Clinical Outcomes for Patients With Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiation Therapy or Radical Prostatectomy: A Comparative Analysis

Purpose/Objective(s): To compare outcomes of patients with Gleason score (GS) 9-10 prostate adenocarcinoma (CaP) following external beam radiation therapy (EBRT), extremely dose-escalated radiation therapy (as exemplified by EBRT with a brachytherapy boost [EBRT+BT]), and radical prostatectomy (RP)

Clinical Outcomes for Patients With Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiation Therapy or Radical Prostatectomy: A Comparative Analysis

Purpose/Objective(s): To compare outcomes of patients with Gleason score (GS) 9-10 prostate adenocarcinoma (CaP) following external beam radiation therapy (EBRT), extremely dose-escalated radiation therapy (as exemplified by EBRT with a brachytherapy boost [EBRT+BT]), and radical prostatectomy (RP)

Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while provid ing better access and reducing trauma. Materials and Methods: Standard prostate cancer high

Whole Pelvis Radiation Therapy Does Not Significantly Improve Prostate-Cancer Specific Survival in Patients With Gleason Score 9-10 Prostate Adenocarcinoma: An Analysis of 942 Patients Treated in the Modern Era

Purpose/Objective(s) To assess the effect on clinical outcomes of the addition of whole pelvis radiation (WPRT) to definitive prostate external beam radiation therapy (EBRT) or external beam radiation therapy plus brachytherapy boost (EBRT-BT) for patients with Gleason Score (GS) 9-10 prostate cancer (PCa), who are at high risk of having occult nodal metastases. Materials/Methods Nine-hundred-forty-two patients with biopsy-proven GS 9-10 PCa treated between 2000 and 2013 at 10 institutions (506 with EBRT and 436 with EBRT+BT) were included. 299 EBRT patients (59%) and 320 EBRT+BT patients (73.4%) received WPRT. A cohort of surgically-treated patients from the same multi-institutional database had a pathologic node positivity rate of 17%. Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM) were compared between groups using Cox proportional hazards models with propensity score adjustment. Propensity scores were calculated as the conditional probability of receiving WPRT given age, tumor stage, GS, and initial PSA. Results The median follow-up was 5.6 years. The median doses were isoeffective to 81 Gy and 96 Gy in 1.8 Gy fractions in the EBRT and EBRT-BT groups, respectively. The median WPRT dose was isoeffective to 50.4 Gy in 1.8 Gy fractions. In the EBRT group 94% of patients receiving WPRT and 96% of patients not receiving WPRT received ADT (median duration 23 months), and in the EBRT-BT group, 80% of patients receiving WPRT received ADT, and 98% not receiving WPRT received ADT (median duration 12 months). WPRT did not significantly improve PCSM in the EBRT group (HR = 0.76, 95% CI 0.45-1.3, p = .3), though it trended towards improvement in the EBRT-BT group (HR 0.46, 0.19-1.11, p = .08). Similar results were seen in a competing risks regression model, treating other cause mortality as a competing risk. WPRT improved bRFS among patients treated with EBRT-BT (HR = 0.4, 95% CI 0.29-0.54, p < .001) but not in those treated with EBRT (HR 1.1, 95% CI 0.67-1.68, p = 0.8). There was borderline improvement in DMFS in the EBRT-BT group (HR 0.64, 95% CI .40-1.03, p = .065), but not the EBRT group (HR = 1.21, 95% CI 0.76-1.93, p= .4). Conclusion WPRT offered a trend towards improved DMFS and PCSM in this large cohort of patients with biopsy GS 9-10 PCa, but only in those treated with EBRT+BT. This trend did not reach statistical significance. WPRT did significantly improve bRFS, but again only in patients treated with EBRT+BT. These results are hypothesis-generating in suggesting that a long-term clinical benefit to WPRT, if present, might only be seen in the setting of extreme dose-escalation to the prostate itself

Whole Pelvis Radiation Therapy Does Not Significantly Improve Prostate-Cancer Specific Survival in Patients With Gleason Score 9-10 Prostate Adenocarcinoma: An Analysis of 942 Patients Treated in the Modern Era

Purpose/Objective(s) To assess the effect on clinical outcomes of the addition of whole pelvis radiation (WPRT) to definitive prostate external beam radiation therapy (EBRT) or external beam radiation therapy plus brachytherapy boost (EBRT-BT) for patients with Gleason Score (GS) 9-10 prostate cancer (PCa), who are at high risk of having occult nodal metastases. Materials/Methods Nine-hundred-forty-two patients with biopsy-proven GS 9-10 PCa treated between 2000 and 2013 at 10 institutions (506 with EBRT and 436 with EBRT+BT) were included. 299 EBRT patients (59%) and 320 EBRT+BT patients (73.4%) received WPRT. A cohort of surgically-treated patients from the same multi-institutional database had a pathologic node positivity rate of 17%. Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM) were compared between groups using Cox proportional hazards models with propensity score adjustment. Propensity scores were calculated as the conditional probability of receiving WPRT given age, tumor stage, GS, and initial PSA. Results The median follow-up was 5.6 years. The median doses were isoeffective to 81 Gy and 96 Gy in 1.8 Gy fractions in the EBRT and EBRT-BT groups, respectively. The median WPRT dose was isoeffective to 50.4 Gy in 1.8 Gy fractions. In the EBRT group 94% of patients receiving WPRT and 96% of patients not receiving WPRT received ADT (median duration 23 months), and in the EBRT-BT group, 80% of patients receiving WPRT received ADT, and 98% not receiving WPRT received ADT (median duration 12 months). WPRT did not significantly improve PCSM in the EBRT group (HR = 0.76, 95% CI 0.45-1.3, p = .3), though it trended towards improvement in the EBRT-BT group (HR 0.46, 0.19-1.11, p = .08). Similar results were seen in a competing risks regression model, treating other cause mortality as a competing risk. WPRT improved bRFS among patients treated with EBRT-BT (HR = 0.4, 95% CI 0.29-0.54, p < .001) but not in those treated with EBRT (HR 1.1, 95% CI 0.67-1.68, p = 0.8). There was borderline improvement in DMFS in the EBRT-BT group (HR 0.64, 95% CI .40-1.03, p = .065), but not the EBRT group (HR = 1.21, 95% CI 0.76-1.93, p= .4). Conclusion WPRT offered a trend towards improved DMFS and PCSM in this large cohort of patients with biopsy GS 9-10 PCa, but only in those treated with EBRT+BT. This trend did not reach statistical significance. WPRT did significantly improve bRFS, but again only in patients treated with EBRT+BT. These results are hypothesis-generating in suggesting that a long-term clinical benefit to WPRT, if present, might only be seen in the setting of extreme dose-escalation to the prostate itself

Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results from a Multi-institutional Consortium Study

Purpose/Objective(s): Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis for patients presenting with GS10 PCa are largely unknown due to its rarity. We interrogated a large, multi-institutional consortium of patients with biopsy GS 9-10 disease to identify those with GS 10 PCa and obtain benchmark clinical outcomes data for patients treated with definitive intent. Materials/Methods: Ninety-eight patients with biopsy GS 10 PCa who received definitive treatment with radical prostatectomy (RP, n = 22), external beam radiotherapy (EBRT, n = 38), and EBRT with a brachytherapy boost (EBRT+BT, n = 38) between 2000 and 2013 were included. Overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and biochemical recurrence-free survival (bRFS) were estimated with the Kaplan-Meier method. Results: The median follow-up was 4.9 years. The median age was 67. The T stage distribution was 32 (33%) T1c, 14 (14%) T2a, 13 (13%) T2b, 6 (6%) T2c, 18 (18%) T3a, 5 (5%) T3b, 10 (10%) T4. The median initial prostate-specific antigen was 7.9 (range, 0.4-219). Six patients (27%) who underwent RP received neoadjuvant systemic therapy (mainly androgen deprivation therapy [ADT]), 5% received adjuvant radiotherapy, and 32% received salvage radiotherapy. All patients undergoing EBRT or EBRT+BT received ADT, with median durations of 24 and 22 months, respectively. Systemic salvage therapy rates were 23% among RP patients, 13% among EBRT patients, and 3% among EBRT+BT patients. For the entire cohort, the 5-year and 10-year OS, CSS, DMFS, and bRFS were 77% and 53%, 86% and 69%, 74% and 66%, and 77% and 52%, respectively. Outcomes stratified by treatment type are presented in Table 1. Conclusion: To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Biopsy GS 10 PCas follow a very aggressive natural history with nearly 30% of patients dying of this disease at 10 years. Nonetheless, aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease five years following treatment

Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results from a Multi-institutional Consortium Study

Purpose/Objective(s): Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis for patients presenting with GS10 PCa are largely unknown due to its rarity. We interrogated a large, multi-institutional consortium of patients with biopsy GS 9-10 disease to identify those with GS 10 PCa and obtain benchmark clinical outcomes data for patients treated with definitive intent. Materials/Methods: Ninety-eight patients with biopsy GS 10 PCa who received definitive treatment with radical prostatectomy (RP, n = 22), external beam radiotherapy (EBRT, n = 38), and EBRT with a brachytherapy boost (EBRT+BT, n = 38) between 2000 and 2013 were included. Overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and biochemical recurrence-free survival (bRFS) were estimated with the Kaplan-Meier method. Results: The median follow-up was 4.9 years. The median age was 67. The T stage distribution was 32 (33%) T1c, 14 (14%) T2a, 13 (13%) T2b, 6 (6%) T2c, 18 (18%) T3a, 5 (5%) T3b, 10 (10%) T4. The median initial prostate-specific antigen was 7.9 (range, 0.4-219). Six patients (27%) who underwent RP received neoadjuvant systemic therapy (mainly androgen deprivation therapy [ADT]), 5% received adjuvant radiotherapy, and 32% received salvage radiotherapy. All patients undergoing EBRT or EBRT+BT received ADT, with median durations of 24 and 22 months, respectively. Systemic salvage therapy rates were 23% among RP patients, 13% among EBRT patients, and 3% among EBRT+BT patients. For the entire cohort, the 5-year and 10-year OS, CSS, DMFS, and bRFS were 77% and 53%, 86% and 69%, 74% and 66%, and 77% and 52%, respectively. Outcomes stratified by treatment type are presented in Table 1. Conclusion: To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Biopsy GS 10 PCas follow a very aggressive natural history with nearly 30% of patients dying of this disease at 10 years. Nonetheless, aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease five years following treatment