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
  1. Michael J Zelefsky
    615 Zelefsky
  2. Daniel R Gomez
    21 Gomez
  3. Marisa A Kollmeier
    144 Kollmeier
  4. Xin Pei
    98 Pei