External beam radiotherapy for clinically node-negative, localized hormone-refractory prostate cancer: impact of pretreatment PSA value on radiotherapeutic outcomes.
OBJECTIVE
To analyze the results of clinically node-negative, localized hormone-refractory prostate cancer treated with external beam radiotherapy (EBRT) and to investigate the potential prognostic factors that influenced the therapeutic outcome.


METHODS
Fifty-three patients who had developed localized hormone-refractory prostate cancer were treated with EBRT between 1994 and 2001. According to the 1992 American Joint Committee on Cancer clinical stage, 4 patients had T2 and 49 had T3 at the start of RT, and 14 patients had a Gleason score <7, 14 had a Gleason score of 7, and 23 had a Gleason score of 8-10. All patients were treated with EBRT using the unblocked oblique four-field technique, with a total dose of 69 Gy. The fraction dose was 3 Gy three times weekly. The median follow-up after RT was 35 months (range, 8-96 months) and after androgen ablation was 73 months (range, 42-156 months).


RESULTS
Of 53 patients, 15 patients subsequently developed clinical relapse, including locoregional and/or distant metastases. The site of first relapse was bone metastasis in 10, lymph nodes in 3, and local failure in 2 patients; 3 patients died of prostate cancer during the analysis period. The 3-year and 5-year cause-specific survival rate was 94% and 87%, respectively, and the 3-year and 5-year clinical relapse-free survival rate was 78% and 56%, respectively. The univariate analysis revealed that a short prostate-specific antigen (PSA) doubling time and high PSA value at the start of RT and a high Gleason score were statistically significant factors for the risk of clinical relapse. Multivariate analysis demonstrated that the PSA value (PSA <or=15 vs. >or=15 ng/mL) at the start of RT was an independent prognostic factor.


CONCLUSIONS
EBRT could be a treatment of choice for clinically node-negative, localized, hormone-refractory prostate cancer.
Akimoto
Tetsuo
T
Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan. takimoto@showa.gunma-u.ac.jp
Kitamoto
Yoshizumi
Y
Saito
Jun-Ichi
J
Harashima
Koichi
K
Nakano
Takashi
T
Ito
Kazuto
K
Yamamoto
Takumi
T
Kurokawa
Kouhei
K
Yamanaka
Hidetoshi
H
Takahashi
Mitsuhiro
M
Mitsuhashi
Norio
N
Niibe
Hideo
H
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000097:blood / Q000556:secondary; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012008:Recurrence; D015996:Survival Rate
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen