Long-term overall survival after external beam radiotherapy for localized prostate cancer

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2023-12, Vol.35 (12), p.e689-e698
• Main Authors: Jahreiβ, Marie-Christina, Incrocci, Luca, Dirkx, Maarten, de Vries, Kim C., Aben, Katja K.H., Bangma, Chris, Heemsbergen, Wilma D.
• Format: Article
• Language: English
• Subjects: Androgen Antagonists - therapeutic use; External beam radiotherapy; Humans; Male; Neoplasm Grading; overall survival; prognostic factors; prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - therapy; Retrospective Studies; Risk Factors
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2023.09.017

Knowledge on survival probabilities is essential for determining optimal treatment strategies. We studied overall survival and associated prognostic factors in Dutch patients with localised prostate cancer (PCa) selected for external beam radiotherapy. For this single-centre retrospective cohort study, we identified all T1-T3 PCa patients (aged 55–80 years) in the radiotherapy planning database with a start date between January 2006 and December 2013, treated with 72–78 Gy in 2 Gy fractions to the prostate ± seminal vesicles (n = 1536). Long-term [AQ1]androgen deprivation therapy (ADT) was predominantly prescribed in the case of extracapsular disease (>T3). Overall survival was estimated using the Kaplan–Meier method. Prognostic factors were evaluated in Cox regression models for the intermediate-risk and high-risk groups. The median follow-up was 12 years for patients who were alive. Ten-year survival rates were 79.0% for low-risk (n = 120), 59.9% for intermediate-risk (n = 430) and 56.8% for high-risk patients (n = 986). A higher age, higher comorbidity score, active smoking and Gleason score ≥ 8 had a statistically significant negative impact on overall survival at multivariable analysis. ADT was associated with superior overall survival in the high-risk group translating into overall survival rates similar to the intermediate-risk group. Although PCa patients selected for external beam radiotherapy are typically in good health, their comorbidity score and smoking habits appeared to be dominant predictors for overall survival. Overall survival rates within the high-risk group varied, showing improved overall survival with ADT prescription and worse overall survival in the case of Gleason score ≥8. •Comorbidity score and smoking status are important predictors for overall survival.•Overall survival for T3 patients with adjuvant hormonal therapy was high.•Only the tumour characteristic Gleason score ≥ 8 was prognostic within risk groups.•10-year survival rates within high-risk subgroups varied between 30 and 80%.