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Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer

Abstract

Purpose: The response of patients with clinical stages T1-4 prostate cancer to radiotherapy is variable. A particularly poor prognostic group has been found to be comprised of those with pretreatment prostate specific antigen (PSA) levels above 30 ng/ml with any tumor grade, or PSA levels > 10 and {<=} 30 with tumors grade 3 or 4. These patients have over an 80% actuarial risk of biochemical failure 3 years after definitive external beam radiotherapy. Thus, patients with these high-risk features require more aggressive therapy. During the last 3-4 years, the policy to treat such patients with radiotherapy and androgen ablation (XRT/HORM) was instituted. A retrospective comparison was made between high-risk patients treated with radiotherapy alone (XRT) vs. XRT/HORM. Methods and Materials: Between 1987 and 1991, there were 81 high-risk patients treated with XRT. There were 38 high-risk patients treated with XRT/HORM between 1990 and 1992. The median follow-up was 37 months for the XRT group and 22 months for the XRT/HORM group. No patient had clinical, radiographic, or pathologic evidence of lymph node involvement. The median dose to the prostate was 66 Gy for the XRT group and 68 Gy for the XRT/HORM group. Results: The distributions of several potential  More>>
Publication Date:
Apr 30, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 1; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 30 Apr 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANDROGENS; CHEMOTHERAPY; COMBINED THERAPY; NEOPLASMS; PROSTATE; RADIOTHERAPY; SURVIVAL CURVES
OSTI ID:
20391087
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1509057434
Submitting Site:
INIS
Size:
page(s) 13-20
Announcement Date:

Citation Formats

Pollack, Alan, Zagars, Gunar K, and Kopplin, Susan. Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer. United States: N. p., 1995. Web. doi:10.1016/0360-3016(94)00450-Y.
Pollack, Alan, Zagars, Gunar K, & Kopplin, Susan. Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer. United States. doi:10.1016/0360-3016(94)00450-Y.
Pollack, Alan, Zagars, Gunar K, and Kopplin, Susan. 1995. "Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer." United States. doi:10.1016/0360-3016(94)00450-Y. https://www.osti.gov/servlets/purl/10.1016/0360-3016(94)00450-Y.
@misc{etde_20391087,
title = {Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer}
author = {Pollack, Alan, Zagars, Gunar K, and Kopplin, Susan}
abstractNote = {Purpose: The response of patients with clinical stages T1-4 prostate cancer to radiotherapy is variable. A particularly poor prognostic group has been found to be comprised of those with pretreatment prostate specific antigen (PSA) levels above 30 ng/ml with any tumor grade, or PSA levels > 10 and {<=} 30 with tumors grade 3 or 4. These patients have over an 80% actuarial risk of biochemical failure 3 years after definitive external beam radiotherapy. Thus, patients with these high-risk features require more aggressive therapy. During the last 3-4 years, the policy to treat such patients with radiotherapy and androgen ablation (XRT/HORM) was instituted. A retrospective comparison was made between high-risk patients treated with radiotherapy alone (XRT) vs. XRT/HORM. Methods and Materials: Between 1987 and 1991, there were 81 high-risk patients treated with XRT. There were 38 high-risk patients treated with XRT/HORM between 1990 and 1992. The median follow-up was 37 months for the XRT group and 22 months for the XRT/HORM group. No patient had clinical, radiographic, or pathologic evidence of lymph node involvement. The median dose to the prostate was 66 Gy for the XRT group and 68 Gy for the XRT/HORM group. Results: The distributions of several potential prognostic factors were analyzed. Significant differences between the groups were observed for tumor grade, pretreatment prostatic acid phosphatase, and age. The XRT/HORM group was composed of patients with worse features, including a greater proportion of patients with grade 4 tumors, more with abnormal acid phosphatase levels, and more under 60 years of age. The actuarial incidence of a rising PSA at 3 years for the XRT group was 81% vs. 15% for the XRT/HORM group (p < 0.0001). In addition, local relapse at 3 years was 34% for the XRT group and 15% for the XRT/HORM group (p < 0.02). There was no difference between the groups in terms of survival. Cox proportional hazards analyses were performed using several disease end points, including a rising PSA, a rising PSA or disease relapse, any disease relapse, and local relapse, and the only prognostic factor of independent predictive value was treatment group, i.e., XRT vs. XRT/HORM. Conclusions: Based on biochemical and disease relapse end points, definitive radiotherapy is insufficient treatment for high-risk prostate cancer patients. The addition of androgen ablation significantly reduces the recurrence rates, although longer follow-up is needed to determine if the combined treatment impacts significantly on survival.}
doi = {10.1016/0360-3016(94)00450-Y}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {1}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Apr}
}