68: Intermediate-Risk Prostate Cancer, Androgen Deprivation Therapy and the Risk of Death
Bibliographic record
Abstract
Purpose: Intermediate-risk prostate cancer comprises a heterogenous group, whose management includes external radiation (EBRT), brachytherapy (brachy), or surgery.Androgen deprivation therapy (ADT) has been shown to improve survival in IR prostate cancer when combined with standard dose EBRT (RTOG 9408).Its role with brachy is unclear, but appears to add 10-15% absolute improvement in biochemical control (as presented at CARO 2015).In our practice the use of ADT in this context has declined from 91% in 1990 to 21% in 2015, because of uncertainty of its role, and concerns of toxicity.The aim of this study was to examine the effect of ADT on subsequent survival of men treated for IR with brachy.Methods and Materials: Men treated for IR prostate cancer 1998-2011 were prospectively followed in an outcomes database.They were risk grouped using the ProCars scheme into low-and high-IR.Endpoints were biochemical control (bNED, by the Phoenix, nadir + 2 definition) and survival.Death information was obtained from the provincial cancer registry.Cause of death was ascribed to prostate cancer, cardiovascular disease, other cause, or unknown.bNED and survival were calculated using the Kaplan-Meier method with log-rank statistics, and multivariable analysis performed.Results: 2232 men form the study cohort.Eighty-seven percent had low-IR cancer, and 13% high-IR.Six months of neoadjuvant and concurrent ADT was used in 50%.Ninety-nine percent received 125I low dose rate permanent brachytherapy monotherapy (144 Gy) and 1% received 115 Gy plus pelvic EBRT, (46 Gy).Median follow up for bNED is five years (range 0-17) and for survival seven years (4-17, with 23% followed for more than 10 years).Actuarial biochemical control at 10 years is 74% without, and 88% with ADT (p < 0.001), and both low-IR (77% versus 86%) and high-IR (68% versus 83% at six years) show this improvement.Overall survival is 89% without ADT and 85% with ADT at 10 years (p = 0.041).Cardiovascular deaths were significantly increased with ADT (5% versus 2.3% at 10 years, p = 0.015), and contribute to the decreased overall survival observed.Prostate cancer deaths occurred in 0.5% and 1.5% without and with ADT, at 10 years.Multivariable analysis shows that the excess cardiac deaths are due to comorbidity and age.Conclusions: Although bNED is improved by the addition of six months of ADT, overall survival is worse when examined in a mature dataset.This detriment is due to excess non-prostate causes, including cardiovascular deaths.The main drivers of the latter appear to be presence of cardiac risk factors, other comorbidity, and age.The use of ADT may be a particular concern in patients with such risk factors.Benefits, risks, and patient preference should be considered when determining the addition of ADT with BT for IR prostate cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".