Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer Journal Article


Authors: Zelefsky, M. J.; Ben-Porat, L.; Scher, H. I.; Chan, H. M.; Fearn, P. A.; Fuks, Z. Y.; Leibel, S. A.; Venkatraman, E. S.
Article Title: Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer
Abstract: Purpose: To identify predictors of distant metastases (DM) among patients who develop an isolated prostate-specific antigen (PSA) relapse after definitive external-beam radiotherapy for clinically localized prostate cancer. Materials and Methods: A total of 1,650 patients with clinical stage T1 to T3 prostate cancer were treated with high-dose three-dimensional conformal radiotherapy. Of these, 381 patients subsequently developed three consecutive increasing PSA values and were characterized as having a biochemical relapse. The median follow-up time was 92 months from the completion of radiotherapy. Results: The 5-year incidence of DM after an established PSA relapse was 29%. In a multivariate analysis, PSA doubling time (PSA-DT; P < .001), the clinical T stage (P < .001), and Gleason score (P = .007) were independent variables predicting for DM after established biochemical failure. The PSA-DT for favorable-, intermediate-, and unfavorable-risk patients who developed a biochemical failure was 20.0, 13.2, and 8.2 months, respectively (P < .001). The 3-year incidence of DM for patients with PSA-DT of 0 to 3, 3 to 6, 6 to 12, and more than 12 months was 49%, 41%, 20%, and 7%, respectively (P < .001). Patients with PSA-DT of 0 to 3 and 3 to 6 months demonstrated a 7.0 and 6.6 increased hazard of developing DM or death, respectively, compared with patients with a DT more than 12 months. Conclusion: In addition to clinical stage and Gleason score, PSA-DT was a powerful predictor of DM among patients who develop an isolated PSA relapse after external-beam radiotherapy for prostate cancer. Patients who develop biochemical relapse with PSA-DT ≤ 6 months should be considered for systemic therapy or experimental protocols because of the high propensity for rapid DM development. © 2005 by American Society of Clinical Oncology.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; cancer risk; cancer radiotherapy; cancer staging; outcome assessment; follow up; cancer incidence; neoplasm staging; prostate specific antigen; metastasis; pathology; retrospective study; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; blood; prostate tumor; neoplasm metastasis; cancer relapse; radiotherapy, conformal; external beam radiotherapy; computer assisted radiotherapy
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 4
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-02-01
Start Page: 826
End Page: 831
Language: English
DOI: 10.1200/jco.2005.02.111
PUBMED: 15681527
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 49" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    285 Seshan
  2. Zvi Fuks
    296 Fuks
  3. Michael J Zelefsky
    615 Zelefsky
  4. Steven A Leibel
    215 Leibel
  5. Howard Scher
    817 Scher
  6. Paul A Fearn
    58 Fearn
  7. Heather May-Hing Chan
    17 Chan