Identification of Early Biochemical Recurrence Predictors in High-Risk Prostate Cancer Patients Treated with Carbon-Ion Radiotherapy and Androgen Deprivation Therapy

Abstract

The aim of this retrospective study was to identify clinical predictors of early biochemical recurrence (BCR) in patients with high-risk prostate cancer (PCa) treated with carbon-ion radiotherapy (CIRT) and androgen deprivation therapy (ADT). A total of 670 high-risk PCa patients treated with CIRT and ADT were included in the study. Early BCR was defined as recurrence occurring during adjuvant ADT after CIRT or within 2 years after completion of ADT. Univariate and multivariate analyses were performed to identify clinical predictors of early BCR. Patients were also classified according to the Systemic Therapy in Advancing or Metastatic Prostate cancer (STAMPEDE) PCa classification. Early BCR was observed in 5.4% of the patients. Multivariate analysis identified clinical T3b stage and ≥75% positive biopsy cores as clinical predictors of early BCR after CIRT and ADT. The STAMPEDE PCa classification was also significantly associated with early BCR based on univariate analysis. These predictors can help clinicians identify patients who are at risk of early BCR. In the future, combination therapy of ADT with abiraterone may be an option for high-risk PCa patients who are at risk of early BCR, based on the results of the STAMPEDE study.

Ultra-High Prostate-Specific Antigen Level: A Potential Very-High-Risk Factor for Localized High-Risk Prostate Cancer

“…Notably, the group with iPSA 20-50 ng/mL was not significantly different from the iPSA less than 20 ng/mL group, which may partly be a reason why the iPSA level could not incorporated as a VHR factor, because previous outcome analyses for VHR were conducted on results from surgical procedures which may exclude an uhPSA of ≥100 ng/mL. Accordingly, some authors have proposed that the uhPSA group is not a good candidate for local therapy and instead is a candidate for systemic therapy, partly because elevated PSA levels imply the existence of disease outside the prostate [16][17][18]. Our data partially concur with this opinion, because the uhPSA group showed increased PSA failure with more distant metastases, but not elevated local failure nor pelvic lymph node recurrence.…”