Genitourinary Cancer

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SU_22_2224 - Delayed Radiation Therapy is Associated with Improved Overall Survival in Node Positive Prostate Cancer Treated with Androgen Deprivation Therapy

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Delayed Radiation Therapy is Associated with Improved Overall Survival in Node Positive Prostate Cancer Treated with Androgen Deprivation Therapy
V. Agrawal1, X. Ma2, J. Kang1, and H. Nagar3; 1NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, 2Weill Cornell Medicine, New York City, NY, 3NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY

Purpose/Objective(s): The optimal treatment sequence for node positive prostate cancer remains unclear. Retrospective studies have demonstrated an overall survival benefit with the combination of androgen deprivation therapy (ADT) and radiation therapy compared to ADT alone. We investigated the association between timing of radiation therapy and survival.

Materials/Methods: Patients with clinically node positive ­prostate adenocarcinoma from 2004-2015 who received ADT and radiation therapy to the prostate or pelvis were identified in the National Cancer Data Base (NCDB). Node positive patients were defined as having either cN1 staging. Patients with metastatic disease (M1), prior surgery or chemotherapy, initiation of radiation>6 months after the start of ADT, or palliative radiation therapy (<45 Gy) were excluded. Univariate and multivariate analysis was performed using the Cox proportional hazard method. Overall survival (OS) was estimated with the Kaplan-Meier method.

Results: A total of 9,840 patients with node positive prostate cancer were identified. 2,283 patients (23.2%) received ADT followed by radiation therapy. 1,624 patients had complete data for analysis. There was a statistically significant association between increased duration of ADT prior to radiation and overall survival. Median survival improved to 139.6 months for >2 months ADT versus 109.8 months for <2 months ADT prior to radiation (HR 0.77, 95% CI [0.65-0.92], p=0.004). On multivariate analysis, exposure to >2 months ADT prior to radiation was associated with improved overall survival independent of age, race, PSA, Charlson/Deyo comorbidity score, facility type, insurance status and year of diagnosis (HR 0.79, 95% CI [0.65-0.95], p=0.01).

Conclusion: Patients with node positive prostate cancer have improved survival with greater than two months of ADT prior to the initiation of radiation therapy. Increased duration of ADT may sensitize prostate cancer to the effects of radiation or reduce disease burden for increased efficacy of radiation therapy. Prospective trials are needed to further characterize the effect of radiation therapy in node positive prostate cancer.

Author Disclosure: V. Agrawal: None. X. Ma: None. J. Kang: None. H. Nagar: None.

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