Influence of initial presentation on treatment outcome of clinically localized prostate cancer treated by definitive radiation therapy

Fady B. Geara, Gunar K. Zagars, Alan Pollack

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: The increasing proportion of early stage prostate cancer diagnosed by various early detection methods together with reports espousing watchful waiting as a management option raise the possibility that patients may be selected for surveillance according to their initial presentation. Methods and Materials: The outcome for 427 men with clinical stages T1 to T4 localized prostate cancer treated with radiation therapy was evaluated according to their presentation: elevated prostate-specific antigen (PSA) level; abnormal digital rectal examination; or, urologic symptomatology. Results: With a median follow-up of 30 months, there were no significant differences in disease outcome according to initial presentation. The actuarial incidence of relapse at 5 years was: PSA-detected (54 patients), 24%; digital rectal-detected (173 patients) 29%; and, symptom-detected (200 patients) 31% (p = 0.79). Likewise, there were no significant differences in the incidence of postradiation rising PSA profiles among the three groups. The actuarial incidence of relapse and/or rising PSA at 5 years was: PSA-detected 35%; digital rectal-detected 42%; symptom-detected, 48% (p = 0.72). On the other hand, T-stage, Gleason grade, pretreatment PSA, pretreatment acid phosphatase, and transurethral resection in T3 T4 disease were each highly correlated with outcome. In multivariate proportional hazards regression pretreatment PSA (p = 0.0003), Gleason grade (p = 0.045), and transurethral resection in T3 T4 disease (p = 0.0562) correlated with outcome, but initial presentation did not (p = 0.25). Conclusion: The absence of a prognostic gradient, good to bad, from PSA-detected through digital rectal-detected to symptom-detected cancer suggests that the initial presentation of patients with localized prostate cancer is not a valid basis for selecting watchful waiting vs. initial treatment.

Original languageEnglish
Pages (from-to)331-337
Number of pages7
JournalInternational journal of radiation oncology, biology, physics
Volume30
Issue number2
DOIs
StatePublished - Sep 30 1994
Externally publishedYes

Fingerprint

antigens
Prostate-Specific Antigen
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
pretreatment
Watchful Waiting
incidence
grade
Incidence
Recurrence
Digital Rectal Examination
phosphatases
surveillance
Acid Phosphatase
hazards
regression analysis
proportion
examination

Keywords

  • Diagnosis
  • Prognostic factors
  • Prostate cancer
  • Prostate-specific antigen
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

@article{a8eae0991e4444b68baad127ca7cee37,
title = "Influence of initial presentation on treatment outcome of clinically localized prostate cancer treated by definitive radiation therapy",
abstract = "Purpose: The increasing proportion of early stage prostate cancer diagnosed by various early detection methods together with reports espousing watchful waiting as a management option raise the possibility that patients may be selected for surveillance according to their initial presentation. Methods and Materials: The outcome for 427 men with clinical stages T1 to T4 localized prostate cancer treated with radiation therapy was evaluated according to their presentation: elevated prostate-specific antigen (PSA) level; abnormal digital rectal examination; or, urologic symptomatology. Results: With a median follow-up of 30 months, there were no significant differences in disease outcome according to initial presentation. The actuarial incidence of relapse at 5 years was: PSA-detected (54 patients), 24{\%}; digital rectal-detected (173 patients) 29{\%}; and, symptom-detected (200 patients) 31{\%} (p = 0.79). Likewise, there were no significant differences in the incidence of postradiation rising PSA profiles among the three groups. The actuarial incidence of relapse and/or rising PSA at 5 years was: PSA-detected 35{\%}; digital rectal-detected 42{\%}; symptom-detected, 48{\%} (p = 0.72). On the other hand, T-stage, Gleason grade, pretreatment PSA, pretreatment acid phosphatase, and transurethral resection in T3 T4 disease were each highly correlated with outcome. In multivariate proportional hazards regression pretreatment PSA (p = 0.0003), Gleason grade (p = 0.045), and transurethral resection in T3 T4 disease (p = 0.0562) correlated with outcome, but initial presentation did not (p = 0.25). Conclusion: The absence of a prognostic gradient, good to bad, from PSA-detected through digital rectal-detected to symptom-detected cancer suggests that the initial presentation of patients with localized prostate cancer is not a valid basis for selecting watchful waiting vs. initial treatment.",
keywords = "Diagnosis, Prognostic factors, Prostate cancer, Prostate-specific antigen, Radiation therapy",
author = "Geara, {Fady B.} and Zagars, {Gunar K.} and Alan Pollack",
year = "1994",
month = "9",
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doi = "10.1016/0360-3016(94)90012-4",
language = "English",
volume = "30",
pages = "331--337",
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TY - JOUR

T1 - Influence of initial presentation on treatment outcome of clinically localized prostate cancer treated by definitive radiation therapy

AU - Geara, Fady B.

AU - Zagars, Gunar K.

AU - Pollack, Alan

PY - 1994/9/30

Y1 - 1994/9/30

N2 - Purpose: The increasing proportion of early stage prostate cancer diagnosed by various early detection methods together with reports espousing watchful waiting as a management option raise the possibility that patients may be selected for surveillance according to their initial presentation. Methods and Materials: The outcome for 427 men with clinical stages T1 to T4 localized prostate cancer treated with radiation therapy was evaluated according to their presentation: elevated prostate-specific antigen (PSA) level; abnormal digital rectal examination; or, urologic symptomatology. Results: With a median follow-up of 30 months, there were no significant differences in disease outcome according to initial presentation. The actuarial incidence of relapse at 5 years was: PSA-detected (54 patients), 24%; digital rectal-detected (173 patients) 29%; and, symptom-detected (200 patients) 31% (p = 0.79). Likewise, there were no significant differences in the incidence of postradiation rising PSA profiles among the three groups. The actuarial incidence of relapse and/or rising PSA at 5 years was: PSA-detected 35%; digital rectal-detected 42%; symptom-detected, 48% (p = 0.72). On the other hand, T-stage, Gleason grade, pretreatment PSA, pretreatment acid phosphatase, and transurethral resection in T3 T4 disease were each highly correlated with outcome. In multivariate proportional hazards regression pretreatment PSA (p = 0.0003), Gleason grade (p = 0.045), and transurethral resection in T3 T4 disease (p = 0.0562) correlated with outcome, but initial presentation did not (p = 0.25). Conclusion: The absence of a prognostic gradient, good to bad, from PSA-detected through digital rectal-detected to symptom-detected cancer suggests that the initial presentation of patients with localized prostate cancer is not a valid basis for selecting watchful waiting vs. initial treatment.

AB - Purpose: The increasing proportion of early stage prostate cancer diagnosed by various early detection methods together with reports espousing watchful waiting as a management option raise the possibility that patients may be selected for surveillance according to their initial presentation. Methods and Materials: The outcome for 427 men with clinical stages T1 to T4 localized prostate cancer treated with radiation therapy was evaluated according to their presentation: elevated prostate-specific antigen (PSA) level; abnormal digital rectal examination; or, urologic symptomatology. Results: With a median follow-up of 30 months, there were no significant differences in disease outcome according to initial presentation. The actuarial incidence of relapse at 5 years was: PSA-detected (54 patients), 24%; digital rectal-detected (173 patients) 29%; and, symptom-detected (200 patients) 31% (p = 0.79). Likewise, there were no significant differences in the incidence of postradiation rising PSA profiles among the three groups. The actuarial incidence of relapse and/or rising PSA at 5 years was: PSA-detected 35%; digital rectal-detected 42%; symptom-detected, 48% (p = 0.72). On the other hand, T-stage, Gleason grade, pretreatment PSA, pretreatment acid phosphatase, and transurethral resection in T3 T4 disease were each highly correlated with outcome. In multivariate proportional hazards regression pretreatment PSA (p = 0.0003), Gleason grade (p = 0.045), and transurethral resection in T3 T4 disease (p = 0.0562) correlated with outcome, but initial presentation did not (p = 0.25). Conclusion: The absence of a prognostic gradient, good to bad, from PSA-detected through digital rectal-detected to symptom-detected cancer suggests that the initial presentation of patients with localized prostate cancer is not a valid basis for selecting watchful waiting vs. initial treatment.

KW - Diagnosis

KW - Prognostic factors

KW - Prostate cancer

KW - Prostate-specific antigen

KW - Radiation therapy

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