The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy Journal Article

Authors: Zumsteg, Z. S.; Spratt, D. E.; Romesser, P. B.; Pei, X.; Zhang, Z. G.; Polkinghorn, W.; McBride, S.; Kollmeier, M.; Yamada, Y.; Zelefsky, M. J.
Article Title: The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy
Abstract: Background: The management of biochemical failure (BF) following external beam radiotherapy (EBRT) for prostate cancer is controversial, due to both the heterogeneous disease course following a BF and a lack of clinical trials in this setting. Objective: We sought to characterize the natural history and predictors of outcome for patients experiencing BF in a large cohort of men with localized prostate cancer undergoing definitive dose-escalated EBRT. Design, setting, and participants: This retrospective analysis included 2694 patients with localized prostate cancer treated with EBRT at a large academic center. Of these, 609 experienced BF, defined as prostate-specific antigen (PSA) nadir + 2 ng/ml. The median follow-up was 83 mo for all patients and 122 mo for BF patients. Intervention(s): All patients received EBRT at doses of 75.6-86.4 Gy. Outcome measurements and statistical analysis: The primary objective of this study was to determine predictors of distant progression at the time of BF. Cox proportional hazards models were used in univariate and multivariate analyses of distant metastases (DM), and a competing risks method was used to analyze prostate cancer-specific mortality (PCSM). Results and limitations: From the date of BF, the median times to DM and PCSM mortality were 5.4 yr and 10.5 yr, respectively. Shorter posttreatment PSA doubling time, a higher initial clinical tumor stage, a higher pretreatment Gleason score, and a shorter interval from the end of radiotherapy to BF were independent predictors for clinical progression following BF. Patients with two of these risk factors had a significantly higher incidence of DM and PCSM following BF than those with zero or one risk factor. The main limitations of this study are its retrospective nature and heterogeneous salvage interventions. Conclusions: Clinical and pathologic factors can help identify patients at high risk of clinical progression following BF. Patient summary: In this report, we look at predictors of outcome for patients with prostate cancer recurrence, as determined by prostate-specific antigen (PSA) levels, following radiation treatment. We found that the approximate median times to distant metastasis and death from prostate cancer for patients in this situation were 5 yr and 10 yr, respectively. Furthermore, we found that patients with a rapid increase in PSA levels following treatment, a short time to PSA recurrence, invasion of extraprostatic organs, or a high Gleason score had worse outcomes. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords: survival; mortality; statistics; radiotherapy; recurrence; prostate cancer; biochemical failure; brachytherapy; radical prostatectomy; external beam radiotherapy; salvage; failure; men; modulated radiation-therapy
Journal Title: European Urology
Volume: 67
Issue: 6
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2015-06-01
Start Page: 1009
End Page: 1016
Language: English
ACCESSION: WOS:000353808900012
DOI: 10.1016/j.eururo.2014.09.028
PUBMED: 25308970
PMCID: PMC5002994
Notes: Article -- Source: Wos
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MSK Authors
  1. Zhigang Zhang
    237 Zhang
  2. Michael J Zelefsky
    610 Zelefsky
  3. Yoshiya Yamada
    353 Yamada
  4. Marisa A Kollmeier
    144 Kollmeier
  5. Zachary Stephan Zumsteg
    34 Zumsteg
  6. Daniel Eidelberg Spratt
    83 Spratt
  7. Xin Pei
    98 Pei
  8. Sean Matthew McBride
    108 McBride