Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy

Daniel N Cagney, Mary Dunne, Carmel O'Shea, Marie Finn, Emma Noone, Martina Sheehan, Lesley McDonagh, Lydia O'Sullivan, Pierre Thirion, John Armstrong, Daniel N Cagney, Mary Dunne, Carmel O'Shea, Marie Finn, Emma Noone, Martina Sheehan, Lesley McDonagh, Lydia O'Sullivan, Pierre Thirion, John Armstrong

Abstract

Background: Our aim was to assess the heterogeneity of high-risk (HR) prostate cancer managed with high-dose external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT).

Methods: We identified 547 patients who were treated with modern EBRT from 1997 to 2013, of whom 98% received ADT. We analyzed biochemical relapse-free survival (bRFS) and distant metastases-free survival (DMFS).

Results: Median EBRT dose was 74 Gy, and median ADT duration was 8 months. At 5 years, the DMFS was 85%. On multivariate analysis, significant predictors of shorter bRFS were biopsy Gleason score (bGS) of 8 to 10, higher prostate-specific antigen (PSA) level, shorter duration of ADT and lower radiation dose while predictors of shorter DMFS were bGS of 8 to 10, higher PSA level, and lower radiation dose. We identified an unfavorable high-risk (UHR) group of with 2-3 HR factors based on 2015 National Comprehensive Cancer Network (NCCN) criteria and a favorable high-risk (FHR) group, with 1 HR feature. Comparing very-HR prostate cancer, UHR & FHR, 5 year bRFS rates were 58.2%, 66.2%, and 69.2%, and 5 year DMFS rates were 78.4%, 81.2%, and 88.0%.

Conclusion: Patients with multiple HR factors have worse outcome than patients with 1 HR factor. Future studies should account for this heterogeneity in HR prostate cancer.

Conflict of interest statement

Ethics approval and consent to participate

Consent to publish this data was approved by the local IRB. The local IRB is from St. Luke’s Hospital, St. Luke’s Institute of Cancer Research, Rathgar, Dublin 6. Tel. No: +353 (01) 496 0852. All patients consent was obtained prior to enrolling on the 6 prospective studies.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves of distant metastases-free survival by high-risk subgroup. Abbreviations: C = censored; O = observed; N = number
Fig. 2
Fig. 2
Kaplan-Meier curves of distant metastases-free survival by favourable versus unfavourable high risk groups.. Abbreviations: FHR = favourable high risk; UHR = unfavourable high risk; C: censored; O: observed; N: number

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