Dose escalation of external beam radiotherapy for high-risk prostate cancer—Impact of multiple high-risk factor

Rei Umezawa, Koji Inaba, Satoshi Nakamura, Akihisa Wakita, Hiroyuki Okamoto, Keisuke Tsuchida, Tairo Kashihara, Kazuma Kobayashi, Ken Harada, Kana Takahashi, Naoya Murakami, Yoshinori Ito, Hiroshi Igaki, Keiichi Jingu, Jun Itami

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Objective: To retrospectively investigate the treatment outcomes of external beam radiotherapy with androgen deprivation therapy (ADT) in high-risk prostate cancer in three radiotherapy dose groups. Methods: Between 1998 and 2013, patients with high-risk prostate cancer underwent three-dimensional conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy, 72 Gy, or 78 Gy with ADT. Prostate-specific antigen (PSA) relapse was defined using the Phoenix definition. PSA relapse-free survival (PRFS) was evaluated in each radiotherapy dose group. Moreover, high-risk patients were divided into H-1 (patients with multiple high-risk factors) and H-2 (patients with a single high-risk factor) as risk subgroups. Results: Two hundred and eighty-nine patients with a median follow-up period of 77.3 months were analyzed in this study. The median duration of ADT was 10.1 months. Age, Gleason score, T stage, and radiotherapy dose influenced PRFS with statistical significance both in univariate and multivariate analyses. The 4-year PRFS rates in Group-66 Gy, Group-72 Gy and Group-78 Gy were 72.7%, 81.6% and 90.3%, respectively. PRFS rates in the H-1 subgroup differed with statistical significance with an increasing radiotherapy dose having a more favorable PRFS, while PRFS rates in H-2 subgroup did not differ with increase in radiotherapy dose. Conclusion: Dose escalation for high-risk prostate cancer in combination with ADT improved PRFS. PRFS for patients in the H-1 subgroup was poor, but dose escalation in those patients was beneficial, while dose escalation in the H-2 subgroup was not proven to be effective for improving PRFS.

Original languageEnglish
Pages (from-to)192-199
Number of pages8
JournalAsian Journal of Urology
Issue number2
Publication statusPublished - 2019 Apr


  • Biochemical control
  • Dose escalation
  • External beam radiotherapy
  • Prostate cancer


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