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Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node-Positive Prostate Cancer: A

Leslie K Ballas1, Chandana A Reddy2, Hye Ri Han3

  • 1Department of Radiation Oncology, Cedars-Sinal Medical Center, Los Angeles, California.

Practical Radiation Oncology
|December 29, 2024
PubMed
Summary
This summary is machine-generated.

Postprostatectomy radiation therapy (RT) with a prostate-specific antigen (PSA) level below 0.5 ng/mL is linked to better outcomes for men with node-positive prostate cancer. Long-term androgen deprivation therapy (ADT) also improves biochemical progression-free survival (bPFS).

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urologic Oncology

Background:

  • Pathologic node-positive (pN1) prostate cancer (PCa) presents a significant risk for recurrence after treatment.
  • Identifying prognostic factors and recurrence patterns is crucial for optimizing treatment strategies in pN1 PCa patients.

Purpose of the Study:

  • To evaluate prognostic factors influencing recurrence in pN1 PCa patients treated with radiation therapy (RT) and androgen deprivation therapy (ADT).
  • To analyze patterns of recurrence in a multi-institutional cohort of pN1 PCa patients receiving RT ± ADT.

Main Methods:

  • A multi-institutional cohort of 270 patients with pN1 PCa treated with RT ± ADT was analyzed.
  • Patients received short-term (ST, ≤6 months) or long-term (LT, >6 months) ADT.
  • Biochemical progression-free survival (bPFS) and distant metastasis-free survival (DMFS) were evaluated as primary endpoints.

Main Results:

  • Higher pre-RT PSA levels (>0.5 ng/mL) were significantly associated with poorer bPFS (HRs 2.97-7.63).
  • Long-term ADT demonstrated a significant benefit for bPFS compared to no ADT (HR 0.43) and ST ADT (HR 0.34).
  • Other adverse prognostic factors included Grade Group 4 and positive surgical margins.

Conclusions:

  • Postprostatectomy RT in pN1 PCa patients with a pre-RT PSA < 0.5 ng/mL is associated with favorable bPFS.
  • Long-term ADT is a significant factor in improving bPFS for this patient population.