Patterns of Clinical Progression in Radiorecurrent High-risk Prostate Cancer,European Urology

当前位置： X-MOL 学术 › Eur. Urol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Patterns of Clinical Progression in Radiorecurrent High-risk Prostate Cancer
European Urology ( IF 23.4 ) Pub Date : 2021-05-10 , DOI: 10.1016/j.eururo.2021.04.035
Rebecca G Philipson ₁ , Tahmineh Romero ₂ , Jessica K Wong ₃ , Bradley J Stish ₄ , Robert T Dess ₅ , Daniel E Spratt ₅ , Avinash Pilar ₆ , Chandana Reddy ₇ , Trude B Wedde ₈ , Wolfgang A Lilleby ₈ , Ryan Fiano ₉ , Gregory S Merrick ₉ , Richard G Stock ₁₀ , D Jeffrey Demanes ₁₁ , Brian J Moran ₁₂ , Michelle Braccioforte ₁₂ , Phuoc T Tran ₁₃ , Santiago Martin ₁₄ , Rafael Martinez-Monge ₁₄ , Daniel J Krauss ₁₅ , Eyad I Abu-Isa ₅ , Luca Valle ₁ , Natalie Chong ₁ , Thomas M Pisansky ₄ , C Richard Choo ₄ , Daniel Y Song ₁₃ , Stephen Greco ₁₃ , Curtiland Deville ₁₃ , Todd McNutt ₁₃ , Theodore L DeWeese ₁₃ , Ashley E Ross ₁₆ , Jay P Ciezki ₇ , Derya Tilki ₁₇ , R Jeffrey Karnes ₁₈ , Eric A Klein ₁₉ , Jeffrey J Tosoian ₂₀ , Paul C Boutros ₂₁ , Nicholas G Nickols ₂₂ , Prashant Bhat ₂₃ , David Shabsovich ₂₃ , Jesus E Juarez ₂₃ , Patrick A Kupelian ₁ , Matthew B Rettig ₂₄ , Alejandro Berlin ₂₅ , Jonathan D Tward ₂₆ , Brian J Davis ₄ , Robert E Reiter ₂₁ , Michael L Steinberg ₁ , David Elashoff ₂ , Eric M Horwitz ₃ , Rahul D Tendulkar ₇ , Amar U Kishan ₂₇

Affiliation

Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Oslo University Hospital, Oslo, Norway.
Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, USA.
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
California Endocurietherapy Cancer Center, Oakland, CA, USA.
Chicago Prostate Cancer Center, Westmont, IL, USA.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiation Oncology, Clínica Universidad de Navarra and Program in Solid Tumors, CIMA- University of Navarra, Pamplona, Spain.
Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Urology and Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Urology, University of California Los Angeles, Los Angeles, CA, USA.
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Department of Medical Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Medical Oncology, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
Department of Radiotherapy Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California Los Angeles, Los Angeles, CA, USA.

The natural history of radiorecurrent high-risk prostate cancer (HRPCa) is not well-described. To better understand its clinical course, we evaluated rates of distant metastases (DM) and prostate cancer-specific mortality (PCSM) in a cohort of 978 men with radiorecurrent HRPCa who previously received either external beam radiation therapy (EBRT, n = 654, 67%) or EBRT + brachytherapy (EBRT + BT, n = 324, 33%) across 15 institutions from 1997 to 2015. In men who did not die, median follow-up after treatment was 8.9 yr and median follow-up after biochemical recurrence (BCR) was 3.7 yr. Local and systemic therapy salvage, respectively, were delivered to 21 and 390 men after EBRT, and eight and 103 men after EBRT + BT. Overall, 435 men developed DM, and 248 were detected within 1 yr of BCR. Measured from time of recurrence, 5-yr DM rates were 50% and 34% after EBRT and EBRT + BT, respectively. Measured from BCR, 5-yr PCSM rates were 27% and 29%, respectively. Interval to BCR was independently associated with DM (p < 0.001) and PCSM (p < 0.001). These data suggest that radiorecurrent HRPCa has an aggressive natural history and that DM is clinically evident early after BCR. These findings underscore the importance of further investigations into upfront risk assessment and prompt systemic evaluation upon recurrence in HRPCa.

Patient summary

High-risk prostate cancer that recurs after radiation therapy is an aggressive disease entity and spreads to other parts of the body (metastases). Some 60% of metastases occur within 1 yr. Approximately 30% of these patients die from their prostate cancer.

中文翻译：

放射复发高危前列腺癌的临床进展模式

放射复发性高危前列腺癌 (HRPCa) 的自然病程尚未得到充分描述。为了更好地了解其临床过程，我们评估了 978 名放射复发性 HRPCa 男性的队列中的远处转移率 (DM) 和前列腺癌特异性死亡率 (PCSM)，这些男性先前接受过外照射放射治疗（EBRT，n = 654、67 %) 或 EBRT + 近距离放射治疗 (EBRT + BT, n = 324, 33%) 从 1997 年到 2015 年跨越 15 个机构。在没有死亡的男性中，治疗后的中位随访时间为 8.9 年，生化复发 (BCR) 后的中位随访时间为 3.7 年。EBRT 后分别对 21 名和 390 名男性以及 EBRT + BT 后的 8 名和 103 名男性进行了局部和全身治疗补救。总体而言，435 名男性患上了 DM，其中 248 名在 BCR 后 1 年内被发现。从复发时间衡量，EBRT 和 EBRT + BT 后 5 年 DM 率分别为 50% 和 34%。根据 BCR 测量，5 年 PCSM 率分别为 27% 和 29%。BCR 的间隔与 DM ( p < 0.001) 和 PCSM ( p < 0.001)。这些数据表明，放射复发性 HRPCa 具有侵袭性的自然病程，并且在 BCR 后早期临床上明显存在 DM。这些发现强调了进一步调查前期风险评估和及时对 HRPCa 复发进行系统评估的重要性。