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PMID- 28263132
STAT- In-Process
DA  - 20170306
LR  - 20170306
IS  - 1195-9479 (Print)
IS  - 1195-9479 (Linking)
VI  - 24
IP  - 1
DP  - 2017 Feb
TI  - The need for androgen deprivation therapy in patients with intermediate-risk
      prostate cancer treated with dose-escalated external beam radiation therapy.
PG  - 8656-8662
AB  - INTRODUCTION: To evaluate if androgen deprivation therapy (ADT) improves outcomes
      for patients with localized, intermediate-risk prostate cancer treated with
      definitive external beam radiation therapy (EBRT) in the dose-escalated era.
      MATERIALS AND METHODS: This is a retrospective study using a single institutional
      database. We included patients with localized, intermediate-risk prostate cancer 
      treated with dose-escalated radiation therapy (RT) with 3D conformal radiotherapy
      or intensity-modulated radiotherapy (74-80 Gy in daily fraction of 1.8 Gy-2.0 Gy,
      or 70.2 Gy in daily fraction of 2.7 Gy) from 1992 to 2013. To further risk
      stratify the patients, PSA 10 ng/mL-20 ng/mL, Gleason 3+4, and T2b-T2c were
      assigned risk score (RS) of 1, while Gleason 4+3 was assigned RS of 2. Patients
      with prior treatment for prostate cancer, those on long term ADT (>= 23 months), 
      or those with follow up < 1 year were excluded. We defined initial ADT as
      initiation within 9 months prior to the start of RT, during RT, or within 2
      months after the completion of RT. Outcomes for patients who received initial ADT
      were compared to men treated with RT alone. Covariates included number of
      intermediate risk factors, age, and baseline comorbidities. Kaplan Meier
      estimates were compared using log rank tests. Competing risk regression and Cox
      proportional hazards regression were used to estimate hazard ratios adjusted for 
      covariates. RESULTS: Of 1,134 patients included in this study, 155 received
      initial ADT with median duration of 4.0 months (m) (range 0.5 m-22.0 m). The
      median follow up was 56.4 m (range 12.3 m-200.7 m). Patients on ADT had higher RS
      compared to those with radiation alone (RS 1: 48% versus 58%; RS 2: 35% versus
      32%; RS 3: 14% versus 9%; RS 4: 3% versus 1%; p=0.01). When patients with ADT
      were compared to those treated with radiation alone, there were no significant
      differences in freedom from biochemical failure (FFBF) (84.0% versus 87.3%, p =
      0.83), freedom from distant metastasis (FFDM) (94.4% versus 96.9%, p = 0.41), or 
      overall survival (OS) (92.3% versus 90.7%, (p = 0.48) at 5 years. Among patients 
      with RS >= 2, there were still no significant differences in FFBF, FFDM, or OS
      when patients treated with ADT were compared to those treated with radiation
      alone. In multivariable analyses adjusting for RS and age, the adjusted hazard
      ratio for ADT use was sHR = 0.89 (95% CI = 0.64-1.66, p = 0.64) for BCF; sHR =
      1.13 (95% CI = 0.48-2.65, p = 0.77) for DM. For overall mortality, adjusted HR = 
      1.23 (95% CI = 0.76-2.01, p = 0.40) where comorbidities (including diabetes,
      cardiac disease, and hypertension) were also included as covariates. CONCLUSION: 
      Our study suggested that treatment of intermediate-risk prostate cancer with
      definitive dose-escalated EBRT alone resulted in acceptable outcomes, and it
      failed to show improved outcomes in patients who received short term ADT.
FAU - Dong, Yanqun
AU  - Dong Y
AD  - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia,
      Pennsylvania, USA.
FAU - Ruth, Karen J
AU  - Ruth KJ
FAU - Churilla, Thomas M
AU  - Churilla TM
FAU - Viterbo, Rosalia
AU  - Viterbo R
FAU - Sobczak, Mark L
AU  - Sobczak ML
FAU - Smaldone, Marc C
AU  - Smaldone MC
FAU - Chen, David Y T
AU  - Chen DY
FAU - Uzzo, Robert G
AU  - Uzzo RG
FAU - Hallman, Mark H
AU  - Hallman MH
FAU - Horwitz, Eric M
AU  - Horwitz EM
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - Can J Urol
JT  - The Canadian journal of urology
JID - 9515842
EDAT- 2017/03/07 06:00
MHDA- 2017/03/07 06:00
CRDT- 2017/03/07 06:00
PST - ppublish
SO  - Can J Urol. 2017 Feb;24(1):8656-8662.