Clinical investigation
Both pretreatment prostate-specific antigen level and posttreatment biochemical failure are independent predictors of overall survival after radiotherapy for prostate cancer

Presented, in part, at the Royal Australian and New Zealand College of Radiologists (Faculty of Radiation Oncology) 2003 Annual Scientific Meeting.
https://doi.org/10.1016/j.ijrobp.2004.04.048Get rights and content

Abstract

Purpose

To assess the impact of pretreatment prognostic factors plus subsequent biochemical failure on overall survival after radiotherapy for prostate cancer.

Methods and materials

We analyzed the prostate-specific antigen (PSA) and survival records of 1571 men with clinically localized prostate cancer treated with external beam radiotherapy monotherapy at the former Queensland Radium Institute between 1990 and 1997. The pretreatment PSA level, biopsy Gleason score, clinical stage, patient age, and the development of biochemical failure were assessed in relationship to overall survival and cause-specific survival, using fixed, as well as time-dependent, statistics.

Results

The median follow-up was 88.1 months (95 months for those still alive). The actuarial overall survival, cause-specific survival, and biochemical failure-free survival rate at 10 years was 61.1%, 80.9%, and 25.9% respectively. Cause-specific survival was independently influenced by the pretreatment PSA level, Gleason score, clinical stage, and the development of biochemical failure (relative risk, 19.1). Using the overall survival endpoint, multivariate analysis showed age, pretreatment PSA level, Gleason score, and biochemical failure (relative risk 1.27) to be statistically significant variables.

Conclusion

In addition to previously identified factors, the pretreatment PSA level and occurrence of biochemical failure after radiotherapy for prostate cancer are associated with an increased overall mortality risk. Both pretreatment PSA 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

References (26)

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Supported by the Peter Grant Hay Fund.

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