Biochemical Outcome After Radical Prostatectomy, External Beam Radiation Therapy, or Interstitial Radiation Therapy for Clinically Localized Prostate Cancer

Abstract

Context.-Interstitial radiation (implant) therapy is used to treat clinically localized adenocarcinoma of the prostate, but how it compares with other treatments is not known. Objective.-To estimate control of prostate-specific antigen (PSA) after radical prostatectomy (RP), external beam radiation (RT), or implant with or without neoadjuvant androgen deprivation therapy in patients with clinically localized prostate cancer. Design.-Retrospective cohort study of outcome data compared using Cox regression multivariable analyses. Setting and Patients.-A total of 1872 men treated between January 1989 and October 1997 with an RP (n = 888) or implant with or without neoadjuvant androgen deprivation therapy (n = 218) at the Hospital of the University of Pennsylvania, Philadelphia, or RT (n = 766) at the Joint Center for Radiation Therapy, Boston, Mass, were enrolled. Main Outcome Measure.-Actuarial freedom from PSA failure (defined as PSA outcome). Results.-The relative risk (RR) of PSA failure in low-risk patients (stage T1c, T2a and PSA level Յ10 ng/mL and Gleason score Յ6) treated using RT, implant plus androgen deprivation therapy, or implant therapy was 1.1 (95% confidence interval [CI], 0.5-2.7), 0.5 (95% CI, 0.1-1.9), and 1.1 (95% CI, 0.3-3.6), respectively, compared with those patients treated with RP. The RRs of PSA failure in the intermediate-risk patients (stage T2b or Gleason score of 7 or PSA level Ͼ10 and Յ20 ng/mL) and high-risk patients (stage T2c or PSA level Ͼ20 ng/mL or Gleason score Ն8) treated with implant compared with RP were 3.1 (95% CI, 1.5-6.1) and 3.0 (95% CI, 1.8-5.0), respectively. The addition of androgen deprivation to implant therapy did not improve PSA outcome in high-risk patients but resulted in a PSA outcome that was not statistically different compared with the results obtained using RP or RT in intermediate-risk patients. These results were unchanged when patients were stratified using the traditional rankings of biopsy Gleason scores of 2 through 4 vs 5 through 6 vs 7 vs 8 through 10. Conclusions.-Low-risk patients had estimates of 5-year PSA outcome after treatment with RP, RT, or implant with or without neoadjuvant androgen deprivation that were not statistically different, whereas intermediate-and high-risk patients treated with RP or RT did better then those treated by implant. Prospective randomized trials are needed to verify these findings.

New variants at 10q26 and 15q21 are associated with aggressive prostate cancer in a genome-wide association study from a prostate biopsy screening cohort

“…Stage 1 consisted of a GWAS to identify novel SNPs. We restricted our GWAS analysis to patients diagnosed with intermediate to high risk prostate cancer for progression to metastasis defined by the D`Amico criteria 8 of prostate cancer risk in order to maximize the probability of finding clinically significant SNPs (rather than those associated with indolent forms of prostate cancer). Stage 2 consisted of a replication study among a separate cohort to determine whether the SNPs from Stage 1 could predict aggressive forms of prostate cancer among a prostate biopsy screening cohort who underwent a prostate biopsy.…”

“…In the first stage, 316 cases and 229 controls were genotyped using the Affymetrix 500K SNP array (443,816 SNPs). Cases were patients with aggressive forms of prostate cancer using the established D'Amico classification criteria, 8 and controls were biopsy proven normal patients. In the second stage, we genotyped positive SNPs found from stage 1 among 3439 patients who underwent prostate biopsy for prostate cancer screening.…”

“…This criteria combines Gleason Score grade, clinical stage and PSA level at diagnosis into risk group categories and is a well-established method of predicting prostate cancer mortality. 8 We chose one SNP to represent each of the two haplotype blocks (the one with the highest odds ratio for prostate cancer) resulting in three SNPs (rs11199874, rs10749408, and rs4775302). We combined the risk alleles from the three SNPs and compared the frequencies of patients with low, intermediate, high risk prostate cancer and with no cancer, by the number of risk alleles (Table 4).…”

Comparison of IPSA and HIPO inverse planning optimization algorithms for prostate HDR brachytherapy

“…Results of multicenter studies 5 , 6 , 7 , 8 have shown that brachytherapy delivered as monotherapy or concurrently with external beam radiotherapy yields biochemical control rates similar to other techniques, while showing the lowest rates of long‐term complications to the organs at risk (OAR) (9) . High‐dose‐rate (HDR) brachytherapy, performed with remote afterloaders, has also the additional advantage of potentially allowing dose escalation (10) without increasing considerably OAR toxicities or treatment times.…”

Validation of prostate‐specific antigen laboratory values recorded in Surveillance, Epidemiology, and End Results registries

“…Given the wide use of PSA as a component of risk group stratification schemas,17, 18 we further analyzed the impact of PSA value corrections on the recurrence risk categorization of patients with prostate cancer. Comparison of PSA values before and after corrections identified 418 patients (0.83% of the study cohort) who potentially could have been placed in a lower risk category before PSA corrections.…”