Prostate Flashcards
What are the three main observation trials in prostate cancer?
- Swedish Trial (Bill-Axelson)
- PIVOT
- Klotz
PIVOT trial: P/D/R
P: 45% low, 35% intermediate, 20% high risk
D: prostatectomy vs. observation
R: marginal / nonsignificant benefit in OS with prostatectomy
Klotz: P/D/R
P: mostly low risk, some intermediate risk if >70yrs
D: single arm PSA every 6mo, biopsy every 3-4 years, definitive treatment for progression of disease
R: no difference in overall survival
MDACC dose escalation: P/D/R
P: T1-T3
D: 70Gy vs. 78Gy
R: PFS improved in all groups, most significant in high risk group, worse GI toxicity, nonsignificant trend for worse GU toxicity
Fox Chase / Gerry Hanks dose escalation: P/D/R
P: nonmetastatic / clinically localized
D: stepwise dose escalation, 68-79Gy
R: BPFS with dose escalation, increased grade 2 GI with higher dose
What three trials examined the utility of long term ADT?
- EORTC 22863 (Bolla)
- RTOG 8531 (Lawton)
- RTOG 9202 (Hanks)
EORTC 22863 (Bolla) long term ADT: P/D/R
P: GS 7+, T3-4
D: RT +/- 36mo adjuvant ADT (goserelin/cyproterone)
R: OS improved with ADT (58% vs 40%)
RTOG 9202 long term ADT: P/D/R
P: T2c-T4
D: neoadjuvant and concurrent ADT with RT +/- 28mo adjuvant ADT (goserelin)
R: long term ADT improved PFS and BPFS but no improvement in OS
RTOG 8531 long term ADT: P/D/R
P: cT3, pT3 or N+ (some post RP)
D: RT +/- indefinite ADT (goserelin)
R: OS improved with ADT (49% vs 39%)
What two trials examined the utility of short term ADT?
- RTOG 8610
2. D’Amico hormone trial
RTOG 8610 short term ADT: P/D/R
P: bulky T2-T4, mostly intermediate risk, some high risk
D: RT +/- 4mo ADT (2mo neoadjuvant, 2mo concurrent)
R: improved DM and PFS with ADT, no OS benefit
D’Amico hormone trial short term ADT: P/D/R
P: intermediate risk with some low risk
D: RT +/- 6mo ADT
R: OS improved with ADT (74% vs 61% at 8yrs)
RTOG 9413 whole pelvis and hormones: P/D/R
P: PSA < 100, risk of LN+ > 15% (Roach formula)
D: 4 arm +/- whole pelvis, neoadj/conc ADT (4mo) vs. adj ADT (4mo)
R: PFS and OS improved in whole pelvis + neoadj/conc ADT but this was unplanned analysis with statistical flaws
What three trials examined the utility of adjuvant RT?
- ARO 96-02
- EORTC 22911
- SWOG 8794
ARO 96-02 adjuvant RT: P/D/R
P: postop, pT3N0, undetectable PSA
D: adjuvant RT 60Gy vs. observation
R: improved BPFS with RT (56% vs 35% at 10yrs), no OS improvement
EORTC 22911 adjuvant RT: P/D/R
P: postop, pT3N0 or positive margin
D: adjuvant RT 60Gy vs. observation (70Gy if failed obs)
R: BPFS improved with adjuvant RT, 56% of obs group got salvage RT
SWOG 8794 adjuvant RT: P/D/R
P: postop, pT3N0 or positive margin
D: adjuvant RT 60-64Gy vs. observation
R: OS benefit with RT (47% vs. 37% at 15yrs), 30% of obs group got salvage RT
What RTOG trial examined ADT in the setting of salvage RT?
RTOG 9601, final results pending, BPFS appears to be improved with ADT
What two trials examined the utility of RT in N+ disease?
- RTOG 8531 (N+ subset)
- Messing study
both showed OS benefit with ADT + RT
MDACC/Zagars N+ study: P/D/R
P: postop, N+
D: ADT +/- RT 70Gy
R: OS improved with RT (67% vs. 46% at 10yrs)
Swedish trial (Bill-Axelson): P/D/R
P: T1/T2, age less than 75
D: prostatectomy vs. observation
R: OS benefit with RP if younger than 65, unclear benefit if older
