Predominant treatment failure in postprostatectomy patients is local

Analysis of patterns of treatment failure in SWOG 8794

Gregory P Swanson, Michael A. Hussey, Catherine M. Tangen, Joseph Chin, Edward Messing, Edith Canby-Hagino, Jeffrey D. Forman, Ian M. Thompson, E. David Crawford

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

Purpose: Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research. Patients and Methods: Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation. Results: Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data. Median follow-up was 10.2 years. For patients with a postsurgical PSA of ≤ 0.2 ng/mL, radiation was associated with reductions in the 10-year risk of biochemical treatment failure (72% to 42%), local failures (20% to 7%), and distant failures (12% to 4%). For patients with a postsurgical PSA between higher than 0.2 and ≤ 1.0 ng/mL, reductions in the 10-year risk of biochemical failure (80% to 73%), local failures (25% to 9%), and distant failures (16% to 12%) were realized. In patients with postsurgical PSA higher than 1.0, the respective findings were 94% versus 100%, 28% versus 9%, and 44% versus 18%. Conclusion: The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.

Original languageEnglish (US)
Pages (from-to)2225-2229
Number of pages5
JournalJournal of Clinical Oncology
Volume25
Issue number16
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

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Prostate-Specific Antigen
Treatment Failure
Radiation
Prostatectomy
Adjuvant Radiotherapy
Seminal Vesicles
Prostate
Prostatic Neoplasms
Observation
Guidelines
Recurrence
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Swanson, G. P., Hussey, M. A., Tangen, C. M., Chin, J., Messing, E., Canby-Hagino, E., ... Crawford, E. D. (2007). Predominant treatment failure in postprostatectomy patients is local: Analysis of patterns of treatment failure in SWOG 8794. Journal of Clinical Oncology, 25(16), 2225-2229. https://doi.org/10.1200/JCO.2006.09.6495

Predominant treatment failure in postprostatectomy patients is local : Analysis of patterns of treatment failure in SWOG 8794. / Swanson, Gregory P; Hussey, Michael A.; Tangen, Catherine M.; Chin, Joseph; Messing, Edward; Canby-Hagino, Edith; Forman, Jeffrey D.; Thompson, Ian M.; Crawford, E. David.

In: Journal of Clinical Oncology, Vol. 25, No. 16, 01.06.2007, p. 2225-2229.

Research output: Contribution to journalArticle

Swanson, GP, Hussey, MA, Tangen, CM, Chin, J, Messing, E, Canby-Hagino, E, Forman, JD, Thompson, IM & Crawford, ED 2007, 'Predominant treatment failure in postprostatectomy patients is local: Analysis of patterns of treatment failure in SWOG 8794', Journal of Clinical Oncology, vol. 25, no. 16, pp. 2225-2229. https://doi.org/10.1200/JCO.2006.09.6495
Swanson, Gregory P ; Hussey, Michael A. ; Tangen, Catherine M. ; Chin, Joseph ; Messing, Edward ; Canby-Hagino, Edith ; Forman, Jeffrey D. ; Thompson, Ian M. ; Crawford, E. David. / Predominant treatment failure in postprostatectomy patients is local : Analysis of patterns of treatment failure in SWOG 8794. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 16. pp. 2225-2229.
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title = "Predominant treatment failure in postprostatectomy patients is local: Analysis of patterns of treatment failure in SWOG 8794",
abstract = "Purpose: Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50{\%} over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research. Patients and Methods: Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation. Results: Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data. Median follow-up was 10.2 years. For patients with a postsurgical PSA of ≤ 0.2 ng/mL, radiation was associated with reductions in the 10-year risk of biochemical treatment failure (72{\%} to 42{\%}), local failures (20{\%} to 7{\%}), and distant failures (12{\%} to 4{\%}). For patients with a postsurgical PSA between higher than 0.2 and ≤ 1.0 ng/mL, reductions in the 10-year risk of biochemical failure (80{\%} to 73{\%}), local failures (25{\%} to 9{\%}), and distant failures (16{\%} to 12{\%}) were realized. In patients with postsurgical PSA higher than 1.0, the respective findings were 94{\%} versus 100{\%}, 28{\%} versus 9{\%}, and 44{\%} versus 18{\%}. Conclusion: The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.",
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AU - Chin, Joseph

AU - Messing, Edward

AU - Canby-Hagino, Edith

AU - Forman, Jeffrey D.

AU - Thompson, Ian M.

AU - Crawford, E. David

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N2 - Purpose: Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research. Patients and Methods: Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation. Results: Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data. Median follow-up was 10.2 years. For patients with a postsurgical PSA of ≤ 0.2 ng/mL, radiation was associated with reductions in the 10-year risk of biochemical treatment failure (72% to 42%), local failures (20% to 7%), and distant failures (12% to 4%). For patients with a postsurgical PSA between higher than 0.2 and ≤ 1.0 ng/mL, reductions in the 10-year risk of biochemical failure (80% to 73%), local failures (25% to 9%), and distant failures (16% to 12%) were realized. In patients with postsurgical PSA higher than 1.0, the respective findings were 94% versus 100%, 28% versus 9%, and 44% versus 18%. Conclusion: The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.

AB - Purpose: Southwest Oncology Group (SWOG) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone. In this analysis, we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure, local recurrence, and distant failure, to serve as guidelines for future research. Patients and Methods: Four hundred thirty-one subjects with pathologically advanced prostate cancer (extraprostatic extension, positive surgical margins, or seminal vesicle invasion) were randomly assigned to adjuvant radiotherapy or observation. Results: Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data. Median follow-up was 10.2 years. For patients with a postsurgical PSA of ≤ 0.2 ng/mL, radiation was associated with reductions in the 10-year risk of biochemical treatment failure (72% to 42%), local failures (20% to 7%), and distant failures (12% to 4%). For patients with a postsurgical PSA between higher than 0.2 and ≤ 1.0 ng/mL, reductions in the 10-year risk of biochemical failure (80% to 73%), local failures (25% to 9%), and distant failures (16% to 12%) were realized. In patients with postsurgical PSA higher than 1.0, the respective findings were 94% versus 100%, 28% versus 9%, and 44% versus 18%. Conclusion: The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.

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