External beam radiation for the treatment of castration‑resistant prostate cancer following primary hormonal therapy with androgen ablation: Analysis and outcome of 21 patients

Kuusk,Teele; Pulliainen,Kristiina; Vaarala,Markku H.

doi:10.3892/mco.2017.1156

External beam radiation for the treatment of castration‑resistant prostate cancer following primary hormonal therapy with androgen ablation: Analysis and outcome of 21 patients

Authors:
- Teele Kuusk
- Kristiina Pulliainen
- Markku H. Vaarala
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Affiliations: Division of Operative Care and Medical Research Center Oulu, Oulu University Hospital, 90220 Oulu, Finland
Published online on: February 6, 2017 https://doi.org/10.3892/mco.2017.1156
Pages: 428-432

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Abstract

Patients who undergo early androgen‑deprivation therapy for prostate cancer may eventually develop castration-resistant prostate cancer. However, no optimal treatment for non‑metastasized castration-resistant prostate cancer has yet been established. In the present retrospective, single-institutional study, the radiotherapy (RT) outcomes were evaluated in patients who underwent androgen‑deprivation therapy for non‑metastatic prostate cancer and subsequently developed castration-resistant disease. Following a thorough chart review, the data of 21 patients with castration-resistant prostate cancer who were treated between 2000 and 2010 with external beam radiation therapy (EBRT) at a prostate radiation dose of >45 Gy were evaluated. Of the 21 patients, 16 (76%) developed biochemical recurrence after RT, with a mean time to biochemical recurrence of 17 months. A total of 18 patients succumbed to the disease during follow-up, with a mean survival of 3 years after RT. A radiation dose of >66 Gy was associated with a longer time to biochemical recurrence after RT (P=0.011) and a longer survival, compared with a dose of ≤66 Gy (P=0.028). The mean overall survival time after RT was 42 months and did not depend on the primary hormonal treatment. Prostate‑specific survival time was negatively associated with the Gleason score at diagnosis. The prostate‑specific antigen (PSA) concentration prior to RT was a prognostic factor for biochemical recurrence of prostate cancer after RT, as well as for prostate cancer-specific survival. Finally, the multivariate analysis revealed that age, PSA concentration prior to RT and a high Gleason score were independent prognostic factors for prostate cancer-specific survival. Overall, our study findings demonstrated that disease progression was common after EBRT for castration‑resistant prostate cancer and that survival was limited. However, young patients and those with low-risk disease at the time of diagnosis may benefit from RT.

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