We evaluate prognostic factors and patterns of recurrence in patients who received RT ± androgen deprivation therapy (ADT) for pathologic node-positive (pN1) prostate cancer (PCa) in a multi-institutional cohort.
Data from patients with pN1 PCa and received RT with short term (ST, ≤6 mo) or long term (LT, >6 mo) ADT were obtained from 4 academic institutions. Biochemical progression free survival (bPFS) and distant metastasis free survival (DMFS) were evaluated.
270 patients were included, with a median follow-up of 48 months. 256 (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, 49% had grade group 5, and 64% had a detectable (>0.1 ng/mL) post-operative PSA. ADT was ST (20%) or LT (68%, median 24 months), while 26 (10%) received no ADT. Biochemical failure (bF) was observed in 29%, with 5% having pelvic nodal failure and 11% having distant metastases. The 4-year bPFS was 72% overall, and was 83% for a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1-<0.5 ng/mL, 60% for PSA 0.5-2 ng/mL, and 35% for PSA >2 ng/mL (p<0.0001). On multivariable analysis, pre-RT PSA >0.5 (0.5 to 2.0 vs <0.1 HR=2.97; >2.0 vs <0.1 HR=7.63), use of LT ADT vs no ADT (HR=0.43) and use of LT ADT compared to ST ADT (HR= 0.34), Grade group 4 vs 2 (HR=4.11), and positive surgical margins (HR 1.773) were significantly associated with bPFS.
Post-prostatectomy RT at PSA <0.5 ng/mL is associated with favorable bPFS in pN1 prostate cancer.
Practical radiation oncology. 2024 Dec 27 [Epub ahead of print]
Leslie K Ballas, Chandana A Reddy, Hye Ri Han, Jelena B Makar, Omar Mian, James Broughman, Conchita de Bustamante, Scott Eggener, Stanley L Liauw, Matthew Abramowitz, Christopher Montoya, Rahul Tendulkar
Department of Radiation Oncology, Cedars-Sinal Medical Center, Los Angeles, CA. Electronic address: ., Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH., Department of Radaition Oncology, University of Southern California, Los Angeles General Medical Center, Los Angeles, CA., Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA., Department of Radiation Oncology Mission Hospital, Asheville, NC., Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL., Department of Radiation Oncology, Univresity of Miami, Miami, FL.