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Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.

Publication ,  Journal Article
Ramey, SJ; Agrawal, S; Abramowitz, MC; Moghanaki, D; Pisansky, TM; Efstathiou, JA; Michalski, JM; Spratt, DE; Hearn, JWD; Koontz, BF; Liauw, SL ...
Published in: Eur Urol
July 2018

BACKGROUND: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). OBJECTIVE: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). DESIGN, SETTING, AND PARTICIPANTS: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. INTERVENTIONS: WPRT and/or ADT in addition to PBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. RESULTS AND LIMITATION: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p<0.001) and no ADT versus ADT (HR 1.70, p<0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p<0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p=0.012). No significant differences in DM cumulative incidence were found. CONCLUSIONS: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. PATIENT SUMMARY: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning).

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Published In

Eur Urol

DOI

EISSN

1873-7560

Publication Date

July 2018

Volume

74

Issue

1

Start / End Page

99 / 106

Location

Switzerland

Related Subject Headings

  • Urology & Nephrology
  • Survival Analysis
  • Salvage Therapy
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate
  • Pelvis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
 

Citation

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Ramey, S. J., Agrawal, S., Abramowitz, M. C., Moghanaki, D., Pisansky, T. M., Efstathiou, J. A., … Tendulkar, R. D. (2018). Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer. Eur Urol, 74(1), 99–106. https://doi.org/10.1016/j.eururo.2017.10.009
Ramey, Stephen J., Shree Agrawal, Matthew C. Abramowitz, Drew Moghanaki, Thomas M. Pisansky, Jason A. Efstathiou, Jeff M. Michalski, et al. “Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.Eur Urol 74, no. 1 (July 2018): 99–106. https://doi.org/10.1016/j.eururo.2017.10.009.
Ramey SJ, Agrawal S, Abramowitz MC, Moghanaki D, Pisansky TM, Efstathiou JA, et al. Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer. Eur Urol. 2018 Jul;74(1):99–106.
Ramey, Stephen J., et al. “Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.Eur Urol, vol. 74, no. 1, July 2018, pp. 99–106. Pubmed, doi:10.1016/j.eururo.2017.10.009.
Ramey SJ, Agrawal S, Abramowitz MC, Moghanaki D, Pisansky TM, Efstathiou JA, Michalski JM, Spratt DE, Hearn JWD, Koontz BF, Liauw SL, Pollack A, Anscher MS, Den RB, Stephans KL, Zietman AL, Lee WR, Stephenson AJ, Tendulkar RD. Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer. Eur Urol. 2018 Jul;74(1):99–106.
Journal cover image

Published In

Eur Urol

DOI

EISSN

1873-7560

Publication Date

July 2018

Volume

74

Issue

1

Start / End Page

99 / 106

Location

Switzerland

Related Subject Headings

  • Urology & Nephrology
  • Survival Analysis
  • Salvage Therapy
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate
  • Pelvis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male