Definition and Validation of “Favorable High-Risk Prostate Cancer”: Implications for Personalizing Treatment of Radiation-Managed Patients

Journal Article · Sun Nov 15 04:00:00 EST 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.07.2281· OSTI ID:22645007

Muralidhar, Vinayak ^[1]; Chen, Ming-Hui ^[2]; Reznor, Gally ^[3]; Moran, Brian J.; Braccioforte, Michelle H. ^[4]; Beard, Clair J. ^[5]; Feng, Felix Y. ^[6]; Hoffman, Karen E. ^[7]; Choueiri, Toni K. ^[8]; Martin, Neil E. ^[5]; Sweeney, Christopher J. ^[8]; Trinh, Quoc-Dien ^[9]

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1. Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts (United States)
2. Department of Statistics, University of Connecticut, Storrs, Connecticut (United States)
3. Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)
4. Prostate Cancer Foundation of Chicago, Westmont, Illinois (United States)
5. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts (United States)
6. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)
7. Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, Texas (United States)
8. Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (United States)
9. Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts (United States)

Purpose: To define and validate a classification of favorable high-risk prostate cancer that could be used to personalize therapy, given that consensus guidelines recommend similar treatments for all radiation-managed patients with high-risk disease. Methods and Materials: We studied 3618 patients with cT1-T3aN0M0 high-risk or unfavorable intermediate-risk prostate adenocarcinoma treated with radiation at a single institution between 1997 and 2013. Favorable high-risk was defined as T1c disease with either Gleason 4 + 4 = 8 and prostate-specific antigen <10 ng/mL or Gleason 6 and prostate-specific antigen >20 ng/mL. Competing risks regression was used to determine differences in the risk of prostate cancer–specific mortality (PCSM) after controlling for baseline factors and treatment. Our results were validated in a cohort of 13,275 patients using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Results: Patients with favorable high-risk disease had significantly better PCSM than other men with high-risk disease (adjusted hazard ratio [AHR] 0.42, 95% confidence interval [CI] 0.18-0.996, P=.049) and similar PCSM as men with unfavorable intermediate-risk disease (AHR 1.17, 95% CI 0.50-2.75, P=.710). We observed very similar results within the SEER-Medicare cohort (favorable high-risk vs other high-risk: AHR 0.21, 95% CI 0.11-0.41, P<.001; favorable high-risk vs unfavorable intermediate-risk: AHR 0.67, 95% CI 0.33-1.36, P=.268). Conclusions: Patients with favorable high-risk prostate cancer have significantly better PCSM than other patients with high-risk disease and similar PCSM as those with unfavorable intermediate-risk disease, who are typically treated with shorter-course androgen deprivation therapy. This new classification system may allow for personalization of treatment within high-risk disease, such as consideration of shorter-course androgen deprivation therapy for favorable high-risk disease.

• OSTI ID: 22645007
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 93; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
NEOPLASMS
PATIENTS
PROSTATE
RADIOTHERAPY
VALIDATION