International Journal of Radiation Oncology*Biology*Physics
Clinical investigationBoth pretreatment prostate-specific antigen level and posttreatment biochemical failure are independent predictors of overall survival after radiotherapy for prostate cancer☆
Introduction
The impact of a rising prostate-specific antigen (PSA) profile after radiotherapy (RT) for prostate cancer has been well defined in relation to metastasis-free, disease-free, and cause-specific survival (CSS) 1, 2. However, a correlation between biochemical failure (bF) and reduced overall survival (OS) has yet to be established in RT series 3, 4, 5, 6. Likewise, radical prostatectomy series have also not yet found a correlation (7). The long natural history of the disease, the typically elderly patient with competing risks of death, and the relative success of hormonal salvage therapy all weigh against the identification of a direct association. Previous reports attempting to show a relationship may have also been hampered by follow-up periods well short of the median survival time and low numbers of patients with biochemical failure 3, 5, 8. Also, variables of interest that change state after treatment, such as local recurrence, need to be dealt with in a specific statistical manner using time-dependent analyses, as has been done in other tumor sites (9).
Despite the lack of evidence for an OS benefit, treatment of biochemical recurrence, often at early stages, is becoming standard treatment in many centers. The present study examined the impact of pretreatment prognostic variables and the development of bF in relation to overall and CSS.
Section snippets
Methods and materials
Radical external beam RT to the prostate was prescribed to a total of 1971 men between January 1990 and December 1997 at the former Queensland Radium Institute (now the Division of Oncology, Royal Brisbane Hospital and Mater Centre) at either of its two Brisbane campuses. All patients had clinical Stage T1-T4 (standardized to TNM 1997 [10]) malignancy and were clinically free of metastases to nodes or distant sites as determined by the results of CT of the abdomen and pelvis and/or bone scan
Results
The median follow-up was 88.1 months (95 months for those still alive). Forty-four men were lost to follow-up at a median of 44 months (range, 1–100 months). Salvage AD was given in 613 men (39%) at a median PSA level of 22.2 ng/mL (interquartile range, 13.0–44.0 ng/mL) and a median time of 39.2 months after RT.
Biochemical failure occurred in 1069 patients (68.0%) at a median of 20.9 months (interquartile range, 13.2–35.2 months). Sixty-six men (4.2%) died before having four PSA measurements
Discussion
The results of this report demonstrated a statistically significant correlation between OS and bF after RT for prostate cancer. By using a large cohort of men treated in a relatively uniform way without planned AD, a time-dependent analysis showed bF to portend a RR of death that was approximately one-quarter greater than for those without bF. To date, previous studies examining this relationship have failed to demonstrate a statistically significant correlation 1, 3, 4, 5, 6.
These data also
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Cited by (26)
Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review
2019, European UrologyCitation Excerpt :For DM and PCSM, 12 out of 14 [7,8,22,23,26–28,38,39,41,43,51,52,55] and 10 out of 13 [7,11,22,25,31,33,36,38–40,48,49,51] studies showed a positive association with HR ranging from 1.2 (95% CI 1–1.5) to 14.4 (95% CI 4.3–48.8) and from 1.35 (95% CI 1.07–1.71) to 10.8 (95% CI 3.1–37.9), respectively. Similarly, for patients with RT as primary treatment, eight out of eight [16,61,64,69,70,72,74,76], five out of eight [15–17,58,60,61,64,71], and seven out of nine [15–17,57,58,60,61,63,70] studies showed a positive association between a higher GS identified on prostate biopsies (bGS) and DM, PCSM, and OM, respectively, with HRs ranging from 1.7 (95% CI 1.1–2.7) to 3.7 (95% CI 1.4–10.3), 2.11 (95% CI 1.03–4.34) to 14.8 (95% CI 2–110), and 1.8 (95% CI 1.3–2.4) to 17.9 (95% CI 9.6–33), respectively. Only a limited number of studies used the recently introduced International Society of Urological Pathology (ISUP) grading in their MVA, allowing for a comparison between ISUP grades 2 and 3.
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2018, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :This was a pragmatic limitation of our study, with the biopsies linked to the time of brachytherapy. With a median interval to a maximal PSA response of approximately 3 years (29-31), the evolution of radioresistant disease cannot yet be defined. Analysis of local recurrence within the prostate at very late points after RT will be crucial in completing our understanding.
A phase III extension trial with a 1-arm crossover from leuprolide to degarelix: Comparison of gonadotropin-releasing hormone agonist and antagonist effect on prostate cancer
2011, Journal of UrologyCitation Excerpt :FSH receptors are selectively expressed on blood vessels of many tumors, including prostate tumors,9 and FSH signaling may contribute to the progression of castration resistant PCa.10 In PCa cases PSA recurrence often precedes clinically detectable recurrence by years and effective PSA control is associated with improved overall survival.11–13 Patients on degarelix 240/80 mg had a significantly lower risk of PSA failure or death than those on leuprolide during treatment year 1.
Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics
2011, International Journal of Radiation Oncology Biology Physics
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Supported by the Peter Grant Hay Fund.