Ten- and 15-yr Prostate Cancer-specific Mortality in Patients with Nonmetastatic Locally Advanced or Aggressive Intermediate Prostate Cancer, Randomized to Lifelong Endocrine Treatment Alone or Combined with Radiotherapy: Final Results of The Scandinavian Prostate Cancer Group-7

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Fossa, Sophie D. (author)

Ten- and 15-yr Prostate Cancer-specific Mortality in Patients with Nonmetastatic Locally Advanced or Aggressive Intermediate Prostate Cancer, Randomized to Lifelong Endocrine Treatment Alone or Combined with Radiotherapy : Final Results of The Scandinavian Prostate Cancer Group-7

Article/chapterEnglish2016

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Elsevier BV,2016
printrdacarrier

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LIBRIS-ID:oai:DiVA.org:umu-127612
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-127612URI
https://doi.org/10.1016/j.eururo.2016.03.021DOI
https://gup.ub.gu.se/publication/236064URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:134399437URI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Background: In high-risk prostate cancer (PCa), no study with observation times beyond 10 yr has demonstrated survival improvement after addition of prostatic radiotherapy (RAD) to endocrine treatment (ET) alone. Objective: To compare mortality rates in patients receiving ET alone versus ET + RAD. Design, settings, and participants: From 1996 to 2002, 875 Scandinavian patients with high-risk (90%) or intermediate PCa were randomized to ET or ET + RAD (The Scandinavian Prostate Cancer Group-7). After 3 mo with total androgen blockade in all patients, all individuals continued lifelong antiandrogen monotherapy. Those randomized to ET + RAD started prostate radiotherapy (70 Gy) at 3 mo. Outcome, measurements and statistical analysis: PCa-specific 15-yr mortality represented the primary endpoint. Assessment of the combination treatment effect and prognostic factors was performed in competing risk analyses and Cox proportional-hazard models. Intervention: RAD added to ET. Results and limitations: With a median observation time of 12 yr, the 15-yr PCa-specific mortality rates were 34% (95% confidence interval, 29-39%) and 17% (95% confidence interval, 13-22%) in the ET and ET + RAD arms respectively (p < 0.001). Compared with the ET arm, the median overall survival in the ET + RAD arm was prolonged by 2.4 yr. Treatment with ET alone, age >= 65 yr and increasing histology grade independently increased the risk of PCa-specific and overall mortality. Limitations include nonformal evaluation of comorbidity, the inability to calculate progression-free survival, and lack of information about salvage therapy and toxicity. Conclusions: In patients with nonmetastatic locally advanced or aggressive PCa, ET + RAD reduces the absolute risk of PCa-specific death by 17% at 15 yr compared with ET alone; the comparable 15-yr PCa-specific mortality rates being 17% and 34%. The results warrant a phase 3 study comparing ET + RAD with radical prostatectomy in high-risk PCa. Patient summary: Adding prostatic therapy to lifelong antiandrogen therapy halves the absolute risk of death from prostate cancer from 34% to 17% 15 yr after diagnosis.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
Antiandrogen monotherapy
High-risk prostate cancer
Radiotherapy
Mortality

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Wiklund, FredrikKarolinska Institutet (author)
Klepp, Olbjorn (author)
Angelsen, Anders (author)
Solberg, Arne (author)
Damber, Jan-Erik,1949Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology(Swepub:gu)xdamja (author)
Hoyer, Morten (author)
Widmark, AndersUmeå universitet,Onkologi(Swepub:umu)anwi0004 (author)
Karolinska InstitutetInstitutionen för kliniska vetenskaper, Avdelningen för urologi (creator_code:org_t)

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In:European Urology: Elsevier BV70:4, s. 684-6910302-28381873-7560

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By the author/editor: Fossa, Sophie D.; Wiklund, Fredrik; Klepp, Olbjorn; Angelsen, Anders; Solberg, Arne; Damber, Jan-Erik ...; show more...; Hoyer, Morten; Widmark, Anders; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Urology and Neph ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cancer and Oncol ...

Articles in the publication: European Urology

By the university: Umeå University; University of Gothenburg; Karolinska Institutet

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