Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/103275
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Type: | Journal article |
Title: | Definition and validation of "favorable high-risk prostate cancer": implications for personalizing treatment of radiation-managed patients |
Author: | Muralidhar, V. Chen, M. Reznor, G. Moran, B. Braccioforte, M. Beard, C. Feng, F. Hoffman, K. Choueiri, T. Martin, N. Sweeney, C. Trinh, Q. Nguyen, P. |
Citation: | International Journal of Radiation: Oncology - Biology - Physics, 2015; 93(4):828-835 |
Publisher: | Elsevier |
Issue Date: | 2015 |
ISSN: | 0360-3016 1879-355X |
Statement of Responsibility: | Vinayak Muralidhar, Ming-Hui Chen, Gally Reznor, Brian J. Moran, Michelle H. Braccioforte, Clair J. Beard, Felix Y. Feng, Karen E. Hoffman, Toni K. Choueiri, Neil E. Martin, Christopher J. Sweeney, Quoc-Dien Trinh and Paul L. Nguyen |
Abstract: | Purpose: To define and validate a classification of favorable high-risk prostate cancer that could be used to personalize therapy, given that consensus guidelines recommend similar treatments for all radiation-managed patients with high-risk disease. Methods and Materials: We studied 3618 patients with cT1-T3aN0M0 high-risk or unfavorable intermediate-risk prostate adenocarcinoma treated with radiation at a single institution between 1997 and 2013. Favorable high-risk was defined as T1c disease with either Gleason 4 + 4 = 8 and prostate-specific antigen <10 ng/mL or Gleason 6 and prostate-specific antigen >20 ng/mL. Competing risks regression was used to determine differences in the risk of prostate cancer–specific mortality (PCSM) after controlling for baseline factors and treatment. Our results were validated in a cohort of 13,275 patients using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Results: Patients with favorable high-risk disease had significantly better PCSM than other men with high-risk disease (adjusted hazard ratio [AHR] 0.42, 95% confidence interval [CI] 0.18-0.996, P=.049) and similar PCSM as men with unfavorable intermediate-risk disease (AHR 1.17, 95% CI 0.50-2.75, P=.710). We observed very similar results within the SEER-Medicare cohort (favorable high-risk vs other high-risk: AHR 0.21, 95% CI 0.11-0.41, P<.001; favorable high-risk vs unfavorable intermediate-risk: AHR 0.67, 95% CI 0.33-1.36, P=.268). Conclusions: Patients with favorable high-risk prostate cancer have significantly better PCSM than other patients with high-risk disease and similar PCSM as those with unfavorable intermediate-risk disease, who are typically treated with shorter-course androgen deprivation therapy. This new classification system may allow for personalization of treatment within high-risk disease, such as consideration of shorter-course androgen deprivation therapy for favorable high-risk disease. |
Keywords: | Humans Prostatic Neoplasms Androgen Antagonists Prostate-Specific Antigen Prognosis Brachytherapy SEER Program Confidence Intervals Proportional Hazards Models Risk Assessment Aged Middle Aged Male Neoplasm Grading Precision Medicine |
Rights: | © 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.ijrobp.2015.07.2281 |
DOI: | 10.1016/j.ijrobp.2015.07.2281 |
Published version: | http://dx.doi.org/10.1016/j.ijrobp.2015.07.2281 |
Appears in Collections: | Aurora harvest 7 Medicine publications |
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