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Radiotherapy for High Grade Clinically Localized Adenocarcinoma of the Prostate

1996; Lippincott Williams & Wilkins; Volume: 156; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(01)65490-9

1527-3792

Mack III Roach, S. Meehan, Stewart Kroll, M Weil, Janice Ryu, Eric J. Small, Lawrence W. Margolis, Joseph C. Presti, Peter Carroll, Theodore L. Phillips,

Urologic and reproductive health conditions

No AccessJournal of UrologyClinical Urology: Original Article1 Nov 1996Radiotherapy for High Grade Clinically Localized Adenocarcinoma of the Prostate Mack III Roach, Shane Meehan, Stewart Kroll, Michael Weil, Janice Ryu, Eric J. Small, Lawrence W. Margolis, Joseph Presti, Peter C. Carroll, and Theodore L. Phillips Mack III RoachMack III Roach More articles by this author , Shane MeehanShane Meehan More articles by this author , Stewart KrollStewart Kroll More articles by this author , Michael WeilMichael Weil More articles by this author , Janice RyuJanice Ryu More articles by this author , Eric J. SmallEric J. Small More articles by this author , Lawrence W. MargolisLawrence W. Margolis More articles by this author , Joseph PrestiJoseph Presti More articles by this author , Peter C. CarrollPeter C. Carroll More articles by this author , and Theodore L. PhillipsTheodore L. Phillips More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65490-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We defined the efficacy of radiotherapy for the treatment of high grade (Gleason scores 8 to 10) adenocarcinoma of the prostate. Materials and Methods: A total of 50 patients underwent radiotherapy with curative intent for clinically localized prostate cancer with Gleason scores of 8 to 10 at 1 of 4 facilities affiliated with the University of California San Francisco. Patients were considered to have biochemical failure if they had a significant increase in prostate specific antigen (PSA) of 0.5 ng./ml. per year, an increase in PSA to greater than 1.0 ng./ml. or a positive biopsy. Results: Among the 50 patients median PSA was 22.7 ng./ml. (range 1.3 to 93.4). Tumors were clinical stage T1 or T2 in 46 percent of the cases and stage T3 or T4 in 54 percent. The overall actuarial probability of freedom from biochemical failure at 4 years was 23 percent. In a multivariate analysis including all patients pretreatment PSA was the only predictor of PSA failure, with 64 percent free of progression if the pretreatment PSA was 10 ng./ml. or less compared to only 16 percent at 3 years if PSA was more than 10 ng./ml. (p = 0.01). In a multivariate analysis restricted to patients with PSA less than 20 ng./ml. 83 percent of those treated to more than 71 Gy. were free of progression compared to 0 percent for those treated to less than 71 Gy. (p = 0.03). In a multivariate analysis PSA 10 ng./ml. or less (related risk 11.4, p = 0.02), T stage 1 or 2 (relative risk 3.8, p = 0.05) and radiation dose more than 71 Gy. (relative risk 4.0, p = 0.06) were associated with a favorable outcome. Conclusions: At 4 years the freedom from PSA failure following radiotherapy for high grade prostate cancer was comparable to previously reported surgical series. The high failure rate among patients with PSA greater than 20 ng./ml. suggests that these patients should be considered for investigational approaches. The apparent improvement in freedom from progression with the use of higher doses provides reason for optimism. References 1 : Cancer statistics 1993. CA1993; 43: 7. Google Scholar 2 : Prostate adenocarcinoma in men younger than 50 years. A retrospective review of 151 patients. Cancer1994; 74: 1768. Google Scholar 3 : Results of conservative management of clinically localized prostate cancer. New Engl. J. Med.1994; 330: 242. Google Scholar 4 : Radical prostatectomy for high grade disease: a reevaluation 1994. J. Urol.1994; 151: 1583. Link, Google Scholar 5 : Can radical prostatectomy alter the progression of poorly differentiated prostate cancer?. J. 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Cancer1995; 76: 1621. Google Scholar 13 : Current conflicts in the management of prostatic cancer. Int. J. Rad. Oncol. Biol. Phys.1986; 12: 1721. Google Scholar 14 : Conformal technique dose escaltion prostate cancer: improved cancer control with higher doses patients with pretreatment PSA greater or equal to 10 ngm/ml. Int. J. Rad. Oncol. Biol. Phys.1995; 32: 141. abstract 2. Google Scholar 15 : Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conform protons compared with conventional dose irradiation using photons alone. Int. J. Rad. Oncol. Biol. Phys.1995; 32: 3. Google Scholar 16 : Re: the use of prostate specific antigen, clinical stage and Gleason score to predict pathologic stage in me with localized prostate cancer. Letter to the editor. J. Urol1993; 150: 1923. Abstract, Google Scholar 17 : Time to second prostate specific antigen (PSA) failure is a surrogate endpoint for prostate cancer death in prospective trials of therapy for localized disease. Int. J. Rad. Oncol. Biol. Phys.1995; 32: 229. abstract 1013. Google Scholar 18 : The impact of age and conformal technique on acute toxicity in patients receiving radiation therapy for clinically localized prostate cancer. Int. J. Rad. Oncol. Biol. Phys.1995; 32: 253. abstract 1061. Google Scholar Departments of Radiation Oncology, Medical Oncology and Urology, University of California San Francisco / Mt. Zion Cancer Center, Department of Radiation Oncology, University of California Davis, and Urology Service, Fort Miley Veterans Affairs Medical Center, San Francisco, California.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byEggener S, Roehl K, Yossepowitch O and Catalona W (2018) Prediagnosis Prostate Specific Antigen Velocity is Associated With Risk of Prostate Cancer Progression Following Brachytherapy and External Beam Radiation TherapyJournal of Urology, VOL. 176, NO. 4, (1399-1403), Online publication date: 1-Oct-2006.ROACH M, LU J, PILEPICH M, ASBELL S, MOHIUDDIN M, TERRY R and GRIGNON D (2018) LONG-TERM SURVIVAL AFTER RADIOTHERAPY ALONE: RADIATION THERAPY ONCOLOGY GROUP PROSTATE CANCER TRIALSJournal of Urology, VOL. 161, NO. 3, (864-868), Online publication date: 1-Mar-1999.PERROTTI M, RABBANI F, FARKAS A, WARD W and CUMMINGS K (2018) TRENDS IN POORLY DIFFERENTIATED PROSTATE CANCER 1973 to 1994: OBSERVATIONS FROM THE SURVEILLANCE, EPIDEMIOLOGY AND END RESULTS DATABASEJournal of Urology, VOL. 160, NO. 3 Part 1, (811-815), Online publication date: 1-Sep-1998. Volume 156Issue 5November 1996Page: 1719-1723 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Mack III Roach More articles by this author Shane Meehan More articles by this author Stewart Kroll More articles by this author Michael Weil More articles by this author Janice Ryu More articles by this author Eric J. Small More articles by this author Lawrence W. Margolis More articles by this author Joseph Presti More articles by this author Peter C. Carroll More articles by this author Theodore L. Phillips More articles by this author Expand All Advertisement PDF downloadLoading ...