Prognostic factors for clinically localized prostate carcinoma: analysis of 938 patients irradiated in the prostate-specific antigen era.

Prostate cancer patient subsets showing improved bNED control with adjuvant androgen deprivation.

Results of 3D Conformal Radiotherapy in the Treatment of Localized Prostate Cancer(Fukunaga-Johnson)

Does Adjuvant Radiation Therapy after RP cause incontinence?

Long-term results of radiation therapy for prostate cancer recurrence
following radical prostatectomy.(Cadeddu,Partin,DeWeese,Walsh)

Prognostic factors for clinically localized prostate carcinoma: analysis of 938 patients irradiated in the prostate-specific antigen era.

Zagars GK, Pollack A and von Eschenbach AC.
Cancer 1997, 79: 1370-1380.

Many studies on prognostic factors come from radical prostatectomy specimen series and their analyses. This study uses clinical stage in patients receiving radical radiotherapy for prostate cancer (T1 to 4, NX, M0) as their only treatment to determine the relative roles of PSA, T stage and Gleason score. Pre-treatment PSA was most important in predicting further rises in PSA or local recurrence whereas T classification was of value in predicting metastatic relapse. The authors formulated a 6-tier classification system with different relapse rates. Unfavourable categories included patients with PSA greater than 20 or patients with tumours of Gleason score 8 to 10 with PSA values between 10 and 20 in whom the relapse rate was 88%.

Prostate cancer patient subsets showing improved bNED control with
adjuvant androgen deprivation.

Anderson PR; Hanlon AL; Movsas B; Hanks GE
Int J Radiat Oncol Biol Phys 1997;39(5):1025-30
Department of Radiation Oncology Fox Chase Cancer Center, Philadelphia,
PA 19111, USA.
AB - PURPOSE: Cooperative groups have investigated the outcome of androgen
deprivation therapy combined with radiation therapy in prostate
cancer patients with variable pretreatment prognostic indicators.
This report describes an objective means of selecting patients for
adjuvant hormonal therapy by a retrospective matched case/control
comparison of outcome between patients with specific pretreatment
characteristics who receive adjuvant hormones (RT+H) vs. patients
with identical pretreatment characteristics treated with radiation
therapy alone (RT). In addition, this report shows the 5-year bNED
control for patients selected by this method for RT+H vs. RT alone.
METHODS AND MATERIALS: From 10/88 to 12/93, 517 T1-T3 NXM0 patients
with known pretreatment PSA level were treated at Fox Chase Cancer
Center. Four hundred fifty-nine of those patients were treated with
RT alone while 58 were treated with RT+H. The patients were
categorized according to putative prognostic factors indicative of
bNED control, which include the palpation stage, Gleason score, and
pretreatment PSA. We compared actuarial bNED control rates according
to treatment group within each of the prognostic groups. In addition,
we devised a retrospective matched case/control selection of RT
patients for comparison with the RT+H group. Five-year bNED control
was compared for the two treatment groups, excluding the best
prognosis group, using 56 RT+H patients and 56 matched (by stage,
grade, and pretreatment PSA level) controls randomly selected from
the RT alone group. bNED control for the entire group of 517 patients
was then analyzed multivariately using step-wise Cox regression to
determine independent predictors of outcome. Covariates considered
for entry into the model included stage (T1/T2AB vs. T2C/T3), grade
(2-6 vs. 7-10), pretreatment PSA (0-15 vs. > 15), treatment (RT vs.
RT+H), and center of prostate dose. bNED failure is defined as PSA >
or = 1.5 ngm/ml and rising on two consecutive determinations. The
median follow-up for the 112 matched case/control patients was 41
months. The median follow-up was 46 months for the RT (range 11-102
months) and 37 months for the RT+H group (range 6-82 months).
RESULTS: Univariate analysis according to treatment for the
prognostic factors of palpation stage, Gleason score, and pretreatme-
nt PSA demonstrates a significant improvement in 3-year bNED control
with the addition of hormones for patients with T2C/T3, Gleason score
7-10, or pretreatment PSA > 15 ngm/ml. A comparison of bNED control
according to treatment demonstrates improvement in 5-year bNED
control of 55% for patients treated with RT+H vs. 31% for those
patients treated with RT alone (p = 0.0088), although there is not a
survival advantage. Multivariate analysis demonstrates that hormonal
treatment is a highly significant independent predictor of bNED
control (p = 0.0006) along with pretreatment PSA (p = 0.0001),
palpation stage (p = 0.0001), grade (p = 0.0030), and dose (p =
0.0001). CONCLUSIONS: (1) Patients with specific adverse pretreatment
prognostic factors (i.e., T2C/T3, Gleason score 7-10, pretreatment
PSA > 15) benefit from adjuvant hormonal therapy. (2) Upon multivari-
ate analysis, hormonal therapy is determined to be a highly
significant predictor of bNED control, after adjusting for all other
covariates. (3) The 5-year bNED control rates of 55% for RT+H vs. 31%
for RT alone represents the magnitude of benefit from adjuvant
hormone therapy. (4) The bNED control curves are separated by about
20 months, representing a delay in disease progression with adjuvant
hormonal therapy, as there is no overall survival difference.

Adjuvant radiation therapy does not cause urinary incontinence after
radical prostatectomy: results of a prospective randomized study
J Urol 1998;159(1):164-6

Van Cangh PJ; Richard F; Lorge F; Castille Y; Moxhon A; Opsomer R; De
Visscher L; Wese FX; Scaillet P
Department of Urology, University of Louvain Medical School, Brussels,
Belgium.

PURPOSE: We analyzed the potential influence of adjuvant radiotherapy
on urinary continence after radical prostatectomy. MATERIALS AND
METHODS: A total of 100 patients with N0M0 prostate cancer randomized
in a prospective study on postoperative radiotherapy for locally
advanced disease (positive surgical margin, capsular perforation
and/or seminal vesicle infiltration) were studied. Objective pad
weighing tests corroborated by direct personal interviews were used
to evaluate urinary continence at regular postoperative intervals.
RESULTS: Of the patients 48 received 60 Gy. external radiotherapy
with 18 MV photon beams between 12 and 16 weeks postoperatively, and
52 were followed expectantly. Risk factors were similar in both
groups. With a mean followup of 24 months, no difference in complete
urinary continence was observed. Of the irradiated group 77% and of
the surveillance group 83% were totally dry. The fate of the bladder
neck had no significant influence on final continence status,
although there was a trend for faster recovery when the bladder neck
was preserved. CONCLUSIONS: In this prospective randomized study 60
Gy. external radiation therapy administered between 3 and 4 months
after radical prostatectomy for pathologically locally advanced
prostate cancer had no significant influence on urinary continence.

Long-term results of radiation therapy for prostate cancer recurrence
following radical prostatectomy.

Cadeddu JA; Partin AW; DeWeese TL; Walsh PC

J Urol 1998;159(1):173-7;
James Buchanan Brady Urological Institute, Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA.

PURPOSE: Following radical prostatectomy, radiation therapy may be
beneficial in select patients with isolated local recurrence.
Pathological stage, Gleason score and the timing of prostate specific
antigen (PSA) elevation are useful in distinguishing men with local
recurrence from those with distant metastases. We test the ability of
these criteria to predict long-term suppression of PSA recurrence
following post-prostatectomy radiation therapy. MATERIALS AND
METHODS: Of 1,699 men treated with radical prostatectomy from 1982 to
1995, 82 with an isolated PSA elevation or local recurrence following
surgery underwent radiation therapy to the prostatic bed and were
followed for at least 2 years. No patient had evidence of metastases
at the time of radiation. RESULTS: Of the men 17 (21%) had an
undetectable PSA (less than 0.2 ng./ml.) for 2 or greater years
following radiation. The 5-year actuarial PSA recurrence-free rate
after radiation was 10%. PSA remained at undetectable levels for 2 or
greater years in no patients with Gleason score 8 or greater (12
cases), positive seminal vesicles (12) or positive lymph nodes (3),
and in only 1 of 16 men (6%) who had a PSA recurrence within 1 year
of prostatectomy. As the interval to PSA recurrence increased, the
likelihood of responding to radiotherapy increased to 44% if initial
disease detection occurred 5 or more years after prostatectomy. There
was no demonstrated advantage to radiating men with an isolated PSA
elevation before a documented local recurrence. CONCLUSIONS: Patients
with Gleason score 8 or greater, positive seminal vesicles or lymph
nodes, or a PSA recurrence within the first year following surgery
rarely benefit from radiation therapy. As the interval to PSA
recurrence increases, the likelihood of responding to radiation
therapy increases substantially. These parameters are useful in the
selection of patients with prostate cancer recurrences who are likely
to benefit from radiation to the prostatic bed.