title: Biochemical control with radiotherapy improves overall survival in intermediate and high-risk prostate cancer patients who have an estimated 10-year overall survival of >90%.
abstract: OBJECTIVE
  To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled.
  
  
  METHODS
  A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival.
  
  
  RESULTS
  Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p < 0.001) were statistically significant.
  
  
  CONCLUSIONS
  Biochemical control translates into improved overall survival in patients with high or intermediate risk disease and an estimated 10-year overall survival of >90%.
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, Vancouver, BC, Canada. cherbert@bccancer.bc.ca
authors.forename: Christopher
authors.initials: C
authors.lastname: Herbert
authors.forename: Mitchell
authors.initials: M
authors.lastname: Liu
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: W James
authors.initials: WJ
authors.lastname: Morris
authors.forename: Michel
authors.initials: M
authors.lastname: Joffres
authors.forename: Mandip
authors.initials: M
authors.lastname: Khaira
authors.forename: Winkle
authors.initials: W
authors.lastname: Kwan
authors.forename: Vitali
authors.initials: V
authors.lastname: Moiseenko
authors.forename: Thomas
authors.initials: T
authors.lastname: Pickles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D017430:Prostate-Specific Antigen