predictive factors of outcome following salvage radiotherapy alone for ...

THE JOURNAL OF UROLOGYâ

Vol. 193, No. 4S, Supplement, Monday, May 18, 2015

bone or CT scan. Associations were compared by ANOVA and Chi-square. Survival function was estimated by Kaplan Meier method with comparisons by log rank and cox regression proportion hazard rates RESULTS: The 10 and 15 year freedom from Metz and CSS were 97.1 and 94% and 98.2 and 94.6%, respectively. Freedom from Metz and CSS decreased by risk group (table). When high risk patients were stratified by very high risk (Gleason score
8 and PSA > 20 ng/ml) there was no difference in CSS. BED was significantly higher in low risk patients free of Metz (198 vs 176 Gy, p¼0.041) and in low (198 vs 172 Gy, p¼0.023) and high risk (193 vs 169 Gy, p¼0.005) patients not dying from prostate cancer. Cox regression revealed stage (p¼0.012, HR 1.45, 95%CI 1.08-1.94), Gleason score (p¼0.037, HR 1.40, 95%CI 1.02-1.91) and BED (p¼0.044, HR 1.01, 95%CI 1-1.03) as significant for Metz. Cox regression for CSS was significant for stage (p¼0.014) and Gleason score (p¼0.002). Use of HT, patient age, and PSA did not influence Metz or CSS. CONCLUSIONS: Radiation dose significantly influences metastases and survival following prostate brachytherapy. Unlike studies which report a beneficial effect of HT combined with EBRT in intermediate and high risk disease, no benefit was experienced when radiation doses are high. Those patients with very high risk disease experienced the same high 10 and 15-year CSS as patients without the highest risk features. These positive results also most likely reflect the high BED. Low Risk

Intermediate Risk

High Risk

10 Year

99.2%

97.6%

90.8%

15 Year

96.1%

94.5%

86.5%

10 Year

99.5%

98.8%

92.3%

15 Year

96.8%

96.6%

80.5%

P Value

Freedom from Metastases P < 0.001

CSS P < 0.001

Source of Funding: none

MP62-17 PREDICTIVE FACTORS OF OUTCOME FOLLOWING SALVAGE RADIOTHERAPY ALONE FOR PATIENTS WITH BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY Wan Song*, Hwang Gyun Jeon, Hyun Hwan Sung, Seoul, Korea, Republic of; Deok Hyun Han, , Korea, Republic of; Joon Hyung Park, Young Hyo Choi, Sang Eun Lee, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han Yong Choi, Hyun Moo Lee, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: In patient with biochemical recurrence (BCR) after radical prostatectomy (RP), salvage radiotherapy (SRT) is recommended as curative treatment option for patient with documented or presumed local recurrence. The aim of this study was to evaluate the oncologic outcomes of SRT and to investigate the predictive factors of SRT failure for patients with BCR after RP. METHODS: We reviewed our prospectively maintained database of 2,043 patients who underwent RP at single institute between September 1995 and December 2011. Of the 297 (14.5%) patients with BCR defined as two consecutive serum prostate specific antigen (PSA) level of > 0.2ng/ml, 149 patients who received SRT and performed prostate magnetic resonance imaging (MRI) before SRT were included. Positive result in prostate MRI was defined when there is a high signal intensity lesion in T2 weighted image (T2WI) that is suspicious for local recurrence. Three-dimensional conformal RT (3D CRT) or intensity-modulated RT (IMRT) was delivered with median dose of 70.0Gy (66.0-78.0Gy) or 67.2Gy (64.8 - 70.0Gy). Treatment failure of SRT was defined as a serum PSA level of ¡Ý0.2ng/ml or as initiation of androgen-deprivation therapy (ADT). Kaplan-Meier and Cox

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regression analysis was carried out to investigate predictive factors of SRT failure RESULTS: The mean age was 62.8 years with median follow up of 82 (20-153) months. The mean pre-operative and pre-SRT PSA were 10.48 ng/ml and 0.54 ng/ml, respectively. Pathologic stage € ¡UpT2 was in 106 patients, Pathologic Gleason score ¡Ý7 was in 130 patients and positive surgical margin was in 47 patients. In prostate MRI, 97 patients showed positive results. Of 149 patients, 55 (36.9%) patients showed SRT failure. The 5 year SRT failure free probability was 53.6 %. By multivariate analysis, pre-SRT PSA ¡Ý1.0 (p ¼ 0.003, hazard ratio [HR]: 3.657, 95% confidence interval [CI]: 1.570-8.517), pathologic stage ¡ÝT3a (p ¼ 0.005, HR: 2.231, 95% CI: 1.278-3.896), pathologic Gleason score ¡Ý7 (p ¼ 0.019, HR: 5.443, 95% CI: 1.320-22.443), and positive result in prostate MRI (p ¼ 0.010, HR: 0.494, 95% CI: 0.289-0.843) were independent predictors of SRT failure after RP. CONCLUSIONS: SRT provided excellent long term control of disease for patients with BCR after RP. Higher pre-SRT PSA, pathologic stage, pathologic Gleason score and negative result in prostate MRI are prognostic factors of SRT failure after RP Source of Funding: none

MP62-18 SURVIVAL AFTER RADICAL PROSTATECTOMY OR RADIOTHERAPY AS PRIMARY TREATMENT IN PATIENTS WITH NON-METASTASIZED PROSTATE CANCER €rr, Kathleen Herkommer, Ralf Oberneder, Christian Gratzke*, Martin Do Helmut Baur, Volker Beer, Claus Belka, Gabriele Schubert-Fritschle, €lzel, Ju € rgen Gschwend, Christian Stief, Jutta Engel, Munich, Dieter Ho Germany INTRODUCTION AND OBJECTIVES: The objective of the study is to evaluate the effectiveness of radical prostatectomy (RPE) or radiotherapy (XRT) in a population-based setting, using different approaches to appropriately consider each diverse cohort. METHODS: 20,935 prostate cancer (PCa) patients (without distant metastases at diagnosis,