Early biochemical predictors of survival in intermediate and high-risk prostate cancer treated with radiation and androgen deprivation therapy Journal Article


Authors: Patel, M. A.; Kollmeier, M.; McBride, S.; Gorovets, D.; Varghese, M.; Chan, L.; Knezevic, A.; Zhang, Z.; Zelefsky, M. J.
Article Title: Early biochemical predictors of survival in intermediate and high-risk prostate cancer treated with radiation and androgen deprivation therapy
Abstract: Background and purpose: To identify early biochemical predictors of survival in intermediate- and high-risk prostate cancer patients with a pre-treatment PSA <20 ng/mL following definitive radiation therapy (RT) and androgen deprivation therapy (ADT). Materials and methods: A single-institution review of 2566 intermediate and high-risk prostate cancer patients treated with definitive RT and neoadjuvant and concurrent ADT from 1990 to 2012 was performed. The first prostate-specific antigen (PSA) value within three months of ADT initiation (post-ADT PSA) and the first PSA within three months after RT completion (post-RT PSA) were recorded. 1275 had baseline PSA <20 ng/mL and either post-ADT or post-RT PSA available. Median follow-up was 7.6 years. The relationship between post-treatment PSA kinetics and biochemical relapse (BR), distant metastasis (DM), prostate cancer specific death (PCSD) and overall survival (OS) was modeled using Cox regression univariate and multivariate analysis (MVA). Results: MVA demonstrated a strong association between a post-RT PSA ≥0.09 ng/mL and a significantly higher risk of BR (HR: 1.93; 95% CI: 1.45–2.57; p < 0.001), DM (HR: 2.97; 95% CI: 2.01–4.39; p < 0.001), PCSD (HR: 2.99; 95% CI: 1.73–5.15; p < 0.001) and OS (HR: 1.49; 95% CI: 1.18–1.86; p < 0.001). Post-RT PSA reduction of ≥95% relative to the baseline PSA was associated with a significantly lower risk of BR (MVA HR: 0.58; 95% CI: 0.41–0.83; p = 0.003) and DM (MVA HR: 0.47; 95% CI: 0.30–0.76; p = 0.002). Conclusion: A PSA value ≥0.09 ng/mL early after RT completion is associated with significantly worse prognosis across all clinical outcomes, and an early PSA reduction of ≥95% is associated with reduced risk of BR and DM. These findings may identify patients who require early aggressive systemic management for high-risk disease. © 2019
Keywords: survival analysis; prostate specific antigen; prostate cancer; radiation therapy; androgen receptor antagonists
Journal Title: Radiotherapy and Oncology
Volume: 140
ISSN: 0167-8140
Publisher: Elsevier Inc.  
Date Published: 2019-11-01
Start Page: 34
End Page: 40
Language: English
DOI: 10.1016/j.radonc.2019.04.003
PROVIDER: scopus
PUBMED: 31177042
DOI/URL:
Notes: Source: Scopus
Altmetric Score
MSK Authors
  1. Zhigang Zhang
    258 Zhang
  2. Michael J Zelefsky
    655 Zelefsky
  3. Marisa A Kollmeier
    158 Kollmeier
  4. Sean Matthew McBride
    134 McBride
  5. Mira Patel
    5 Patel
  6. Luanna Lu Chan
    1 Chan