Long-term outcome of patients with prostate cancer and pathologic seminal vesicle invasion (pT3b): effect of adjuvant radiotherapy

Lee, Heather M; Solan, Merrill J.; Lupinacci, Paul; Gomella, Leonard G.; Valicenti, Richard K.

doi:10.1016/j.urology.2004.02.004

Cited by 35 publications

(24 citation statements)

References 25 publications

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“…Unfortunately, the numbers are very small and in some cases, seminal vesicle positive patients are a small part of a larger retrospective study. In two representative studies, adjuvant radiation reduced the five year biochemical failure rate from 92% to 20% (7) and 82% to 40% (8). On the contrary, another study (5) showed that those that received adjuvant radiation did worse (58% 4 year biochemical failure rate) than those that didn't (48% 4 year biochemical failure rate), although they acknowledged that there may have been some selection biases.…”

Section: Discussionmentioning

confidence: 99%

“…More contemporary studies with earlier diagnosed patients suggest the risk may not be so dire. (5,6) In addition, adjuvant radiation has been used in these patients, and on retrospective reviews, the results have been mixed, with some studies suggesting there might be a benefit (7,8), while others suggesting there is none (6). Therefore, there are two issues that need more clarification: the exact detriment to having pathologically positive seminal vesicles and whether adjuvant radiation benefits those patients.…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794

et al. 2008

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Purpose From the randomized study SWOG 8794, we evaluated the effect of seminal vesicle involvement on outcomes and whether those patients benefited from post prostatectomy adjuvant radiation therapy. Materials and Methods SWOG 8794 randomized high risk (SV+ and/or capsular penetration and/or positive margins) post prostatectomy patients to radiation versus observation. 431 subjects with pathologically-advanced prostate cancer were randomized Results Median follow up is 12.2 years. A total of 139 patients had involved seminal vesicles with or without other risk factors. Compared to SV negative patients, survival was marginally worse for these patients (10 year overall survival 61% versus 74%). For all (radiated and observed) the SV negative patients, 5 and 10 year biochemical failure free survival (bffs) was 56% and 33%, respectively. For SV positive patients, it was 49% and 22%, respectively. The numbers for both groups were better if they received adjuvant radiation. (SV negative patients 68% and 39% and SV positive 62% and 36% 5 and 10 year bffs, respectively). Noteworthy is the administration of radiation negated the negative prognostic effect of positive seminal vesicles. Radiated patients were less likely to require subsequent androgen ablation (p=.01). Conclusions Although seminal vesicle involvement is a negative prognostic factor, long term control is possible, especially if patients are given adjuvant radiation therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794

et al. 2008

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“…A range of definitions exist in the literature concerning what is meant by poor-prognosis non-metastatic prostate cancer. [27][28][29][30][31][32] However, for the purposes of this review, we have only examined findings from randomized clinical studies that enrolled patients meeting a set of conservative and well-substantiated prognostic criteria (Table 1). Patients with non-metastatic disease who meet the following criteria clearly have a poor prognosis: cN12, cM0 and either Gleason scoreX8; or PSA level X20 ng/ ml; or stage cT3/4; or adverse pathologic features, that is, pT3b/pT4 or dominant Gleason grade pattern 4.…”

Section: Challenging the Historical Paradigm Of Androgen Deprivation mentioning

confidence: 99%

Adjuvant androgen deprivation therapy augments cure and long-term cancer control in men with poor prognosis, nonmetastatic prostate cancer

Fleshner

Keane

Lawton

et al. 2007

Prostate Cancer Prostatic Dis

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Historically, adjuvant androgen deprivation therapy has been viewed as a palliative treatment option for patients with poor-prognosis non-metastatic prostate cancer. In addition, guidelines from bodies such as the European Association of Urology and American Society for Clinical Oncology do not specifically categorize adjuvant hormonal therapy as being curative in intent. We propose that adjuvant androgen deprivation therapy should now be classified as a treatment of curative intent in patients with poor-prognosis, non-metastatic prostate cancer. By applying a carefully considered definition of cure (based on long-term (10-to 15-year) disease-free survival curves) to the findings from randomized controlled clinical trials that have studied adjuvant hormonal treatments in nonmetastatic prostate cancer, we challenged whether this viewpoint should now be considered redundant. According to our review of relevant studies and our definition of cure, goserelin appears to augment cure in a sizeable proportion of men with poor-prognosis non-metastatic prostate cancer when given adjuvant to radical prostatectomy or radiotherapy. Across several trials, the relevant survival curves for the goserelin-treated population became indefinitely flat after long-term followup. This indicates that these patients have a mortality risk comparable to the general population without prostate cancer. On the basis of the evidence presented within this review, we believe that, given it can control disease for a long period of time, adjuvant goserelin should be reclassified as a treatment of curative intent for patients with poor-prognosis non-metastatic prostate cancer.

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“…A direct comparison evidence of adjuvant and salvage RT is difficult to find due to the numerous confusing factors [2]. Although several studies comparing ART and SRT have been reported, most are small series with unclear results [10], [11], [12], [13], [14], [15]. The appropriate timing of postoperative RT, either early in the adjuvant setting, or after PSA recurrence in the salvage setting, remains unclear [16], [17].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant and Salvage Radiotherapy after Prostatectomy: A Systematic Review and Meta-Analysis

et al. 2014

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PurposeIn men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).Materials and MethodsWe comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT.ResultsBetween May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30–0.46; p<0.00001, I2 = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28–0.52; p<0.00001, I2 = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41–0.68; p<0.00001, I2 = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43–0.66; p<0.00001, I2 = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis.ConclusionART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.

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Long-term outcome of patients with prostate cancer and pathologic seminal vesicle invasion (pT3b): effect of adjuvant radiotherapy

Cited by 35 publications

References 25 publications

The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794

The Prognostic Impact of Seminal Vesicle Involvement Found at Prostatectomy and the Effects of Adjuvant Radiation: Data From Southwest Oncology Group 8794

Adjuvant androgen deprivation therapy augments cure and long-term cancer control in men with poor prognosis, nonmetastatic prostate cancer

Adjuvant and Salvage Radiotherapy after Prostatectomy: A Systematic Review and Meta-Analysis

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