ContextClinically localized prostate cancer is very prevalent among US men,
but recurrence after treatment with conventional radiation therapy is common.ObjectiveTo evaluate the hypothesis that increasing the radiation dose delivered
to men with clinically localized prostate cancer improves disease outcome.Design, Setting, and PatientsRandomized controlled trial of 393 patients with stage T1b through T2b
prostate cancer and prostate-specific antigen (PSA) levels less than 15 ng/mL
randomized between January 1996 and December 1999 and treated at 2 US academic
institutions. Median age was 67 years and median PSA level was 6.3 ng/mL.
Median follow-up was 5.5 (range, 1.2-8.2) years.InterventionPatients were randomized to receive external beam radiation to a total
dose of either 70.2 Gy (conventional dose) or 79.2 Gy (high dose). This was
delivered using a combination of conformal photon and proton beams.Main Outcome MeasureIncreasing PSA level (ie, biochemical failure) 5 years after treatment.ResultsThe proportions of men free from biochemical failure at 5 years were
61.4% (95% confidence interval, 54.6%-68.3%) for conventional-dose and 80.4%
(95% confidence interval, 74.7%-86.1%) for high-dose therapy (P<.001), a 49% reduction in the risk of failure. The advantage to
high-dose therapy was observed in both the low-risk and the higher-risk subgroups
(risk reduction, 51% [P<.001] and 44% [P = .03], respectively). There has been no significant difference
in overall survival rates between the treatment groups. Only 1% of patients
receiving conventional-dose and 2% receiving high-dose radiation experienced
acute urinary or rectal morbidity of Radiation Therapy Oncology Group (RTOG)
grade 3 or greater. So far, only 2% and 1%, respectively, have experienced
late morbidity of RTOG grade 3 or greater.ConclusionsMen with clinically localized prostate cancer have a lower risk of biochemical
failure if they receive high-dose rather than conventional-dose conformal
radiation. This advantage was achieved without any associated increase in
RTOG grade 3 acute or late urinary or rectal morbidity.

https://jamanetwork.com/journals/jama/articlepdf/201516/joc50091.pdf

Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate : A randomized controlled trial

Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update

Purpose Active surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer. Patients and Methods In a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable- or intermediate-risk prostate cancer were managed with an initial expectant approach. Intervention was offered for a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression, or unequivocal clinical progression. Main outcome measures were overall and disease-specific survival, rate of treatment, and PSA failure rate in the treated patients. Results Among the 819 survivors, the median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients are alive (censored rate, 8...

/pdf/long-term-follow-up-of-a-large-active-surveillance-cohort-of-2u6cfkloqw.pdf

Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

The introduction of an effective blood test, prostate specific antigen (PSA), has made it possible to diagnose more and more men in an earlier stage where they can be offered potentially curative treatments. The other side of the coin is that if effective diagnostic procedures are used unselectively in elderly men with a short life expectancy, a problem with over diagnosis and over treatment might occur. Thus the same stage of prostate cancer may need different treatment strategies, pending on the patient’s life expectancy. This, and many other issues regarding the disease, is the subject of the EAU guidelines on prostate cancer. G UI DE LI N ES O N P RO ST AT E CA N CE R 10

/pdf/guidelines-on-prostate-cancer-xdnunn4th8.pdf

Guidelines on Prostate Cancer

Understanding the benefits and harms of treatment strategies for clinically localized prostate cancer is difficult because of shortcomings in the evidence and the treatments themselves. This system...

Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer.

Purpose The optimal radiation dose fractionation schedule for localized prostate cancer is unclear. This study was designed to compare two dose fractionation schemes (a shorter 4-week radiation schedule v a longer 6.5-week schedule). Patients and Methods Patients with early-stage (T1 or T2) prostate cancer were randomly assigned to 66 Gy in 33 fractions over 45 days (long arm) or 52.5 Gy in 20 fractions over 28 days (short arm). The study was designed as a noninferiority investigation with a predefined tolerance of −7.5%. The primary outcome was a composite of biochemical or clinical failure (BCF). Secondary outcomes included presence of tumor on prostate biopsy at 2 years, survival, and toxicity. Results From March 1995 to December 1998, 936 men were randomly assigned to treatment; 470 were assigned to the long arm, and 466 were assigned to the short arm. The median follow-up time was 5.7 years. At 5 years, the BCF probability was 52.95% in the long arm and 59.95% in the short arm (difference = −7.0%; 90...

https://ascopubs.org/doi/pdf/10.1200/JCO.2005.06.153

Hugh M. Prichard

Papers

Randomized trial comparing two fractionation schedules for patients with localized prostate cancer.

Impact of noninvasive imaging on increased incidental detection of renal cell carcinoma