Assessment of the American Joint Committee on Cancer Staging (sixth and seventh editions) for clinically localized prostate cancer treated with external beam radiotherapy and comparison with the National Comprehensive Cancer Network risk-stratification me (original) (raw)
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Inadequacies of the current American Joint Committee on cancer staging system for prostate cancer
Cancer, 2006
BACKGROUND. Two major objectives of the American Joint Committee on Cancer (AJCC) staging system are to ensure appropriate treatments for patients and to determine prognosis. AJCC stage for distant prostate cancer includes patients with regional lymph node involvement. In the current study, the authors assessed whether patients with lymph node involvement and patients with distant metastasis, as determined using the Surveillance, Epidemiology, and End Results (SEER) staging system, had similar treatment and survival duration and, thus, were grouped together appropriately in the AJCC system.
Predictive models in external beam radiotherapy for clinically localized prostate cancer
Cancer, 2009
Predictive models are increasingly being used in effort to allow Physician and patient expectations to be aligned with outcomes that are based on available data. Most predictive models for men treated with external beam radiotherapy for clinically localized prostate cancer are based on Gleason Score, clinical T-Stage and prostate specific antigen (PSA) levels. More sophisticated models have also been developed that incorporate treatment related variables such as the dose of radiation and use of androgen deprivation therapy. Most of the predictive models applied to prostate cancer were derived using PSA recurrence rates as the major endpoint but increasingly clinical endpoints have been incorporated into predictive models. Biomarkers are also increasingly being added to predictive models in an effort to strengthen them. The Radiation Therapy Oncology Group (RTOG) have completed studies on a wide range of markers using tissue from two Phase III Trials (RTOG 8610 and 9202). To date preliminary assessments of p53, DNA Ploidy, p16/pRB, Ki-67, MDM2, Bcl-2/Bax, CAG repeats, Cox-2, Stat3, Cyp3A4 and PKA have been completed. Although not ready for wide spread routine use, there are reasons to believe that future models will combine these markers with traditional pretreatment and treatment related variables and improve our ability to predict outcome and select the optimal treatment.
Radiotherapy and Survival in Prostate Cancer Patients: A Population-Based Study
International Journal of Radiation Oncology*Biology*Physics, 2009
Purpose-To investigate the association of overall and disease specific survival with the 5 standard treatment modalities for prostate cancer (CaP): radical prostatectomy (RP), brachytherapy (BT), external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), and no treatment (NT) within 6 months after CaP diagnosis.
Clinical Genitourinary Cancer, 2018
The current prognosis group from American Joint Committee on Cancer (AJCC) guidelines shows some contradictory results. We suggest that pathologic Gleason score should be weighed more than prostatespecific antigen level in predicting patient prognosis. Our new stratification system showed better prognostic ability than the current system. Introduction: The American Joint Committee on Cancer (AJCC) tumor, node, metastasis classification system (TNM) staging manual has been updated and provides more specified stage grouping for prostate cancer (PCa). We aimed to validate the updated AJCC stage groups for PCa using a radical prostatectomy (RP) cohort. Patients and Methods: We analyzed the data of 3032 patients previously treated with RP for localized PCa. We stratified patients into stage groups according to the 8th edition of the AJCC manual and compared biochemical recurrence (BCR)-free survival using Kaplan-Meier analyses. Results: There were 217 patients in stage group I, 33 in IIA, 1101 in IIB, 535 in IIC, 129 in IIIA, 781 in IIIB, and 236 in IIIC. There were no significant differences in BCR-free survival between stage groups IIC and IIIA (P ¼ .875). Subsequently, the loweGleason score (GS) IIIA subgroup (GS 3 þ 4, P ¼ .025) showed superior BCR-free survival than the IIC group, and the high-GS IIIA subgroups (GS 4 þ 3, P ¼ .004) showed a poorer BCRfree survival than the IIC group. Furthermore, there were no significant differences between groups I and IIA (P ¼ 330) and between groups IIA and IIB (P ¼ .942). Our new staging system provided a better ability to discriminate the prognosis of each group. However, our study has several limitations, such as retrospective design, relatively short follow-up period, and need for further validation. Conclusion: The current AJCC prognostic groups show some contradictory results, particularly concerning prognosis of the IIC and IIIA groups. We suggest that GS be given more weight than serum prostate-specific antigen level in stage group stratification.
Radiation Oncology
Background: The aim of this study is to investigate the effect of tumor characteristics and parameters of treatment response in predicting biochemical disease-free survival (BFS) for patients with intermediate or high risk prostate cancer treated by combined definitive external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). Methods: Between June 1995 and January 2015, 375 patients with localized prostate cancer and a National Comprehensive Cancer Network (NCCN) intermediate or high risk categories were treated by definitive EBRT and ADT. Median duration of androgen blockade was 10 months (range: 3-36 months); Median radiation dose was 72 Gy (Range: 70-78 Gy). Median follow-up time was 5.8 years (range: 0.8-16.39 years). The main study endpoint was biochemical disease free survival (BFS). Results: Forty seven patients (12.5%) developed biochemical recurrence (BCR) during the observation period. Monovariate analysis identified baseline PSA (bPSA) (p = 0.024), T-stage (p = 0.001), Gleason's score (GS) (p = 0.042), radiation dose (p = 0.045), PSA pre-radiation therapy (p = 0.048), and nadir PSA (nPSA), (p < 0.001) as significant variables affecting BCR. The receiver operating characteristic (ROC) curve identified a nPSA of 0.06 ng/ml as optimal cutoff value significantly predicting the patients' risk of BCR (p < 0.001). Multivariate cox regression analysis revealed T-stage, GS, and nPSA as independent variable affecting BFS, while bPSA, age, and radiation dose were not. Conclusion: Nadir PSA at 0.06 is a strong independent predictor of BFS in patients with intermediate or high risk prostate cancer treated by definitive EBRT and ADT.
Therapeutic advances in urology, 2018
The objective in this paper was to validate the prognostic performance of the American Joint Committee on Cancer (AJCC) 7th and 8th systems among prostate cancer patients treated with radical prostatectomy. The surveillance, epidemiology and end results (SEER) database (2006-2014) was accessed through the SEER*Stat program and AJCC 7th and 8th editions were calculated utilizing T, N and M stages, histological grade group, as well as baseline prostatic-specific antigen (PSA). Cancer-specific and overall survival analyses according to 7th and 8th editions were conducted. Moreover, multivariate analysis was conducted through a Cox proportional hazard model. A total of 72,999 patients with prostate cancer were identified in the period from 2006 to 2014. Overall survival was assessed according to AJCC 7th and 8th staging systems. The test for trend for overall survival was significant (< 0.0001) for both staging systems. Concordance index for AJCC 7th system was: 0.791 [standard error...
BJU International, 2014
To test the hypothesis that observation with early salvage radiotherapy (SRT) is not inferior to 'standard' treatment with adjuvant RT (ART) with respect to biochemical failure in patients with pT3 disease and/or positive surgical margins (SMs) after radical prostatectomy (RP). To compare the following secondary endpoints between the two arms: patient-reported outcomes, adverse events, biochemical failure-free survival, overall survival, disease-specific survival, time to distant failure, time to local failure, cost utility analysis, quality adjusted life years and time to androgen deprivation. Patients and Methods The Radiotherapy-Adjuvant Versus Early Salvage (RAVES) trial is a phase III multicentre randomised controlled trial led by the Trans Tasman Radiation Oncology Group (TROG), in collaboration with the Urological Society of Australia and New Zealand (USANZ), and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP). In all, 470 patients are planned to be randomised 1:1 to either ART commenced at ≤4 months of RP (standard of care) or close observation with early SRT triggered by a PSA level of >0.20 ng/mL (experimental arm). Eligible patients have had a RP for adenocarcinoma of the prostate with at least one of the following risk factors: positive SMs ± extraprostatic extension ± seminal vesicle involvement. The postoperative PSA level must be ≤0.10 ng/mL. Rigorous investigator credentialing and a quality assurance programme are designed to promote consistent RT delivery among patients. Results Trial is currently underway, with 258 patients randomised as of 31 October 2013. International collaborations have developed, including a planned meta-analysis to be undertaken with the UK Medical Research Council/National Cancer Institute of Canada Clinical Trials Group RADICALS (Radiotherapy and Androgen Deprivation In Combination with Local Surgery) trial and an innovative psycho-oncology sub-study to investigate a patient decision aid resource. Conclusion On the current evidence available, it remains unclear if ART is equivalent or superior to observation with early SRT.