Hormonal therapy or external-beam radiation with brachytherapy and the risk of death from prostate cancer in men with intermediate risk prostate cancer |
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Authors: | Rosenberg Jonathan E Chen Ming-Hui Nguyen Paul L Braccioforte Michelle H Moran Brian J D'Amico Anthony V |
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Institution: | 1 Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 2 Department of Statistics, University of Connecticut, Storrs, CT 3 Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA 4 Prostate Cancer Foundation of Chicago, Westmont, IL |
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Abstract: | PurposeTo determine whether external-beam radiotherapy (EBRT) improves disease control compared with supplemental androgen suppression therapy (AST) in men with intermediate-risk prostate cancer who are being treated with brachytherapy.Patients and MethodsA total of 807 men with intermediate-risk prostate cancer (T2bNXM0, Gleason ≤7, prostate-specific antigen PSA] <20 ng/mL; or cT1c-T2bNXM0, Gleason 7) were consecutively treated with either AST and brachytherapy or EBRT and brachytherapy, between 1997 and 2007, and were followed up until September 21, 2007. A Fine and Gray competing risks multivariable regression model was used to assess whether AST or radiotherapy dose escalation reduced the risk of prostate-cancer-specific mortality (PCSM) when adjusting for age, PSA, Gleason score, and tumor category.ResultsTreatment with brachytherapy and with EBRT was associated with a significant increase in the risk of PCSM compared with brachytherapy and AST (adjusted hazard ratio HR] 4.027 95% CI, 1.168-13.89]; P = .027) after adjusting for age and prostate cancer prognostic factors. A Gleason score of 4+3 and increasing PSA were associated with worse PCSM (adjusted HR 8.882 95% CI, 1.095-72.04]; P = .041; and adjusted HR 8.029 95% CI, 2.38-28.8]; P = .0014, respectively).ConclusionSupplemental AST use compared with EBRT is associated with a lower risk of PCSM in men with intermediate-risk PC undergoing brachytherapy. Prospective validation in a randomized controlled trial is needed. |
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Keywords: | Androgen deprivation therapy Brachytherapy External-beam radiotherapy Hormonal therapy Prostate cancer |
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