Does prostate-specific antigen nadir predict longer-term outcomes of prostate cancer after neoadjuvant and adjuvant androgen deprivation therapy in conjunction with brachytherapy?

Morris, Lloyd; Izard, Michael A.; Wan, Wai Yin

doi:10.1016/j.brachy.2014.11.002

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…Threshold levels of nPSA for the prediction of treatment failure vary depending on the local extent of the cancer, the type of radiotherapy, and the duration of ADT. Our value of nPSA for predicting the clinical outcome is an extremely low level compared with previous studies – ranging from 0.1 to 1.5 ng/ml [ 17 , 18 , 19 , 20 ]. Combined HDR brachytherapy and EBRT could deliver effective radiation doses more precisely and intensely than conventional EBRT, with some margin even in patients with extracapsular extensions and seminal vesicle invasion.…”

Section: Discussioncontrasting

confidence: 55%

Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

Tsumura¹,

Satoh²,

Ishiyama

et al. 2016

jcb

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PurposeTo evaluate the prognostic value of prostate-specific antigen nadir (nPSA) after high-dose-rate (HDR) brachytherapy in clinically non-metastatic high-risk prostate cancer patients.Material and methodsData from 216 patients with high-risk or locally advanced prostate cancer who underwent HDR brachytherapy and external beam radiation therapy with long-term androgen deprivation therapy (ADT) between 2003 and 2008 were analyzed. The median prostate-specific antigen (PSA) level at diagnosis was 24 ng/ml (range: 3-338 ng/ml). The clinical stage was T1c-2a in 55 cases (26%), T2b-2c in 48 (22%), T3a in 75 (35%), and T3b-4 in 38 (17%). The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After 5 fractions, external beam radiation therapy with 10 fractions of 3 Gy was administered. All patients initially underwent neoadjuvant ADT for at least 6 months, and adjuvant ADT was continued for 36 months. The median follow-up was 7 years from the start of radiotherapy.ResultsThe 7-year PSA relapse-free rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 94%, compared with 23% for patients with higher nPSA values (HR = 28.57; 95% CI: 12.04-66.66; p < 0.001). Multivariate analysis revealed that the nPSA value after radiotherapy was a significant independent predictor of biochemical failure, whereas pretreatment predictive values for worse biochemical control including higher level of initial PSA, Gleason score ≥ 8, positive biopsy core rate ≥ 67%, and T3b-T4, failed to reach independent predictor status. The 7-year cancer-specific survival rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 99%, compared with 82% for patients with higher nPSA values (HR = 32.25; 95% CI: 3.401-333.3; p = 0.002).ConclusionsA post-radiotherapy nPSA value of ≤ 0.02 ng/ml was associated with better long-term biochemical tumor control even if patients had pretreatment predictive values for worse control.

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Section: Discussioncontrasting

confidence: 55%

Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

Tsumura¹,

Satoh²,

Ishiyama

et al. 2016

jcb

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“…As in our results, Kamrava et al found that T stage, GS, and use of ADT were significantly associated with CSS on univariate analysis, but on multivariate analysis only GS and use of ADT were significantly associated CSS [30] It is expected that the grouping of the patients in risk groups for biochemical failure based on PSAi, GS and CS, to aggregate patients with adverse features in the intermediate and high risk, leading to worse CSS and BC for the two last one, what was confirmed in our analysis. This was also observed by Morris et al [31].…”

Section: Discussionsupporting

confidence: 84%

“…In our series, as in others, patients who received adjuvant ADT had significantly higher risk features suggesting patient selection bias for CSS in this group of patients, instead of a negative interaction between HDR and EBRT [31][32].…”

Section: Discussionsupporting

confidence: 79%

Long Term Results of High Dose Rate Brachytherapy and External Beam Radiotherapy for Local and Locally Advanced Prostate Cancer

2017

Cancer Stud Ther J

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“…While the Phoenix definition is the current standard to define biochemical recurrence (BCR) in patients with a rising PSA after primary RT [1], it represents a threshold value which has known limitations with respect to establishing disease recurrence and outcome [2]. Other biochemical metrics—such as nadir PSA, PSA velocity, and PSA doubling time—may provide additional prognostic information [3,4]; however, no biochemical threshold has been proven to localize recurrence and, with the exception of nadir PSA, all require longitudinal PSA measures. Given that local salvage treatment of recurrent CaP can result in cancer-specific survival of up to 70–83% at 10 yr [5], accurate localization of recurrence site is critically important for the optimal management of patients with a rising PSA after RT.…”

Section: Introductionmentioning

confidence: 99%

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

et al. 2017

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Background Management of recurrent prostate cancer (CaP) after radiotherapy (RT) is dependent on accurate localization of the site of recurrent disease. Objective To describe the anatomic patterns and clinical features associated with CaP recurrence following RT identified on advanced imaging. Design, setting, and participants Retrospective review of 184 patients with a rising prostate-specific antigen (PSA) after RT for CaP. Intervention C-11 choline positron emission tomography/computed tomography (CholPET). Outcome measurements and statistical analysis Recurrence patterns were classified as pelvic soft tissue only (as a surrogate for potentially salvageable disease) versus any extrapelvic disease, and clinical features were compared between patterns. Multivariable logistic regression was used to generate a predictive nomogram for extrapelvic recurrence. Discrimination was assessed with a c-index. Results and limitations Recurrence site was identified in 161 (87%) patients, with 95 (59%) sites histologically confirmed. Factors associated with the detection of recurrence included the difference between PSA nadir and PSA at CholPET (odds ratio: 1.30, p < 0.01) and National Comprehensive Cancer Network high-risk classification (odds ratio: 10.83, p = 0.03). One hundred (54.3%) patients recurred in the pelvic soft tissue only, while 61 (33%) had extrapelvic recurrence. Of 21 patients who underwent CholPET prior to meeting the Phoenix criteria of biochemical failure, 15 (71%) had recurrence identified on CholPET with 11 localized to the pelvis. On multivariable analysis, PSA at CholPET, time from RT, and National Comprehensive Cancer Network risk group were predictive of recurrence outside of the pelvis, and a nomogram was generated with a c-index of 0.79. Conclusions CholPET identified the site of recurrence in 87% of patients with a rising PSA after RT; most commonly within the pelvis in potentially salvageable locations. A predictive nomogram was generated, and pending external validation, this may aid in assessing the risk of disease beyond the pelvis. These findings underscore the importance of advanced imaging when considering management strategies for patients with a rising PSA following primary RT. Patient summary We identified anatomic patterns of recurrence in patients with a rising prostate-specific antigen after radiotherapy using C-11 choline positron emission tomography/computed tomography. Most recurrences were localized to the pelvis and we were able to generate a tool to aid in disease localization prior to evaluation with advanced imaging.

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Does prostate-specific antigen nadir predict longer-term outcomes of prostate cancer after neoadjuvant and adjuvant androgen deprivation therapy in conjunction with brachytherapy?

Cited by 6 publications

References 26 publications

Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

Long Term Results of High Dose Rate Brachytherapy and External Beam Radiotherapy for Local and Locally Advanced Prostate Cancer

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

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