Rebecca Levin-Epstein1, Ryan R Cook1, J Karen Wong2, Richard G Stock3, D Jeffrey Demanes4, Sean P Collins5, Nima Aghdam5, Simeng Suy5, Constantine Mantz6, Alan J Katz7, Nicholas G Nickols8, Leszek Miszczyk9, Aleksandra Napieralska9, Agnieszka Namysl-Kaletka9, Nicholas D Prionas10, Hilary Bagshaw10, Mark K Buyyounouski10, Minsong Cao1, Brandon A Mahal11, David Shabsovich12, Audrey Dang13, Ye Yuan1, Matthew B Rettig14, Albert J Chang1, William C Jackson15, Daniel E Spratt15, Eric J Lehrer3, Nicholas G Zaorsky16, Patrick A Kupelian1, Michael L Steinberg1, Eric M Horwitz2, Naomi Y Jiang1, Amar U Kishan17. 1. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States. 2. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, United States. 3. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States. 4. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States; California Endocurietherapy Cancer Center, Oakland, United States. 5. Department of Radiation Medicine, Georgetown University Hospital, Washington, United States. 6. 21(st) Century Oncology, Inc., Fort Myers, United States. 7. FROS Radiation Oncology and Cyberknife Center, Flushing, United States. 8. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States; Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, United States. 9. Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland. 10. Department of Radiation Oncology, Stanford University Medical Center, Stanford, United States. 11. Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, United States. 12. David Geffen School of Medicine, University of California, Los Angeles, United States. 13. Department of Radiation Oncology, Tulane Medical Center, New Orleans, United States. 14. Department of Medical Oncology, University of California Los Angeles, Los Angeles, United States; Department of Medical Oncology, West Los Angeles Veterans Health Administration, Los Angeles, United States. 15. Department of Radiation Oncology, University of Michigan, Ann Arbor, United States. 16. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, United States. 17. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, United States. Electronic address: aukishan@mednet.ucla.edu.
Abstract
BACKGROUND AND PURPOSE: Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). METHODS AND MATERIALS: Retrospective PSA data were analyzed for 3502 men with low-risk (n = 2223; 63.5%), favorable intermediate-risk (n = 869; 24.8%), and unfavorable intermediate-risk (n = 410; 11.7%) PCa treated with SBRT (n = 1716; 49.0%), HDR-BT (n = 512; 14.6%), or LDR-BT (n = 1274; 36.4%) without upfront androgen deprivation therapy at 10 institutions from 1990 to 2017. We compared nadir PSA (nPSA), time to nPSA, achievement of nPSA <0.2 ng/mL and <0.5 ng/mL, rates of nPSA <0.4 ng/mL at 4 years, and BCRFS. RESULTS: Median follow-up was 72 months. Median nPSA and nPSA <0.2 ng/mL were stratified by risk group (interaction p ≤ 0.001). Median nPSA and time to nPSA were 0.2 ng/mL at 44 months after SBRT, 0.1-0.2 ng/mL at 37 months after HDR-BT, and 0.01-0.2 ng/mL at 51 months after LDR-BT (mean log nPSA p ≤ 0.009 for LDR-BT vs. SBRT or HDR-BT for low/favorable intermediate-risk). There were no differences in nPSA <0.4 ng/mL at 4 years (p ≥ 0.51). BCRFS was similar for all three modalities (p ≥ 0.27). Continued PSA decay beyond 4 years was predictive of durable biochemical control. CONCLUSION: LDR-BT led to lower nPSAs with longer continued decay compared to SBRT and HDR-BT, but no differences in BCRFS.
BACKGROUND AND PURPOSE: Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). METHODS AND MATERIALS: Retrospective PSA data were analyzed for 3502 men with low-risk (n = 2223; 63.5%), favorable intermediate-risk (n = 869; 24.8%), and unfavorable intermediate-risk (n = 410; 11.7%) PCa treated with SBRT (n = 1716; 49.0%), HDR-BT (n = 512; 14.6%), or LDR-BT (n = 1274; 36.4%) without upfront androgen deprivation therapy at 10 institutions from 1990 to 2017. We compared nadir PSA (nPSA), time to nPSA, achievement of nPSA <0.2 ng/mL and <0.5 ng/mL, rates of nPSA <0.4 ng/mL at 4 years, and BCRFS. RESULTS: Median follow-up was 72 months. Median nPSA and nPSA <0.2 ng/mL were stratified by risk group (interaction p ≤ 0.001). Median nPSA and time to nPSA were 0.2 ng/mL at 44 months after SBRT, 0.1-0.2 ng/mL at 37 months after HDR-BT, and 0.01-0.2 ng/mL at 51 months after LDR-BT (mean log nPSA p ≤ 0.009 for LDR-BT vs. SBRT or HDR-BT for low/favorable intermediate-risk). There were no differences in nPSA <0.4 ng/mL at 4 years (p ≥ 0.51). BCRFS was similar for all three modalities (p ≥ 0.27). Continued PSA decay beyond 4 years was predictive of durable biochemical control. CONCLUSION: LDR-BT led to lower nPSAs with longer continued decay compared to SBRT and HDR-BT, but no differences in BCRFS.
Authors: Wei Liu; Andrew Loblaw; David Laidley; Hatim Fakir; Lucas Mendez; Melanie Davidson; Zahra Kassam; Ting-Yim Lee; Aaron Ward; Jonathan Thiessen; Jane Bayani; John Conyngham; Laura Bailey; Joseph D Andrews; Glenn Bauman Journal: Front Oncol Date: 2022-04-13 Impact factor: 5.738
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