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- Title
Long-term oncologic outcomes of radiotherapy combined with maximal androgen blockade for localized, high-risk prostate cancer.
- Authors
Luo, Yong; Li, Mingchuan; Qi, Hengzhi; Zhao, Jiahui; Han, Yili; Lin, Yunhua; Hou, Zhu; Jiang, Yongguang
- Abstract
Background: To assess the oncologic outcomes of radiation therapy (RT) combined with maximal androgen blockade (MAB) and prostate-specific antigen (PSA) kinetics in patients with localized, high-risk prostate carcinoma (PCa). Methods: Three-hundred twenty individuals with localized PCa who underwent RT + MAB in 2001–2015 were evaluated retrospectively. All patients had received 36 months of MAB therapy and 45 Gy of pelvic irradiation, plus a dose-escalated external beam radiation therapy (DE-EBRT) boost to 76~81 Gy (MAB + EBRT group), or a low-dose-rate prostate permanent brachytherapy (LDR-PPB) boost to 110 Gy with I-125 (MAB + EBRT + PPB group). Results: Follow-up median is 90 months, ranging from 12 to 186 months; 117 (36.6%) and 203 (63.4%) cases underwent MAB + EBRT and MAB + EBRT + PPB, respectively. Multivariate Cox regression showed that the PPB regimen and PSA kinetics were positive indicators of oncologic outcomes. Compared with MAB + EBRT, MAB + EBRT + PPB remarkably improved PSA kinetics more pronouncedly: PSA nadir (1.3 ± 0.7 vs 0.11 ± 0.06 ng/mL); time of PSA decrease to nadir (7.5 ± 1.8 vs 3.2 ± 2.1 months); PSA doubling time (PSADT; 15.6 ± 4.2 vs 22.6 ± 6.1 months); decrease in PSA (84.6 ± 6.2% vs 95.8 ± 3.4%). Additionally, median times of several important oncologic events were prolonged in the MAB + EBRT + PPB group compared with the MAB + EBRT group: overall survival (OS; 12.3 vs 9.1 years, <italic>P</italic> < 0.001), biochemical recurrence-free survival (BRFS; 9.8 vs 6.5 years, <italic>P</italic> < 0.001), skeletal-related event (SRE; 10.4 vs 8.2 years, <italic>P</italic> < 0.001), and cytotoxic chemotherapy (CCT; 11.6 vs 8.8 years, <italic>P</italic> = 0.007). Conclusion: MAB + EBRT + PPB is extremely effective in patients with localized, high-risk PCa, indicating that PPB may play a synergistic role in improving PSA kinetics and independently predicts oncologic outcomes.
- Subjects
PROSTATE cancer; RADIOTHERAPY; ANDROGENS; PROSTATE-specific antigen; ONCOLOGY
- Publication
World Journal of Surgical Oncology, 2018, Vol 16, Issue 1, pN.PAG
- ISSN
1477-7819
- Publication type
Article
- DOI
10.1186/s12957-018-1395-5