BACKGROUND The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases. OBJECTIVE To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT). DESIGN, SETTING, AND PARTICIPANTS We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT+BT). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment. RESULTS AND LIMITATIONS A total of 299 EBRT patients (41%) and 320 EBRT+BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT+BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT+BT groups were 58% and 78%, respectively. The median follow-up was 5.6yr. WPRT was associated with improved bRFS among patients treated with EBRT+BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2-0.9, p=0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6-1.2, p=0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7-1.7, p=0.8 for DMFS and HR 0.7, 95% CI 0.4-1.1, p=0.1 for PCSS), or in the EBRT+BT group (HR 0.6, 95% CI 0.3-1.4, p=0.2 for DMFS and HR 0.5 95% CI 0.2-1.2, p=0.1 for PCSS). CONCLUSIONS WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT+BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT+BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted. PATIENT SUMMARY When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy.

中文翻译：

---

格里森第5级前列腺癌的仅前列腺对全骨盆腔放疗伴或不伴近距离放射治疗的效果：回顾性分析。

背景技术全骨盆选择性放射治疗（WPRT）的作用仍存在争议。很少有研究在Gleason分级组（GG）5前列腺癌（PCa）中进行研究，已知该癌具有高的淋巴结转移风险。目的评估WPRT对GG 5 PCa的患者的影响，这些GG 5 PCa接受外束放射治疗（EBRT）或近距离放射治疗增强（EBRT + BT）的EBRT。设计，地点和参与者我们从2000年至2013年在美国的11个中心和挪威的1个中心确定了1170例经活检证实的GG 5 PCa患者（EBRT 734例，EBRT + BT 436例）。结果测量和统计分析使用具有倾向性得分调整的Cox比例风险模型比较了无生化复发生存期（bRFS），无远处转移生存期（DMFS）和前列腺癌特异性生存期（PCSS）。结果与局限性共有299例EBRT患者（41％）和320例EBRT + BT患者（73％）接受了WPRT。EBRT和EBRT + BT组中用WPRT调整的5年期bRFS发生率分别为66％和88％。如果不使用WPRT，则EBRT和EBRT + BT组的这些比率分别为58％和78％。中位随访时间为5。6年。在EBRT + BT治疗的患者中，WPRT与bRFS改善相关（危险比[HR] 0.5，95％置信区间[CI] 0.2-0.9，p = 0.02），但在EBRT治疗的患者中未发现改善的证据（ HR 0.8，95％CI 0.6-1.2，p = 0.4）。在EBRT组中，WPRT与DMFS或PCSS改善没有显着相关性（DMFS的HR 1.1，95％CI 0.7-1.7，p = 0.8，PCSS HR的0.7，95％CI 0.4-1.1，p = 0.1），或者EBRT + BT组（DMFS的HR 0.6，95％CI 0.3-1.4，p = 0.2，PCSS的HR 0.5 95％CI 0.2-1.2，p = 0.1）。结论在接受EBRT或EBRT + BT的GG 5 PCa患者中，WPRT与PCSS或DMFS改善无关。然而，在接受EBRT + BT的患者中，WPRT与bRFS的显着改善相关。有必要通过潜在的先进成像技术识别隐匿性淋巴结疾病来优化WPRT。患者概述当格里森级前列腺癌高发男性接受外部放射和近距离放射治疗时，向骨盆增加放射会导致更长的前列腺特异性抗原控制时间。但是，我们没有发现它们在前列腺癌中的生存率或无转移性疾病的生存率上没有差异。对于未接受近距离放射治疗的男性，我们也没有发现对骨盆放射的益处。