Scientific publications

Patterns of Clinical Progression in Radiorecurrent High-risk Prostate Cancer. Scientific Publication

Aug 1, 2021 | Magazine: European Urology

Rebecca G Philipson  1 , Tahmineh Romero  2 , Jessica K Wong  3 , Bradley J Stish  4 , Robert T Dess  5 , Daniel E Spratt  5 , Avinash Pilar  6 , Chandana Reddy  7 , Trude B Wedde  8 , Wolfgang A Lilleby  8 , Ryan Fiano  9 , Gregory S Merrick  9 , Richard G Stock  10 , D Jeffrey Demanes  11 , Brian J Moran  12 , Michelle Braccioforte  12 , Phuoc T Tran  13 , Santiago Martin  14 , Rafael Martinez-Monge  14 , Daniel J Krauss  15 , Eyad I Abu-Isa  5 , Luca Valle  1 , Natalie Chong  1 , Thomas M Pisansky  4 , C Richard Choo  4 , Daniel Y Song  13 , Stephen Greco  13 , Curtiland Deville  13 , Todd McNutt  13 , Theodore L DeWeese  13 , Ashley E Ross  16 , Jay P Ciezki  7 , Derya Tilki  17 , R Jeffrey Karnes  18 , Eric A Klein  19 , Jeffrey J Tosoian  20 , Paul C Boutros  21 , Nicholas G Nickols  22 , Prashant Bhat  23 , David Shabsovich  23 , Jesus E Juarez  23 , Patrick A Kupelian  1 , Matthew B Rettig  24 , Alejandro Berlin  25 , Jonathan D Tward  26 , Brian J Davis  4 , Robert E Reiter  21 , Michael L Steinberg  1 , David Elashoff  2 , Eric M Horwitz  3 , Rahul D Tendulkar  7 , Amar U Kishan  27


Abstract

The natural history of radiorecurrent high-risk prostate cancer (HRPCa) is not well-described.

To better understand its clinical course, we evaluated rates of distant metastases (DM) and prostate cancer-specific mortality (PCSM) in a cohort of 978 men with radiorecurrent HRPCa who previously received either external beam radiation therapy (EBRT, n = 654, 67%) or EBRT + brachytherapy (EBRT + BT, n = 324, 33%) across 15 institutions from 1997 to 2015. In men who did not die, median follow-up after treatment was 8.9 yr and median follow-up after biochemical recurrence (BCR) was 3.7 yr. Local and systemic therapy salvage, respectively, were delivered to 21 and 390 men after EBRT, and eight and 103 men after EBRT + BT.

Overall, 435 men developed DM, and 248 were detected within 1 yr of BCR. Measured from time of recurrence, 5-yr DM rates were 50% and 34% after EBRT and EBRT + BT, respectively. Measured from BCR, 5-yr PCSM rates were 27% and 29%, respectively. Interval to BCR was independently associated with DM (p < 0.001) and PCSM (p < 0.001).

These data suggest that radiorecurrent HRPCa has an aggressive natural history and that DM is clinically evident early after BCR. These findings underscore the importance of further investigations into upfront risk assessment and prompt systemic evaluation upon recurrence in HRPCa.

PATIENT SUMMARY: High-risk prostate cancer that recurs after radiation therapy is an aggressive disease entity and spreads to other parts of the body (metastases). Some 60% of metastases occur within 1 yr. Approximately 30% of these patients die from their prostate cancer.

CITATION Eur Urol. 2021 Aug;80(2):142-146. doi: 10.1016/j.eururo.2021.04.035. Epub 2021 May 10