Background: Radical three-dimensional conformal radiotherapy (CFRT) with initial androgen suppression (AS) is a standard management for localised prostate cancer (PC).
This pilot study evaluated the role of dose escalation and appropriate target volume margin. Here, we report long-term follow-up.
Methods: Eligible patients had T1b-T3b N0 M0 PC. After neoadjuvant AS, they were randomised to CFRT, giving (a) 64 Gy with either a 1.0- or 1.5-cm margin and (b) ±10 Gy boost to the prostate alone.
Results: One hundred and twenty-six men were randomised and treated. Median follow-up was 13.7 years. The median age was 66.6 years at randomisation. Median presenting prostate-specific antigen (PSA) was 14 ng ml-1. Sixty-four out of 126 patients developed PSA failure. Forty-nine out of 126 patients restarted AS, 34 out of 126 developed metastases and 28 out of 126 developed castrate-resistant prostate cancer (CRPC). Fifty-one out of 126 patients died; 19 out of 51 died of PC. Median overall survival (OS) was 14.4 years. Although escalated dose results were favourable, no statistically significant differences were seen between the randomised groups; PSA control (hazard ratio (HR): 0.77 (95% confidence interval (CI): 0.47-1.26)), development of CRPC (HR: 0.81 (95% CI: 0.40-1.65)), PC-specific survival (HR: 0.59 (95% CI:0.23-1.49)) and OS (HR: 0.81 (95% CI: 0.47-1.40)). There was no evidence of a difference in PSA control according to margin size (HR: 1.01 (95% CI: 0.61-1.66)).
Interpretation: Long-term follow-up of this small pilot study is compatible with a benefit from dose escalation, but confirmation from larger trials is required. There was no obvious detriment using the smaller radiotherapy margin.
Written by:
Creak A, Hall E, Horwich A, Eeles R, Khoo V, Huddart R, Parker C, Griffin C, Bidmead M, Warrington J, Dearnaley D. Are you the author?
Academic Urology Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton and London, UK.
Reference: Br J Cancer. 2013 Aug 6;109(3):651-7.
doi: 10.1038/bjc.2013.394
PubMed Abstract
PMID: 23880826
UroToday.com Prostate Cancer Section
