OBJECTIVE: To evaluate outcomes in @entity263 @entity1 classified as high-risk (HR) or very high-risk (VHR) who were treated with conformal radiation therapy (CRT) and @entity342 deprivation therapy (ADT). METHODS: Between 11/2001 and 3/2012, 203 @entity1 with @entity66 received CRT to the prostate (78-82  Gy) and pelvic lymph nodes (46-50  Gy) with ADT (6  m-2  years). Median follow-up was 50  months (12  m-142  m). Biochemical failure was defined according to Phoenix definition. Imaging studies were used to identify local, regional or metastatic failure. Four different VHR/HR groupings were formed using the 2014 and revised 2015 NCCN guidelines. Differences were examined using Kaplan Meier (KM) estimates with log rank test and uni- and multivariate Cox regression analysis (MVA). RESULTS: Failure occurred in 30/203  @entity1 (15%). Median time to failure was 30  m (4  m-76  m). KM estimate of 4  year biochemical disease free survival (b-DFS) for the entire cohort was 87% (95%CI: 82-92%). Four year KM survival estimates for b-DFS, PCSS and @entity3012 were comparable for each NCCN subgroup. On univariate analysis, the NCCN subgroups were not predictive of b-DFS at 4  years, however, DMFS was worse for both VHR subgroups (p   =   .03and .01) respectively. Cox univariate analysis was also significant for: PSA >= 40  ng/ml p   =   0.001; clinical stages T2c p   =   .004, T3b p   =   .02 and   >   4 cores with Gleason score 8-10 p   <   .03. On MVA, only PSA   >=    40  ng/ml was predictive for b-DFS or @entity1614 at 4  years (HR: 3.75 and 3.25, p   <   0.005). CONCLUSION: @entity1 with @entity66 treated with CRT and ADT had good outcomes. Stratification into HR and VHR sub-groups provided no predictive value. Only PSA >= 40  ng/ml predicted poor outcomes on MVA. Distant failure was dominant and local recurrence rare, suggesting that improved systemic treatment rather than intensification of local therapy is needed. @entity1 with high-risk @entity263 are most often treated with conformal dose escalated radiation therapy with @entity342 deprivation. Stratification into high versus very high-risk subgroups using 2014 or revised 2015 National @entity5 Network (NCCN) criteria did not impact treatment outcomes. Only Prostate Serum Antigen (PSA) >= 40  ng/ml was predictive of poor prognosis. Distant failure was dominant and local recurrence uncommon which challenges the notion that intensification of local therapy will further improve outcomes in @entity1 with high-risk disease.

Classifying high-risk versus very high-risk XXXX : is it relevant to outcomes of conformal radiotherapy and @entity342 deprivation?

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity263 :: ('MESH:D011471', 'Disease') :: ['prostate cancer'] @entity66 :: ('MESH:D004194', 'Disease') :: ['HR and VHR disease', 'HR disease'] @entity3012 :: ('MESH:C567932', 'Disease') :: ['OS'] @entity5 :: ('MESH:D009369', 'Disease') :: ['Comprehensive Cancer'] @entity1614 :: ('MESH:D008382', 'Disease') :: ['MFS'] @entity342 :: ('CHEBI:50113', 'Chemical') :: ['androgen']
@entity263 :: (MESH:D011471,Disease) :: ['prostate cancer']
