Failed treatment in high-risk prostate cancer patients is often local

Treatment failure in patients at high risk for prostate cancer is primarily local, with a markedly low metastatic failure incidence, researchers from the Southwest Oncology Group recently reported. Further, at all postsurgical PSA levels, additional radiation to the prostate bed lowers metastatic disease risk and biochemical failure.

A total of 431 patients with pathologically advanced prostate cancer after prostatectomy were randomized to additional radiotherapy or observation and were followed for a median of 10.2 years.

Of 374 men with a post-surgical PSA <0.2 ng/mL, treatment with radiation versus active surveillance was associated with lowered 10-year risk of biochemical treatment failure (72% to 42%), local failures (20% to 7%), and distant failures (12% to 4%). Among men whose postsurgical PSA was >0.2 but <1.0 ng/mL, 10-year risk of biochemical failure (80% to 73%), local failures (25% to 9%), and distant failures (16% to 12%) were reduced. Respective findings for patients with postsurgical PSA >1.0 ng/mL were 94% to100%, 28% to 9%, and 44% to 18%.

Study results were published in the Journal of Clinical Oncology (2007; 25:2225-9).