Should we reconsider the necessity of a refinement of prostate cancer risk classification and radiotherapy treatment strategy? Experiences from a retrospective analysis of data from a single institution

Abstract

Background: Radiation therapy has undergone significant technical development in the past decade. However, the complex therapy of intermediate‐risk patients with organ‐confined prostate carcinoma still poses many questions. Our retrospective study investigated the impact of se-lected components of the treatment process including radiotherapy, hormone deprivation, risk clas-sification, and patients’ response to therapy. Methods: The impact of delivered dose, planning ac-curacy, duration of hormone deprivation, risk classification, and the time to reach prostate‐specific antigen (PSA) nadir state were analyzed among ninety‐nine individuals afflicted with organ‐con-fined disease. Progression was defined as a radiological or biochemical relapse within five years from radiotherapy treatment. Results: We found that 58.3% of the progressive population consisted of intermediate‐risk patients. The progression rate in the intermediate group was higher (21.9%) than in the high‐risk population (12.1%). Dividing the intermediate group, according to the International Society of Urological Pathology (ISUP) recommendations, resulted in the non‐favorable subgroup having the highest rate of progression (33.3%) and depicting the lowest percentage of progression‐free survival (66.7%). Conclusion: Extended pelvic irradiation on the regional lymph nodes may be necessary for the ISUP Grade 3 subgroup, simi larly to the high‐risk treatment. Therapy optimization regarding the intermediate‐risk population based on the ISUP subgrouping sug-gestions is highly recommended in the treatment of organ‐confined prostate cancer.