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A Comparison of Biochemical Relapse Free Survival (bRFS) Between Primary Gleason 3 and Primary Gleason 4 for Biopsy Gleason 7 Prostate Cancer
I. J. Radiation Oncology d Biology d Physics
S360
2281
Volume 69, Number 3, Supplement, 2007
A Comparison of Biochemical Relapse Free Survival (bRFS) Between Primary Gleason 3 and Primary Gleason 4 for Biopsy Gleason 7 Prostate Cancer
M. J. Burdick1, C. A. Reddy1, J. P. Ciezki1, J. Ulchaker1, K. Angermeier1, A. Altman2, N. Chehade2, A. Mahadevan1, P. A. Kupelian3, E. A. Klein1 1
Cleveland Clinic, Cleveland, OH, 2Kaiser Permanente, Cleveland, OH, 3MD Anderson Cancer Center, Orlando, FL
Purpose/Objective(s): Biopsy Gleason score (bx GS) has been shown to be a powerful prognostic indicator for prostate cancer outcomes. Most risk stratifications classify bx GS 7 prostate cancers as intermediate or high risk. Several institutions have retrospectively examined surgical outcomes for patients with bx GS 7 prostate cancer. Here we present biochemical relapse free survival (bRFS) rates comparing primary grade 3 (G3) to primary grade 4 (G4) for bx GS 7 patients treated with external beam radiation therapy (EBRT), interstitial prostate brachytherapy with I125 seeds (PI), or radical prostatectomy (RPR). Materials/Methods: We reviewed 705 cases of bx GS 7 prostate cancer from a prospectively maintained database that were treated at our institution between 9/1996 and 3/2005 with RPR (n = 310), EBRT (n = 268), or PI (n = 127). All patients had bx GS 7 prostate cancer with both a primary and secondary grade recorded, and all pathology slides were reviewed at our institution. Cox Proportional Hazards Regression was used for univariate and multivariate analysis examining these factors: primary bx GS grade, initial PSA, clinical T stage, use of androgen deprivation (AD), risk group (high or intermediate risk), and treatment modality. For RPR, biochemical failure was defined as PSA $ 0.3 ng/mL on one reading. For PI and EBRT, biochemical failure was defined as a PSA value $2 ng/mL above a PSA nadir value. Results: We identified 508 cases of G3 bx GS 7 prostate cancer and 197 cases of G4 bx GS 7 prostate cancer. Median follow-up for all patients was 54 months. The percentages of high-risk patients in the EBRT, PI, and RPR groups were 50.7%, 15.0%, and 31.0%, respectively. At 5 years, bRFS rates for G3 and G4 prostate cancer were 78.3% and 70.7%, respectively. This amounted to a relative risk (RR) of 0.655 (p = 0.0113) for G3 compared to G4. For all patients, RPR had lower rates of bRFS when compared to EBRT (RR 2.389, p # 0.0001) and PI (RR 2.295, p = 0.0042). For G3, RPR had lower rates of bRFS than EBRT (RR 2.370, p = 0.0004) and PI (RR 2.885, p = 0.0052). For G4, RPR, EBRT, and PI had similar bRFS. AD did not improve bRFS for either G3 or G4 bx GS 7 prostate cancer. Conclusions: G3 bx GS 7 prostate cancer had better bRFS when compared to G4 regardless of treatment modality. Author Disclosure: M.J. Burdick, None; C.A. Reddy, None; J.P. Ciezki, None; J. Ulchaker, None; K. Angermeier, None; A. Altman, None; N. Chehade, None; A. Mahadevan, None; P.A. Kupelian, None; E.A. Klein, None.
2282
Intermediate Risk Prostate Adenocarcinoma Patient (IRPC) Outcome Appears Equivalent Whether Treated With I-125 Brachytherapy (BT) or Dose Escalated Conformal External Beam Radiotherapy (EBRT)
N. Salem1, F. Bladou2, G. Gravis1, M. Resbeut1, M. Simonian1, K. Gilles2, G. Serment2 1
Institu Paoli Calmettes, Marseilles, France, 2Hopital Salvator, Marseilles, France
Purpose/Objective(s): To report IRPC patients outcome treated in the same institution with dose escalated conformal radiotherapy or iodine-125 brachytherapy. Materials/Methods: Between 1996 and 2003, 318 patients with IRPC (according to D’amico classification) were treated at Institut PAOLI CALMETTES; 162 received transperineal I-125 brachytherapy and 156 conformal EBRT. Patients characteristics were: Median age 68 years (65 for BT and 70 for EBRT), median PSA at diagnosis 11 ng/ml (10.8 for BT and 12 for EBRT). T stage was defined according to biopsy (for 298 patients) and TURP (for 20 EBRT patients) results: T1b: 20 pts, T2a: 151 pts, T2b: 147 pts. Gleason score was \6 in 90 pts, 6 in 133 pts and 7 in 95 pts. One hundred and sixty five pts received androgen deprivation in a neoadjuvant setting for a median duration of 3 months (1–11 months). EBRT was delivered with high energy photons using a conformal technique to the prostate and pelvic nodes; median dose to the prostate was 78 Gy (70–80) and to the nodes 46 Gy (0–56) to ICRU point. BT used stranded iodine-125 seeds (Rapid Strand, Oncura) using a preplanning technique and prescribed dose was 145 Gy. Median post implant D90 for brachytherapy patients was 157 Gy (75–211). Relapse was defined according to the ASTRO nadir +2 definition. Results: Median follow-up was 62 months, ranging from 24 to 125 months. Eight pts were lost to follow-up. EBRT pts had significantly more Gleason 7 tumors (71 vs 24 pts) received significantly more often neoadjuvant androgen deprivation (99 vs 68 pts) and had shorter follow-up (54 vs 66 months). Sixty one pts experimented relapse (32 in BT treated pts and 29 EBRT treated pts). Median time to relapse was 27 months. Fifty five patients died, of these 9 died from prostate cancer metastases and all others from intercurrent disease. Five year relapse free survival was 76% identical in both treatment group. In BT treated patients PSA nadir was significantly lower 0.2 ng/ml vs 0.5 ng/ml in EBRT pts. In multivariate step by step analysis including all the population, only Gleason score 7 vs \7 was independant prognostic factor (p = 0.02); when Gleason 4+3 and 3+4 scores are analysed, significant adverse prognosis is shawn with 4+3 score wether patients received EBRT or BT. Conclusions: In this retrospective study, BT treated IRPC patients showed equivalent relapse free survival than those treated during the same period with conformal EBRT with dose escalation. Relapse free survival of patients with glesaon score 3+4 was equivalent to those with score less than 7. Author Disclosure: N. Salem, None; F. Bladou, None; G. Gravis, None; M. Resbeut, None; M. Simonian, None; K. Gilles, None; G. Serment, None.
2283
Should Prior TURP Influence the Decision to Treat Prostate Cancer With External Beam Radiation Therapy?
K. Devisetty1, A. B. Jani2, K. S. Choe1, S. L. Liauw1 1
University of Chicago, Chicago, IL, 2Emory University, Atlanta, GA
Purpose/Objective(s): To determine if a prior history of transurethral resection of the prostate (TURP) in men with prostate cancer treated with external beam radiation therapy (RT) is associated with an increased risk of acute or late genitourinary (GU) toxicity.
S360
2281
Volume 69, Number 3, Supplement, 2007
A Comparison of Biochemical Relapse Free Survival (bRFS) Between Primary Gleason 3 and Primary Gleason 4 for Biopsy Gleason 7 Prostate Cancer
M. J. Burdick1, C. A. Reddy1, J. P. Ciezki1, J. Ulchaker1, K. Angermeier1, A. Altman2, N. Chehade2, A. Mahadevan1, P. A. Kupelian3, E. A. Klein1 1
Cleveland Clinic, Cleveland, OH, 2Kaiser Permanente, Cleveland, OH, 3MD Anderson Cancer Center, Orlando, FL
Purpose/Objective(s): Biopsy Gleason score (bx GS) has been shown to be a powerful prognostic indicator for prostate cancer outcomes. Most risk stratifications classify bx GS 7 prostate cancers as intermediate or high risk. Several institutions have retrospectively examined surgical outcomes for patients with bx GS 7 prostate cancer. Here we present biochemical relapse free survival (bRFS) rates comparing primary grade 3 (G3) to primary grade 4 (G4) for bx GS 7 patients treated with external beam radiation therapy (EBRT), interstitial prostate brachytherapy with I125 seeds (PI), or radical prostatectomy (RPR). Materials/Methods: We reviewed 705 cases of bx GS 7 prostate cancer from a prospectively maintained database that were treated at our institution between 9/1996 and 3/2005 with RPR (n = 310), EBRT (n = 268), or PI (n = 127). All patients had bx GS 7 prostate cancer with both a primary and secondary grade recorded, and all pathology slides were reviewed at our institution. Cox Proportional Hazards Regression was used for univariate and multivariate analysis examining these factors: primary bx GS grade, initial PSA, clinical T stage, use of androgen deprivation (AD), risk group (high or intermediate risk), and treatment modality. For RPR, biochemical failure was defined as PSA $ 0.3 ng/mL on one reading. For PI and EBRT, biochemical failure was defined as a PSA value $2 ng/mL above a PSA nadir value. Results: We identified 508 cases of G3 bx GS 7 prostate cancer and 197 cases of G4 bx GS 7 prostate cancer. Median follow-up for all patients was 54 months. The percentages of high-risk patients in the EBRT, PI, and RPR groups were 50.7%, 15.0%, and 31.0%, respectively. At 5 years, bRFS rates for G3 and G4 prostate cancer were 78.3% and 70.7%, respectively. This amounted to a relative risk (RR) of 0.655 (p = 0.0113) for G3 compared to G4. For all patients, RPR had lower rates of bRFS when compared to EBRT (RR 2.389, p # 0.0001) and PI (RR 2.295, p = 0.0042). For G3, RPR had lower rates of bRFS than EBRT (RR 2.370, p = 0.0004) and PI (RR 2.885, p = 0.0052). For G4, RPR, EBRT, and PI had similar bRFS. AD did not improve bRFS for either G3 or G4 bx GS 7 prostate cancer. Conclusions: G3 bx GS 7 prostate cancer had better bRFS when compared to G4 regardless of treatment modality. Author Disclosure: M.J. Burdick, None; C.A. Reddy, None; J.P. Ciezki, None; J. Ulchaker, None; K. Angermeier, None; A. Altman, None; N. Chehade, None; A. Mahadevan, None; P.A. Kupelian, None; E.A. Klein, None.
2282
Intermediate Risk Prostate Adenocarcinoma Patient (IRPC) Outcome Appears Equivalent Whether Treated With I-125 Brachytherapy (BT) or Dose Escalated Conformal External Beam Radiotherapy (EBRT)
N. Salem1, F. Bladou2, G. Gravis1, M. Resbeut1, M. Simonian1, K. Gilles2, G. Serment2 1
Institu Paoli Calmettes, Marseilles, France, 2Hopital Salvator, Marseilles, France
Purpose/Objective(s): To report IRPC patients outcome treated in the same institution with dose escalated conformal radiotherapy or iodine-125 brachytherapy. Materials/Methods: Between 1996 and 2003, 318 patients with IRPC (according to D’amico classification) were treated at Institut PAOLI CALMETTES; 162 received transperineal I-125 brachytherapy and 156 conformal EBRT. Patients characteristics were: Median age 68 years (65 for BT and 70 for EBRT), median PSA at diagnosis 11 ng/ml (10.8 for BT and 12 for EBRT). T stage was defined according to biopsy (for 298 patients) and TURP (for 20 EBRT patients) results: T1b: 20 pts, T2a: 151 pts, T2b: 147 pts. Gleason score was \6 in 90 pts, 6 in 133 pts and 7 in 95 pts. One hundred and sixty five pts received androgen deprivation in a neoadjuvant setting for a median duration of 3 months (1–11 months). EBRT was delivered with high energy photons using a conformal technique to the prostate and pelvic nodes; median dose to the prostate was 78 Gy (70–80) and to the nodes 46 Gy (0–56) to ICRU point. BT used stranded iodine-125 seeds (Rapid Strand, Oncura) using a preplanning technique and prescribed dose was 145 Gy. Median post implant D90 for brachytherapy patients was 157 Gy (75–211). Relapse was defined according to the ASTRO nadir +2 definition. Results: Median follow-up was 62 months, ranging from 24 to 125 months. Eight pts were lost to follow-up. EBRT pts had significantly more Gleason 7 tumors (71 vs 24 pts) received significantly more often neoadjuvant androgen deprivation (99 vs 68 pts) and had shorter follow-up (54 vs 66 months). Sixty one pts experimented relapse (32 in BT treated pts and 29 EBRT treated pts). Median time to relapse was 27 months. Fifty five patients died, of these 9 died from prostate cancer metastases and all others from intercurrent disease. Five year relapse free survival was 76% identical in both treatment group. In BT treated patients PSA nadir was significantly lower 0.2 ng/ml vs 0.5 ng/ml in EBRT pts. In multivariate step by step analysis including all the population, only Gleason score 7 vs \7 was independant prognostic factor (p = 0.02); when Gleason 4+3 and 3+4 scores are analysed, significant adverse prognosis is shawn with 4+3 score wether patients received EBRT or BT. Conclusions: In this retrospective study, BT treated IRPC patients showed equivalent relapse free survival than those treated during the same period with conformal EBRT with dose escalation. Relapse free survival of patients with glesaon score 3+4 was equivalent to those with score less than 7. Author Disclosure: N. Salem, None; F. Bladou, None; G. Gravis, None; M. Resbeut, None; M. Simonian, None; K. Gilles, None; G. Serment, None.
2283
Should Prior TURP Influence the Decision to Treat Prostate Cancer With External Beam Radiation Therapy?
K. Devisetty1, A. B. Jani2, K. S. Choe1, S. L. Liauw1 1
University of Chicago, Chicago, IL, 2Emory University, Atlanta, GA
Purpose/Objective(s): To determine if a prior history of transurethral resection of the prostate (TURP) in men with prostate cancer treated with external beam radiation therapy (RT) is associated with an increased risk of acute or late genitourinary (GU) toxicity.