Timing Of Biochemical Failure And Distant Metastatic Disease For Low-, Intermediate-, And High-Risk Prostate Cancer After Radiotherapy

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Radiology / Nuclear Medicine;  Clinical Trials / Drug Trials
Article Date: 18 Jun 2007 - 0:00 PDT

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UroToday.com- In an online report in the journal Cancer, Dr. Peter Morgan and colleagues compare the ASTRO definition of biochemical failure (BF) to the Phoenix (nadir + 2) definition and find that due to backdating ASTRO BF underestimates late BF.

The study cohort consisted of 1,833 men with clinically localized prostate cancer (CaP) between 1987 and 2001. Men who received neoadjuvant or adjuvant androgen deprivation therapy of <6 months duration were included. Patients were stratified into low, intermediate, and high-risk groups. Estimates of biochemical failure, distant metastases, overall mortality (OM), and cause-specific mortality (CSM) were calculated by using the Kaplan-Meier method. Median follow-up was 67 months.

The study results showed that increasing risk category was independently associated with higher BF by ASTRO and Nadir + 2 definitions. ASTRO BF occurred in 22% of the patients compared to Nadir + 2 BF in 24%. The 5-year ASTRO BF increased from 16% to 54% in higher-risk groups. The 5-year Nadir + 2 BF increased from 9% to 43% in higher-risk groups. However, the ASTRO BF occurred earlier <4 years after radiotherapy as compared to the Nadir + 2 analysis that demonstrated BF over years 1-12 with 43% of BF at >4 years. Furthermore, in all risk groups the Nadir + 2 definition demonstrated a persistent hazard for BF in years 8-12.

Ten-year OM was 30%, 33% and 50% for low, intermediate, and high-risk men. Ten-year CSM was 1%, 3% and 11% for low, intermediate, and high-risk men. Regarding distant metastasis an early peak followed by a decrease then a late second increase was noted for intermediate and high-risk patients, but no early peak was found for low-risk men. These data suggest that intermediate and high-risk patients harbor a greater risk of micro-metastatic disease and present with an early peak of distant metastasis when compared to low-risk men. The late Nadir + 2 BF suggest that local disease remains problematic in some patients and results in late BF even for those with low-risk disease.

Morgan PB, Hanlon AL, Horwitz EM, Buyyounouski MK, Uzzo RG, Pollack A

Cancer. ePub. May 22, 2007

doi: 10.1002/cncr.22755

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D.

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