Prostate cancer-specific mortality after definitive radiation therapy: Who dies of disease? - Abstract

BACKGROUND:A competing risks analysis was undertaken to identify subgroups at greatest risk of dying from prostate cancer (PC) after definitive external beam radiation therapy (RT)±androgen deprivation therapy (ADT) in the prostate specific antigen (PSA) era.

METHODS: Outcomes of 2675 men with localised PC treated with RT±ADT from 1987-2007 were analysed. Prostate cancer-specific mortality (PCSM) and non-PCSM rates were calculated after stratifying patients according to National Comprehensive Cancer Network (NCCN) risk-group, RT dose, use of ADT and age at treatment.

RESULTS: Only 0.2% of low-risk men died of PC 10years after treatment. All of these deaths occurred in patients treated with < 72Gy, and only one patient ⩾70years old who received ⩾72Gy died of PC at last follow-up. Likewise, none of the patients with intermediate-risk disease treated with ⩾72Gy and ADT died of PC at 10years, and the highest 10-year rate of PCSM was seen in men ⩾70years old treated with < 72Gy without ADT (5.1%). Among high-risk men < 70years old, treatment with RT dose < 72Gy without ADT yielded similar 10-year rates of PCSM (15.2%) and non-PCSM (18.5%), whereas men treated with ⩾72Gy and ADT were twice as likely to die from other causes (16.2%) than PC (9.4%). In high-risk men ⩾70years old, dose-escalation with ADT reduced 10-year PCSM from 14% to 4%, and most deaths were due to other causes.

CONCLUSION: Low- and intermediate-risk patients treated with definitive RT are unlikely to die of PC. PCSM is higher in men with high-risk disease but may be reduced with dose-escalation and ADT, although patients are still twice as likely to die of other causes.

Written by:
Kim MM, Hoffman KE, Levy LB, Frank SJ, Pugh TJ, Choi S, Nguyen QN, McGuire SE, Lee AK, Kuban DA. Are you the author?
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 97, Houston, TX 77030-4009, USA.

Reference: Eur J Cancer. 2012 Feb 13. Epub ahead of print.
doi: 10.1016/j.ejca.2012.01.026

PubMed Abstract
PMID: 22336663