How Can Men Destined for Biochemical Failure After Androgen Deprivation and Radiotherapy Be Identified Earlier?

Journal Article · Tue Apr 01 04:00:00 EDT 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.08.057· OSTI ID:21124157

D'Ambrosio, David J ^[1]; Ruth, Karen ^[2]; Horwitz, Eric M; Uzzo, Robert G ^[1]; Pollack, Alan ^[3]

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1. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States)
3. Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)

Purpose: The significance of prostate-specific antigen (PSA) increases during the recovery of androgen after androgen deprivation therapy (ADT) and radiotherapy for prostate cancer is not well understood. This study sought to determine whether the initial PSA increase from undetectable after completion of all treatment predicts for eventual biochemical failure (BF). Methods and Materials: Between July 1992 and March 2004, 163 men with a Gleason score of 8-10 or initial PSA level >20 ng/mL, or Stage T3 prostate cancer were treated with radiotherapy (median dose, 76 Gy) and ADT and achieved an undetectable PSA level. The first detectable PSA level after the cessation of ADT was defined as the PSA sentinel rise (SR). A PSA-SR of >0.25, >0.5, >0.75, and >1.0 ng/mL was studied as predictors of BF (nadir plus 2 ng/mL). Cox proportional hazards models were used for univariate and multivariate analyses for BF adjusting for pretreatment differences in Gleason score, stage, PSA level (continuous), dose (continuous), and ADT duration (<12 vs. {>=}12 months). Results: Of the 163 men, 41 had BF after therapy. The median time to BF was 25 months (range, 4-96). The 5-year BF rate stratified by a PSA-SR of {<=}0.25 vs. >0.25 ng/mL was 28% vs. 43% (p = 0.02), {<=}0.5 vs. >0.5 ng/mL was 30% vs. 56% (p = 0.0003), {<=}0.75 vs. >0.75 ng/mL was 29% vs. 66% (p < 0.0001), and {<=}1.0 vs. >1.0 ng/mL was 29% vs. 75% (p < 0.0001). All four PSA-SRs were independently predictive of BF on multivariate analysis. Conclusion: The PSA-SR predicts for BF. A PSA-SR of >0.5 ng/mL can be used for early identification of men at greater risk of BF.

• OSTI ID: 21124157
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 70; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANDROGENS
ANTIGENS
CARCINOMAS
FAILURES
MULTIVARIATE ANALYSIS
PROSTATE
RADIATION DOSES
RADIOTHERAPY