated with residual cancer: hazard ratio 2.69 (1.45-4.99), p = 0.002, and endocrine therapy alone hazard ratio 3.45 (1.80-6.62), p < 0.0001. Conclusions: Radiotherapy combined with hormones improved local tumor control in comparison with endocrine therapy alone. Residual prostate cancer was significantly associated with serum prostate-specific antigen recurrence, local tumor progression, clinical recurrence, and cancer-specific death in univariable analysis. Residual cancer was predictive of prostate-specific antigen recurrence in multivariable analysis.
- OSTI ID:
- 21491736
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 80, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2010.01.072; PII: S0360-3016(10)00315-9; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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