Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer

Stephen J Ramey, Shree Agrawal, Matthew C. Abramowitz, Drew Moghanaki, Thomas M. Pisansky, Jason A. Efstathiou, Jeff M. Michalski, Daniel E. Spratt, Jason W.D. Hearn, Bridget F. Koontz, Stanley L. Liauw, Alan Pollack, Mitchell S. Anscher, Robert B. Den, Kevin L. Stephans, Anthony L. Zietman, W. Robert Lee, Andrew J. Stephenson, Rahul D. Tendulkar

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions: WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). Among patients treated with postprostatectomy salvage radiation therapy for Gleason score 7–10 prostate cancer, this multi-institutional database found improved freedom from biochemical failure when whole pelvis radiation therapy or androgen deprivation therapy was added to prostate bed–only radiation therapy.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalEuropean urology
Volume74
Issue number1
DOIs
StatePublished - Jul 1 2018

Fingerprint

Androgens
Prostatic Neoplasms
Radiotherapy
Prostate
Salvage Therapy
Therapeutics
Neoplasm Grading
Prostate-Specific Antigen
Neoplasm Metastasis
Incidence
Databases
Radiation
Pelvis
Testosterone

Keywords

  • Androgen deprivation therapy
  • Biochemical failure
  • Postprostatectomy
  • Prostate bed
  • Prostate cancer
  • Prostatectomy
  • Radiotherapy
  • Salvage
  • Whole pelvis

ASJC Scopus subject areas

  • Urology

Cite this

Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer. / Ramey, Stephen J; Agrawal, Shree; Abramowitz, Matthew C.; Moghanaki, Drew; Pisansky, Thomas M.; Efstathiou, Jason A.; Michalski, Jeff M.; Spratt, Daniel E.; Hearn, Jason W.D.; Koontz, Bridget F.; Liauw, Stanley L.; Pollack, Alan; Anscher, Mitchell S.; Den, Robert B.; Stephans, Kevin L.; Zietman, Anthony L.; Lee, W. Robert; Stephenson, Andrew J.; Tendulkar, Rahul D.

In: European urology, Vol. 74, No. 1, 01.07.2018, p. 99-106.

Research output: Contribution to journalArticle

Ramey, SJ, Agrawal, S, Abramowitz, MC, Moghanaki, D, Pisansky, TM, Efstathiou, JA, Michalski, JM, Spratt, DE, Hearn, JWD, Koontz, BF, Liauw, SL, Pollack, A, Anscher, MS, Den, RB, Stephans, KL, Zietman, AL, Lee, WR, Stephenson, AJ & Tendulkar, RD 2018, 'Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer', European urology, vol. 74, no. 1, pp. 99-106. https://doi.org/10.1016/j.eururo.2017.10.009
Ramey, Stephen J ; Agrawal, Shree ; Abramowitz, Matthew C. ; Moghanaki, Drew ; Pisansky, Thomas M. ; Efstathiou, Jason A. ; Michalski, Jeff M. ; Spratt, Daniel E. ; Hearn, Jason W.D. ; Koontz, Bridget F. ; Liauw, Stanley L. ; Pollack, Alan ; Anscher, Mitchell S. ; Den, Robert B. ; Stephans, Kevin L. ; Zietman, Anthony L. ; Lee, W. Robert ; Stephenson, Andrew J. ; Tendulkar, Rahul D. / Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer. In: European urology. 2018 ; Vol. 74, No. 1. pp. 99-106.
@article{e240f9b22a2e4044946f23ab1844d7af,
title = "Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer",
abstract = "Background: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions: WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62{\%} versus 49{\%} (p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55{\%} vs 50{\%}, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). Among patients treated with postprostatectomy salvage radiation therapy for Gleason score 7–10 prostate cancer, this multi-institutional database found improved freedom from biochemical failure when whole pelvis radiation therapy or androgen deprivation therapy was added to prostate bed–only radiation therapy.",
keywords = "Androgen deprivation therapy, Biochemical failure, Postprostatectomy, Prostate bed, Prostate cancer, Prostatectomy, Radiotherapy, Salvage, Whole pelvis",
author = "Ramey, {Stephen J} and Shree Agrawal and Abramowitz, {Matthew C.} and Drew Moghanaki and Pisansky, {Thomas M.} and Efstathiou, {Jason A.} and Michalski, {Jeff M.} and Spratt, {Daniel E.} and Hearn, {Jason W.D.} and Koontz, {Bridget F.} and Liauw, {Stanley L.} and Alan Pollack and Anscher, {Mitchell S.} and Den, {Robert B.} and Stephans, {Kevin L.} and Zietman, {Anthony L.} and Lee, {W. Robert} and Stephenson, {Andrew J.} and Tendulkar, {Rahul D.}",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.eururo.2017.10.009",
language = "English (US)",
volume = "74",
pages = "99--106",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer

AU - Ramey, Stephen J

AU - Agrawal, Shree

AU - Abramowitz, Matthew C.

AU - Moghanaki, Drew

AU - Pisansky, Thomas M.

AU - Efstathiou, Jason A.

AU - Michalski, Jeff M.

AU - Spratt, Daniel E.

AU - Hearn, Jason W.D.

AU - Koontz, Bridget F.

AU - Liauw, Stanley L.

AU - Pollack, Alan

AU - Anscher, Mitchell S.

AU - Den, Robert B.

AU - Stephans, Kevin L.

AU - Zietman, Anthony L.

AU - Lee, W. Robert

AU - Stephenson, Andrew J.

AU - Tendulkar, Rahul D.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions: WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). Among patients treated with postprostatectomy salvage radiation therapy for Gleason score 7–10 prostate cancer, this multi-institutional database found improved freedom from biochemical failure when whole pelvis radiation therapy or androgen deprivation therapy was added to prostate bed–only radiation therapy.

AB - Background: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions: WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). Among patients treated with postprostatectomy salvage radiation therapy for Gleason score 7–10 prostate cancer, this multi-institutional database found improved freedom from biochemical failure when whole pelvis radiation therapy or androgen deprivation therapy was added to prostate bed–only radiation therapy.

KW - Androgen deprivation therapy

KW - Biochemical failure

KW - Postprostatectomy

KW - Prostate bed

KW - Prostate cancer

KW - Prostatectomy

KW - Radiotherapy

KW - Salvage

KW - Whole pelvis

UR - http://www.scopus.com/inward/record.url?scp=85033378201&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033378201&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2017.10.009

DO - 10.1016/j.eururo.2017.10.009

M3 - Article

VL - 74

SP - 99

EP - 106

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 1

ER -