PURPOSE: To investigate a potential correlation between the achievement of a cut-off of nadir PSA (nPSA) after brachytherapy (BRT) with biochemical Disease-Free Survival (bDFS) and to define the rate of post-BRT PSA bounces. METHODS: Retrospective analysis was carried out in 105 consecutive patients affected with early-stage prostate adenocarcinoma who underwent (125)I BRT. Only patients with a minimum follow-up ≥24 months were included. Biochemical DFS was chosen as primary endpoint. RESULTS: At a median follow-up of 51.2 months, 3- and 5-year bDFS were 96.8 and 91.2%, respectively. Median time to biochemical failure (BF) was 54 months. By Kaplan-Meier analysis, patients achieving nPSA ≤ 0.35 ng/mL had significantly higher bDFS (3- and 5-year bDFS: 100 and 98.5 % vs. 83.3 and 66.7 %, respectively; p = 0.001). Bounce PSA occurred in 28.6% of patients, at a median time of 21.5 months. No BFs were observed in the bounce group. Achieving a nPSA ≤ 0.35 ng/mL was the only factor independently associated with long-term bDFS on both univariate (p = 0.000) and multivariate analysis (HR 3.82; p = 0.003). CONCLUSIONS: Patients attaining a nPSA ≤ 0.35 ng/mL are significantly more likely to experience long-term freedom-from-biochemical failure. Bounce PSA occurs in approximately 30% of patients. Time to onset of PSA increase seems the most reliable feature to distinguish bounce from failure. Tailored follow-up strategies are needed for patients at higher risk of recurrence, and caution is advised in interpreting an early increase in PSA levels in the first 24-30 months after BRT.
PURPOSE: To investigate a potential correlation between the achievement of a cut-off of nadir PSA (nPSA) after brachytherapy (BRT) with biochemical Disease-Free Survival (bDFS) and to define the rate of post-BRT PSA bounces. METHODS: Retrospective analysis was carried out in 105 consecutive patients affected with early-stage prostate adenocarcinoma who underwent (125)I BRT. Only patients with a minimum follow-up ≥24 months were included. Biochemical DFS was chosen as primary endpoint. RESULTS: At a median follow-up of 51.2 months, 3- and 5-year bDFS were 96.8 and 91.2%, respectively. Median time to biochemical failure (BF) was 54 months. By Kaplan-Meier analysis, patients achieving nPSA ≤ 0.35 ng/mL had significantly higher bDFS (3- and 5-year bDFS: 100 and 98.5 % vs. 83.3 and 66.7 %, respectively; p = 0.001). Bounce PSA occurred in 28.6% of patients, at a median time of 21.5 months. No BFs were observed in the bounce group. Achieving a nPSA ≤ 0.35 ng/mL was the only factor independently associated with long-term bDFS on both univariate (p = 0.000) and multivariate analysis (HR 3.82; p = 0.003). CONCLUSIONS:Patients attaining a nPSA ≤ 0.35 ng/mL are significantly more likely to experience long-term freedom-from-biochemical failure. Bounce PSA occurs in approximately 30% of patients. Time to onset of PSA increase seems the most reliable feature to distinguish bounce from failure. Tailored follow-up strategies are needed for patients at higher risk of recurrence, and caution is advised in interpreting an early increase in PSA levels in the first 24-30 months after BRT.
Authors: Michael E Ray; Howard D Thames; Larry B Levy; Eric M Horwitz; Patrick A Kupelian; Alvaro A Martinez; Jeff M Michalski; Thomas M Pisansky; William U Shipley; Michael J Zelefsky; Anthony L Zietman; Deborah A Kuban Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-29 Impact factor: 7.038
Authors: Mack Roach; Gerald Hanks; Howard Thames; Paul Schellhammer; William U Shipley; Gerald H Sokol; Howard Sandler Journal: Int J Radiat Oncol Biol Phys Date: 2006-07-15 Impact factor: 7.038
Authors: Jay P Ciezki; Chandana A Reddy; Jorge Garcia; Kenneth Angermeier; James Ulchaker; Arul Mahadevan; Nabil Chehade; Andrew Altman; Eric A Klein Journal: Int J Radiat Oncol Biol Phys Date: 2005-10-06 Impact factor: 7.038
Authors: Daniel R Zwahlen; Ryan Smith; Nick Andrianopoulos; Bronwyn Matheson; Peter Royce; Jeremy L Millar Journal: Int J Radiat Oncol Biol Phys Date: 2010-04-06 Impact factor: 7.038
Authors: F A Critz; W H Williams; C T Holladay; A K Levinson; J B Benton; D A Holladay; F J Schnell; L S Maxa; P D Shrake Journal: Urology Date: 1999-12 Impact factor: 2.649
Authors: Darren M Mitchell; Ric Swindell; Tony Elliott; James P Wylie; Cathy M Taylor; John P Logue Journal: Radiother Oncol Date: 2008-04-29 Impact factor: 6.280
Authors: Frank A Critz; W Hamilton Williams; A Keith Levinson; James B Benton; Frederick J Schnell; Clinton T Holladay; Philip D Shrake Journal: J Urol Date: 2003-11 Impact factor: 7.450
Authors: Daniel S Engeler; Christoph Schwab; Armin F Thöni; Werner Hochreiter; Ladislav Prikler; Stefan Suter; Patrick Stucki; Johann Schiefer; Ludwig Plasswilm; Hans-Peter Schmid; Paul Martin Putora Journal: Strahlenther Onkol Date: 2015-06-23 Impact factor: 3.621