Document Detail


A multi-institutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer.
MedLine Citation:
PMID:  18672274     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure. METHODS: Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery. RESULTS: A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, SRT and Gleason score >or=8 were independent predictors of diminished FFBF. From the date of surgery, Gleason score >or=8 was a significant predictor of FFBF. CONCLUSIONS: Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score >or=8 was the only factor on multivariate analysis associated with metastasic progression.
Authors:
Edouard J Trabulsi; Richard K Valicenti; Alexandra L Hanlon; Thomas M Pisansky; Howard M Sandler; Deborah A Kuban; Charles N Catton; Jeff M Michalski; Michael J Zelefsky; Patrick A Kupelian; Daniel W Lin; Mitchell S Anscher; Kevin M Slawin; Claus G Roehrborn; Jeffrey D Forman; Stanley L Liauw; Larry L Kestin; Theodore L DeWeese; Peter T Scardino; Andrew J Stephenson; Alan Pollack
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-07-30
Journal Detail:
Title:  Urology     Volume:  72     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2009-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1298-302; discussion 1302-4     Citation Subset:  IM    
Affiliation:
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Case-Control Studies
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Period
Proportional Hazards Models
Prostatic Neoplasms / radiotherapy*,  surgery*
Radiotherapy / methods*
Salvage Therapy / methods*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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