Alex K Bryant1, Anthony V D'Amico2,3, Paul L Nguyen2,3, John P Einck1, Christopher J Kane4, Rana R McKay5, Daniel R Simpson1,6, Arno J Mundt1, James D Murphy1,6, Brent S Rose1,6. 1. Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, California. 2. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 4. Department of Urology, University of California at San Diego, San Diego, California. 5. Division of Hematology-Oncology, Department of Internal Medicine, University of California at San Diego, San Diego, California. 6. Clinical and Translational Research Institute, University of California at San Diego, San Diego, California.
Abstract
BACKGROUND: Prostate-specific antigen (PSA) measurement after definitive radiotherapy (RT) and androgen deprivation therapy for localized prostate cancer has been proposed as an early prognostic biomarker. In the current study, the authors investigated the association between 3-month post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS). METHODS: A total of 5783 patients with intermediate-risk or high-risk localized prostate cancer who were diagnosed between 2000 and 2015 and treated with RT and androgen deprivation therapy were identified from Veterans Affairs data. Patients were divided into groups based on 3-month post-RT PSA values: <0.10 ng/mL, 0.10 to 0.49 ng/mL, and ≥0.50 ng/mL. The effect of the 3-month PSA group on bPFS, PCSS, and OS was evaluated in multivariable Cox models adjusting for potential confounders. RESULTS: There were 2651 patients with intermediate-risk and 3132 with high-risk disease; approximately 11% had a 3-month PSA level of ≥0.50 ng/mL. A higher 3-month PSA level was found to be strongly associated with each outcome; compared with patients in the group with a 3-month PSA value <0.10 ng/mL, the authors noted greater hazards for the patients with a 3-month PSA value ≥0.50 ng/mL (hazard ratio for bPFS: 5.23; PCSS: 3.97; and OS: 1.50 [P<.001 for all]) and the patients with a 3-month PSA value of 0.10 to 0.49 ng/mL (hazard ratio for bPFS: 2.41 [P<.001]; PCSS: 2.29 [P<.001]; and OS: 1.21 [P = .003]). When analyzed separately, the 3-month PSA level was found to be predictive of OS in the high-risk group (P<.001) but not the intermediate-risk group (P = .21). CONCLUSIONS: The 3-month post-RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate-risk and high-risk prostate cancer, particularly those with high-risk disease. The 3-month PSA measurement may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials. Cancer 2018;124:2939-47.
BACKGROUND:Prostate-specific antigen (PSA) measurement after definitive radiotherapy (RT) and androgen deprivation therapy for localized prostate cancer has been proposed as an early prognostic biomarker. In the current study, the authors investigated the association between 3-month post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS). METHODS: A total of 5783 patients with intermediate-risk or high-risk localized prostate cancer who were diagnosed between 2000 and 2015 and treated with RT and androgen deprivation therapy were identified from Veterans Affairs data. Patients were divided into groups based on 3-month post-RT PSA values: <0.10 ng/mL, 0.10 to 0.49 ng/mL, and ≥0.50 ng/mL. The effect of the 3-month PSA group on bPFS, PCSS, and OS was evaluated in multivariable Cox models adjusting for potential confounders. RESULTS: There were 2651 patients with intermediate-risk and 3132 with high-risk disease; approximately 11% had a 3-month PSA level of ≥0.50 ng/mL. A higher 3-month PSA level was found to be strongly associated with each outcome; compared with patients in the group with a 3-month PSA value <0.10 ng/mL, the authors noted greater hazards for the patients with a 3-month PSA value ≥0.50 ng/mL (hazard ratio for bPFS: 5.23; PCSS: 3.97; and OS: 1.50 [P<.001 for all]) and the patients with a 3-month PSA value of 0.10 to 0.49 ng/mL (hazard ratio for bPFS: 2.41 [P<.001]; PCSS: 2.29 [P<.001]; and OS: 1.21 [P = .003]). When analyzed separately, the 3-month PSA level was found to be predictive of OS in the high-risk group (P<.001) but not the intermediate-risk group (P = .21). CONCLUSIONS: The 3-month post-RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate-risk and high-risk prostate cancer, particularly those with high-risk disease. The 3-month PSA measurement may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials. Cancer 2018;124:2939-47.
Authors: Alex K Bryant; Tyler J Nelson; Rana R McKay; A Karim Kader; J Kellogg Parsons; John P Einck; Christopher J Kane; Ajay P Sandhu; Arno J Mundt; James D Murphy; Brent S Rose Journal: BJUI Compass Date: 2021-12-27
Authors: Juho Jasu; Teemu Tolonen; Emmanuel S Antonarakis; Himisha Beltran; Susan Halabi; Mario A Eisenberger; Michael A Carducci; Yohann Loriot; Kim Van der Eecken; Martijn Lolkema; Charles J Ryan; Sinja Taavitsainen; Silke Gillessen; Gunilla Högnäs; Timo Talvitie; Robert J Taylor; Antti Koskenalho; Piet Ost; Teemu J Murtola; Irina Rinta-Kiikka; Teuvo Tammela; Anssi Auvinen; Paula Kujala; Thomas J Smith; Pirkko-Liisa Kellokumpu-Lehtinen; William B Isaacs; Matti Nykter; Juha Kesseli; G Steven Bova Journal: Eur Urol Open Sci Date: 2021-07-02