[en] PURPOSE: To investigate early prostate-specific antigen (PSA) kinetics after high radiation doses of 85 Gy on locally advanced prostate cancer. METHODS AND MATERIALS: A total of 201 patients were prospectively and consecutively treated with external beam radiotherapy and a brachytherapy boost. Of the 201 patients, 104 received concomitant hormonal therapy on the decision of the referring urologist and were excluded, yielding a study population of 97 patients. The first posttreatment PSA analysis was performed not earlier than 1 month after treatment completion but within the first 4 months, and then every 4 months. Analysis of PSA kinetics included the PSA nadir (nPSA) at values of < or =4 ng/mL to < or =0.5 ng/mL. The nPSA at < or =4 ng/mL within 4 months (nPSA < or =4/4m) was the variable of interest. RESULTS: We established highly significant associations between an nPSA of < or =1 and < or =0.5 ng/mL and the nPSA < or =4/4m (p <0.0001). A hazard ratio of 0.33 (95% Confidence Interval (CI), 0.12-0.91) underlined the lower risk of recurrence related to nPSA < or =4/4m achievement (p = 0.033). Using time-dependent covariate models for patients who did not reach an nPSA < or =4/4m, an nPSA of < or =1 ng/mL remained without prognostic significance (p = 0.06). However, for patients who reached an nPSA < or =4/4m, an nPSA of < or =1 ng/mL did significantly improve the prognosis (p <0.001), but much later after treatment. The same analysis was repeated for nPSA < or =0.5 ng/mL with similar conclusions as when nPSA < or =4/4m was obtained (p <0.01). CONCLUSION: The nPSA < or =4/4m has been demonstrated to be a significant predictor of biochemical no evidence of disease after high radiation doses of 85 Gy. Its major advantage is that it was available earlier than the other nadirs.
Disciplines :
Oncology Radiology, nuclear medicine & imaging
Author, co-author :
Nickers, Philippe ; Université de Liège - ULiège > Département des sciences cliniques
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Waltregny, David ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Labo de recherche sur les métastases
Deneufbourg, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Radiothérapie
Language :
English
Title :
Prognostic value of PSA nadir < or =4 ng/ml within 4 months of high-dose radiotherapy for locally advanced prostate cancer
Publication date :
01 May 2006
Journal title :
International Journal of Radiation, Oncology, Biology, Physics
ISSN :
0360-3016
eISSN :
1879-355X
Publisher :
Elsevier Science Inc, New York, United States - New York
Partin A.W., Kattan M.W., Subong E.N.P., et al. Combination of prostate specific antigen, clinical stage and Gleason score to predict pathological stage of localized prostate cancer. JAMA 277 (1997) 1445-1451
Crook J.M., Bahadur Y.A., Bociek R.G., et al. Radiotherapy for localized prostate carcinoma. The correlation of pretreatment prostate specific antigen and nadir prostate specific antigen with outcome as assessed by systematic biopsy and serum prostate specific antigen. Cancer 79 (1997) 328-336
Ben-Josef E.A., Shamsa F.A., Forman J.D., et al. Predicting the outcome of radiotherapy for prostate carcinoma. A model-building strategy. Cancer 82 (1998) 1334-1342
Zelefsky M.J., Leibel S.A., Gaudin P.B., et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 41 (1998) 491-500
Critz F.A., Levinson A.K., Williams W.H., et al. Prostate-specific antigen nadir achieved by men apparently cured of prostate cancer by radiotherapy. J Urol 161 (1999) 1199-1203
Preston D.M., Bauer J.J., Connelly R.R., et al. Prostate-specific antigen to predict outcome of external beam radiation for prostate cancer. Walter Reed Army Medical Center experience, 1988-1995. Urology 53 (1999) 131-138
Storey M.R., Landgren R.C., Cottone J.L., et al. Transperineal 125Iodine implantation for treatment of clinically localized prostate cancer. 5-year tumor control and morbidity. Int J Radiat Oncol Biol Phys 43 (1999) 565-570
Martinez A.A., Gustafson G., Gonzalez J., et al. Dose escalation using conformal high dose rate brachytherapy improves outcome in unfavorable prostate cancer. Int J Radiat Oncol Biol Phys 53 (2002) 316-327
Gleave M.E., Goldenberg S.L., Chin J.L., et al. Randomized comparative study of 3 versus 8 months neoadjuvant hormonal therapy before radical prostatectomy. Biochemical and pathological effects. J Urol 166 (2001) 500-597
Merrick G.S., Butler W.M., Wallner K.E., et al. Temporal effect of neoadjuvant androgen deprivation therapy on PSA kinetics following permanent prostate brachytherapy with or without supplemental external beam radiation. Brachytherapy 3 (2004) 141-146
Roach M., Lu J., Pilepich M.V., et al. Predicting long-term survival, and the need for hormonal therapy. A meta-analysis of RTOG prostate cancer trials. Int J Radiat Oncol Biol Phys 47 (2000) 617-627
Bolla M., Gonzalez D., Warde P., et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337 (1997) 295-300
Hanks G.E., Pajak T.F., Grignon D., et al. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate. The Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol 21 (2003) 3972-3978
Galalae R.M., Martinez A., Mate T., et al. Long-term outcome by risk factors using conformal high dose rate (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. Int J Radiat Oncol Biol Phys 58 (2004) 1048-1055
Nickers P., Coppens L., Beauduin M., et al. Feasibility study combining low dose rate 192Ir brachytherapy and external beam radiotherapy aiming at delivering 80-85 Gy to prostatic adenocarcinoma. Radiother Oncol 55 (2000) 41-47
Sobin L.H., and Wittekind C.H. TNM classification of malignant tumors (2002), Wiley-Liss, New York
Dale R.G. The use of small fraction numbers in high dose-rate gynaecological afterloading. Some radiobiological considerations. Br J Radiol 63 (1990) 290-294
Wang J.Z., Li A., Yu C.X., et al. The low α/β ratio for prostate cancer. What does the clinical outcome of HDR brachytherapy tell us?. Int J Radiat Oncol Biol Phys 57 (2003) 1101-1108
ASTRO. Consensus statement. Guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 37 (1997) 1035-1041
Harris E.K., and Albert A. Survivorship analysis for clinical studies (1997), Dekker, New York
Ray M.E., Thames H.D., Levy L.B., et al. PSA nadir predicts biochemical and distant failures after external beam radiation therapy for prostate cancer. A multi-institutional analysis. Abstract. Int J Radiat Oncol Biol Phys 60 Suppl. 1 (2004) 234
Feigenberg S., Hanlon H.L., Horwitz E.M., et al. Post-treatment PSA values within 6 months of 3D conformal radiotherapy for prostate cancer predict for distant metastases. Abstract. Int J Radiat Oncol Biol Phys 60 Suppl. 1 (2004) S234-S235
Chandra A., Levy L.B., and Kuban D.A. The predictive value of PSA nadir and time to nadir after external beam radiation for prostate cancer. Abstract. Int J Radiat Oncol Biol Phys 60 Suppl. 1 (2004) 439-440
Cavanaugh S.X., Kupelian P.A., Fuller C.D., et al. Early prostate-specific antigen (PSA) kinetics following prostate carcinoma radiotherapy. Cancer 101 (2004) 96-105