PATTERNS-OF-FAILURE ANALYSIS OF PATIENTS WITH HIGH PRETREATMENT PROSTATE-SPECIFIC ANTIGEN LEVELS TREATED BY RADIATION-THERAPY - THE NEED FOR IMPROVED SYSTEMIC AND LOCOREGIONAL TREATMENT
Ge. Hanks et al., PATTERNS-OF-FAILURE ANALYSIS OF PATIENTS WITH HIGH PRETREATMENT PROSTATE-SPECIFIC ANTIGEN LEVELS TREATED BY RADIATION-THERAPY - THE NEED FOR IMPROVED SYSTEMIC AND LOCOREGIONAL TREATMENT, Journal of clinical oncology, 14(4), 1996, pp. 1093-1097
Purpose: The patterns of failure (local and/or regional v metastatic)
have been determined for patients with prostate cancer and pretreatmen
t prostate-specific antigen (PSA) levels greater than or equal to 20 n
g/mL treated with radiation alone with the purpose to design appropria
te multimodal treatments. Materials and Methods: One hundred twenty pa
tients with pretreatment PSA levels greater than or equal to 20 ng/mL
were treated with external-beam radiation alone between February 1988
and October 1993. They were arbitrarily divided by PSA levels, 20 to 2
9.9 ng/mL, 30 to 49.9 ng/ mL, and greater than or equal to 50 ng/mL, a
nd analyzed in terms of freedom from any failure (no evidence of bioch
emical disease [bNED], and PSA level < 1.5 ngm/mL and not increasing),
as well as freedom from imaging evidence of distant metastasis (fdm).
Results: There was no significant difference in shortterm outcome by
pretreatment PSA level, and thus all patients were pooled for analysis
. At 4 years, 81% were fdm and 28% were free of any failure. This sugg
ests that approximately 50% have recurred with local and/or regional d
isease or undetectable metastatic disease. Multivariate analysis indic
ated that low palpation stage and higher center of prostate dose were
associated with better bNED survival. Multivariate analysis indicated
that increasing stage and younger age are significantly associated wit
h increasing distant metastasis. Conclusion: patients with pretreatmen
t PSA levels greater than or equal to 20 ng/mL are not optimally treat
ed by irradiation alone. The pattern of failure suggests improvement m
ay come from systemic treatment of metastatic disease and high-dose ra
diation to improve locoregional disease. To evaluate this, we have beg
un a multimodal trial of chemohormonal therapy followed by extended-fi
eld irradiation. (C) 1996 by American Society of Clinical Oncology.