Biochemical response to androgen deprivation therapy before external beam radiation therapy predicts long-term prostate cancer survival outcomes Journal Article
| Authors: | Zelefsky, M. J.; Gomez, D. R.; Polkinghorn, W. R.; Pei, X.; Kollmeier, M. |
| Article Title: | Biochemical response to androgen deprivation therapy before external beam radiation therapy predicts long-term prostate cancer survival outcomes |
| Abstract: | To determine whether the response to neoadjuvant androgen deprivation therapy (ADT) defined by a decline in prostate-specific antigen (PSA) to nadir values is associated with improved survival outcomes after external beam radiation therapy (EBRT) for prostate cancer. One thousand forty-five patients with localized prostate cancer were treated with definitive EBRT in conjunction with neoadjuvant and concurrent ADT. A 6-month course of ADT was used (3 months during the neoadjuvant phase and 2 to 3 months concurrently with EBRT). The median EBRT prescription dose was 81 Gy using a conformal-based technique. The median follow-up time was 8.5 years. The 10-year PSA relapse-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 74.3%, compared with 57.7% for patients with higher PSA nadir values (P<.001). The 10-year distant metastases-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 86.1%, compared with 78.6% for patients with higher PSA nadir values (P=.004). In a competing-risk analysis, prostate cancer-related deaths were also significantly reduced among patients with pre-radiation therapy PSA nadirs of <0.3 ng/mL compared with higher values (7.8% compared with 13.7%; P=.009). Multivariable analysis demonstrated that the pre-EBRT PSA nadir value was a significant predictor of long-term biochemical tumor control, distant metastases-free survival, and cause-specific survival outcomes. Pre-radiation therapy nadir PSA values of ≤0.3 ng/mL after neoadjuvant ADT were associated with improved long-term biochemical tumor control, reduction in distant metastases, and prostate cancer-related death. Patients with higher nadir values may require alternative adjuvant therapies to improve outcomes. Copyright © 2013 Elsevier Inc. All rights reserved. |
| Keywords: | treatment outcome; aged; disease-free survival; middle aged; retrospective studies; mortality; antineoplastic agents; adjuvant therapy; disease free survival; radiation dose; neoadjuvant therapy; methodology; antineoplastic agent; prostate specific antigen; proportional hazards models; pathology; retrospective study; gonadorelin; prostate-specific antigen; prostatic neoplasms; blood; proportional hazards model; prostate tumor; androgen antagonists; radiotherapy, conformal; antiandrogen; bicalutamide; computer assisted radiotherapy; gonadotropin-releasing hormone; anilides; nitriles; tosyl compounds; nitrile; anilide; toluenesulfonic acid derivative; radiation tolerance |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 86 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2013-07-01 |
| Start Page: | 529 |
| End Page: | 533 |
| Language: | English |
| PUBMED: | 23523323 |
| PROVIDER: | scopus |
| DOI: | 10.1016/j.ijrobp.2013.02.004 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2013" - "Source: Scopus" |
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MSK Authors
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615Zelefsky -
21Gomez -
144Kollmeier -
24Polkinghorn -
98
Pei
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