AUA 2017: Long-term Survival in Men with Gleason Score 9-10 Treated with Prostate Brachytherapy and External Beam Irradiation
Boston, MA (UroToday.com) This study attempts to address an important question: whether high risk prostate cancer is better treated with RP or combined radiation therapy following neoadjuvant ADT. The authors retrospectively reviewed the clinical course in patients with high risk prostate cancer as defined by the D’Amico risk categories, who underwent RP or combined external-beam radiation and high dose-rate brachytherapy. Importantly, biochemical recurrence (BR) was defined differently for the two groups: while BR was defined as PSA>0.2ng/mL after RP, it was defined according to the Phoenix criteria for patients after combined radiation treatment. Owing to their high risk disease, 10.8% of the patients had elevated PSA above 0.2ng/mL after RP. Analysis showed worse biochemical free survival in patients with RP, while finding no difference in overall survival.
Although provocative, It is important to point out the different scales used to measure biochemical recurrence in the two groups. Despite being on ADT, this population at high risk for harboring occult metastases may not reach levels traditionally used to define treatment success with RP. The difference in BR definition has been the Achilles heel in several attempts to compare the effectiveness of surgery to radiation. Until better definitions for BR are identified to uniformly compare the two modalities, further efforts will unlikely be fruitful.
Presented By: Nelson N. Stone, Vail, Colorado
Reviewed by: Roger Li MD Urologic Oncology Fellow, UT MD Anderson Cancer Center, Houston, TX
Ashish M. Kamat MD Professor, UT MD Anderson Cancer Center, Houston TX
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA