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Racial Disparities in Prostate Cancer–Specific Survival After Definitive Treatment for Gleason 8-10 Localized Prostate Cancer
Volume 96 Number 2S Supplement 2016
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2601 Racial Disparities in Prostate CancereSpecific Survival After Definitive Treatment for Gleason 8-10 Localized Prostate Cancer C. Wang,1 J. Wang,2 J.D.D. Pennington,3 P.A. Kupelian,4 M.L. Steinberg,4 and M. Kamrava3; 1UCLA Department of Radiation Oncology, Los Angeles, CA, 2University of California Los Angeles, Los Angeles, CA, 3 University of California, Los Angeles, Los Angeles, CA, 4University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): The purpose of this study is to investigate whether prostate cancer specific survival (PCSS) following definitive treatment for Gleason 8-10 localized PCa varies by race. Materials/Methods: This study included 27,168 men in the SEER database with T1-T2N0M0 Gleason score 8-10 PCa diagnosed between 2000 and 2012 who underwent definitive treatment with radical prostatectomy (RP), external beam radiation therapy (EBRT), EBRT + brachytherapy boost (EBRT+B) or no definitive treatment (NDT). The distribution of races amongst the study patients was: 1,955 Asian Americans (AsA), 20,172 Non-Hispanic Whites (NHW), and 4,580 African Americans (AA). Median age was 68 years (71 years for AsA, 69 years for NHW and 65 years for AA). Data on prostate specific antigen was not available in current SEER database and so it could not be included in the analysis. Mean follow up was 5.17+/-0.78 years (5.50+/0.73 years for AsA, 5.25+/-0.77 years for NHW and 4.75+/-0.78 years for AA). Kaplan-Meier curves were computed to compare PCSS differences stratified by race and definitive treatment modality. Cox proportional hazards regression was used to assess the impact of race and definitive treatment modality on PCSS. All P values were 2-sided with statistical significance set at 0.05. Results: After RP 12y PCSS for AsA, NHW and AA men were: 95%, 92%, and 91%. After EBRT 12y PCSS for these three groups were: 87%, 81%, and 81%. After EBRT+B 12y PCSS for these three groups were: 90%, 86%, and 87%. After NDT 12y PCSS for these three groups were: 79%, 58%, and 55%. AsA demonstrated statistically significant superior PCSS compared to NHW and AA after EBRT and NDT but not after EBRT+B or RP (Table 1).
Abstract 2601; Table 1. Cox Proportional Hazards Regression Stratified by Treatment Modality.
RP (AsA vs NHW) RP (AsA vs AA) EBRT (AsA vs NHW) EBRT (AsA vs AA) EBRT+B (AsA vs NHW) EBRT+B (AsA vs AA) NDT (AsA vs NHW) NDT (AsA vs AA)
HR
P value
95% CI - lower
95% CI - upper
1.7480 1.9430 1.7060 1.5570 1.7372 1.7702 2.1040 2.0940
0.0700 0.0450 2.800E-03 0.0323 0.1500 0.1800 7.200E-07 4.290E-06
0.9553 1.0134 1.2010 1.0380 0.8119 0.7732 1.5683 1.5272
3.1953 3.7237 2.4226 2.3367 3.7170 4.0527 2.8236 2.8707
Table 1. Cox proportional hazards regression analysis of PCSS stratified by treatment modalities including radical prostatectomy (RP), external beam radiation therapy (EBRT), external beam radiation therapy plus brachytherapy boost (EBRT+B) and no definitive treatment (NDT). AsA [ Asian Americans, NHW [ Non-Hispanic Whites, AA [ African Americans.
Conclusion: AsA race is associated with a 6% improvement in PCSS compared with NHW and AA following EBRT. However, racial-based disparities in PCSS were not observed in patients receiving brachytherapy boost in addition to EBRT perhaps due to less prostate cancer specific mortality events at maximum follow up of 12 years. It is unclear if PCSS of each race will diverge with longer follow up. Further research is needed to better understand the impact of race on PCa treatment outcomes.
Author Disclosure: C. Wang: Independent Contractor; ViewRay. J. Wang: None. J.D. Pennington: None. P.A. Kupelian: None. M.L. Steinberg: Travel Expenses; ViewRay. M. Kamrava: None.
2602 Prostate Hypofractionated Radiation Therapy (62 Gy at 3.1 Gy Per Fraction) With Injection of Hyaluronic Acid: Final Results of the RPAH1 Study O. Chapet,1 S. Bin,2 P. Fenoglietto,3 P. Jalade,1 A. Faix,4 A. Ruffion,1 C. Udrescu,1 C. Enachescu,1 S. Yossi,1 and D. Azria3; 1Centre Hospitalier Lyon Sud, Lyon, France, 2Hospices Civils de Lyon - Pole IMER, Lyon, France, 3Institut du Cancer de Montpellier, Montpellier, France, 4Clinique Beausoleil, Montpellier, France Purpose/Objective(s): Results of Phase I to III trials showed that hypofractionated radiation therapy (HFR) with doses per fraction of 3Gy can be associated with late grade 2 rectal toxicities, between 15% and 25%. The main objective of the RPAH1 phase II study was to report the rate of late grade 2 rectal toxicities at 3 years, after HFR of prostate cancer with injection of hyaluronic acid (HA) between the prostate and the rectum. Tolerance of the HA injection, other acute and late toxicities and biochemical results are reported as well. Materials/Methods: Between 2010 and 2012, 36 patients with low- or intermediate-risk prostate cancer were treated by exclusive HFR (IMRT + IGRT) with 20 fractions of 3.1Gy, 5 days per week for a total dose of 62Gy (BED Z 84Gy with a/b ratio of 1.5 Gy). A transperineal injection of 10 cc of HA was systematically done between the rectum and the prostate, under local anesthesia and under ultrasound guidance. Three gold markers were implanted in the prostate, for CT/MRI fusion and daily repositioning. Hormonotherapy was accepted. Toxicities were evaluated weekly during treatment, 1 week after the last session of irradiation, and then at 3, 6, 12, 18, 24, 30 and 36 months after the end of treatment. Late toxicity was defined by toxicity occurring after the third month. Grading was done using the Common Terminology Criteria for Adverse Events v4 classification. Results: Median pretreatment PSA was 7.32 ng/mL (range: 0.57-19.59 ng/ mL). Cancer characteristics were as follows: Stage T1, 18 (50%) and T2, 18 (50%); Gleason 6, 22 (61%) and Gleason 7, 14 (39%). One patient withdrew before receiving HFR and was not considered for analysis, 3 patients withdrew study (1 at 3 months and 2 after 30 months), their data were considered. HA was very well tolerated with no pain or discomfort during the time of follow-up. None of the patients experienced late grade 3e4 toxicities. Late grade 2 gastro-intestinal (GI) toxicities occurred in 4 (12%) patients with 3 (9%) grade 2 rectal bleedings and one diarrhea. Late grade 2 genitourinary (GU) toxicities occurred in 14 (41%) patients. The most frequent grade 2 GU toxicities were dysuria and pollakiurie (observed in 8 patients each). Among the 32 patients completing the 36 months’ visit, none still had a grade 2 GI toxicity and, 4 patients still experienced a GU grade 2 toxicity. The biochemical relapse rate (nadir + 2ng/ml) was 6% (2 patients). Conclusion: With an injection of HA, hypofractionated irradiation in 4 weeks is well tolerated with no grade 3 rectal toxicity and a rate of grade 2 rectal bleeding below 10%. Late urinary toxicities are the most frequent but the rate decreases largely at three years. Author Disclosure: O. Chapet: speaker; IPSEN, TAKEDA. Board member; Astellas. S. Bin: None. P. Fenoglietto: None. P. Jalade: None. A. Faix: None. A. Ruffion: None. C. Udrescu: None. C. Enachescu: None. S. Yossi: None. D. Azria: None.
2603 Stereotactic Radiation Therapy (SRT) for Metastatic Renal Cell Carcinoma (mRCC) E. Meyer,1 D. Pasquier,2 G. Bernadou,3 G. Calais,3 C. Carrie,4 D. Stefan,1 C. Theodore,5 L. Albiges,6 A. Bossi,7 P. Maroun,6 R. De Crevoisier,8 C. Hennequin,9 J.L. Lagrange,10 F. Lesaunier,1 J.M. Grellard,11
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2601 Racial Disparities in Prostate CancereSpecific Survival After Definitive Treatment for Gleason 8-10 Localized Prostate Cancer C. Wang,1 J. Wang,2 J.D.D. Pennington,3 P.A. Kupelian,4 M.L. Steinberg,4 and M. Kamrava3; 1UCLA Department of Radiation Oncology, Los Angeles, CA, 2University of California Los Angeles, Los Angeles, CA, 3 University of California, Los Angeles, Los Angeles, CA, 4University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): The purpose of this study is to investigate whether prostate cancer specific survival (PCSS) following definitive treatment for Gleason 8-10 localized PCa varies by race. Materials/Methods: This study included 27,168 men in the SEER database with T1-T2N0M0 Gleason score 8-10 PCa diagnosed between 2000 and 2012 who underwent definitive treatment with radical prostatectomy (RP), external beam radiation therapy (EBRT), EBRT + brachytherapy boost (EBRT+B) or no definitive treatment (NDT). The distribution of races amongst the study patients was: 1,955 Asian Americans (AsA), 20,172 Non-Hispanic Whites (NHW), and 4,580 African Americans (AA). Median age was 68 years (71 years for AsA, 69 years for NHW and 65 years for AA). Data on prostate specific antigen was not available in current SEER database and so it could not be included in the analysis. Mean follow up was 5.17+/-0.78 years (5.50+/0.73 years for AsA, 5.25+/-0.77 years for NHW and 4.75+/-0.78 years for AA). Kaplan-Meier curves were computed to compare PCSS differences stratified by race and definitive treatment modality. Cox proportional hazards regression was used to assess the impact of race and definitive treatment modality on PCSS. All P values were 2-sided with statistical significance set at 0.05. Results: After RP 12y PCSS for AsA, NHW and AA men were: 95%, 92%, and 91%. After EBRT 12y PCSS for these three groups were: 87%, 81%, and 81%. After EBRT+B 12y PCSS for these three groups were: 90%, 86%, and 87%. After NDT 12y PCSS for these three groups were: 79%, 58%, and 55%. AsA demonstrated statistically significant superior PCSS compared to NHW and AA after EBRT and NDT but not after EBRT+B or RP (Table 1).
Abstract 2601; Table 1. Cox Proportional Hazards Regression Stratified by Treatment Modality.
RP (AsA vs NHW) RP (AsA vs AA) EBRT (AsA vs NHW) EBRT (AsA vs AA) EBRT+B (AsA vs NHW) EBRT+B (AsA vs AA) NDT (AsA vs NHW) NDT (AsA vs AA)
HR
P value
95% CI - lower
95% CI - upper
1.7480 1.9430 1.7060 1.5570 1.7372 1.7702 2.1040 2.0940
0.0700 0.0450 2.800E-03 0.0323 0.1500 0.1800 7.200E-07 4.290E-06
0.9553 1.0134 1.2010 1.0380 0.8119 0.7732 1.5683 1.5272
3.1953 3.7237 2.4226 2.3367 3.7170 4.0527 2.8236 2.8707
Table 1. Cox proportional hazards regression analysis of PCSS stratified by treatment modalities including radical prostatectomy (RP), external beam radiation therapy (EBRT), external beam radiation therapy plus brachytherapy boost (EBRT+B) and no definitive treatment (NDT). AsA [ Asian Americans, NHW [ Non-Hispanic Whites, AA [ African Americans.
Conclusion: AsA race is associated with a 6% improvement in PCSS compared with NHW and AA following EBRT. However, racial-based disparities in PCSS were not observed in patients receiving brachytherapy boost in addition to EBRT perhaps due to less prostate cancer specific mortality events at maximum follow up of 12 years. It is unclear if PCSS of each race will diverge with longer follow up. Further research is needed to better understand the impact of race on PCa treatment outcomes.
Author Disclosure: C. Wang: Independent Contractor; ViewRay. J. Wang: None. J.D. Pennington: None. P.A. Kupelian: None. M.L. Steinberg: Travel Expenses; ViewRay. M. Kamrava: None.
2602 Prostate Hypofractionated Radiation Therapy (62 Gy at 3.1 Gy Per Fraction) With Injection of Hyaluronic Acid: Final Results of the RPAH1 Study O. Chapet,1 S. Bin,2 P. Fenoglietto,3 P. Jalade,1 A. Faix,4 A. Ruffion,1 C. Udrescu,1 C. Enachescu,1 S. Yossi,1 and D. Azria3; 1Centre Hospitalier Lyon Sud, Lyon, France, 2Hospices Civils de Lyon - Pole IMER, Lyon, France, 3Institut du Cancer de Montpellier, Montpellier, France, 4Clinique Beausoleil, Montpellier, France Purpose/Objective(s): Results of Phase I to III trials showed that hypofractionated radiation therapy (HFR) with doses per fraction of 3Gy can be associated with late grade 2 rectal toxicities, between 15% and 25%. The main objective of the RPAH1 phase II study was to report the rate of late grade 2 rectal toxicities at 3 years, after HFR of prostate cancer with injection of hyaluronic acid (HA) between the prostate and the rectum. Tolerance of the HA injection, other acute and late toxicities and biochemical results are reported as well. Materials/Methods: Between 2010 and 2012, 36 patients with low- or intermediate-risk prostate cancer were treated by exclusive HFR (IMRT + IGRT) with 20 fractions of 3.1Gy, 5 days per week for a total dose of 62Gy (BED Z 84Gy with a/b ratio of 1.5 Gy). A transperineal injection of 10 cc of HA was systematically done between the rectum and the prostate, under local anesthesia and under ultrasound guidance. Three gold markers were implanted in the prostate, for CT/MRI fusion and daily repositioning. Hormonotherapy was accepted. Toxicities were evaluated weekly during treatment, 1 week after the last session of irradiation, and then at 3, 6, 12, 18, 24, 30 and 36 months after the end of treatment. Late toxicity was defined by toxicity occurring after the third month. Grading was done using the Common Terminology Criteria for Adverse Events v4 classification. Results: Median pretreatment PSA was 7.32 ng/mL (range: 0.57-19.59 ng/ mL). Cancer characteristics were as follows: Stage T1, 18 (50%) and T2, 18 (50%); Gleason 6, 22 (61%) and Gleason 7, 14 (39%). One patient withdrew before receiving HFR and was not considered for analysis, 3 patients withdrew study (1 at 3 months and 2 after 30 months), their data were considered. HA was very well tolerated with no pain or discomfort during the time of follow-up. None of the patients experienced late grade 3e4 toxicities. Late grade 2 gastro-intestinal (GI) toxicities occurred in 4 (12%) patients with 3 (9%) grade 2 rectal bleedings and one diarrhea. Late grade 2 genitourinary (GU) toxicities occurred in 14 (41%) patients. The most frequent grade 2 GU toxicities were dysuria and pollakiurie (observed in 8 patients each). Among the 32 patients completing the 36 months’ visit, none still had a grade 2 GI toxicity and, 4 patients still experienced a GU grade 2 toxicity. The biochemical relapse rate (nadir + 2ng/ml) was 6% (2 patients). Conclusion: With an injection of HA, hypofractionated irradiation in 4 weeks is well tolerated with no grade 3 rectal toxicity and a rate of grade 2 rectal bleeding below 10%. Late urinary toxicities are the most frequent but the rate decreases largely at three years. Author Disclosure: O. Chapet: speaker; IPSEN, TAKEDA. Board member; Astellas. S. Bin: None. P. Fenoglietto: None. P. Jalade: None. A. Faix: None. A. Ruffion: None. C. Udrescu: None. C. Enachescu: None. S. Yossi: None. D. Azria: None.
2603 Stereotactic Radiation Therapy (SRT) for Metastatic Renal Cell Carcinoma (mRCC) E. Meyer,1 D. Pasquier,2 G. Bernadou,3 G. Calais,3 C. Carrie,4 D. Stefan,1 C. Theodore,5 L. Albiges,6 A. Bossi,7 P. Maroun,6 R. De Crevoisier,8 C. Hennequin,9 J.L. Lagrange,10 F. Lesaunier,1 J.M. Grellard,11