Nadir prostate-specific antigen within 12 months after radiotherapy predicts biochemical and distant failure Journal Article


Authors: Ray, M. E.; Levy, L. B.; Horwitz, E. M.; Kupelian, P. A.; Martinez, A. A.; Michalski, J. M.; Pisansky, T. M.; Zelefsky, M. J.; Zietman, A. L.; Kuban, D. A.
Article Title: Nadir prostate-specific antigen within 12 months after radiotherapy predicts biochemical and distant failure
Abstract: Objectives: To determine whether nadir prostate-specific antigen (PSA) levels within 12 months (nadir PSA12) after completion of radiotherapy (RT) can be used as an early marker of recurrence risk. Methods: A total of 4839 patients were treated with RT and without hormonal therapy from 1986 to 1995 for Stage T1-T2 prostate cancer at nine institutions. Of these 4839 patients, 4833, with a median follow-up of 6.3 years, met the criteria for analysis. The study endpoints included freedom from PSA failure, initiation of androgen deprivation, or documented local or distant failure (PSA-DFS); freedom from clinically apparent distant metastasis (DMFS); and overall survival (OS). Results: Patients with a nadir PSA12 of 2.0 ng/mL or less had an 8-year PSA-DFS, DMFS, and OS rate of 55%, 95%, and 73%, respectively, compared with 40%, 88%, and 69%, respectively, for patients with a nadir PSA12 of more than 2.0 ng/mL. Multivariate analysis confirmed that a nadir PSA12 of greater than 2 ng/mL was an independent predictor of PSA-DFS, DMFS, and OS. Classification and regression tree analysis identified the nadir PSA12 levels after RT associated with PSA-DFS, DMFS, and OS. Nadir PSA12, combined with the pretreatment PSA level, identified patients at particularly high risk of distant metastasis. Conclusions: The results of this large, multi-institutional study have demonstrated that nadir PSA12 is predictive of clinical outcomes for patients with localized prostate cancer after RT. A high pretreatment PSA level and high nadir PSA12 will identify patients at particularly high risk who might benefit from early adjuvant therapy. © 2006 Elsevier Inc. All rights reserved.
Keywords: cancer survival; controlled study; treatment outcome; treatment failure; retrospective studies; major clinical study; cancer localization; cancer recurrence; cancer risk; cancer radiotherapy; radiation dose; cancer staging; follow up; follow-up studies; neoplasm staging; adenocarcinoma; prostate specific antigen; neoplasm recurrence, local; tumor markers, biological; risk factors; biopsy; high risk patient; patient identification; time factors; prostate cancer; prostate-specific antigen; prostatic neoplasms; multivariate analysis; hormonal therapy; external beam radiotherapy; antiandrogen; regression analysis; biochemistry; androgen deprivation therapy
Journal Title: Urology
Volume: 68
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2006-12-01
Start Page: 1257
End Page: 1262
Language: English
DOI: 10.1016/j.urology.2006.08.1056
PUBMED: 17141830
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 10" - "Export Date: 4 June 2012" - "CODEN: URGYA" - "Source: Scopus"
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  1. Michael J Zelefsky
    754 Zelefsky