TY - JOUR
T1 - Prostate-only Versus Whole-pelvis Radiation with or Without a Brachytherapy Boost for Gleason Grade Group 5 Prostate Cancer
T2 - A Retrospective Analysis
AU - Sandler, Kiri A.
AU - Cook, Ryan R.
AU - Ciezki, Jay P.
AU - Ross, Ashley E.
AU - Pomerantz, Mark M.
AU - Nguyen, Paul L.
AU - Shaikh, Talha
AU - Tran, Phuoc T.
AU - Stock, Richard G.
AU - Merrick, Gregory S.
AU - Demanes, David Jeffrey
AU - Spratt, Daniel E.
AU - Abu-Isa, Eyad I.
AU - Wedde, Trude B.
AU - Lilleby, Wolfgang
AU - Krauss, Daniel J.
AU - Shaw, Grace K.
AU - Alam, Ridwan
AU - Reddy, Chandana A.
AU - Song, Daniel Y.
AU - Klein, Eric A.
AU - Stephenson, Andrew J.
AU - Tosoian, Jeffrey J.
AU - Hegde, John V.
AU - Yoo, Sun Mi
AU - Fiano, Ryan
AU - D'Amico, Anthony V.
AU - Nickols, Nicholas G.
AU - Aronson, William J.
AU - Sadeghi, Ahmad
AU - Greco, Stephen C.
AU - Deville, Curtiland
AU - McNutt, Todd
AU - DeWeese, Theodore L.
AU - Reiter, Robert E.
AU - Said, Jonathan W.
AU - Steinberg, Michael L.
AU - Horwitz, Eric M.
AU - Kupelian, Patrick A.
AU - King, Christopher R.
AU - Kishan, Amar U.
N1 - Publisher Copyright:
© 2019 European Association of Urology
PY - 2020/1
Y1 - 2020/1
N2 - Background: The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases. Objective: To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT + BT). Design, setting, and participants: We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT + BT). Outcome measurements and statistical analysis: Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment. Results and limitations: A total of 299 EBRT patients (41%) and 320 EBRT + BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT + BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT + BT groups were 58% and 78%, respectively. The median follow-up was 5.6 yr. WPRT was associated with improved bRFS among patients treated with EBRT + BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2–0.9, p = 0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6–1.2, p = 0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7–1.7, p = 0.8 for DMFS and HR 0.7, 95% CI 0.4–1.1, p = 0.1 for PCSS), or in the EBRT + BT group (HR 0.6, 95% CI 0.3–1.4, p = 0.2 for DMFS and HR 0.5 95% CI 0.2–1.2, p = 0.1 for PCSS). Conclusions: WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT + BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT + BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted. Patient summary: When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy.
AB - Background: The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases. Objective: To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT + BT). Design, setting, and participants: We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT + BT). Outcome measurements and statistical analysis: Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment. Results and limitations: A total of 299 EBRT patients (41%) and 320 EBRT + BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT + BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT + BT groups were 58% and 78%, respectively. The median follow-up was 5.6 yr. WPRT was associated with improved bRFS among patients treated with EBRT + BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2–0.9, p = 0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6–1.2, p = 0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7–1.7, p = 0.8 for DMFS and HR 0.7, 95% CI 0.4–1.1, p = 0.1 for PCSS), or in the EBRT + BT group (HR 0.6, 95% CI 0.3–1.4, p = 0.2 for DMFS and HR 0.5 95% CI 0.2–1.2, p = 0.1 for PCSS). Conclusions: WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT + BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT + BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted. Patient summary: When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy.
KW - Brachytherapy
KW - Gleason grade group 5
KW - Prostate cancer
KW - Radiation therapy
KW - Whole-pelvis irradiation
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U2 - 10.1016/j.eururo.2019.03.022
DO - 10.1016/j.eururo.2019.03.022
M3 - Article
C2 - 30992160
AN - SCOPUS:85064121702
SN - 0302-2838
VL - 77
SP - 3
EP - 10
JO - European urology
JF - European urology
IS - 1
ER -
