Table 4.
High Risk Disease (HR)
| HR | Type of the study |
Year of the study |
Number of patients |
Median FU |
Treatment | % ADT |
Median ADT duration |
Overall bPFS |
ADT benefit on bPFS |
Overall CSS | ADT benefit on CSS |
Overall OS |
ADT benefit on OS |
Comments and factors predictive of outcome bPFS, CSS and OS |
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LDR | |||||||||||||||
| Ohashi (89) | Japan | 2003-2009 | 206 | 5y | 1 HRf 90% 2 HRf 9% 3 HRf 0.5% |
LDR+EBRT±ADT | 4[0-9]% | 4mo | 84.4% | No benefit | 98% | NR | 97% | NR | bPFS (PPC and risk features) |
| Bittner (56) | Multiinstitutional US (very high risk) | 1995-2007 | 131 | 6.6y | GS 8/9:80% PSA>20:29% | LDR+EBRT±ADT | 9[0-9]% | 19mo (4–36) | 87% | Benefit to longer ADT (13%) | 91% | Benefit with longer ADT | 70% | No benefit | bPFS (longer ADT. PPC) CSS (longer ADT, PPC) OS (age, PPC) |
| Bittner (90) | Multiinstitutional US | 1995-2005 | 186 | 6.7y | GS8-10:76% Med iPSA:11 | LDR+EBRT (mini vs whole pelvis) ±ADT | 7[0-9]% | >6mo (75%) | 92/84% WP vs Mini P | ADT benefit | 95%/92% WPRT vs MPRT | No benefit | 79/67% WPRT vs MPRT | No benefit | bPFS (ADT) OS (age, PPC, WPRT in ADT naïve pts) |
| Wattson (91) | Multiinstitutional, US | 1991+2007 | 2234 | 4.3y | 1HRf: 83% 2HRf: 14% 3HRf:2% |
LDR±EBRT,±ADT | 7[0-9]% | 4mo | NR | NR | NR | ADT benefit | NR | NR | CSS(ADT, number of high risk factors, triple therapy vs. LDR or LDR+EBRT) |
| D'Amico (92) | Multiinstitutional US | 1991-2005 | 1342 | 5.1y | 1HRf: 5% 2HRf: 86% 3HRf:8% |
LDR±ADT or EBRT+LDR or EBRT+LDR+ADT | 6[0-9]% | 4mo (IQR 3.4-6.2mo) | NR | NR | 84% | Benefit to ADT+EBRT vs LDR alone | NR | NR | CSS (trend for better tri vs. bimodality AHR 0.32 CI 0.14-0.73) |
| Merrick (93) | Multiinstitutional US | 1995-2002 | 204 | 7y | Med iPSA 9.9 Med GS8 | EBRT+LDR±ADT | 4[0-9]% | 4 and 12mo (3–36) | 89% | ADT benefit (6-16%) | 86% | No benefit | 68% | No benefit | bPFS (PPC, ADT and ADT duration) CSS (GS) OS (GS, diabetes) |
| Shilkurt (94) | Multiinstitutional US | 1995-2010 | 448 | 5.2y | 1HRf: 84% 2HRf: 14% 3HRf: 2% |
LDR+EBRT±ADT | 7[0-9]% | 12mo (8–24) | 86% | ADT benefit (HR 0.2) | 93% | No benefit | NR | NR | From the analysis of 958 pts who received EBRT ±ADT or LDR+EBRT±ADT |
| Merrick (55) | Multiinstitutional US | 1995-2005 | 284 | 7.8y | NR | LDR+EBRT±ADT | 6[0-9]% | 4-12 mo (range 3-36) | 89% | ADT benefit if PSA>2 0 (10%) | 94% | No benefit | 69% | No benefit | bPFS(PPC, ADT) CSS(nil) OS(age, diabetes, PPC) |
| Liss (95) | Multiinstitutional US | 1998-2008 | 141 | 4.7 | GS8-10:75% Med iPSA:20 T2b-T4:40% | LDR+EBRT±ADT | 8[0-9]% | 12 mo | 80% | Benefit to ADT>1 2 mo | 94 | No benefit | 88% (with GS5) | No benefit | bPFS (iPSA, ADT, CSS(nil) MFS(iPSA, GS5, ADT OS (iPSA, GS5) |
| Fang (96) | Multiinstitution al US | 1995-2005 | 174 | 6.6y | GS 8-10 PSA<15 | LDR+EBRT±ADT | 6[0-9]% | 12mo(3–36) | 92/95% with/without ADT | No benefit | 92/95-% with/without ADT | No benefit | 66/75% with/without ADT | No benefit Detriment to OS (p=ns) | bPFS(age) CSS(iPSA, Hypertension) OS CS, Prostate Vol) NS detriment to OS with ADT |
| HDR | |||||||||||||||
| Prada (97) | Oviedo, Spain | 1998-2006 | 252 | 6.1y | 2 IRf17% 1 HRf 40% 2 HRf 35% 3 HRf8% |
HDR+EBRT±ADT | 69% | 12mo | 84%/78% 5 and 10y | No benefit | NR | NR | NR | NR | bPFS (GS, benefit to ADT 6% p=ns) |