Definition and Validation of “Favorable High-Risk Prostate Cancer”: Implications for Personalizing Treatment of Radiation-Managed Patients

• DOI: 10.1016/j.ijrobp.2015.07.2281
• Publication Date: 2015-07-29T21:22:56Z
• Authors: Vinayak Muralidhar; Ming-Hui Chen; Gally Reznor; Brian J. Moran; Michelle H. Bracc...; Clair J. Beard; Felix Y. Feng; Karen E. Hoffman; Toni K. Choueiri; Neil E. Martin; Christopher J. Sw...; Quoc-Dien Trinh; Paul L. Nguyen
• Keywords: Male; Cancer Research; Radiation; Brachytherapy; 610; Prostatic Neoplasms; Androgen Antagonists; Middle Aged; Prostate-Specific Antigen; Prognosis; Risk Assessment; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Oncology; Radiology Nuclear Medicine and imaging; Confidence Intervals; Humans; Neoplasm Grading; Precision Medicine; Aged; Proportional Hazards Models; SEER Program

PurposeTo define and validate a classification of favorable high-risk prostate cancer that could be used to personalize therapy, given consensus guidelines recommend similar treatments for all radiation-managed patients with disease.Methods MaterialsWe studied 3618 cT1-T3aN0M0 or unfavorable intermediate-risk adenocarcinoma treated radiation at single institution between 1997 2013. Favorable was defined as T1c disease either Gleason 4 + = 8 prostate-specific antigen <10 ng/mL 6 >20 ng/mL. Competing risks regression determine differences in the risk cancer–specific mortality (PCSM) after controlling baseline factors treatment. Our results were validated cohort 13,275 using Surveillance, Epidemiology, End Results (SEER)-Medicare linked database.ResultsPatients had significantly better PCSM than other men (adjusted hazard ratio [AHR] 0.42, 95% confidence interval [CI] 0.18-0.996, P=.049) (AHR 1.17, CI 0.50-2.75, P=.710). We observed very within SEER-Medicare (favorable vs high-risk: AHR 0.21, 0.11-0.41, P<.001; intermediate-risk: 0.67, 0.33-1.36, P=.268).ConclusionsPatients have those disease, who are typically shorter-course androgen deprivation therapy. This new system may allow personalization treatment such consideration therapy disease. To database. Patients P=.268).