Vol. 36, pp , 2008 T1-3N0M0 : T1-3. prostate-specific antigen PSA. 68 Gy National Institutes of Health 10

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1 25 Vol. 36, pp , 2008 T1-3N0M0 : T1-3 N0M Gy 68 Gy 24 prostate-specific antigen PSA p 0.04 T3 PSA60 ng ml 68 Gy p Cox PSA60 ng ml 68 Gy 68 Gy 68 Gy 1987 National Institutes of Health

2 26 prostatespecific antigen PSA T1-3N0M0 113 retrospective Table UICC T T1: 17 T2: 48 T3: 48 Gleason GS 4 : 18 GS5-7: 76 GS8-10: 19 PSA ng ml 19ng ml 10ng ml: ng ml: ng ml: 30 60ng ml: 23 1 T PSA T1 2 PSA 10 GS 7 T3 PSA 20 GS cm 7 7cm cm X CT X ml ml : : 64 0 Table 1. Patient Characteristics 10MV-X Gy Gy 68Gy Gy Gy

3 LH-RH : 103 : 5 : PSA PSA Kaplan-Meier PSA Gy 24 2 T T1-T2 T3 PSA 60ng ml - 2 log-rank Cox 5 R version2.6.1 National Cancer Institute- Common Toxicity Criteria 1998 Fig. 1. Overall OS and disease-specific survival DSS for all patients Fig p Fig. 2 T 5 T1-2 T p Fig. 3 PSA 5 60ng ml 60ng ml p 0.03 Fig. 4 PSA60ng ml 20ng ml 20 59ng ml 5 Fig. 2. Disease-specific survival by risk category. Fig. 3. Disease-specific survival by T stage. 27

4 28 Fig. 4. Disease-specific survival by initial prostatespecific antigen 60ng ml vs. 60ng ml. Fig. 5. Disease-specific survival by total dose 68 Gy vs. 68Gy Gy 68Gy p 0.04Fig. 5 T PSA T1 2 T PSA60ng ml 5.0 p Gy 0.16 p 0.03 Table 2 n Gy 0.2 p 0.04 Table 3 Table 2. Results of Univariate and Multivariate Analysis for Disease-specific Survival of All Patients 28

5 29 Table 3. Results of Univariate and Multivariate Analysis for Disease-specific Survival of High-risk Patients grade grade2 1.7 T PSA PSA60 ng ml 68 Gy 68 Gy PSA Roach 5 20 ng ml PSA PSA 6 PSA T GS 60 ng ml PSA 60 ng ml PSA ng ml Gy Swanson 7 60 Gy A: 9 B: 93 C: Gy Gy Akakura Gy Gy 29

6 30 70 Gy 70 Gy CT 74 Gy T1-3N0M0 113 retrospective PSA60 ng ml 68Gy. 68 Gy. grade The management of clinically localized prostate cancer, National Institutes of Health Consensus Development Conference, June 15 17, J Uro 1987; 138: Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimano# RO, Storme G, Bernier J, Kuten A, Sternberg C, Matterlaer J, Lopez Torecilla J, Pfe#er JR, Lino Cutajar C, Zurlo A and Pierart M. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer an EORTC study : a phase III randomised trial. Lancet 2002; 360: Hanks GE, Pajak TF, Porter A, Grignon D, Brereton H, Venkatesan V, Horwitz EM, Lawton C, Rosenthal SA, Sandler HM and Shipley WU. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol J Clin Oncol 2003; 21: Akimoto T, Kitamoto Y, Saito J, Harashima K, Nakano T, Ito K, Yamamoto T, Kurokawa K, Yamanaka H, Takahashi M, Mitsuhashi N and Niibe H. External beam radiotherapy for clinically node-negative, localized hormonerefractory prostate cancer: impact of pretreatment PSA value on radiotherapeutic outcomes. Int J Radiat Oncol Biol Phys 2004; 59: Roach M 3rd, Weinberg V, McLaughlin PW, Grossfeld G and Sandler HM. Serum prostatespecific antigen and survival after external beam radiotherapy for carcinoma of the prostate. Urology 2003; 61: Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol 1991; 145: Swanson GP, Riggs MW and Earle JD. Longterm follow-up of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2004; 59: Akakura K, Suzuki H, Ichikawa T, Fujimoto H, Maeda O, Usami M, Hirano D, Takimoto Y, Kamoto T, Ogawa O, Sumiyoshi Y, Shimazaki J, Kakizoe T and the Japanese Study Group for Locally Advanced Prostate Cancer. A randomized trial comparing radical prostatectomy plus endocrine therapy versus exter- 30

7 31 nal beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months. Jpn J Clin Oncol 2006; 36: Vicini FA, Abner A, Baglan KL, Kestin LL and Martinez AA. Defining a dose-response relationship with radiotherapy for prostate cancer: is more really better?. Int J Radiat Oncol Biol Phys 2001; 51: Speight JL and Roach M. Radiotherapy in the management of clinically localized prostate cancer: evolving standards, consensus, controversies and new directions. J Clin Oncol 2005; 23: Leibel SA, Fuks Z, Zelefsky MJ, Hunt M, Burman CM, Mageras GS, Chui CS, Jackson A, Amols HI and Ling CC. Technological advances in external-beam radiation therapy for the treatment of localized prostate cancer. Semin Oncol 2003; 30: Jacob R, Hanlon AL, Horwitz EM, Movsas B, Uzzo RG and Pollack A. Role of prostate dose escalation in patients with greater than 15 risk of pelvic lymph node involvement. Int J Radiat Oncol Biol Phys 2005; 61:

8 32 Abstract Therapeutic Results and Prognostic Factors in Patients with T1-3N0M0 Prostate Cancer Treated by Definitive External-Beam Radiotherapy Combined with Hormonal Therapy Tatsuyuki Abe, Hiromichi Gomi, Shinjiro Sakaino, and Yasuo Nakajima When considering treatment strategy, it is very important to evaluate the prognostic factors for overall survival OS and disease-specific survival DSS in patients with prostate cancer treated by external-beam radiotherapy combined with hormonal therapy. The purpose of this study was to evaluate the treatment and to determine these prognostic factors in patients with T1-3N0M0 prostate cancer treated by definitive external beam radiotherapy combined with hormonal therapy. In total, we studied 113 of these patients between 1990 and The median total dose of radiation was 68Gy and the median duration of hormonal therapy was 24 months range, 2 to 134 months. Risk groups were defined as follows: low-risk, T1 2 and Gleason score 7, or well di#erentiated and PSA 10ng ml; high-risk, T3 or Gleason score 7 or poorly di#erentiated or PSA 20ng ml; intermediate-risk, all others. Follow-up ranged from 1,2 to 17.2 years median, 6.5 years. Clinicopathologic factors a#ecting OS and DSS were univariately and multivariately analyzed. For all patients, 5-year OS and DSS rate were 91 and 95 respectively. The 5-year DSS rate by risk group was 100 for the low- and intermediate-risk groups and 93 for the high-risk group p Univariate analysis showed that higher grade of T-factor, greater initial PSA value and higher total dose were significantly associated with poorer DSS p , 0.03, and 0.04 respectively. Multivariate analysis showed that initial PSA value 60ng ml and total dose 68Gy were significantly associated with poorer DSS. In addition, among high-risk patients, total dose 68Gy was significantly associated with DSS. Since the DSS of patients with high-risk prostate cancer is significantly worse, we suggest that total dose 68Gy is needed for treatment of high-risk prostate cancer. Department of Radiology, St. Marianna University School of Medicine 32