Local control changes patterns of failure in prostate cancer patients

A trimodality treatment regimen results in excellent local control that alters patterns of failure in patients with high-risk prostate cancer, according to a study published in the International Journal of Radiation Oncology, Biology & Physics (2006; 66:389-94). Most failures appear to be distant and exhibit biologically aggressive behavior, according to the authors, from Mount Sinai School of Medicine, New York.

In the study, 360 patients with high-risk prostate cancer were treated with hormonal, radioactive seed, and external beam radiation therapy. Patients were followed for a median of 4.25 years. The actuarial 7-year freedom from PSA failure and freedom from distant metastases rates were 83% and 89%, respectively. Patients developing PSA failure exhibited aggressive disease behavior with short PSA doubling times and a 7-year freedom from distant metastases rate of 48%.

Local control was high, the authors said. The last post-treatment biopsy results were negative in 97% of cases (68 of 70). In multivariate analysis, only PSA >20.0 ng/mL predicted biochemical failure (p=.04), and only seminal vesicle status predicted developing distant failure (p=.01).