PURPOSE: We recently identified a progression-free survival advantage for clinically localized high-risk prostate cancer patients receiving whole-pelvic irradiation. We now seek to identify a subgroup most likely to benefit from whole-pelvic irradiation. METHODS: Between October 1987 and December 1995, 506 clinically localized prostate cancer patients were treated with definitive radiotherapy consisting of whole-pelvic irradiation followed by a prostate-only boost, or prostate-only treatment (median follow-up, 35 months vs 30 months). Prostate-specific antigen (PSA) failure was defined as (1) a PSA value > or = 1 ng/mL or (2) a PSA value that rose > or = 0.5 ng/mL in < or = 1 year posttreatment on two consecutive measurements, with the first rise defined as the time of failure. The calculated risk of lymph node positivity (%rLN+) was defined as 2/3 (initial PSA) + 10(Gleason score - 6), with intermediate risk defined as 15% < or = %rLN+ < 35% and highest risk defined as %rLN+ > or = 35%. Univariate and multivariate analyses were performed. RESULTS: Intermediate-risk patients receiving whole-pelvic irradiation had significantly improved freedom from PSA failure compared with those receiving prostatic irradiation only (median progression-free survival 39.5 months vs 22.5 months; P < 0.0001); highest-risk patients did not (median progression-free survival 27.2 months vs 20.8 months, P = NS). Multivariate analysis revealed type of radiation treatment to be the most significant independent predictor of outcome (P < 0.0001). DISCUSSIONS: Whole-pelvic radiotherapy most significantly improves the PSA failure-free survival in patients with an intermediate calculated risk of lymph node positivity, suggesting that highest-risk patients may present with distant micrometastases.
PURPOSE: We recently identified a progression-free survival advantage for clinically localized high-risk prostate cancerpatients receiving whole-pelvic irradiation. We now seek to identify a subgroup most likely to benefit from whole-pelvic irradiation. METHODS: Between October 1987 and December 1995, 506 clinically localized prostate cancerpatients were treated with definitive radiotherapy consisting of whole-pelvic irradiation followed by a prostate-only boost, or prostate-only treatment (median follow-up, 35 months vs 30 months). Prostate-specific antigen (PSA) failure was defined as (1) a PSA value > or = 1 ng/mL or (2) a PSA value that rose > or = 0.5 ng/mL in < or = 1 year posttreatment on two consecutive measurements, with the first rise defined as the time of failure. The calculated risk of lymph node positivity (%rLN+) was defined as 2/3 (initial PSA) + 10(Gleason score - 6), with intermediate risk defined as 15% < or = %rLN+ < 35% and highest risk defined as %rLN+ > or = 35%. Univariate and multivariate analyses were performed. RESULTS: Intermediate-risk patients receiving whole-pelvic irradiation had significantly improved freedom from PSA failure compared with those receiving prostatic irradiation only (median progression-free survival 39.5 months vs 22.5 months; P < 0.0001); highest-risk patients did not (median progression-free survival 27.2 months vs 20.8 months, P = NS). Multivariate analysis revealed type of radiation treatment to be the most significant independent predictor of outcome (P < 0.0001). DISCUSSIONS: Whole-pelvic radiotherapy most significantly improves the PSA failure-free survival in patients with an intermediate calculated risk of lymph node positivity, suggesting that highest-risk patients may present with distant micrometastases.
Authors: Jeremie Calais; Amar U Kishan; Minsong Cao; Wolfgang P Fendler; Matthias Eiber; Ken Herrmann; Francesco Ceci; Robert E Reiter; Matthew B Rettig; John V Hegde; Narek Shaverdian; Chris R King; Michael L Steinberg; Johannes Czernin; Nicholas G Nickols Journal: J Nucl Med Date: 2018-04-13 Impact factor: 10.057
Authors: Kiri A Sandler; Ryan R Cook; Jay P Ciezki; Ashley E Ross; Mark M Pomerantz; Paul L Nguyen; Talha Shaikh; Phuoc T Tran; Richard G Stock; Gregory S Merrick; David Jeffrey Demanes; Daniel E Spratt; Eyad I Abu-Isa; Trude B Wedde; Wolfgang Lilleby; Daniel J Krauss; Grace K Shaw; Ridwan Alam; Chandana A Reddy; Daniel Y Song; Eric A Klein; Andrew J Stephenson; Jeffrey J Tosoian; John V Hegde; Sun Mi Yoo; Ryan Fiano; Anthony V D'Amico; Nicholas G Nickols; William J Aronson; Ahmad Sadeghi; Stephen C Greco; Curtiland Deville; Todd McNutt; Theodore L DeWeese; Robert E Reiter; Jonathan W Said; Michael L Steinberg; Eric M Horwitz; Patrick A Kupelian; Christopher R King; Amar U Kishan Journal: Eur Urol Date: 2019-04-13 Impact factor: 20.096
Authors: Berardino De Bari; Filippo Alongi; Pierfrancesco Franco; Patrizia Ciammella; Tarik Chekrine; Lorenzo Livi; Barbara A Jereczek-Fossa; Andrea Riccardo Filippi Journal: Radiol Med Date: 2013-05-27 Impact factor: 3.469