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Heterogeneity in high-risk prostate cancer treated with high-dose radiation therapy and androgen deprivation therapy: Beyond the Abstract

High-risk localized prostate cancer is a highly heterogeneous disease from a clinical and biological standpoint. It carries a significant chance of morbidity and mortality. The 2015 National Comprehensive Cancer Network (NCCN) guidelines define high-risk prostate cancer as a biopsy Gleason score of 8–10, a PSA level greater than 20 ng/mL, or clinical stage T3a disease. Despite the impact of PSA screening on improves outcome of men with prostate cancer, a significant proportion of men continue to present with high risk disease and need optimal treatment.

We sought to identify distinct subgroups of men with high-risk localized prostate cancer who experience varying outcomes following treatment with a combination of high-dose contemporary radiation therapy and androgen-deprivation therapy (ADT). We found that patients with a single high-risk factor (favorable high-risk subgroup) had better outcomes than those with multiple high-risk factors (unfavorable high-risk subgroup) following treatment with a combination of external beam radiation therapy and ADT.

The favorable high-risk subgroup had a 5-year distant metastasis-free survival (88.0%) rate akin to patients with intermediate-risk prostate cancer (93.7%). The unfavorable high-risk subgroup had a 5-year distant metastasis-free survival rate (81.2%) more like patients with very high risk prostate cancer (78.4%).

These results highlight the heterogeneity within high-risk prostate cancer. This is one of the first series from Europe in patients with high-risk prostate cancer treated with radiotherapy that has sought to sub-classify high-risk disease. Further studies should consider the marked heterogeneity in this disease. 

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Written By: Daniel Cagney