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Positive post-radiation biopsy may predict worse outcomes for early-stage prostate cancer
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A positive post-radiation therapy biopsy appeared associated with increased rates of distant metastases and inferior disease-specific survival among men with early-stage prostate cancer, according to the results of a prospective randomized trial.
Further, patients with high-grade tumors who had positive post-radiation therapy biopsies also had inferior OS.
Daniel J. Krauss
“While performing a post-radiation biopsy is not currently a standard practice, the fact that it was done as part of this clinical trial afforded the opportunity to more precisely quantify the importance of successful local therapy for this disease,” Daniel J. Krauss, MD, assistant professor of radiation oncology at Oakland University William Beaumont School of Medicine in Rochester, Michigan, said in a press release.
Krauss and colleagues sought to assess the association between positive post-radiation therapy biopsy results and subsequent clinical outcomes in men with localized prostate cancer.
The Radiation Therapy Oncology Group study 94-08 included men with stage Ib to stage IIb prostate cancer with PSA concentrations less than or equal to 20 ng/dL. Between 1994 and 2001, researchers randomly assigned 1,979 patients to receive radiation therapy alone or with 4 months of total androgen suppression (TAS).
Patients without evidence of clinical recurrence and who did not initiate additional endocrine therapy underwent repeat prostate biopsy 2 years after completing radiation therapy (TAS plus radiation, n = 433; radiation therapy alone, n = 398).
Patients with positive biopsy results had higher rates of biochemical failure (HR = 1.7; 95% CI, 1.3-2.1) and distant metastases (HR = 2.4; 95% CI, 1.3-4.4), as well as inferior disease-specific survival (HR = 3.8; 95% CI, 1.9-7.5). Positive biopsy results remained predictive after the researchers adjusted for potential confounding factors, including Gleason score, tumor stage and TAS administration.
Patients with positive biopsy results and high (≥ 7) Gleason scores experienced inferior OS outcomes than patients with negative biopsy results (HR = 1.56; 95% CI, 1.04-2.35).
“This study allowed us to look more closely at the long-term outcomes of patients in whom the localized cancer in the prostate was successfully eradicated and compare them to patients whose disease persisted within the prostate following treatment,” Krauss said. “Failure to control localized cancer, confined to the prostate, predicts a poor clinical outcome — PSA recurrence, the spread of cancer beyond the prostate and the likelihood of dying of prostate cancer.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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