Recognizing False Biochemical Failure Calls After Radiation With or Without Neo-Adjuvant Androgen Deprivation for Prostate Cancer

Journal Article · Mon Jun 01 00:00:00 EDT 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.08.047· OSTI ID:21276815

Kumar, Mahesh ^[1]; Gleeson, Paul S ^[2]; Lamb, David S ^[3]; Joseph, David FRANZCR ^[4]; Atkinson, Chris FRANZCR ^[5]; Matthews, John FRANZCR ^[6]; Tai, K -H ^[7]; Spry, Nigel A ^[4]; Christie, David ^[8]; Turner, Sandra FRANZCR ^[9]; Greer, Peter B ^[10]; D'Este, Catherine ^[11]; Steigler, Allison ^[2]

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1. Calvary Mater Newcastle, Newcastle, New South Wales (Australia)
2. School of Medicine and Public Health, University of Newcastle, New South Wales (Australia)
3. Wellington Cancer Centre, Wellington Hospital (New Zealand)
4. Sir Charles Gairdner Hospital, Perth, Western Australia (Australia)
5. Christchurch Hospital, Christchurch (New Zealand)
6. Auckland Hospital, Auckland (New Zealand)
7. Peter MacCallum Cancer Institute, Melbourne, Victoria (Australia)
8. Premion, Tugun, Queensland (Australia)
9. Westmead Hospital, Sydney, New South Wales (Australia)
10. School of Physical and Mathematical Sciences, University of Newcastle, Newcastle, New South Wales (Australia)
11. Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales (Australia)

Purpose: We studied prostate-specific antigen (PSA) changes after radiation with or without neoadjuvant androgen deprivation to determine posttreatment PSA scenarios in which false-positive biochemical failures (FPBF) are most likely to occur. Methods and Materials: In the Trans-Tasman Radiation Oncology 96.01 Group trial, patients with T2b, 2c, 3, 4 N0 prostate cancer were randomized to 3 or 6 months goserelin and flutamide (STAD) before and during 66 Gy to the prostate and seminal vesicles (XRT) or to XRT alone. Piecewise longitudinal changes in PSA before relapse were characterized and quantified to determine which might cause FPBF calls. Results: Between 1996 and 2000, 802 eligible patients were randomized. Of these, 492 met the criteria for American Society for Therapeutic Radiology and Oncology (ASTRO) failure and 467 for Phoenix failure. Seventy-seven ASTRO fails and 39 Phoenix fails were deemed false positives (FPs). The majority of FPBFs were associated with the 'plateauing' in PSA values that follow posttreatment nadir. FPBFs were particularly common in men treated with STAD, in whom small, consecutive PSA rises before or during this phenomenon triggered 56 FP ASTRO fail calls. In these men, the Phoenix fail criteria triggered only 15 FPBF calls. However, the Phoenix criteria were more vulnerable than ASTRO to short-term isolated PSA rises during plateau, which resulted in 15 Phoenix fail calls but only 3 FP ASTRO fails. Conclusions: The Phoenix definition avoided 50% of FPBF calls that occurred with the ASTRO definition. Failures should be confirmed by further PSA rises before investigation and treatment is considered.

• OSTI ID: 21276815
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 74, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2008.08.047; PII: S0360-3016(08)03515-3; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANDROGENS
ANTIGENS
MEN
NEOPLASMS
PATIENTS
PROSTATE
RADIOTHERAPY