Predictors of improved outcome for patients with localized prostate cancer treated with neoadjuvant androgen ablation therapy and three-dimensional conformal radiotherapy Journal Article


Authors: Zelefsky, M. J.; Lyass, O.; Fuks, Z.; Wolfe, T.; Burman, C.; Ling, C. C.; Leibel, S. A.
Article Title: Predictors of improved outcome for patients with localized prostate cancer treated with neoadjuvant androgen ablation therapy and three-dimensional conformal radiotherapy
Abstract: Purpose: To identify prognostic variables that predict for improved biochemical and local control outcome in patients with localized prostatic cancer treated with neoadjuvant androgen deprivation (NAAD)and three- dimensional conformal radiotherapy (3D-CRT). Materials and Methods: Between 1989 and 1995, 213 patients with localized prostate cancer were treated with a 3-month course of NAAD that consisted of leuprolide acetate and fiutamide before 3D-CRT. The purpose of NAAD in these patients was to reduce the preradiotherapy target volume so as to decrease the dose delivered to adjacent normal tissues and thereby minimize the risk of morbidity from high- dose radiotherapy. The median pretreatment prostate-specific antigen (PSA) level was 15.3 ng/mL (range, 1 to 560 ng/mL). The median 3D-CRT dose was 75.6 Gy (range, 64.8 to 81 Gy), and the median follow-up time was 3 years (range, 1 to 7 years). Results: The significant predictors for improved outcome as identified in a multivariate analysis included pretreatment PSA level ≤ 10.0 ng/mL (P < .001), NAAD-induced preradiotherapy PSA nadir ≤0.5 ng/mL (P < .001), and clinical stage ≤ T2c (P < .04). The 5-year PSA relapse-free survival rates were 93%, 60%, and 40% for patients with pretreatment PSA levels ≤ 10 ng/mL, 10 to 20 ng/mL, and greater than 20 ng/mL, respectively (P < .001). Patients with preradiotheropy nadir levels ≤ 0.5 ng/mL after 3 months of NAAD experienced a 5-year PSA relapse-free survival rate of 74%, as compared with 40% for patients with higher nadir levels (P< .001). The incidence of a positive biopsy among 34 patients pretreated with androgen ablation was 12%, as compared with 39% for 117 patients treated with 3D-CRT alone who underwent a biopsy (P < .001). Conclusion: For patients treated with NAAD and high-dose 3D-CRT, pretreatment PSA, preradiotherapy PSA nadir response, and clinical stage are important predictors of biochemical outcome. Patients with NAAD-induced PSA nadir levels greater than 0.5 ng/mL before radiotherapy are more likely to develop biochemical failure and may benefit from more aggressive therapies.
Keywords: adult; cancer survival; treatment outcome; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; androgen; cancer adjuvant therapy; cancer radiotherapy; radiation dose; combined modality therapy; cancer staging; neoplasm staging; prostate specific antigen; metastasis; tumor biopsy; prostate cancer; prostate-specific antigen; prostatic neoplasms; leuprorelin; three dimensional imaging; androgen antagonists; flutamide; antineoplastic agents, hormonal; radiosensitizing agent; leuprolide; intramuscular drug administration; radiotherapy, computer-assisted; humans; prognosis; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 16
Issue: 10
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1998-10-01
Start Page: 3380
End Page: 3385
Language: English
PUBMED: 9779716
PROVIDER: scopus
DOI: 10.1200/JCO.1998.16.10.3380
DOI/URL:
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Chandra M Burman
    137 Burman
  2. Zvi Fuks
    313 Fuks
  3. Michael J Zelefsky
    624 Zelefsky
  4. Steven A Leibel
    220 Leibel
  5. C Clifton Ling
    313 Ling
  6. Theresa J Wolfe
    4 Wolfe