Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results from a Multi-institutional Consortium Study

Abstract

ClinicalTrials.gov, #NCT00223171), the aim of this analysis was to determine if testosterone level (TL) measured at the end of androgen deprivation therapy (ADT) could predict outcomes in intermediate risk (IR) and high risk (HR) prostate cancer patients treated with ADT and radiotherapy (RT). Materials/Methods: Between October 2000 and September 2010, 1030 patients with IR (400) and HR (630) prostate cancer were treated with a combination of RT and ADT. IR patients received short term ADT with Bicalutamide and Goserelin during 6 months and HR patients received either 36 or 18 months of ADT (Bicalutamide during the first month plus Goserelin for 36 vs. 18 months). TL was available in 796 patients (77%) at the end of ADT. Castration was defined as testosterone level below 1.7 nmol/L (<50 ng/dL). Patients were distributed within two castrate strata (lower stratum: testosterone <0.7 nmol/L and an upper stratum: testosterone between 0.7 and 1.7 nmol/L) or a non-castrate testosterone level (testosterone >1.7 nmol/L) and outcomes were compared between the 3 groups. Patient's characteristics were compared with ANOVA and Fisher's exact test. Rates of biochemical failure, prostate cancer progression, resistance to castration and death were estimated with Kaplan-Meier. Multivariate Cox regressions were used to model testosterone effect and to include risk level (IR vs HR) and unbalanced patient's characteristics as covariables. Results: Patient's characteristics (age, zubrod, PSA, stage, ADT duration) were well balanced between the 3 groups. At the end of ADT 50.8% (404/ 796) presented testosterone levels 0.7 nmol/L and 40.3% (321/796) levels of >0.7 and <1.7 nmol/L for a total of 91.1% (725/796) reaching castrate levels <1.7 nmol/L. In 8.9% of patients (71/796), a castrate testosterone level was not achieved. Duration of ADT and disease risk stratification had no bearing on testosterone castrate level at the end of ADT. With a median follow-up of 9.15 years (range: 7.15-11.15), outcomes are shown below: Conclusion: At the end of ADT, the majority of patients (91.1%) achieves a castrate level of testosterone <1.7 nmol/L regardless of ADT duration. There was no significant difference in outcomes between patients achieving a TL <0.7 nmol/L to those with TL between >0.7 and <1.7 nmol/L. Although not statistically significant, likely because of the small number of patients, a non-castrate testosterone level was associated with worse outcomes Our results do not support the idea that better outcomes are associated with testosterone below 0.7 nmol/L.

A comparison between high dose rate brachytherapy and stereotactic body radiotherapy boost after elective pelvic irradiation for high and very high-risk prostate cancer

“…These data corresponded to our previous findings of 78% of BRFS after HDRB of patients with high-risk prostate cancer [14]. On the other hand, the prospective multicenter trials and some retrospective reports pointed out that 5-year BRFS in mixed population of high and very high-risk prostate cancer patients varied from 47% to 67% [6,15,16]. Taking into account the predominance of very high-risk patients in both HDRB and SBRT boost groups of our study and considering that most of relapses were represented by generalization with bone and/or "out of fields" lymph node metastases, the presented rates of BRFS seem acceptable.…”

“…boost as it allows delivery of highest total equivalent dose (EQD 2 > 100 Gy) without a significant increase of radiation burden for normal tissues [5,6,8].…”

A multi-criteria optimization approach for HDR prostate brachytherapy: I. Pareto surface approximation

“…It consists in temporarily implanting a small radioactive source directly into or near the tumor (Nath et al 2016). Several studies have demonstrated an excellent therapeutic outcome for HDR brachytherapy in combination with external beam radiation therapy (EBRT), in particular for intermediate and high risk localized prostate cancer (Bachand et al 2009, Fatyga et al 2009, Sandler et al 2017 and for gynecologic cancer (Banerjee and Kamrava 2014).Treatment planning in radiation therapy directly affects patient treatment quality (Laberta 2017). The optim ized quantities in HDR brachytherapy is a set of dwell times and dwell positions necessary to achieve good ther apeutic results, i.e.…”

“…It consists in temporarily implanting a small radioactive source directly into or near the tumor (Nath et al 2016). Several studies have demonstrated an excellent therapeutic outcome for HDR brachytherapy in combination with external beam radiation therapy (EBRT), in particular for intermediate and high risk localized prostate cancer (Bachand et al 2009, Fatyga et al 2009, Sandler et al 2017 and for gynecologic cancer (Banerjee and Kamrava 2014).…”