Genitourinary Cancer

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SU_32_2325 - Definitive Local Therapy and Survival in Clinically Node-Positive Prostate Cancer

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

Definitive Local Therapy and Survival in Clinically Node-Positive Prostate Cancer
R. R. Sarkar1, A. K. Bryant1, K. Kader2, R. Mckay3, J. P. Einck1, A. J. Mundt Jr1, C. J. Kane2, J. K. Parsons2, J. D. Murphy1, and B. S. Rose1; 1Department of Radiation Medicine, University of California, San Diego, La Jolla, CA, 2Department of Urology, University of California, San Diego, La Jolla, CA, 3Department of Hematology-Oncology, University of California, San Diego, La Jolla, CA

Purpose/Objective(s): While the use of radiation therapy (RT) in clinically lymph node-positive prostate cancer is approved by National Comprehensive Cancer Network guidelines, the benefit of radical prostatectomy (RP) is unclear. We hypothesized that compared to non-definitive therapy, RP improves survival in clinically lymph node-positive prostate cancer.

Materials/Methods: We identified clinically node-positive, non-metastatic prostate cancer patients diagnosed between 2000 and 2015 and treated with non-definitive therapy (n=470) or definitive local therapy +/- ADT (n=271) from a national Veterans Affairs (VA) database. Of the non-definitive therapy cohort, 445 received ADT alone, and 25 received no therapy. Of the definitive local therapy cohort, 78 patients received RP regimens, and 193 received RT. Of patients who were classified as receiving RP, 9 received salvage RT. Patient-level covariates included Charlson comorbidity score, marital status, employment status, age, regional median income and high school graduation rate, body mass index, and race. Tumor-related covariates included clinical T stage, Gleason score, and prostate specific antigen concentration. We compared prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) between treatment groups using multivariable Cox regression, controlling for potential confounders. All tests of statistical significance were two sided.

Results: Median follow-up time was 4.3 years. Of the 741 patients in the study cohort, 318 deaths were recorded, 180 of which were due to cancer-related causes. Definitive local therapy was associated with improved PCSM (HR 0.53, 95% CI 0.36-0.77, p=0.001) and ACM (hazard ratio [HR 0.52, 95% CI 0.39-0.69, p<0.001). When isolating RP regimens from RT, RP was associated with improved PCSM (HR 0.28, 95% CI 0.13-0.59 p=0.001) and ACM (HR 0.36, 95% CI 0.21-0.62, p=0.0002) compared to no definitive therapy. On subgroup analysis, RP did not have significantly different PCSM (HR 0.46, 95% CI 0.19-1.12, p=0.09) or ACM (HR 0.82, 95% CI 0.43-1.56, p=0.54) compared to RT.

Conclusion: Definitive local treatment with RP or RT is associated with improved PCSM and ACM among patients with clinically node-positive prostate cancer. There was no significant difference in survival between patients undergoing RP or RT. Randomized trials are required to confirm the benefit and optimal local therapy in clinically node-positive prostate cancer.

Author Disclosure: R.R. Sarkar: None. K. Kader: None. R. Mckay: Research Grant; Bayer, Pfizer, Genentech. Advisory Board; Novartis, Janssen. J.P. Einck: Independent Contractor; American College of Radiation Oncology. Board Member; Cure Cervical Cancer. oRG. A.J. Mundt: Honoraria; Up to Date, US Oncology, Varian Medical Systems. C.J. Kane: Advisory Board; Janssen, SNP Bio. J.K. Parsons: None. B.S. Rose: None.

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