PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s):External beam radiotherapy (EBRT) plus androgen deprivation therapy (ADT) is a standard of care for men diagnosed with unfavorable risk prostate cancer based on several prospective studies demonstrating a long-term overall survival (OS) benefit with the combination compared to either modality alone. However, D’Amico et al. reported decreased OS with EBRT plus ADT versus EBRT alone for men with moderate to severe co-morbidities randomized to the two therapies.1 We report large-scale, co-morbidity-related survival outcomes for men included in the National Cancer Database who were diagnosed with high-risk prostate cancer and treated with EBRT plus ADT or EBRT alone from 2004 to 2012.
Materials/Methods:High-risk prostate cancer was defined as clinical stage T3a or Gleason score ≥ 8 or PSA ≥ 20 ng/ml, in accordance with National Comprehensive Cancer Network guidelines. Cases were limited to those that received EBRT and had 1) known ADT status, 2) baseline Charlson co-morbidity score (CCS) of 1 or more, and 3) documented survival outcome for the follow-up period. The log rank test was used to evaluate the difference in OS between the treatment groups. Cox regression models were used to assess the effects of covariates on OS.
Results:At median follow-up length of 42.1 months (IQR, 24.4–67.9) for EBRT plus ADT (n = 10,712) and 46.5 months (IQR, 27.5–70.4) for EBRT alone (n = 4,111), there were 3,599 deaths (33.6%) and 1,049 deaths (25.5%) in the respective treatment groups (Log rank p < 0.001). On multivariate testing adjusted for income, insurance status, and treatment facility type there was a significant increase in the risk of death when treatment with EBRT plus ADT was compared to EBRT alone (hazard ratio = 1.35, 95% CI 1.25-1.45, p < 0.001) There was no race-related increase in mortality when OS for black men was compared to that of non-Hispanic white men.
Conclusion:Men with baseline co-morbidities diagnosed with high risk prostate cancer appear to have decreased OS when treated with EBRT plus ADT as compared to EBRT alone. These findings highlight the importance of careful patient selection and comorbidity management in men with HRPC treated with curative intent. 1 D’Amico AV, Chen MH, Renshaw A, Loffredo M, Kantoff PW. Long term Follow-up of a Randomized Trial of Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA 2015;314:1291-3.
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