Using one of the largest databases of prostate cancer outcomes in the United States, Fox Chase Cancer Center researchers have developed a prediction tool that uses a patient's clinical information to estimate the benefit of adding androgen deprivation therapy of various durations to radiation therapy.
Such hormone therapy has been shown to help radiation kill prostate cancer cells and improve survival in men at a high risk of recurrence, but it is associated with significant side effects. Even when the cancer has been characterized as high-risk, the degree of benefit from the addition of androgen deprivation can be quite variable.
"Studies have generally lumped patients into three levels of risk, and physicians have recommended hormone therapy based on these studies," says Niraj H. Pahlajani, a resident in the radiation oncology department at Fox Chase Cancer Center in Philadelphia. "Our experience tells us that prostate patients can't be lumped together into broad categories and expected to respond the same way to treatment even when they fall into similar risk-categories. Fortunately, we've been able to generate a nuanced prediction tool that incorporates disease burden and individualizes treatment recommendations. We can enter each patient's clinical information and estimate the probability of the cancer coming back using different durations of hormone therapy to determine the best course."
Pahlajani says other similar tools exist to predict cancer treatment outcomes, but none is as personalized and none has yet been used to estimate the gains from different lengths of hormone therapy. The Fox Chase researchers used two key factors derived via biopsy to identify subtle differences among those at intermediate to high-risk of recurrence. The two factors were the percent of cancer-positive tissue identified and the percent of that positive tissue with a Gleason grade of four or five.
"With this information, we're able to personalize each man's treatment by quantifying the optimal duration of hormones based on his individual factors," Pahlajani says.
Pahlajani presented the study supporting the tool at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology.
In addition to Pahlajani, co-authors include Brian L. Egleston, Mark K. Buyyounouski, David Y.T. Chen, and Eric M. Horwitz of Fox Chase Cancer Center, and Alan Pollack of University of Miami. The authors report no disclosures. Funding for this study was provided by the National Cancer Institute and Varian Medical Systems.
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