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