Prostate

Question 1

What are the three main observation trials in prostate cancer?

Answer 1

1. Swedish Trial (Bill-Axelson)
2. PIVOT
3. Klotz

Question 2

PIVOT trial: P/D/R

Answer 2

P: 45% low, 35% intermediate, 20% high risk
D: prostatectomy vs. observation
R: marginal / nonsignificant benefit in OS with prostatectomy

Question 3

Klotz: P/D/R

Answer 3

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

Question 4

MDACC dose escalation: P/D/R

Answer 4

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

Question 5

Fox Chase / Gerry Hanks dose escalation: P/D/R

Answer 5

P: nonmetastatic / clinically localized
D: stepwise dose escalation, 68-79Gy
R: BPFS with dose escalation, increased grade 2 GI with higher dose

Question 6

What three trials examined the utility of long term ADT?

Answer 6

1. EORTC 22863 (Bolla)
2. RTOG 8531 (Lawton)
3. RTOG 9202 (Hanks)

Question 7

EORTC 22863 (Bolla) long term ADT: P/D/R

Answer 7

P: GS 7+, T3-4
D: RT +/- 36mo adjuvant ADT (goserelin/cyproterone)
R: OS improved with ADT (58% vs 40%)

Question 8

RTOG 9202 long term ADT: P/D/R

Answer 8

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

Question 9

RTOG 8531 long term ADT: P/D/R

Answer 9

P: cT3, pT3 or N+ (some post RP)
D: RT +/- indefinite ADT (goserelin)
R: OS improved with ADT (49% vs 39%)

Question 10

What two trials examined the utility of short term ADT?

Answer 10

1. RTOG 8610

2. D’Amico hormone trial

Question 11

RTOG 8610 short term ADT: P/D/R

Answer 11

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

Question 12

D’Amico hormone trial short term ADT: P/D/R

Answer 12

P: intermediate risk with some low risk
D: RT +/- 6mo ADT
R: OS improved with ADT (74% vs 61% at 8yrs)

Question 13

RTOG 9413 whole pelvis and hormones: P/D/R

Answer 13

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

Question 14

What three trials examined the utility of adjuvant RT?

Answer 14

1. ARO 96-02
2. EORTC 22911
3. SWOG 8794

Question 15

ARO 96-02 adjuvant RT: P/D/R

Answer 15

P: postop, pT3N0, undetectable PSA
D: adjuvant RT 60Gy vs. observation
R: improved BPFS with RT (56% vs 35% at 10yrs), no OS improvement

Question 16

EORTC 22911 adjuvant RT: P/D/R

Answer 16

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

Question 17

SWOG 8794 adjuvant RT: P/D/R

Answer 17

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

Question 18

What RTOG trial examined ADT in the setting of salvage RT?

Answer 18

RTOG 9601, final results pending, BPFS appears to be improved with ADT

Question 19

What two trials examined the utility of RT in N+ disease?

Answer 19

1. RTOG 8531 (N+ subset)
2. Messing study
   both showed OS benefit with ADT + RT

Question 20

MDACC/Zagars N+ study: P/D/R

Answer 20

P: postop, N+
D: ADT +/- RT 70Gy
R: OS improved with RT (67% vs. 46% at 10yrs)

Question 21

Swedish trial (Bill-Axelson): P/D/R

Answer 21

P: T1/T2, age less than 75
D: prostatectomy vs. observation
R: OS benefit with RP if younger than 65, unclear benefit if older