Introduction and Objectives
The role of Radiation Therapy (RT) for high risk prostate cancer is still debated. The aim of this study was to evaluate the biochemical recurrence free survival (b-Ned) in high-risk prostate cancer treated with RT combined Hormonal Therapy (HT).
Material and Methods
Patients affected by high risk prostate cancer were selected for this retrospective analyses. RT was combined with HT. Radiotherapy was delivered on prostate (CTV1) and seminal vesicles (CTV2) ± pelvic lymph nodes (CTV3); total dose was: 64–74 Gy (1.8 Gy/fx), according to T categorize, to CTV1, 55 or 64 Gy to CTV2 according to seminal vesicles status and 45 Gy (1.8 Gy/fx) to CTV3. 3D-conformal RT was always performed while intensity modulated RT was used when CTV3 was avoided. HT were administered combined to RT both neo-adjuvant (NAD) both concomitant and adjuvant (AD). High risk was defined according to the American Society for Therapeutic Radiology and Oncology [ASTRO] (Gleason score [GS] ≥8 and/or PSA ≥20 ng/mL). B-Ned was defined using ASTRO definition based on a sequence of 3 consecutive PSA rises. Acute and late toxicity were evaluated according to the EORTC-RTOG toxicity scale.
From January 1998 to December 2007, 127 patients affected by high risk prostate cancer were identified. Median age was 71 years (range 42–80 yrs). Gleason score was ≤7 in 63 pts, 8 in 39 pts, 9 in 22 pts and 10 in 3 pts. PSA value at the diagnosis was <10 ng/mL in 24 pts, >10 and <20 ng/mL in 25 pts, ≥20 ng/mL in 82 pts. 19 patients presented Gleason score ≥8 and PSA ≥ 20 ng/mL. Clinical stages were distributed as follows: T1c: 1; T2a: 4; T2b: 4; T2c: ; T3a: 76; T3b: 40; T4: 1. Mean duration of HT was 26 months. Pelvic lymph node was treated in 62 pts while the dose delivered to prostate was 64 Gy in 4 pts, 70 Gy in 37 pts and 74 Gy in 86 pts. Acute gastrointestinal (GI) and genitourinary (GU) toxicity grade >2 was seen in 4 pts (3%) and 3 (2%) pts respectively while the same grade of late toxicity was seen in 3 pts (2%) respectively. Twenty seven pts developed a biochemical recurrence, with an actuarial 5-year b-Ned rate of 68%. The mean biochemical progression-free survival time was 86 months. Correlating the b-ned with the stage of disease, there is not statistical significance (p = 0.4).
Our data suggest that RT combined with NAD, concomitant and AD HT for high risk prostate cancer is able to obtain good 5-years b-Ned with acceptable toxicity.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.