(P055) Can High-Grade Prostate Cancer (Gleason 8–10) Be Cured With Definitive Local Therapy Without Testosterone Suppression? Five-Year Outcomes Employing Up-Front Prostatectomy in Patients With Clinically Localized, Nonmetastatic Disease

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Patients with HGPC at diagnosis have high rates of early disease recurrence, though mortality at 5 years remains low. Following RP without systemic therapy, high primary GS and initial post-RP PSA were independently associated with worse FFF outcomes.

Darrion L. Mitchell, MD, PhD, Kyle Russo, MD, Mark C. Smith, MD, Sarah L. Mott, MS, John M. Watkins, MD; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa; Bismarck Cancer Center

PURPOSE: High-grade prostate cancer (HGPC) is associated with an aggressive clinical course and poor outcomes; thus, a common approach involves the combination of long-term testosterone suppression with definitive local therapy. Small single-institution case series report that long-term disease control can be obtained in selected patients who undergo definitive local therapy alone; however, prognostic factors for this approach remain to be identified. The current investigation seeks to describe disease control and survival outcomes for patients with clinically localized HGPC at biopsy who were managed with primary radical prostatectomy (RP) without systemic therapy, with analyses performed to identify prognostic factors associated with disease control. 

MATERIALS AND METHODS: Patients were retrospectively identified for inclusion by biopsy-proven Gleason 8–10 adenocarcinoma managed with primary RP, without preoperative evidence of nodal or distant metastasis. Patient who received any preoperative intervention or adjuvant hormone therapy were excluded, as were patients with insufficient prostate-specific antigen (PSA) follow-up (< 12 mo). Patient-, tumor-, and treatment-related factors were analyzed for association with freedom from failure (FFF, defined as PSA > 0.2 ng/mL and rising or upon initiation of salvage therapy), employing Cox proportional hazards regression. The Kaplan-Meier method was employed for estimation of FFF and survival. 

RESULTS: From 2003–2010, a total of 69 eligible patients were identified. Median age was 63 years (range: 48–75 yr) and median PSA was 11.7 ng/mL (range: 3.5–64.9 ng/mL). Gleason score (GS) at RP was < 7, 8, and > 9 for 22, 17, and 29 patients, respectively. Extraprostatic extension, involved surgical margin, seminal vesicle invasion, and lymph node involvement were identified in 32, 33, 18, and 6 patients, respectively, with adjuvant radiotherapy delivered to 5 patients. At a median follow-up of 67.3 months (range: 13.3–141.2 mo), 40 patients had disease recurrence, and 8 patients died (6 cancer-specific). The 5-year FFF and overall survival (OS) rates were 39% (95% confidence interval [CI], 21%–58%) and 87% (95% CI, 72%–94%), respectively. Primary and overall Gleason score at RP, involved surgical margin, seminal vesicle involvement, nodal involvement, and elevated initial postprostatectomy PSA were significantly associated with FFF in the univariate analysis, with primary GS at RP (hazard ratio [HR] = 1.80; P < .01) and post-RP PSA (HR = 4.64; P < .01) significant in the multivariate analysis.

CONCLUSIONS: Patients with HGPC at diagnosis have high rates of early disease recurrence, though mortality at 5 years remains low. Following RP without systemic therapy, high primary GS and initial post-RP PSA were independently associated with worse FFF outcomes.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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