Téma: 

Evaluation of essential prognostic factors in series of patients with prostate cancer treated with radiotherapy with or without hormonal therapy

Pavol Dubinský, Katarína Belanová, Pavol Matula, Eva Bergendyová, Igor Andrašina

Objective: Radiotherapy has been accepted as a treatment option of localized prostate cancer. TNM classification, initial PSA and Gleason score are essential factors for prognosis, prediction of disease control by local means of treatment and comparison of therapeutic outcomes. Institutional series of patients treated with radiotherapy with or without hormonal therapy was analysed. Treatment results and essential prognostic factors were evaluated. Material and methods: 218 patients with localized prostate cancer were treated from January 1993 to December 2003 at East Slovakia Institute of Oncology: Median age was 69 years. Treatment was radiation alone or combined with short-term maximal androgen blockade or long term androgen deprivation. Radiotherapy planning was 2 dimensional with CT scans. Dose in isocentre was 66 - 70 Gy with median 70 Gy. Salvage hormonal treatment was commenced in case of biochemical failure. Median follow up was 50 months. Statistical analysis was performed for following tumour characteristics: T code assessed by digital rectal examination, PSA, Gleason score and risk group. Treatment outcomes for radiation without and with hormonal therapy were compared. Biochemical control was defined in accordance with ASTRO consensus. Results: Five-year overall survival, cancer specific survival and biochemical control were 72 %, 95 % and 70 %. Biochemical control for T1T2 and T3T4 tumours was 83 % and 46 % respectively. Lower probability of biochemical control was implied by T3T4 tumour, PSA pre-treatment value > 10 mg/ml and high and very high-risk group. Overall survival at 5 years was 86 % for T1T2 and 76 % for T3T4 tumours (p = 0,045). T stage and risk group determined cancer specific survival. Grade 2 and 3 of late toxicity in pelvis was identified in 24 and 10 patients respectively. Conclusion: T stage was identified as the only prognostic factor for both overall and cancer specific survival. High mortality of intercurrent diseases, improvement of treatment outcomes of radiotherapy by addition of hormonal therapy in case of risk factors were present and effectiveness of salvage hormonal therapy could be the explanation. T stage, pre-treatment PSA and risk group were found as independent factors determining probability of biochemical control.

Ročník 2007  Témy časopisu Clinical urology 2 / 2007

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