Cancer-specific mortality after radiation therapy with short-course hormonal therapy or radical prostatectomy in men with localized, intermediate-risk to high-risk prostate cancer.

Abstract

BACKGROUND:

The presence of multiple determinants of aggressive cancer biology may impact prostate cancer-specific mortality (PCSM) rates compared with fewer factors. The authors estimated PCSM after radiation therapy with short-course androgen suppression therapy (RT+AST) or radical prostatectomy (RP) in men with clinically localized, intermediate-risk to high-risk prostate cancer.

METHODS:

The study cohort included 3240 men treated from 1981 to 2002 with RT with 6 months of AST (n = 550) or RP (n = 2690) for localized prostate cancer with at least 1 risk factor (prostate-specific antigen [PSA] >10 ng/mL, biopsy Gleason score 7-10, or clinical tumor category T2b or T2c). Competing risks regression analyses were used to determine whether the number of risk factors present was associated with time to PCSM.

RESULTS:

Men with all 3 risk factors had significantly shorter time to PCSM after RT+AST (adjusted hazards ratio [HR] of 9.3; 95% confidence interval [95% CI], 1.9-44.5 [P(Gray) = .005]) or RP (adjusted HR of 6.3; 95% CI, 3.2-12.2 [P(Gray) < .001]) when compared with men with any 1 or 2 risk factors. The 7-year estimates of PCSM for men having 1, 2, or 3 risk factors were 0.83% (95% CI, 0.27-1.4%), 2.6% (95% CI, 1.0-4.2%), and 12.6% (95% CI, 7.1-18.1%), respectively.

CONCLUSIONS:

Men with multiple determinants of intermediate-risk to high-risk prostate cancer have significantly increased estimates of PCSM despite aggressive therapy compared with men with only 1 or 2 determinants. These men are appropriate candidates for enrollment onto randomized controlled trials evaluating the benefit of adding systemic therapies such as docetaxel to RT+AST or RP.

• Authors: Henry K Tsai, Ming-Hui Chen, David G McLeod, Peter R Carroll, Jerome P Richie, Anthony V D'Amico
• Journal: Cancer (Cancer) Vol. 107 Issue 11 Pg. 2597-603 (Dec 01 2006) ISSN: 0008-543X [Print] United States
• PMID: 17039498 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: (c) 2006 American Cancer Society.

Chemical References

• Androgen Antagonists
• Anilides
• Nitriles
• Tosyl Compounds
• Flutamide
• bicalutamide
• Prostate-Specific Antigen

Topics

• Aged
• Androgen Antagonists (therapeutic use)
• Anilides (therapeutic use)
• Cohort Studies
• Flutamide (therapeutic use)
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Nitriles
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Neoplasms (blood, mortality, pathology, therapy)
• Regression Analysis
• Risk Factors
• Tosyl Compounds
• Treatment Outcome