title: Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease?
abstract: OBJECTIVE
  To report long-term failure patterns and survival in a randomized radiotherapy dose escalation trial for prostate cancer.
  
  
  METHODS
  A total of 301 patients with Stage T1b-T3 prostate cancer treated to 70 Gy versus 78 Gy now have a median follow-up of 9 years. Failure patterns and survival were compared between dose levels. The cumulative incidence of death from prostate cancer versus other causes was examined and regression analysis was used to establish predictive factors.
  
  
  RESULTS
  Patients with pretreatment prostate-specific antigen (PSA) >10 ng/mL or high-risk disease had higher biochemical and clinical failures rates when treated to 70 Gy. These patients also had a significantly higher risk of dying of prostate cancer. Patients <70 years old at treatment died of prostate cancer nearly three times more frequently than of other causes when they were radiated to 70 Gy, whereas those treated to 78 Gy died of other causes more frequently. Patients age 70 or older treated to 70 Gy died of prostate cancer as often as other causes, and those receiving 78 Gy never died of prostate cancer within 10 years of follow-up. In regression analysis, factors predicting for death from prostate cancer were pretreatment PSA >10.5 ng/mL, Gleason score 9 and 10, recurrence within 2.6 years of radiation, and doubling time of <3.6 months at the time of recurrence.
  
  
  CONCLUSIONS
  Moderate dose escalation (78 Gy) decreases biochemical and clinical failure as well as prostate cancer death in patients with pretreatment PSA >10 ng/mL or high-risk disease.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030., USA. dakuban@mdanderson.org
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Levy
authors.forename: M Rex
authors.initials: MR
authors.lastname: Cheung
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Lee
authors.forename: Seungtaek
authors.initials: S
authors.lastname: Choi
authors.forename: Steven
authors.initials: S
authors.lastname: Frank
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen