Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up

Merino, Tomás; Francisco, Ignacio F. San; Rojas, Pablo A.; Bettoli, Piero; Zúñiga, Álvaro; Besa, Pablo

doi:10.1186/1471-2407-13-530

Cited by 46 publications

(33 citation statements)

References 24 publications

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“…Our results show that the radical radiotherapy treatment results of early prostate cancer are excellent. Overall the 5year OS (88.9%), PCSS (97.9%), MFS (94.8%) and BRFS (88.7%) were similar or better compared with the figures reported in other studies [12][13][14][15][16][17][18]. In recent years, there have been some large high-quality population-based studies that have demonstrated an association between increased overall mortality and comorbidity [19][20][21].…”

Section: Discussionsupporting

confidence: 65%

Both comorbidity and worse performance status are associated with poorer overall survival after external beam radiotherapy for prostate cancer

et al. 2020

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Background: In this retrospective study, we evaluated the biochemical recurrence rate, metastatic disease progression, and prostate cancer-specific and overall survival in patients curatively treated with external beam radiotherapy (EBRT) for early prostate cancer (PC). We also examined the prognostic effect of comorbidity by Charlson Comorbidity Index (CCI) and overall performance status by Eastern Clinical Oncology Group (ECOG) score. Methods: A total of 665 men treated between 2008 and 2013 were enrolled from Tampere University Hospital, Finland. Prostate-specific antigen (PSA) tests and hospital records were used to determine the 5-year survival for each aforementioned endpoint using a Kaplan-Meyer estimate. To analyze the impact of the selected prognostic factor, we used a Cox regression model to calculate the corresponding hazard ratio (HR) and 95% confidence interval (CI). Results: With a median follow-up-time of 7.12 years, the 5-year overall survival (OS) after EBRT was 88.9% [86.5 -91.3%], prostate cancer-specific survival (PCSS) was 97.9% [96.7 -99.1%], metastasis-free survival (MFS) 94.8% [93.0 -96.6%] and biochemical recurrence-free survival (BRFS) 88.7% [86.2 -91.2%]. Both CCI (HR = 1.38, [1.25-1.51]) and ECOG score (HR = 1.63, [1.29-2.05]) declined OS, as well as Gleason score and T score (P < 0.05). Gleason score and T grade also associated to worse PCSS, MFS and BRFS.Conclusions: CCI and ECOG score are useful tools in evaluating the overall life expectancy of the patient after EBRT for PC. T-stage and Gleason score remain still the major prognostic factors. BackgroundProstate cancer (PC) is the most common cancer among men in developed countries worldwide. In Finland, 5162 new cases were reported in 2016 [1]. PC primarily affects older males, with a peak incidence in men over 65 years [2] and it accounted for 13.3% of all cancer-related deaths among men in 2016 [3]. With earlier diagnostics in the PSA (prostate-specific antigen) era and advancements in treatment options, the prognosis has steadily improved in the past 15 years. The most recent register data reported a 5-year survival rate as high as 93% in the entire country [4].External beam radiotherapy (EBRT) is one of the most common treatments of early PC and is often combined with androgen deprivation therapy (ADT) for patients with intermediate and high-risk disease. For localized disease, radical prostatectomy is also a viable option, especially for younger patients with few comorbidities. Other treatment options include brachytherapy, active and passive surveillance and ADT [5,6].

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Section: Discussionsupporting

confidence: 65%

Both comorbidity and worse performance status are associated with poorer overall survival after external beam radiotherapy for prostate cancer

et al. 2020

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“…Thus again, our data substantially indicate that SC in patients with RT only is related to a strong selection bias rather than indicating a real risk of SC after RT. Mainly patients being not fit for surgery will be selected for RT with smoking related disorders and age being major reasons [30, 36]. …”

Section: Discussionmentioning

confidence: 99%

Risk of second cancer following radiotherapy for prostate cancer: a population-based analysis

Hegemann¹,

Schlesinger-Raab²,

Ganswindt³

et al. 2017

Radiat Oncol

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BackgroundTo investigate the risk of second cancer and radiation induced second cancer following prostate cancer radiotherapy.MethodsWe compared men with radiotherapy only with those treated with radical prostatectomy only and those with radiotherapy after radical prostatectomy. Cumulative incidences of second cancers were calculated. Cox analyses were performed to identify determinants influencing second cancer incidence.ResultsNineteen thousand five hundred thirty eight patients were analyzed. Age and median follow-up differed significantly with radiotherapy only patients having the highest median age (70.3 years) and radical prostatectomy only patients the longest median follow-up (10.2 years). Ten-year cumulative incidence of second cancer was 15.9%, 13.2% and 10.5% for patients with radiotherapy only, radiotherapy after radical prostatectomy and radical prostatectomy only (p <0.0001). Increasing age and belonging to the radiotherapy only group were associated with a higher risk of second cancer—no significant increase was seen in radiotherapy after radical prostatectomy patients. A significantly higher rate of smoking related malignancies, like lung, bladder and non-melanoma skin cancer, was seen in radiotherapy only patients.ConclusionsNo clear increase in radiation induced second cancer was found in patients after radiotherapy for prostate cancer. Whereas the rate of second cancer was increased in radiotherapy only patients, no such increase was seen in patients with radiotherapy after radical prostatectomy. The increase of second cancer following radiotherapy only is highly likely to reflect advanced age and lifestyle habits and comorbidities.

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“…Table 4 summarizes the PCSM rates for patients with highrisk PC from previous reports. (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(38)(39)(40) The 10-year PCSM rates after RP and EBRT including IMRT were 5-9% (7-11) and 8-12%, (13,39) respectively. The PCSM rate after CIRT (Figs S1 and S2).…”

Section: Discussionmentioning

confidence: 99%

“…(6) In contrast, favorable treatment outcomes after RP have been demonstrated, (7)(8)(9)(10)(11) and the superiority of RP compared with EBRT, including intensity modulated RT (IMRT) with or without ADT, has been suggested by several authors. (12)(13)(14)(15)(16) In addition, high-dose or low-dose-rate brachytherapy combined with EBRT plus ADT is sometimes selected for patients with high-risk PC. (17,18) However, to the best of our knowledge, the best treatment for high-risk PC is still unknown, because no adequate comparisons of treatment modalities for high-risk PC have been performed.The National Institute of Radiological Science (NIRS) started carbon-ion RT (CIRT) for localized PC in 1995.…”

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confidence: 99%

Cancer‐specific mortality of high‐risk prostate cancer after carbon‐ion radiotherapy plus long‐term androgen deprivation therapy

et al. 2017

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The treatment outcomes of patients with high‐risk localized prostate cancer (PC) after carbon‐ion radiotherapy (CIRT) combined with long‐term androgen deprivation therapy (LTADT) were analyzed, and compared with those of other treatment modalities, focusing on PC‐specific mortality (PCSM). A total of 1247 patients were enrolled in three phase II clinical trials of fixed‐dose CIRT between 2000 and 2013. Excluding patients with T4 disease, 608 patients with high‐risk or very‐high‐risk PC, according to the National Comprehensive Cancer Network classification system, who received CIRT with LTADT were evaluated. The median follow‐up time was 88.4 months, and the 5‐/10‐year PCSM rates were 1.5%/4.3%, respectively. T3b disease, Gleason score of 9–10 and percentage of positive biopsy cores >75% were associated with significantly higher PCSM on univariate and multivariate analyses. The 10‐year PCSM rates of patients having all three (n = 16), two (n = 74) or one of these risk factors (n = 217) were 27.1, 11.6 and 5.7%, respectively. Of the 301 patients with none of these factors, only 1 PCSM occurred over the 10‐year follow‐up (10‐year PCSM rate, 0.3%), and significant differences were observed among the four stratified groups (P <0.001). CIRT combined with LTADT yielded relatively favorable treatment outcomes in patients with high‐risk PC and very favorable results in patients without any of the three abovementioned factors for PCSM. Because a significant difference in PCSM among the high‐risk PC patient groups was observed, new categorization and treatment intensity adjustment may be required for high‐risk PC patients treated with CIRT.

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Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up

Cited by 46 publications

References 24 publications

Both comorbidity and worse performance status are associated with poorer overall survival after external beam radiotherapy for prostate cancer

Both comorbidity and worse performance status are associated with poorer overall survival after external beam radiotherapy for prostate cancer

Risk of second cancer following radiotherapy for prostate cancer: a population-based analysis

Cancer‐specific mortality of high‐risk prostate cancer after carbon‐ion radiotherapy plus long‐term androgen deprivation therapy

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