Artikel
Biochemical recurrence (bREC) and survival in patients with conformal radiation therapy (CRT) for prostate cancer
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Veröffentlicht: | 20. März 2006 |
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Gliederung
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Purpose: To evaluate the incidence of bREC and its association with survival in patients who received definitive CRT for prostate cancer.
Material and Methods: 385 patients with localized prostate cancer (cN0M0) were retrospectively analyzed. T-stage: T1: 19%, T2: 57%, T3: 23%, T4: 1%. Grading: G1: 16%, G2: 72%, G3: 12 % G4: < 1%. Median initial PSA: 11.7 ng/ml. Median follow-up was 60 months (12-128 m.). The median dose to the prostate was 70 Gy (59-72 Gy), 78% of the patients received short term neoadjuvant hormonal therapy. Biochemical recurrence (bREC) was defined either as 3 consecutive PSA-rises (ASTRO) or as an increase of 2ng/ml above the current PSA-nadir (HOUSTON).
Results: Five-year biochemical free survival (bNED) was 69% (ASTRO) and 77% (HOUSTON), respectively. The overall- and disease specific survival was 87% and 99% at 5 years, respectively. The 5-year incidence of local recurrence and distant metastasis was 3% and 4%, respectively. In multivariate analysis the following variables were significantly associated with bNED: ASTRO: initial PSA (p<0.001), grading (p=0.005), T-stage (p=0.020); HOUSTON: initial PSA (p<0.001), grading (p=0.001), PSA nadir after CRT (p=0.008). Univariately bREC (ASTRO or HOUSTON) significantly correlated with local recurrence, distant metastasis and disease specific survival but not with overall survival. In multivariate analysis bREC (ASTRO or HOUSTON) was associated with local recurrence and distant metastasis but only bREC HOUSTON correlated with disease specific survival.
Conclusions: Initial PSA and WHO-grading are closely associated with bNED. bREC is a negative predictor for local recurrence, distant metastasis and disease specific survival but -after a median follow-up of five years- it is not associated with overall survival. bREC HOUSTON seems to better predict disease specific survival than bREC ASTRO.