Outcome of patients with localised PCa treated by radiotherapy
Tuesday, 27 July 2010- N. Suzuki and colleagues conducted a study on the outcome of patients with localised prostate cancer who underwent radiotherapy after confirming the absence of lymph node invasion. They published their findings in the Japanese Journal of Clinical Oncology.
"Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy," the authors wrote.
After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean). Biochemical failure occurred in 47 patients.
Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk.
Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure.
Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate-and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective," wrote N. Suzuki and colleagues of the Asahi General Hospital, Department of Urology.
"Prostate-specific antigen parameters were predictive factors for further outcome," the researchers concluded.
Source: N. Suzuki, et al., "Outcome of patients with localized prostate cancer treated by radiotherapy after confirming the absence of lymph node invasion," Japanese Journal of Clinical Oncology, 2010;40(7):652-7).