Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer

Chad G. Rusthoven, Bernard L. Jones, Thomas W. Flaig, E. David Crawford, Matthew Koshy, David J. Sher, Usama Mahmood, Ronald C. Chen, Brian F. Chapin, Brian D. Kavanagh, Thomas J. Pugh

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Purpose: There is growing interest in the role of local therapies, including external beamradiotherapy (RT), formen with metastatic prostate cancer (mPCa).We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT. Methods: The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results: From 2004 to 2012, 6,382menwithmPCawere identified, including 538 (8.4%) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio, 0.624; 95% CI, 0.551 to 0.706; P<.001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superiormedian (55 v 37months) and 5-year OS (49% v 33%) with prostate RT plus ADT compared with ADT alone (P,.001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P<.05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone. Conclusion: In this large contemporary analysis, menwithmPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.

Original languageEnglish (US)
Pages (from-to)2835-2842
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number24
DOIs
StatePublished - Aug 20 2016

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Androgens
Prostate
Prostatic Neoplasms
Radiation
Survival
Therapeutics
Propensity Score
Neoplasm Grading
Prostate-Specific Antigen
Comorbidity
Databases
Insurance Coverage
Survival Analysis
Prostatectomy
Proportional Hazards Models
Survivors
Neoplasms
Multivariate Analysis
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer. / Rusthoven, Chad G.; Jones, Bernard L.; Flaig, Thomas W.; Crawford, E. David; Koshy, Matthew; Sher, David J.; Mahmood, Usama; Chen, Ronald C.; Chapin, Brian F.; Kavanagh, Brian D.; Pugh, Thomas J.

In: Journal of Clinical Oncology, Vol. 34, No. 24, 20.08.2016, p. 2835-2842.

Research output: Contribution to journalArticle

Rusthoven, CG, Jones, BL, Flaig, TW, Crawford, ED, Koshy, M, Sher, DJ, Mahmood, U, Chen, RC, Chapin, BF, Kavanagh, BD & Pugh, TJ 2016, 'Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer', Journal of Clinical Oncology, vol. 34, no. 24, pp. 2835-2842. https://doi.org/10.1200/JCO.2016.67.4788
Rusthoven, Chad G. ; Jones, Bernard L. ; Flaig, Thomas W. ; Crawford, E. David ; Koshy, Matthew ; Sher, David J. ; Mahmood, Usama ; Chen, Ronald C. ; Chapin, Brian F. ; Kavanagh, Brian D. ; Pugh, Thomas J. / Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 24. pp. 2835-2842.
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title = "Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer",
abstract = "Purpose: There is growing interest in the role of local therapies, including external beamradiotherapy (RT), formen with metastatic prostate cancer (mPCa).We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT. Methods: The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results: From 2004 to 2012, 6,382menwithmPCawere identified, including 538 (8.4{\%}) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio, 0.624; 95{\%} CI, 0.551 to 0.706; P<.001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superiormedian (55 v 37months) and 5-year OS (49{\%} v 33{\%}) with prostate RT plus ADT compared with ADT alone (P,.001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P<.05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone. Conclusion: In this large contemporary analysis, menwithmPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.",
author = "Rusthoven, {Chad G.} and Jones, {Bernard L.} and Flaig, {Thomas W.} and Crawford, {E. David} and Matthew Koshy and Sher, {David J.} and Usama Mahmood and Chen, {Ronald C.} and Chapin, {Brian F.} and Kavanagh, {Brian D.} and Pugh, {Thomas J.}",
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T1 - Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer

AU - Rusthoven, Chad G.

AU - Jones, Bernard L.

AU - Flaig, Thomas W.

AU - Crawford, E. David

AU - Koshy, Matthew

AU - Sher, David J.

AU - Mahmood, Usama

AU - Chen, Ronald C.

AU - Chapin, Brian F.

AU - Kavanagh, Brian D.

AU - Pugh, Thomas J.

PY - 2016/8/20

Y1 - 2016/8/20

N2 - Purpose: There is growing interest in the role of local therapies, including external beamradiotherapy (RT), formen with metastatic prostate cancer (mPCa).We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT. Methods: The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results: From 2004 to 2012, 6,382menwithmPCawere identified, including 538 (8.4%) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio, 0.624; 95% CI, 0.551 to 0.706; P<.001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superiormedian (55 v 37months) and 5-year OS (49% v 33%) with prostate RT plus ADT compared with ADT alone (P,.001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P<.05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone. Conclusion: In this large contemporary analysis, menwithmPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.

AB - Purpose: There is growing interest in the role of local therapies, including external beamradiotherapy (RT), formen with metastatic prostate cancer (mPCa).We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT. Methods: The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results: From 2004 to 2012, 6,382menwithmPCawere identified, including 538 (8.4%) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio, 0.624; 95% CI, 0.551 to 0.706; P<.001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superiormedian (55 v 37months) and 5-year OS (49% v 33%) with prostate RT plus ADT compared with ADT alone (P,.001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P<.05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone. Conclusion: In this large contemporary analysis, menwithmPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted.

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