This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT).
Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses.
Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities.
Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.
Clinical oncology (Royal College of Radiologists (Great Britain)). 2023 Apr 06 [Epub ahead of print]
S Chilukuri, I Mallick, A Agrawal, P Maitre, M Arunsingh, F V James, T Kataria, K Narang, B C Gurram, A K Anand, N Utreja, D Dutta, S Pavamani, S Mitra, S Mallik, N Mahale, M Chandra, A N Chinnachamy, T Shahid, M S Raghunathan, V Kannan, S K Mohanty, T Basu, C Hotwani, G Panigrahi, V Murthy
Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India., Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India., Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India., Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India., Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India., Department of Radiation Oncology, Yashoda Cancer Institute, Somajiguda, Hyderabad, India., Max Super Speciality Hospital, Saket, New Delhi, India., Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India., Department of Radiation Oncology, Christian Medical College, Vellore, India., Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India., Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, India., Nirali Memorial Radiation Centre and Bharat Cancer Hospital, Surat, India., Department of Radiation Oncology, Jupiter Hospital, Thane, India., Department of Radiation Oncology, VN Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India., Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India., Department of Radiotherapy, Kovai Medical Centre and Hospital, Coimbatore, India., Department of Radiation Oncology, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, India., Department of Radiation Oncology, Sterling Cancer Hospital, Rajkot, Gujrat, India., Department of Radiation Oncology, HCG Cancer Centre, Mumbai, India., Department of Radiation Oncology, Alexis Multi-Speciality Hospital, Nagpur, India., Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India. Electronic address: .