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)
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.
Cancer, 2011
BACKGROUND-We compared the long-term survival of patients with high-risk prostate cancer following radical prostatectomy (RRP) and external beam radiation therapy (EBRT) with and without adjuvant androgen deprivation treatment (ADT). METHODS-We identified 1,238 patients who underwent RRP and 609 patients treated with EBRT (344 with EBRT + ADT and 265 with EBRT alone) between 1988-2004 who had a pretreatment prostate-specific antigen level (PSA) ≥ 20 ng/mL, biopsy Gleason score 8-10, or clinical stage ≥ T3. Median follow-up was 10.2, 6.0, and 7.2 years after RRP, EBRT + ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancerspecific, and overall survival was evaluated using multivariable Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS-Ten-year cancer-specific survival was 92%, 92%, and 88% following RRP, EBRT + ADT, and EBRT alone (p=0.06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio, 0.78; 95% CI, 0.51 to 1.18; p=0.23) or prostate cancer death (hazard ratio 1.14; 95% CI, 0.68 to 1.91; p=0.61) were seen between patients treated with EBRT + ADT and patients who underwent RRP. The risk of all-cause mortality was, however, greater after EBRT + ADT than RRP (hazard ratio, 1.60; 95% CI, 1.25 to 2.05; p=0.0002). CONCLUSIONS-RRP and EBRT + ADT provide similar long-term cancer control for patients with high-risk disease. Continued investigation into the differing impact of treatments on qualityof-life and non-cancer mortality are necessary to determine the optimal management approach for these patients.
Cancer, 2007
BACKGROUND. The American Joint Committee on Cancer (AJCC) staging system for prostate cancer is based primarily based on clinical tumor (T) classification. In this article, the authors summarize arguments for incorporating additional pretreatment parameters and creating a new staging system for prostate cancer. METHODS. Men with localized prostate cancer who received treatment with external beam radiation alone were analyzed using the 1997 AJCC staging system compared with a system that included pretreatment prostate-specific antigen (pPSA) level and Gleason score (GS). Multivariate analyses using a Cox proportional-hazards model were carried out to evaluate T classification, GS, and pPSA as predictors of overall survival (OS), disease-specific survival (DSS), and freedom from PSA failure (FFPF). RESULTS. Based on pretreatment characteristics in a series of contemporary patients, only 0.6% of patients were classified with AJCC stage I disease, 16.0% were classified with AJCC stage III disease, and 83.4% were classified with AJCC stage II disease. Multivariate analyses indicated the independent statistical significance of T classification, GS, and pPSA in predicting OS, DSS, and FFPF (model chi-square value, P < .0001 for each). Using these 3 predictors, subsets of patients who had similar outcomes were combined to provide examples of the insensitivity of the AJCC system for predicting outcomes. Incorporating pPSA and GS allowed the identification of differences in OS, DSS, and FFPF for subsets of patients with AJCC stage II disease (P < .0001, P ¼ .005, and P < .0001, respectively). CONCLUSIONS. The current AJCC staging system does not divide contemporary patients with prostate cancer into prognostic subgroups and does not identify patients who have comparable biochemical control and survival. The AJCC staging system for prostate cancer should be changed to incorporate pPSA, GS, and
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.
Clinical Genitourinary Cancer, 2015
Stage IV prostate cancer is a heterogeneous group. Considering the favorable outcomes of T4 or N1 nonmetastatic prostate cancer relative to those with M1 disease in this analysis of data from the Surveillance, Epidemiology, and End Results database, the authors propose that T4 or N1 M0 prostate cancer should be reclassified into a new stage IIIB and that patients with such disease should be offered curative-intent therapy whenever possible. Background: Prostate cancer is the most common noncutaneous malignancy diagnosed in men. From a large population-based database, this study aimed to report prostate cancerespecific mortality (PCSM) rates of men diagnosed with various presentations of prostate cancer and to examine the adequacy of the current American Joint Committee on Cancer (AJCC) staging system. Patients and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients diagnosed with prostate cancer from 1997 to 2005. PCSM was reported by the classification of extent of disease provided by the SEER database, for clinically staged and pathologically staged cohorts. Results: Using the cumulative incidence method, PCSM at 10 years for all patients (n ¼ 354,326) was 5% for clinically localized (CL) lesions, 7% for T3aN0M0, 14% for T3bN0M0, 26% for T4N0M0, 27% for T any N1M0, and 66% for T any N any M1. Within the pathologically staged subgroup (n ¼ 108,135), PCSM at 10 years was 1% for CL lesions, 4% for T3aN0M0, 9% for T3bN0M0, 9% for T4N0M0, and 19% for T any N1M0. Conclusion: Staging of any disease site aims to accurately communicate, prognosticate, and guide management for that particular level of disease. Stage IV prostate cancer is a diverse group, with PCSM in the subgroups ranging from 9% to 68% in this study. Considering the favorable outcomes of those with T4 or N1 nonmetastatic prostate cancer relative to those with M1 disease, the authors propose that T4 or N1 M0 prostate cancer should be reclassified into a new stage IIIB and that patients with such disease should be offered curative-intent therapy whenever possible.
685 Outcomes of Radiotherapy Among Men with Low-Risk Localized Prostate Cancer
The Journal of Urology, 2012
progression, the treatment effect persists, suggesting APC8015F may have extended survival of control subjects. Using the RPSFT model, and assuming APC8015F was equally as effective as sipuleucel-T, the estimate of median OS for control would be 18.0 months, representing a 7.8 month improvement in median OS in favor of sipuleucel-T (HRϭ0.60, 95% CI: 0.41, 0.96). Results from the RPSFT model that assumed a lesser treatment effect of APC8015F will be presented. CONCLUSIONS: Post-progression treatment with APC8015F may have extended the survival of control subjects in the IMPACT study. Adjusting for use of APC8015F resulted in an increase in median OS benefit with sipuleucel-T of up to 7.8 months. These results suggest a greater treatment effect of sipuleucel-T than reported in IMPACT, and should be factored into future studies without APC8015F crossover.