The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer: Effects of radiation dose escalation

Michelle S. Ludwig, Deborah A. Kuban, Xianglin L. Du, David Lopez, Jose Miguel Yamal, Sara S. Strom

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: To determine whether the effect of androgen deprivation therapy (ADT) on the risk of biochemical failure varies at different doses of radiation in patients treated with definitive external beam radiation for intermediate risk prostate cancer (IRPC). Methods: This study included 1218 IRPC patients treated with definitive external beam radiation therapy to the prostate and seminal vesicles from June 1987 to January 2009 at our institution. Patient, treatment, and tumor information was collected, including age, race, Gleason score, radiation dose, PSA, T-stage, and months on ADT. Results: The median follow-up was 6 years. A total of 421(34.6%) patients received ADT, 211 (17.3%) patients experienced a biochemical failure, and 38 (3.1%) developed distant metastasis. On univariable analyses, higher PSA, earlier year of diagnosis, higher T-stage, lower doses of radiation, and the lack of ADT were associated with an increased risk of biochemical failure. No difference in biochemical failure was seen among different racial groups or with the use of greater than 6 months of ADT compared with less than 6 months. On multivariate analysis, the use of ADT was associated with a lower risk of biochemical failure than no ADT (HR, 0.599; 95% CI, 0.367-0.978; P < 0.04) and lower risk of distant metastasis (HR, 0.114; 95% CI, 0.014-0.905; P = 0.04). Conclusions: ADT reduced the risk of biochemical failure and distant metastasis in both low- and high dose radiation groups among men with intermediate-risk PCa. Increasing the duration of ADT beyond 6 months did not reduce the risk of biochemical failures. Better understanding the benefit of ADT in the era of dose escalation will require a randomized clinical trial.

Original languageEnglish (US)
Article number190
JournalBMC Cancer
Volume15
Issue number1
DOIs
StatePublished - Mar 27 2015
Externally publishedYes

Fingerprint

Radiation Effects
Androgens
Prostatic Neoplasms
Neoplasm Metastasis
Radiation
Therapeutics
Neoplasm Grading
Seminal Vesicles
Prostate
Early Diagnosis
Radiotherapy
Multivariate Analysis
Randomized Controlled Trials

Keywords

  • Androgen deprivation therapy
  • Dose escalation
  • Intermediate risk prostate cancer
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer : Effects of radiation dose escalation. / Ludwig, Michelle S.; Kuban, Deborah A.; Du, Xianglin L.; Lopez, David; Yamal, Jose Miguel; Strom, Sara S.

In: BMC Cancer, Vol. 15, No. 1, 190, 27.03.2015.

Research output: Contribution to journalArticle

Ludwig, Michelle S. ; Kuban, Deborah A. ; Du, Xianglin L. ; Lopez, David ; Yamal, Jose Miguel ; Strom, Sara S. / The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer : Effects of radiation dose escalation. In: BMC Cancer. 2015 ; Vol. 15, No. 1.
@article{b016b9725c674421a6d54173c9b68984,
title = "The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer: Effects of radiation dose escalation",
abstract = "Background: To determine whether the effect of androgen deprivation therapy (ADT) on the risk of biochemical failure varies at different doses of radiation in patients treated with definitive external beam radiation for intermediate risk prostate cancer (IRPC). Methods: This study included 1218 IRPC patients treated with definitive external beam radiation therapy to the prostate and seminal vesicles from June 1987 to January 2009 at our institution. Patient, treatment, and tumor information was collected, including age, race, Gleason score, radiation dose, PSA, T-stage, and months on ADT. Results: The median follow-up was 6 years. A total of 421(34.6{\%}) patients received ADT, 211 (17.3{\%}) patients experienced a biochemical failure, and 38 (3.1{\%}) developed distant metastasis. On univariable analyses, higher PSA, earlier year of diagnosis, higher T-stage, lower doses of radiation, and the lack of ADT were associated with an increased risk of biochemical failure. No difference in biochemical failure was seen among different racial groups or with the use of greater than 6 months of ADT compared with less than 6 months. On multivariate analysis, the use of ADT was associated with a lower risk of biochemical failure than no ADT (HR, 0.599; 95{\%} CI, 0.367-0.978; P < 0.04) and lower risk of distant metastasis (HR, 0.114; 95{\%} CI, 0.014-0.905; P = 0.04). Conclusions: ADT reduced the risk of biochemical failure and distant metastasis in both low- and high dose radiation groups among men with intermediate-risk PCa. Increasing the duration of ADT beyond 6 months did not reduce the risk of biochemical failures. Better understanding the benefit of ADT in the era of dose escalation will require a randomized clinical trial.",
keywords = "Androgen deprivation therapy, Dose escalation, Intermediate risk prostate cancer, Prostate cancer",
author = "Ludwig, {Michelle S.} and Kuban, {Deborah A.} and Du, {Xianglin L.} and David Lopez and Yamal, {Jose Miguel} and Strom, {Sara S.}",
year = "2015",
month = "3",
day = "27",
doi = "10.1186/s12885-015-1180-6",
language = "English (US)",
volume = "15",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - The role of androgen deprivation therapy on biochemical failure and distant metastasis in intermediate-risk prostate cancer

T2 - Effects of radiation dose escalation

AU - Ludwig, Michelle S.

AU - Kuban, Deborah A.

AU - Du, Xianglin L.

AU - Lopez, David

AU - Yamal, Jose Miguel

AU - Strom, Sara S.

PY - 2015/3/27

Y1 - 2015/3/27

N2 - Background: To determine whether the effect of androgen deprivation therapy (ADT) on the risk of biochemical failure varies at different doses of radiation in patients treated with definitive external beam radiation for intermediate risk prostate cancer (IRPC). Methods: This study included 1218 IRPC patients treated with definitive external beam radiation therapy to the prostate and seminal vesicles from June 1987 to January 2009 at our institution. Patient, treatment, and tumor information was collected, including age, race, Gleason score, radiation dose, PSA, T-stage, and months on ADT. Results: The median follow-up was 6 years. A total of 421(34.6%) patients received ADT, 211 (17.3%) patients experienced a biochemical failure, and 38 (3.1%) developed distant metastasis. On univariable analyses, higher PSA, earlier year of diagnosis, higher T-stage, lower doses of radiation, and the lack of ADT were associated with an increased risk of biochemical failure. No difference in biochemical failure was seen among different racial groups or with the use of greater than 6 months of ADT compared with less than 6 months. On multivariate analysis, the use of ADT was associated with a lower risk of biochemical failure than no ADT (HR, 0.599; 95% CI, 0.367-0.978; P < 0.04) and lower risk of distant metastasis (HR, 0.114; 95% CI, 0.014-0.905; P = 0.04). Conclusions: ADT reduced the risk of biochemical failure and distant metastasis in both low- and high dose radiation groups among men with intermediate-risk PCa. Increasing the duration of ADT beyond 6 months did not reduce the risk of biochemical failures. Better understanding the benefit of ADT in the era of dose escalation will require a randomized clinical trial.

AB - Background: To determine whether the effect of androgen deprivation therapy (ADT) on the risk of biochemical failure varies at different doses of radiation in patients treated with definitive external beam radiation for intermediate risk prostate cancer (IRPC). Methods: This study included 1218 IRPC patients treated with definitive external beam radiation therapy to the prostate and seminal vesicles from June 1987 to January 2009 at our institution. Patient, treatment, and tumor information was collected, including age, race, Gleason score, radiation dose, PSA, T-stage, and months on ADT. Results: The median follow-up was 6 years. A total of 421(34.6%) patients received ADT, 211 (17.3%) patients experienced a biochemical failure, and 38 (3.1%) developed distant metastasis. On univariable analyses, higher PSA, earlier year of diagnosis, higher T-stage, lower doses of radiation, and the lack of ADT were associated with an increased risk of biochemical failure. No difference in biochemical failure was seen among different racial groups or with the use of greater than 6 months of ADT compared with less than 6 months. On multivariate analysis, the use of ADT was associated with a lower risk of biochemical failure than no ADT (HR, 0.599; 95% CI, 0.367-0.978; P < 0.04) and lower risk of distant metastasis (HR, 0.114; 95% CI, 0.014-0.905; P = 0.04). Conclusions: ADT reduced the risk of biochemical failure and distant metastasis in both low- and high dose radiation groups among men with intermediate-risk PCa. Increasing the duration of ADT beyond 6 months did not reduce the risk of biochemical failures. Better understanding the benefit of ADT in the era of dose escalation will require a randomized clinical trial.

KW - Androgen deprivation therapy

KW - Dose escalation

KW - Intermediate risk prostate cancer

KW - Prostate cancer

UR - http://www.scopus.com/inward/record.url?scp=84935832822&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84935832822&partnerID=8YFLogxK

U2 - 10.1186/s12885-015-1180-6

DO - 10.1186/s12885-015-1180-6

M3 - Article

C2 - 25885406

AN - SCOPUS:84935832822

VL - 15

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

IS - 1

M1 - 190

ER -