(P139) Clinical Outcomes and Patient-Reported Outcomes After Local Treatment for High-Risk, Localized Prostate Cancer

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Long-term CaP-specific survival is equally high after RT + ADT and RP + RT in clinically high-risk CaP patients. Further investigation should be aimed at integrating quality of life measures when considering the optimal treatment for men with high-risk CaP.

Lora S. Wang, MD, Colin T. Murphy, MD, Tianyu Li, MS, Marc C. Smaldone, MD, Matthew E. Johnson, MD, Mark Hallman, MD, Yu Ning Wong, MD, Daniel Geynisman, MD, Mark L. Sobczak, MD, David Chen, MD, Eric Horwitz, MD; Fox Chase Cancer Center

INTRODUCTION: Men with high-risk prostate cancer (CaP) have low rates of disease control and long-term survival compared with their low-risk counterparts. We sought to investigate CaP-specific and patient-reported outcomes for high-risk CaP men treated with prostate-directed therapy.

METHODS: From 1989–2011, a total of 1,091 patients with localized, high-risk CaP treated at our institution were analyzed. All patients were staged clinically (prostate-specific antigen [PSA] > 20 ng/mL, biopsy Gleason score > 8, or > clinical T3) and were included if they received radical prostatectomy (RP) plus radiation (RT), RT plus androgen deprivation therapy (ADT), and RT alone. Cox proportional hazards regression models and Kaplan-Meier estimates were used to assess the risk of biochemical failure (BF), distant metastasis (DM), cause-specific mortality (CSM), and overall mortality (OM). Patient-reported outcomes included International Prostate Symptom Score (IPSS) results, Sexual Health Inventory for Men (SHIM) scores, and ADT side effects.

RESULTS: There were 315 patients who received RT alone, 681 who received RT + ADT, and 95 who received RP + RT identified. Median follow-up was 68 months. Men who underwent surgery were significantly younger than those who received RT alone or RT + ADT (P < .001). Patients in the RT + ADT cohort had significantly more advanced T-stages and fewer patients with only one high-risk feature compared with men who received RP + RT (P < .001). Men in the RT + ADT group had significantly lower 5-year BF rates (19% vs 36% for RT alone vs 40% for RP + RT), but patients in the RP + RT arm had significantly lower 5-year OM rates (0% vs 14% for RT alone vs 15% for RT + ADT).

After adjusting for covariates, patients in the RT + ADT cohort were less likely to have BF compared with the RP + RT group (P < .001), with no significant difference in the development of DM or CSM. Receipt of RT, either alone (P = .006) or with ADT (P = .010), was associated with a significantly increased risk of OM compared with men who received surgery.

There were significantly fewer men in the RT-alone group who experienced any ADT side effects (P < .001) compared with men who received RT + ADT or RP + RT. There were 446 patients with evaluable IPSS scores, with median baseline scores of 7, 7, and 4 for RT alone, RT + ADT, and RP + RT, respectively (P = .002). The median baseline SHIM scores were 5, 19, and 15 for RP + RT, RT alone, and RT + ADT, respectively (P < .001), with 96 evaluable patients.

CONCLUSIONS: Long-term CaP-specific survival is equally high after RT + ADT and RP + RT in clinically high-risk CaP patients. Further investigation should be aimed at integrating quality of life measures when considering the optimal treatment for men with high-risk CaP.

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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