Journal of Cancer Research and Clinical Oncology

, Volume 139, Issue 7, pp 1141–1147

Radical radiotherapy in high-risk prostate cancer patients with high or ultra-high initial PSA levels: a single institution analysis

  • Alessia Guarneri
  • Angela Botticella
  • Andrea Riccardo Filippi
  • Andrea Ruggieri
  • Cristina Piva
  • Fernando Munoz
  • Riccardo Ragona
  • Paolo Gontero
  • Umberto Ricardi
Original Paper

DOI: 10.1007/s00432-013-1426-0

Cite this article as:
Guarneri, A., Botticella, A., Filippi, A.R. et al. J Cancer Res Clin Oncol (2013) 139: 1141. doi:10.1007/s00432-013-1426-0

Abstract

Purpose

Purpose of this study is to analyze outcomes and pre-treatment prognostic factors in high-risk prostate cancer patients with initial PSA ≥20 ng/mL, treated with high-dose external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) in a single institution.

Methods

Between March 2003 and December 2011, 155 consecutive high-risk prostate cancer patients (a) presenting with pre-treatment PSA level ≥20 ng/mL, (b) treated with definitive EBRT, and (c) with a minimum follow-up of 24 months were included in this retrospective analysis. Phoenix definition was used to define biochemical control. Primary endpoints were as follows: biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS) and overall survival (OS). Multivariate analysis was performed to determine the independent prognostic impact of pre-treatment clinical factors [T stage, PSA, and Gleason score (GS)].

Results

At a median follow-up time of 62 months, actuarial bDFS, DMFS, CSS, and OS at 5 years were 64.8, 85.2, 95.8, and 94.4 %, respectively. On multivariate analysis, only GS was significantly associated with three clinical endpoints (bDFS: HR 1.6; p = 0.022, CSS: HR 4.27, p = 0.044, OS: HR 2.6; p = 0.038). Pre-treatment zenith PSA was associated only with bDFS (HR 1.87; p = 0.027).

Conclusions

Patients with “high” PSA levels (≥20 ng/mL) showed favorable clinical outcomes, supporting the role of local radiotherapy as primary therapy in combination with long-term ADT in patients with high PSA levels at diagnosis. A GS of 8–10 is the strongest predictor of outcome.

Keywords

High-risk prostate cancerExternal beam radiotherapyProstate-specific antigenGleason Score

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Alessia Guarneri
    • 1
  • Angela Botticella
    • 1
  • Andrea Riccardo Filippi
    • 1
  • Andrea Ruggieri
    • 1
  • Cristina Piva
    • 1
  • Fernando Munoz
    • 1
  • Riccardo Ragona
    • 1
  • Paolo Gontero
    • 2
  • Umberto Ricardi
    • 1
  1. 1.Radiation Oncology, San Giovanni Battista HospitalUniversity of TorinoTurinItaly
  2. 2.Urology, San Giovanni Battista HospitalUniversity of TorinoTurinItaly