International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: prostateImprovement in relapse-free survival throughout the PSA era in patients with localized prostate cancer treated with definitive radiotherapy: Year of treatment an independent predictor of outcome
Introduction
During the past 10–15 years, a significant stage migration toward more favorable presentations has occurred. Most of this stage migration has been attributed to prostate-specific antigen (PSA) screening. However, in patients treated with radical prostatectomy, a steady decrease in the extracapsular extension rates has occurred independent of the presentation PSA level, biopsy Gleason score, and clinical stage (1). This would indicate a stage migration that is occurring in conjunction with PSA screening. Better relapse-free survival rates have also been reported in different eras for radical prostatectomy patients, with the year of therapy an independent predictor of relapse (2). This has led to an update of the Partin tables predicting pathologic outcomes, with observations made on contemporary patients rather than patients from prior eras (3). In the current study, we attempted to demonstrate a similar phenomenon of outcomes improving during the years in the PSA era, independent of other well-known prognosticators.
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Methods and materials
A total of 1276 patients were treated with external beam radiotherapy (EBRT) for adenocarcinoma of the prostate at the Cleveland Clinic Foundation between 1986 and 1999. To include the most homogeneous group possible, with the longest follow-up possible, the following cases were excluded: patients receiving <70 Gy total radiation dose (n = 386), clinical Stage T3 disease (n = 101), no available pretreatment PSA level (n = 2), no available biopsy Gleason score (n = 11), patients receiving
Results
Table 1 summarizes the pretreatment clinical and treatment characteristics of the 467 patients. The median age was 68 years (range 46–82). Clinical T stages were significantly lower in the more recent years. The median iPSA level was 8.6 ng/mL (range 1.0–150.0). Although trends in PSA distributions could be seen, these were not significantly different statistically between the earlier and later periods. Similarly, no differences were found in the biopsy Gleason scores.
The projected 5- and
Discussion
During the past 10–15 years, significant stage migration toward more favorable presentations has occurred. Most of this stage migration has been attributed to PSA screening 7, 8. However, in patients treated with radical prostatectomy, a steady decrease in ECE rates has occurred, independent of presentation PSA level, biopsy Gleason score, and clinical stage (1). This would indicate a stage migration that is occurring in conjunction with PSA screening. Better relapse-free survival rates have
Conclusion
When controlling for tumor and treatment parameters, the year in which RT was performed was still an independent predictor of outcome. This is consistent with observations made for radical prostatectomy patients. A more favorable presentation of localized prostate cancer seen in current years in conjunction with PSA screening is possibly related to changing cancer biology, but more probably to increased physician and patient awareness, leading to more aggressive biopsies detecting earlier
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