Prostate-specific antigen (PSA) bounce after dose-escalated external beam radiation therapy is an independent predictor of PSA recurrence, metastasis, and survival in prostate adenocarcinoma patients Journal Article


Authors: Romesser, P. B.; Pei, X.; Shi, W.; Zhang, Z.; Kollmeier, M.; McBride, S. M.; Zelefsky, M. J.
Article Title: Prostate-specific antigen (PSA) bounce after dose-escalated external beam radiation therapy is an independent predictor of PSA recurrence, metastasis, and survival in prostate adenocarcinoma patients
Abstract: Purpose To evaluate the difference in prostate-specific antigen (PSA) recurrence–free, distant metastasis–free, overall, and cancer-specific survival between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated external beam radiation therapy (DE-EBRT). Methods and Materials During 1990-2010, 1898 prostate adenocarcinoma patients were treated with DE-EBRT to ≥75 Gy with ≥5 years follow-up. Patients receiving neoadjuvant/concurrent androgen-deprivation therapy (n=1035) or with fewer than 4 PSA values obtained 6 months or more after post-EBRT completion (n=87) were excluded. The evaluable 776 patients were treated (median, 81.0 Gy). Prostate-specific antigen bounce was defined as a ≥0.2-ng/mL increase above the interval PSA nadir, followed by a decrease to nadir or below. Prostate-specific antigen relapse was defined as post–radiation therapy PSA nadir + 2 ng/mL. Median follow-up was 9.2 years (interquartile range, 6.9-11.3 years). Results One hundred twenty-three patients (15.9%) experienced PSA-B after DE-EBRT at a median of 24.6 months (interquartile range, 16.1-38.5 months). On multivariate analysis, younger age (P=.001), lower Gleason score (P=.0003), and higher radiation therapy dose (P=.0002) independently predicted PSA-B. Prostate-specific antigen bounce was independently associated with decreased risk for PSA relapse (hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.33-0.85; P=.008), distant metastatic disease (HR 0.34; 95% CI 0.12-0.94; P=.04), and all-cause mortality (HR 0.53; 95% CI 0.29-0.96; P=.04) on multivariate Cox analysis. Because all 50 prostate cancer–specific deaths in patients without PSA-B were in the non-bounce cohort, competing-risks analysis was not applicable. A nonparametric competing-risks test demonstrated that patients with PSA-B had superior cancer-specific survival compared with patients without PSA-B (P=.004). Conclusions Patients treated with dose-escalated radiation therapy for prostate adenocarcinoma who experience posttreatment PSA-B have improved PSA recurrence-free survival, distant metastasis–free survival, overall survival, and cancer-specific survival outcomes. © 2017 Elsevier Inc.
Keywords: cancer survival; aged; major clinical study; overall survival; cancer recurrence; cancer patient; cancer radiotherapy; follow up; prostate specific antigen; metastasis; radiotherapy; patient monitoring; pathology; retrospective study; risk assessment; gleason score; antigens; cancer specific survival; urology; prostate adenocarcinoma; external beam radiotherapy; patient treatment; multi variate analysis; multivariant analysis; androgen deprivation therapy; risk analysis; diseases; cause specific survival; recurrence free survival; independent predictors; external beam radiation therapy; clinical outcome; recurrence-free survival; distant metastasis free survival; radiation dose escalation; human; male; priority journal; article; competing risks analysis; all cause mortality; prostate adenocarcinomas
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 100
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2018-01-01
Start Page: 59
End Page: 67
Language: English
DOI: 10.1016/j.ijrobp.2017.09.003
PROVIDER: scopus
PUBMED: 29254782
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    237 Zhang
  2. Michael J Zelefsky
    611 Zelefsky
  3. Weiji Shi
    110 Shi
  4. Marisa A Kollmeier
    144 Kollmeier
  5. Xin Pei
    98 Pei
  6. Sean Matthew McBride
    108 McBride