Adjuvant Radiotherapy for Pathologically Advanced Prostate Cancer

Thompson, Ian M.; Tangen, Catherine M.; Paradelo, Jorge C.; Lucia, M. Scott; Miller, Gary J.; Troyer, Dean A.; Messing, Edward M.; Forman, Jeffrey D.; Chin, Joseph L.; Swanson, Gregory P.; Canby-Hagino, Edith; Crawford, E. David

doi:10.1001/jama.296.19.2329

Cited by 853 publications

(608 citation statements)

References 19 publications

(23 reference statements)

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“…However, cases with aggressive pathology exhibit high rates of biochemical and clinical disease progression 1. Randomized controlled trials have demonstrated a progression‐free survival benefit for adjuvant radiotherapy (ART) for patients with aggressive pathology after radical prostatectomy, defined by extracapsular extension, seminal vesicle invasion, or a positive surgical margin 2, 3, 4. However, the impact of ART on overall survival is less clear.…”

Section: Introductionmentioning

confidence: 99%

Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

Gore

Plessis

Santiago-Jiménez

et al. 2017

Cancer

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BACKGROUNDPatients with prostate cancer and their providers face uncertainty as they consider adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) after undergoing radical prostatectomy. The authors prospectively evaluated the impact of the Decipher test, which predicts metastasis risk after radical prostatectomy, on decision making for ART and SRT.METHODSA total of 150 patients who were considering ART and 115 who were considering SRT were enrolled. Providers submitted a management recommendation before processing the Decipher test and again at the time of receipt of the test results. Patients completed validated surveys on prostate cancer (PCa)‐specific decisional effectiveness and PCa‐related anxiety.RESULTSBefore the Decipher test, observation was recommended for 89% of patients considering ART and 58% of patients considering SRT. After Decipher testing, 18% (95% confidence interval [95% CI], 12%‐25%) of treatment recommendations changed in the ART arm, including 31% among high‐risk patients; and 32% (95% CI, 24%‐42%) of management recommendations changed in the salvage arm, including 56% among high‐risk patients. Decisional Conflict Scale (DCS) scores were better after viewing Decipher test results (ART arm: median DCS before Decipher, 25 and after Decipher, 19 [P<.001]; SRT arm: median DCS before Decipher, 27 and after Decipher, 23 [P<.001]). PCa‐specific anxiety changed after Decipher testing; fear of PCa disease recurrence in the ART arm (P = .02) and PCa‐specific anxiety in the SRT arm (P = .05) decreased significantly among low‐risk patients. Decipher results reported per 5% increase in 5‐year metastasis probability were associated with the decision to pursue ART (odds ratio, 1.48; 95% CI, 1.19‐1.85) and SRT (odds ratio, 1.41; 95% CI, 1.09‐1.81) in multivariable logistic regression analysis.CONCLUSIONSKnowledge of Decipher test results was associated with treatment decision making and improved decisional effectiveness among men with PCa who were considering ART and SRT. Cancer 2017;123:2850–59. © 2017 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

Gore

Plessis

Santiago-Jiménez

et al. 2017

Cancer

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“…Although many men have relatively indolent disease amenable to active surveillance or definitive local monotherapy, others have more aggressive disease requiring multimodal treatment. Proper risk assessment to identify men at high risk for cancer recurrence, for whom additional treatment may be beneficial [2], is essential to help direct appropriate individualized management.…”

Section: Introductionmentioning

confidence: 99%

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

et al. 2014

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“…1 As such, margin status has been incorporated as a component of multiple prostate cancer outcome predictive models, 2,3 and as a criterion for enrollment in adjuvant therapy trials. 4,5 However, as surgical margin status has been linked to other clinicopathological features such as tumor stage, Gleason score, tumor volume and even year of surgery, 1,[6][7][8][9] the independent impact of margin status on patient outcome has been challenged. 10 In particular, the rate of postoperative disease recurrence for patients with a PSM has been reported as between 19 and 50%, reflecting a lack of consistency in the association of margin status with cancer progression.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

Boorjian

Tollefson

Rangel

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Although a positive surgical margin (PSM) at radical prostatectomy (RRP) has been consistently linked to an increased risk of biochemical recurrence, the impact of margin status on patient survival continues to be debated. We evaluated long-term outcomes of patients with a PSM at RRP and determined predictors of systemic progression (SP) and mortality in these men. METHODS:We reviewed our institutional registry of 16 749 patients who underwent RRP between 1990 and 2008 to identify 2895 patients with a PSM. Median follow-up was 10.6 years. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with SP and death from prostate cancer. RESULTS:A 15-year SP-free and cancer-specific survival was 90 and 93%, respectively. On multivariate analysis, higher tumor volume, increased pathological Gleason score and advanced pathological tumor stage were associated with significantly increased risks of SP and death from prostate cancer, whereas number and location of PSM did not predict mortality. CONCLUSIONS:The risks of SP and prostate cancer death in patients with a PSM remain low on long-term follow-up. Tumor variables are the primary determinants of cancer death. These results should be considered when evaluating patients with a PSM for adjuvant therapy.

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Adjuvant Radiotherapy for Pathologically Advanced Prostate Cancer

Cited by 853 publications

References 19 publications

Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

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