High Risk Prostate Cancer

Hypofractionated

• radiation therapy at 2.7 Gy per fraction was well tolerated acutely. Reference: Pollack, et al. International Journal of Radiation Oncology, Biology, Physics. 2006 (Feb 1);64(2):518-26

Androgen Ablation

== Anti-androgen Trials ==

• Androgen Ablation (AA) is indicated for following situations
• 3 years of AA for "high-risk":(ie. T3/T4 or Gleason 8-10) based on Bolla trial
• Alternatively 2 years and 4 months of AA for Gleason 8-10 based on RTOG 9202.
• Life time AA for Pelvic or para-aortic LN(+) based on RTOG 85-31
• 6 mont AA for Intermediate risk based on D-Amico (Mass Gen)

STUDY	CONTROL	RX	TYPE OF BENEFIT	GROUPS BENEFITED
RTOG 8610	None	4 mo.	Local Control	bulky G: 2-6
RTOG 8531	None	Life	Survival	regional LN(+)
RTOG 9202	4 mo.	2 yrs & 4 mo.	DFS	G: 8-10
EORTC (Bolla)	None	3 yrs.	Survival	All high-risk
D-Amico	None	6 mo.	OS-5	Intermediate

RTOG 75-06

• Para-aortic and pelvic radiation shows no survival advantage over pelvic radiation for Stage C or Stage A and B with positive nodes.

Bibliography

1. Gunderson L, Tepper J: Clinical Radiation Oncology. 2nd ed. China: Elsevier 2007.

2. Teh BS, Mai WY, Augspurger ME, Uhl BM, McGary J, Dong L, Grant WH 3rd, Lu HH, Woo SY, Carpenter LS, Chiu JK, Butler EB. Intensity modulated radiation therapy (IMRT) following prostatectomy: more favorable acute genitourinary toxicity profile compared to primary IMRT for prostate cancer. Int J Radiat Oncol Biol Phys. 2001 Feb 1;49(2):465-72. Erratum in: Int J Radiat Oncol Biol Phys 2001 Apr 1;49(5):1529. PMID: 11173142

3. Pound, Charles R. MD; Partin, Alan W. MD, PhD; Eisenberger, Mario A. MD; Chan, Daniel W. PhD; Pearson, Jay D. PhD; Walsh, Patrick C. MD Natural History of Progression After PSA Elevation Following Radical Prostatectomy. JAMA. 281(17):1591-1597, May 5, 1999.

4. Michel Bolla, Hein van Poppel, Laurence Collette, Paul van Cangh, Kris Vekemans, Luigi Da Pozzo, Theo M de Reijke, Antony Verbaeys, Jean-François Bosset, Roland van Velthoven, Jean-Marie Maréchal, Pierre Scalliet, Karin Haustermans, Marianne Piérart. Postoperative radiotherapy after radical Prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005; 366: 572–78.

5. Spiotto MT, Hancock SL, King CR. Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys 2007; 69(1):54-61.