Conventional external-beam radiation therapy alone or with androgen ablation for clinical stage III (T3, NX/N0, M0) adenocarcinoma of the prostate

Gunar K. Zagars, Alan Pollack, Lewis G. Smith

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Purpose: To evaluate the outcome of clinical Stage III (T3, N0/NX, M0) prostate cancer treated by conventional radiation alone or with adjuvant androgen ablation. Methods and Materials: Three hundred forty-four men with T3, N0/NX, M0 adenocarcinoma of the prostate who received conventional radiation alone (260) or with androgen ablation (84) were analyzed for relapse or rising prostate-specific antigen (PSA), using univariate and multivariate techniques. Results: With a median follow-up of 68 months, the 260 men treated with radiation alone had a 10-year actuarial rate of relapse or rising PSA of 76%. Pretreatment PSA level (≤ 10 ng/ml vs. > 10 ≤ 20 ng/ml vs. > 20 ng/ml) and radiation dose (< 68 Gy vs. ≥ 68 Gy) were the only independently significant determinants of biochemical failure; Gleason score (2-7 vs. 8-10) was an additional determinant of metastatic relapse. Patients treated to doses < 68 Gy experienced 6-year failure rates exceeding 50% regardless of PSA level. Patients with PSA ≤ 10 ng/ml and receiving 68-70 Gy had a 6-year failure of 24%, but those with PSA > 10 ng/ml had relapse rates exceeding 50% even at doses of 70 Gy. At a median follow-up of 44 months, the 84 patients treated with radiation and androgen ablation had a 6-year biochemical failure rate of 22%. The only significant determinant of outcome in this group was pretreatment PSA; patients with PSA ≤ 80 ng/ml had a 6- year failure rate of only 12% compared to a failure rate of 53% for those with PSA > 80 ng/ml. The outcome for those treated with combined modalities was significantly better than for those treated with radiation alone in all PSA strata. Conclusion: Conventional radiation alone has little curative potential for Stage III disease. Doses < 68 Gy are particularly ineffective. Patients with PSA ≤ 10 ng/ml may be candidates for conventional radiation to a dose of 70 Gy. Other patients are probably best served by combined radiation-androgen ablation or high-dose conformal radiation.

Original languageEnglish
Pages (from-to)809-819
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume44
Issue number4
DOIs
StatePublished - Jul 1 1999
Externally publishedYes

Fingerprint

Androgens
ablation
Prostate
antigens
radiation therapy
Prostate-Specific Antigen
Adenocarcinoma
Radiotherapy
Radiation
radiation
dosage
Recurrence
pretreatment
strata
determinants
Prostatic Neoplasms
cancer

Keywords

  • Androgen ablation
  • Dose-response
  • Prostate cancer
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

@article{09aaa50c929f48e1866c50f25d687959,
title = "Conventional external-beam radiation therapy alone or with androgen ablation for clinical stage III (T3, NX/N0, M0) adenocarcinoma of the prostate",
abstract = "Purpose: To evaluate the outcome of clinical Stage III (T3, N0/NX, M0) prostate cancer treated by conventional radiation alone or with adjuvant androgen ablation. Methods and Materials: Three hundred forty-four men with T3, N0/NX, M0 adenocarcinoma of the prostate who received conventional radiation alone (260) or with androgen ablation (84) were analyzed for relapse or rising prostate-specific antigen (PSA), using univariate and multivariate techniques. Results: With a median follow-up of 68 months, the 260 men treated with radiation alone had a 10-year actuarial rate of relapse or rising PSA of 76{\%}. Pretreatment PSA level (≤ 10 ng/ml vs. > 10 ≤ 20 ng/ml vs. > 20 ng/ml) and radiation dose (< 68 Gy vs. ≥ 68 Gy) were the only independently significant determinants of biochemical failure; Gleason score (2-7 vs. 8-10) was an additional determinant of metastatic relapse. Patients treated to doses < 68 Gy experienced 6-year failure rates exceeding 50{\%} regardless of PSA level. Patients with PSA ≤ 10 ng/ml and receiving 68-70 Gy had a 6-year failure of 24{\%}, but those with PSA > 10 ng/ml had relapse rates exceeding 50{\%} even at doses of 70 Gy. At a median follow-up of 44 months, the 84 patients treated with radiation and androgen ablation had a 6-year biochemical failure rate of 22{\%}. The only significant determinant of outcome in this group was pretreatment PSA; patients with PSA ≤ 80 ng/ml had a 6- year failure rate of only 12{\%} compared to a failure rate of 53{\%} for those with PSA > 80 ng/ml. The outcome for those treated with combined modalities was significantly better than for those treated with radiation alone in all PSA strata. Conclusion: Conventional radiation alone has little curative potential for Stage III disease. Doses < 68 Gy are particularly ineffective. Patients with PSA ≤ 10 ng/ml may be candidates for conventional radiation to a dose of 70 Gy. Other patients are probably best served by combined radiation-androgen ablation or high-dose conformal radiation.",
keywords = "Androgen ablation, Dose-response, Prostate cancer, Radiation therapy",
author = "Zagars, {Gunar K.} and Alan Pollack and Smith, {Lewis G.}",
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T1 - Conventional external-beam radiation therapy alone or with androgen ablation for clinical stage III (T3, NX/N0, M0) adenocarcinoma of the prostate

AU - Zagars, Gunar K.

AU - Pollack, Alan

AU - Smith, Lewis G.

PY - 1999/7/1

Y1 - 1999/7/1

N2 - Purpose: To evaluate the outcome of clinical Stage III (T3, N0/NX, M0) prostate cancer treated by conventional radiation alone or with adjuvant androgen ablation. Methods and Materials: Three hundred forty-four men with T3, N0/NX, M0 adenocarcinoma of the prostate who received conventional radiation alone (260) or with androgen ablation (84) were analyzed for relapse or rising prostate-specific antigen (PSA), using univariate and multivariate techniques. Results: With a median follow-up of 68 months, the 260 men treated with radiation alone had a 10-year actuarial rate of relapse or rising PSA of 76%. Pretreatment PSA level (≤ 10 ng/ml vs. > 10 ≤ 20 ng/ml vs. > 20 ng/ml) and radiation dose (< 68 Gy vs. ≥ 68 Gy) were the only independently significant determinants of biochemical failure; Gleason score (2-7 vs. 8-10) was an additional determinant of metastatic relapse. Patients treated to doses < 68 Gy experienced 6-year failure rates exceeding 50% regardless of PSA level. Patients with PSA ≤ 10 ng/ml and receiving 68-70 Gy had a 6-year failure of 24%, but those with PSA > 10 ng/ml had relapse rates exceeding 50% even at doses of 70 Gy. At a median follow-up of 44 months, the 84 patients treated with radiation and androgen ablation had a 6-year biochemical failure rate of 22%. The only significant determinant of outcome in this group was pretreatment PSA; patients with PSA ≤ 80 ng/ml had a 6- year failure rate of only 12% compared to a failure rate of 53% for those with PSA > 80 ng/ml. The outcome for those treated with combined modalities was significantly better than for those treated with radiation alone in all PSA strata. Conclusion: Conventional radiation alone has little curative potential for Stage III disease. Doses < 68 Gy are particularly ineffective. Patients with PSA ≤ 10 ng/ml may be candidates for conventional radiation to a dose of 70 Gy. Other patients are probably best served by combined radiation-androgen ablation or high-dose conformal radiation.

AB - Purpose: To evaluate the outcome of clinical Stage III (T3, N0/NX, M0) prostate cancer treated by conventional radiation alone or with adjuvant androgen ablation. Methods and Materials: Three hundred forty-four men with T3, N0/NX, M0 adenocarcinoma of the prostate who received conventional radiation alone (260) or with androgen ablation (84) were analyzed for relapse or rising prostate-specific antigen (PSA), using univariate and multivariate techniques. Results: With a median follow-up of 68 months, the 260 men treated with radiation alone had a 10-year actuarial rate of relapse or rising PSA of 76%. Pretreatment PSA level (≤ 10 ng/ml vs. > 10 ≤ 20 ng/ml vs. > 20 ng/ml) and radiation dose (< 68 Gy vs. ≥ 68 Gy) were the only independently significant determinants of biochemical failure; Gleason score (2-7 vs. 8-10) was an additional determinant of metastatic relapse. Patients treated to doses < 68 Gy experienced 6-year failure rates exceeding 50% regardless of PSA level. Patients with PSA ≤ 10 ng/ml and receiving 68-70 Gy had a 6-year failure of 24%, but those with PSA > 10 ng/ml had relapse rates exceeding 50% even at doses of 70 Gy. At a median follow-up of 44 months, the 84 patients treated with radiation and androgen ablation had a 6-year biochemical failure rate of 22%. The only significant determinant of outcome in this group was pretreatment PSA; patients with PSA ≤ 80 ng/ml had a 6- year failure rate of only 12% compared to a failure rate of 53% for those with PSA > 80 ng/ml. The outcome for those treated with combined modalities was significantly better than for those treated with radiation alone in all PSA strata. Conclusion: Conventional radiation alone has little curative potential for Stage III disease. Doses < 68 Gy are particularly ineffective. Patients with PSA ≤ 10 ng/ml may be candidates for conventional radiation to a dose of 70 Gy. Other patients are probably best served by combined radiation-androgen ablation or high-dose conformal radiation.

KW - Androgen ablation

KW - Dose-response

KW - Prostate cancer

KW - Radiation therapy

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