Comparison of biochemical failure definitions for permanent prostate brachytherapy
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
- New York Prostate Institute, Oceanside, NY (United States)
- Arizona Oncology Services, Scottsdale, AZ (United States)
- Seattle Prostate Institute, Seattle, WA (United States)
- Chicago Prostate Institute, Chicago, IL (United States)
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States)
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States)
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable.
- OSTI ID:
- 20850032
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 65, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2006.03.027; PII: S0360-3016(06)00466-4; Copyright (c) 2006 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
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