Patterns of Clinical Progression in Radiorecurrent High-risk Prostate Cancer
Rebecca G Philipson 1 , Tahmineh Romero 2 , Jessica K Wong 3 , Bradley J Stish 4 , Robert T Dess 5 , Daniel E Spratt 5 , Avinash Pilar 6 , Chandana Reddy 7 , Trude B Wedde 8 , Wolfgang A Lilleby 8 , Ryan Fiano 9 , Gregory S Merrick 9 , Richard G Stock 10 , D Jeffrey Demanes 11 , Brian J Moran 12 , Michelle Braccioforte 12 , Phuoc T Tran 13 , Santiago Martin 14 , Rafael Martinez-Monge 14 , Daniel J Krauss 15 , Eyad I Abu-Isa 5 , Luca Valle 1 , Natalie Chong 1 , Thomas M Pisansky 4 , C Richard Choo 4 , Daniel Y Song 13 , Stephen Greco 13 , Curtiland Deville 13 , Todd McNutt 13 , Theodore L DeWeese 13 , Ashley E Ross 16 , Jay P Ciezki 7 , Derya Tilki 17 , R Jeffrey Karnes 18 , Eric A Klein 19 , Jeffrey J Tosoian 20 , Paul C Boutros 21 , Nicholas G Nickols 22 , Prashant Bhat 23 , David Shabsovich 23 , Jesus E Juarez 23 , Patrick A Kupelian 1 , Matthew B Rettig 24 , Alejandro Berlin 25 , Jonathan D Tward 26 , Brian J Davis 4 , Robert E Reiter 21 , Michael L Steinberg 1 , David Elashoff 2 , Eric M Horwitz 3 , Rahul D Tendulkar 7 , Amar U Kishan 27
The natural history of radiorecurrent high-risk prostate cancer (HRPCa) is not well-described.
To better understand its clinical course, we evaluated rates of distant metastases (DM) and prostate cancer-specific mortality (PCSM) in a cohort of 978 men with radiorecurrent HRPCa who previously received either external beam radiation therapy (EBRT, n = 654, 67%) or EBRT + brachytherapy (EBRT + BT, n = 324, 33%) across 15 institutions from 1997 to 2015. In men who did not die, median follow-up after treatment was 8.9 yr and median follow-up after biochemical recurrence (BCR) was 3.7 yr. Local and systemic therapy salvage, respectively, were delivered to 21 and 390 men after EBRT, and eight and 103 men after EBRT + BT.
Overall, 435 men developed DM, and 248 were detected within 1 yr of BCR. Measured from time of recurrence, 5-yr DM rates were 50% and 34% after EBRT and EBRT + BT, respectively. Measured from BCR, 5-yr PCSM rates were 27% and 29%, respectively. Interval to BCR was independently associated with DM (p < 0.001) and PCSM (p < 0.001).
These data suggest that radiorecurrent HRPCa has an aggressive natural history and that DM is clinically evident early after BCR. These findings underscore the importance of further investigations into upfront risk assessment and prompt systemic evaluation upon recurrence in HRPCa.
PATIENT SUMMARY: High-risk prostate cancer that recurs after radiation therapy is an aggressive disease entity and spreads to other parts of the body (metastases). Some 60% of metastases occur within 1 yr. Approximately 30% of these patients die from their prostate cancer.
CITATION Eur Urol. 2021 Aug;80(2):142-146. doi: 10.1016/j.eururo.2021.04.035. Epub 2021 May 10