Audrey Tetreault-Laflamme1, Juanita Crook2, Jeremy Hamm3, Tom Pickles4, Mira Keyes4, Michael McKenzie4, Howard Pai5, Francois Bachand6, James Morris4. 1. Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. 2. British Columbia Cancer Agency, Kelowna, British Columbia, Canada. Electronic address: jcrook@bccancer.bc.ca. 3. Cancer Surveillance and Outcomes, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. 4. British Columbia Cancer Agency, Vancouver, British Columbia, Canada. 5. British Columbia Cancer Agency, Victoria, British Columbia, Canada. 6. British Columbia Cancer Agency, Kelowna, British Columbia, Canada.
Abstract
PURPOSE: Defining biochemical failure as nadir + 2 may overestimate cure after radiotherapy. We assessed long-term prostate specific antigen stability after low dose rate prostate brachytherapy and predictors of biochemical failure when prostate specific antigen was slowly rising below the nadir + 2 ng/ml threshold. MATERIALS AND METHODS: A total of 2,339 patients with low or intermediate risk prostate cancer received 125iodine brachytherapy from 1998 to 2010 with a minimum 3-year followup. In addition, 49.7% of the patients received 6 months of androgen deprivation. Clinical, dosimetric and prostate specific antigen data were retrieved from a prospective database. Biochemical results were classified as stable or rising prostate specific antigen (0.2 ng/ml or greater and increased 0.1 ng/ml or greater during the preceding 2 years), or biochemical failure (defined as nadir + 2). Multivariate analysis was done to identify predictors of failure used to create logistic regression models. RESULTS: At a median followup of 89 months (range 37 to 199) prostate specific antigen was stable (nadir 0.03 ng/ml and at 60 months 0.04 ng/ml) in 2,004 patients (86%) and rising (nadir 0.16 ng/ml and at 60 months 0.29 ng/ml) in 145 (6%) while biochemical failure (nadir 0.51 ng/ml, p <0.001) was noted in 190 (8%). When there was no prior androgen deprivation therapy, the prostate specific antigen nadir and prostate specific antigen at 60 months were the strongest predictors of failure (OR 20.6 and 18.3, respectively, each p <0.0001). The logistic regression model had 85% sensitivity and 98% specificity, and predicted failure in 8 of 82 men (9.8%). A second model was created for the group with androgen deprivation therapy and rising prostate specific antigen using the predictive factors prostate specific antigen at 60 months (OR 53.9, p <0.0001) and T stage (OR 0.25, p = 0.0008). This model predicted biochemical failure in 30 of 56 men (54%) with 85% sensitivity and 93% specificity. The 2 predictive models yield an anticipated 90% cure rate in the entire cohort. CONCLUSIONS: Brachytherapy is highly curative with stable prostate specific antigen at a surgical ablation level in 86% of patients. Rising prostate specific antigen is rare at a 6% incidence and often innocuous.
PURPOSE: Defining biochemical failure as nadir + 2 may overestimate cure after radiotherapy. We assessed long-term prostate specific antigen stability after low dose rate prostate brachytherapy and predictors of biochemical failure when prostate specific antigen was slowly rising below the nadir + 2 ng/ml threshold. MATERIALS AND METHODS: A total of 2,339 patients with low or intermediate risk prostate cancer received 125iodine brachytherapy from 1998 to 2010 with a minimum 3-year followup. In addition, 49.7% of the patients received 6 months of androgen deprivation. Clinical, dosimetric and prostate specific antigen data were retrieved from a prospective database. Biochemical results were classified as stable or rising prostate specific antigen (0.2 ng/ml or greater and increased 0.1 ng/ml or greater during the preceding 2 years), or biochemical failure (defined as nadir + 2). Multivariate analysis was done to identify predictors of failure used to create logistic regression models. RESULTS: At a median followup of 89 months (range 37 to 199) prostate specific antigen was stable (nadir 0.03 ng/ml and at 60 months 0.04 ng/ml) in 2,004 patients (86%) and rising (nadir 0.16 ng/ml and at 60 months 0.29 ng/ml) in 145 (6%) while biochemical failure (nadir 0.51 ng/ml, p <0.001) was noted in 190 (8%). When there was no prior androgen deprivation therapy, the prostate specific antigen nadir and prostate specific antigen at 60 months were the strongest predictors of failure (OR 20.6 and 18.3, respectively, each p <0.0001). The logistic regression model had 85% sensitivity and 98% specificity, and predicted failure in 8 of 82 men (9.8%). A second model was created for the group with androgen deprivation therapy and rising prostate specific antigen using the predictive factors prostate specific antigen at 60 months (OR 53.9, p <0.0001) and T stage (OR 0.25, p = 0.0008). This model predicted biochemical failure in 30 of 56 men (54%) with 85% sensitivity and 93% specificity. The 2 predictive models yield an anticipated 90% cure rate in the entire cohort. CONCLUSIONS: Brachytherapy is highly curative with stable prostate specific antigen at a surgical ablation level in 86% of patients. Rising prostate specific antigen is rare at a 6% incidence and often innocuous.
Authors: Kilian E Salerno; Baris Turkbey; Liza Lindenberg; Esther Mena; Erica E Schott; Alexandra K Brennan; Soumyajit Roy; Uma Shankavaram; Krishnan Patel; Theresa Cooley-Zgela; Yolanda McKinney; Bradford J Wood; Peter A Pinto; Peter Choyke; Deborah E Citrin Journal: Brachytherapy Date: 2022-05-04 Impact factor: 2.441
Authors: Juanita M Crook; Chad Tang; Howard Thames; Pierre Blanchard; Jeremiah Sanders; Jay Ciezki; Mira Keyes; W James Morris; Gregory Merrick; Charles Catton; Hamid Raziee; Richard Stock; Frank Sullivan; Mitch Anscher; Jeremy Millar; Steven Frank Journal: Radiother Oncol Date: 2020-04-27 Impact factor: 6.280
Authors: Jose Luis Guinot; Juan Casanova; Victor Gonzalez-Perez; Miguel Angel Santos; Victor De Los Dolores; Maria Isabel Tortajada; Carmen Guardino; Vicente Crispin; Jose Rubio-Briones; Leoncio Arribas Journal: J Contemp Brachytherapy Date: 2022-05-12