Медицинская и хирургическая урология
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Influence of Race on Outcomes of Patients with Localized Prostate Cancer Considered Intermediate or High Risk of Biochemical Failure Treated with High Dose Rate Brachytherapy and External Beam Radiotherapy

Antonio Cassio Assis Pellizzon

Purpose: There is a growing need to identify prognostic factors in prostate cancer (PCA) to avoid excessive or

inappropriate treatment of patients. It may be helpful to identify patients with poor outcomes who would be candidates for more intensive treatments.

Methods: we performed a retrospective analysis of data of the charts of all unfavorable PCA treated with the combination of High-Dose-Rate Brachytherapy (HDR-BT) and External Beam Radiotherapy (EBRT) at the department of radiation oncology (ac Camargo cancer center), são paulo, brazil, between 1997 and 2010. Ethnicity definition was based on 4 categorizations: black, mulatto, white and Asiatic. We included 229 patients (age range 47-83 years). The median follow-up was 70.3 months (range, 36 –155 months). There were 7.4% (17) yellow, 79.0% (181) white, 7.9% (18) black and 5.7% (13) mulatto patients.

Results: EBRT and HDR-BT doses ranged from 40 to 54 gy and 16 to 30 gy given in 4 fractions, respectively. Actuarial 5- and 10-year overall and disease-free survival (DFS) rates were 87.6%, 61.3%, 90.9% and 54.2%, respectively. On univariate analysis, prognostic factors related to improved DFS were a white/Asiatic race (p<0.001), initial clinical stage p=0.004, HDR-BT dsoe >20 gy (p<0.001) and Gleason-score <7 (p<0.001). On multivariate analysis black/mulatto race (p=0.037), advanced clinical stage (p=0.038) and HDR-BT dose <20gy (p<0.001) were associated with biochemical failure.

Conclusion: The race seems to be one of the markers of prognosis for PCA. Already known predictive factors of biochemical failure were confirmed in our analysis (clinical stage, Gleason score). An improved DFS was related to HDR-BT dose escalation. Further studies are still necessary to provide more information about clinical and genetic predictive factors of aggressiveness that can be used to guide a personalized dose intensification treatment.