Different outcomes among favourable and unfavourable intermediate-risk prostate cancer patients treated with hypofractionated radiotherapy and androgen deprivation therapy.
BACKGROUND
to evaluate the role of a risk stratification system in intermediate-risk prostate cancer (PCa) treated with hypofractionated radiotherapy (HyRT).


METHODS
131 patients affected by intermediate-risk PCa were treated with HyRT at the total dose of 54,75 Gy in 15 fraction plus 9 months of androgen deprivation therapy (ADT). Patients were classified as favourable risk (FIR) if they had a single NCCN intermediate-risk factor (IRF), a Gleason score ≤3 + 4 = 7, and <50 % of biopsy cores containing cancer (PBCC). If these criteria were not met were classified as unfavourable risk (UIR). Univariate and multivariate analyses using Cox proportional hazards model were calculated for biochemical recurrence-free survival (bRFS), the risk of local recurrence and metastasis-free survival (MFS).


RESULTS
After a median follow-up of 56.7 months (range 9.8 to 93.7 months), 11 patients (8.4 %) died, of whom 2 (1.5 %) for PCa. In the univariate analysis, Gleason score, PPBCs, IRFs and PSA at first follow-up were prognostic factors for bRFS and LF while Gleason score, PPBCs and PSA at first follow-up were significant predictor for MFS. In the multivariate analysis only the PSA at first follow-up resulted a prognostic factor for bRFS and MFS. Patients with a value of PSA at first follow-up <0.7 ng/mL respect to those with PSA ≥0,7 ng/mL had a 5y-bRFS of 93.3 % vs. 57.5 %, 5y-MFS of 99.0 % vs. 78.9 % and 5y-LF of 5.8 % vs. 38.3 %. Patients in the UIR PCa group with a PSA value <0.7 ng/mL at first follow-up had significant better bRFS, LF and MFS.


CONCLUSIONS
Risk factors currently not included in the guidelines are useful to stratify patients with intermediate-risk PCa in two groups of different prognosis even when HyRT is delivered. PSA at first follow-up is useful in UIR PCa to guide the overall length of ADT.
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy. stefanobracci@gmail.com.
Stefano
S
Bracci
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Mattia F
MF
Osti
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Linda
L
Agolli
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Luca
L
Bertaccini
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Vitaliana
V
De Sanctis
Institute of Radiation Oncology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Maurizio
M
Valeriani
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D050397:Radiotherapy, Intensity-Modulated; D015996:Survival Rate
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
3D-CRT; Hypofractionated radiotherapy; Intermediate-risk prostate cancer; Prognostic factors