A Gomez-Iturriaga1, Á Cabeza2, J Pastor3, J Jove4, M Casaña5, A G Caamaño6, J Mengual5, I Henríquez7, J Muñoz8, A Hervás9, C G-S Segundo10. 1. Department of Radiation Oncology, Hospital Universitario Cruces, Plaza Cruces Gurutzeta 12, 48903, Barakaldo, Spain. agomeziturriaga@gmail.com. 2. Department of Radiation Oncology, Hospital Doce de Octubre, Madrid, Spain. 3. Department of Radiation Oncology, Hospital General de Valencia, Valencia, Spain. 4. Department of Radiation Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain. 5. Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain. 6. Department of Radiation Oncology, Hospital Clínico Universitario, Santiago de Compostela, Spain. 7. Department of Radiation Oncology, Hospital Universitario San Joan, Reus, Tarragona, Spain. 8. Department of Radiation Oncology, Hospital Infanta Cristina, Badajoz, Spain. 9. Department of Radiation Oncology, Hospital Ramón y Cajal, Madrid, Spain. 10. Department of Radiation Oncology, Hospital Gregorio Marañon, Madrid, Spain.
Abstract
PURPOSE: To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis. MATERIALS AND METHODS: Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b-cT4, Gleason score 9-10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c-cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients. RESULTS: With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the "number of risk factors" variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint. CONCLUSIONS: Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.
PURPOSE: To report treatment outcomes in a cohort of extreme-risk prostate cancerpatients and identify a subgroup of patients with worse prognosis. MATERIALS AND METHODS: Extreme-risk prostate cancerpatients were defined as patients with at least one extreme-risk factor: stage cT3b-cT4, Gleason score 9-10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c-cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients. RESULTS: With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the "number of risk factors" variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint. CONCLUSIONS:Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.
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