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Radiation therapy for clinically localized prostate cancer: a multi-institutional pooled analysis
W U Shipley1, H D Thames, H M Sandler
1Department of Radiation Oncology, Massachusetts General Hospital, Boston 02114, USA.
JAMA
|May 11, 1999
Summary
This study shows prostate-specific antigen (PSA) evaluation after radiation therapy predicts long-term prostate cancer control. Prognostic groups based on PSA and Gleason score help estimate treatment success and guide patient counseling.
Area of Science:
- Oncology
- Radiation Oncology
- Urology
Background:
- Prostate-specific antigen (PSA) is crucial for early prostate cancer detection and monitoring treatment response.
- Limited data exists on PSA outcomes 5+ years post-treatment, especially from multi-institutional studies.
Purpose of the Study:
- To evaluate long-term tumor control using PSA levels 5+ years after radical external beam radiation therapy (EBRT).
- To identify pretreatment prognostic factors for men with early prostate cancer treated in the PSA era.
Main Methods:
- Retrospective, multi-institutional pooled analysis of 1765 men treated with EBRT alone (1988-1995).
- Follow-up up to 9 years, with outcomes analyzed using Cox regression and recursive partitioning.
- Key outcome: freedom from biochemical failure.
Main Results:
- 5-year estimates: overall survival 85.0%, disease-specific survival 95.1%, freedom from biochemical failure 65.8%.
- Patients with initial PSA <10 ng/mL had higher 5- and 7-year PSA failure-free rates (77.8% and 72.9%).
- Four prognostic groups identified based on PSA and Gleason score, with 5-year PSA failure-free rates ranging from 81% (Group 1) to 29% (Group 4).
Conclusions:
- Multi-institutional PSA control rates are comparable to single-institution data.
- Prognostic groupings offer evidence-based benchmarks for counseling patients on radiation treatment outcomes.
- Long-term PSA monitoring remains essential for assessing treatment durability.
