PSA Outcome Research Articles

Is body mass index associated with pathological outcomes after radical prostatectomy in Korean men?

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Today, controversies continue with regards to the potential impact of obesity or increased body mass index (BMI) on actual pathological features of prostate cancer and/or clinical outcome after radical prostatectomy (RP). Moreover, a paucity of relevant data exist in the literature regarding Asian or Korean men. For the first time to our knowledge, the study demonstrated that although higher BMI was significantly associated with extracapsular extension of tumour, BMI did not significantly enhance ability to preoperatively predict extracapsular extension of tumour and was not significantly associated with PSA outcome as well as other objective pathological outcomes in Korean men undergoing RP, who are generally leaner than Western counterparts. • To investigate the impact of increased body mass index (BMI) on pathological features after radical prostatectomy (RP) in Korean patients. • We reviewed the records of 1000 Korean patients who underwent RP for prostate cancer and assessed the differences in pathological outcomes and biochemical recurrence-free survival after RP according to BMI of subjects via univariate and multivariate analyses. • A multivariate logistics regression model, the performance of which was analysed from a receiver operator characteristics curve, was applied to assess the predictive capacity of variables shown to be significant predictors of adverse pathological outcome. • Among our subjects, only 17 (1.7%) men had BMI ≥30 kg/m(2). After adjusting for various clinical variables, BMI (highest quartile vs others) was shown to be significantly associated with extracapsular extension of tumour (P= 0.014) and positive surgical margin (P= 0.019), but not with high pathological Gleason score (P= 0.912) and seminal vesicle invasion (P= 0.191). • Meanwhile, the addition of BMI to a multivariate model devised for preoperatively predicting extracapsular extension of tumour did not significantly increase predictive accuracy of the model (P= 0.319). On multivariate analysis, BMI was not shown to be a significant predictor of biochemical recurrence-free survival (P= 0.201). • Although higher BMI was significantly associated with extracapsular extension of tumour, BMI did not significantly enhance the ability to preoperatively predict extracapsular extension of tumour and was not significantly associated with PSA outcome or with other objective pathological outcomes in Korean men undergoing RP, who are generally leaner than their western counterparts.

Disease Burden Predicts for Favorable Post Salvage Cryoablation PSA

We wanted to identify prognostic factors for favorable biochemical outcome (prostate specific antigen [PSA] < 0.6 ng/mL) after salvage prostate cryoablation. The charts from 58 salvage cryoablation patients treated at Cleveland Clinic from 2004 through July 2009 were reviewed. Patient age, race, PSA at diagnosis, Gleason score, risk category, prostate volume, clinical T stage, number of cores positive, percent of cores involved with disease, ratios of number of cores positive to total cores biopsied and number of cores positive to prostate gland volume, and initial PSA results were studied. Initial PSA levels measured at 6-12 weeks post treatment of < 0.6 ng/mL were used as the criterion for a favorable outcome based on previously published data. Thirty-one percent of patients had unfavorable postoperative PSA levels. The number of positive biopsy cores (P = .012), ratio of positive cores to prostate volume (mL) (P = .004), and, marginally, the percentage of cores positive divided by total number of cores biopsied (P = .060) were prognostic for favorable PSA outcomes. A higher ratio of number of cores positive to prostate volume (third quartile) had a lower (35%) chance of a favorable PSA than a lower ratio (first quartile) (OR = 0.35, 95% CI: .14-.84, P = .019). Prostate gland disease burden as reflected by the number of cores positive and ratio of positive cores to gland volume (mL) is prognostic for favorable biochemical outcome after salvage whole-gland prostate cryoablation. Further study is warranted to better delineate this relationship.

468 IMPACT OF DISEASE BURDEN ON CRYOABLATION PSA OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2010468 IMPACT OF DISEASE BURDEN ON CRYOABLATION PSA OUTCOMES David Levy and Stephen Jones David LevyDavid Levy More articles by this author and Stephen JonesStephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.541AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To identify prognostic factors for favorable biochemical outcome (PSA < 0.6 ng/ml) following primary whole gland prostate cryoablation. METHODS The charts from 122 cryoablation patients treated at Cleveland Clinic from 2004 through May 2009 were reviewed. Patient age, race, PSA at diagnosis, Gleason score, risk category, prostate gland volume, clinical T stage, number of cores positive, percent of core involved with disease, ratios of: number of cores positive to total cores biopsied and number of cores positive to prostate gland volume, and initial PSA results were studied. An initial PSA of < 0.6 was employed as the criterion for favorable outcome based on previously published data. RESULTS 16.4% of patients had unfavorable postoperative PSA levels. On univariate analysis, number of cores positive (p= 0.0312) and maximum percent core positive (0.0236) were prognostic of PSA outcome. On multivariate analysis, number of cores positive (p=0.0097), maximum percent core positive (p= 0.0337) and ratio of number of positive cores to prostate gland volume (p=0.0225) were prognostic for favorable PSA outcomes based on an initial PSA < 0.6 ng/ml. CONCLUSIONS This is the first published report of prognostic factors for favorable PSA outcomes following primary prostate cryoablation. The relative disease burden as defined by the number of and percent core positive, and the ratio of number of cores positive to prostate gland volume are highly prognostic for initial post cryoablation PSA < 0.6 ng/ml which is associated with favorable long term biochemical disease free survival regardless of risk stratification. Table 1. Logistic regression analysis of PSA < 0.6; univariate and multivariate results. Variable Coefficient (S.E.) p-value Univariate analysis Age -0.0378 (0.0356) 0.2875 Race -0.1252 (0.6803) 0.8526 Initial PSA -0.0356 (0.0325) 0.2745 Volume -0.0005 (0.0219) 0.9834 Gleason scores -0.2558 (0.2377) 0.2818 No. positive cores -0.1729 (0.0803) 0.0312 Max% of positive cores -0.0208 (0.0092) 0.0236 Risk groups criteria -0.0114 (0.5216) 0.9825 No. positive cores / total no. -1.508 (1.1185) 0.1776 No. positive cores / volume -0.8966 (1.8978) 0.6366 Multivariate analysis No. positive cores -0.6898 (0.2665) 0.0097 Max% positive cores -0.0255 (0.012) 0.0337 No. positive cores / volume 18.2113 (7.9794) 0.0225 Cleveland, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e184-e185 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Levy More articles by this author Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of Biologic Effective Dose on PSA Outcomes for Prostate Cancer Treated with Combination External Beam and Brachytherapy

Effect of Biologic Effective Dose on PSA Outcomes for Prostate Cancer Treated with Combination External Beam and Brachytherapy

Changes In PSA Kinetics After DNA Vaccine Therapy–Not So Fast!

TO THE EDITOR: In the September 1, 2009, issue of Journal of Clinical Oncology, McNeel et al reported the results of a phase I clinical trial of a DNA vaccine encoding prostatic acid phosphatase in men with nonmetastatic prostate cancer. They reported that nine of 22 (41%) participants developed prostatic acid phosphatase–specific T cell proliferation and seven of 22 (32%) had a post-treatment prostatespecific antigen doubling time (PSA DT) of greater than 200% of the baseline PSA DT. They offer the observed T cell responses and increased PSA DT as evidence of biologic activity and recommend a multi-institutional phase II trial to evaluate clinical efficacy. Although the observed T cell responses are compelling, the changes in PSA DT after vaccine treatment are similar to outcomes previously reported in placebo-treated participants. In two randomized controlled trials of men with rising PSA after prior surgery or radiation therapy for prostate cancer, post-treatment PSA DT of greater than 200% of the baseline PSA DT was observed in 20% to 31% of the participants assigned to placebo. The observed rates of positive PSA outcomes after placebo treatment appear to be explained primarily by variation in serial assessment of PSA DT. We conclude that the post-treatment changes in PSA DT after vaccine treatment do not provide evidence of biologic activity. Additional studies are necessary to assess the relationship between PSA kinetics and clinical outcomes and to evaluate the utility of post-treatment PSA DT or PSA velocity in the development of new drugs.

Impact of Disease Burden on Cryoablation Prostate-specific Antigen Outcomes

To identify prognostic factors for favorable biochemical outcome (prostate-specific antigen [PSA] <0.6 ng/mL) after primary whole gland prostate cryoablation. The charts from 122 cryoablation patients treated at Cleveland Clinic from 2004 through May 2009 were reviewed. Patient age, race, PSA at diagnosis, Gleason score, risk category, prostate gland volume, clinical T stage, number of cores positive, percent of core involved with disease, ratios of number of cores positive to total cores biopsied and number of cores positive to prostate gland volume, and initial PSA results were studied. An initial post-cryoablation PSA of <0.6 was used as the criterion for favorable outcome based on previously published data. A total of 16.4% of patients had unfavorable postoperative PSA levels. On univariate analysis, number of cores positive (P = .031) and maximum percent core positive (P = .024) were prognostic of PSA outcome. On multivariate analysis, number of cores positive (P = .010), maximum percent core positive (P = .034), and ratio of number of positive cores to prostate gland volume (cm(3)) (P = .023) were prognostic for favorable PSA outcomes based on an initial PSA <.6 ng/mL. Favorable PSA outcomes after primary prostate cryoablation appear to be correlated with disease burden. The relative disease burden as defined by the number of and percent core positive, and the ratio of number of cores positive to prostate gland volume (cm(3)) are highly prognostic for initial post-cryoablation PSA <0.6 ng/mL, which is associated with favorable long-term biochemical disease-free survival regardless of risk stratification.

Stereotactic Body Radiotherapy: An Emerging Treatment Approach for Localized Prostate Cancer

Here we report results from the first cohort of over 100 patients treated with hypofractionated, stereotactic body radiotherapy (SBRT) for early stage prostate cancer. Between February 2005 and December 2006, 112 patients with localized, biopsy-proven adenocarcinoma of the prostate (clinical stage T1cN0M0 to T2cN0M0) were treated in Naples, FL on a CyberKnife system (Accuray Incorporated, Sunnyvale, CA). Eighty-one patients had a Gleason score of 3+3. Mean initial PSA was 6.0, and mean initial prostate volume was 46.3cc. Implanted gold fiducials were used for image-guided targeting and tracking. Patients received 35-36 Gy administered in 5 consecutive fractions to the prostate and the proximal seminal vesicles, as identified on CT and MRI scans. At a median follow-up of 24 months, the mean PSA value was 0.78 ng/ml. Two patients have developed biopsy-confirmed local relapse; one developed distant metastases. Acute side effects were generally mild and resolved shortly after treatment. A single Grade 3 rectal complication was reported (bleeding). Eighty-two percent of patients who were sexually potent before treatment maintained erectile function post-treatment. Additional follow-up is required to better evaluate potential late toxicity and long-term PSA outcomes.

A phase II study of patupilone in patients (pts) with metastatic castration- resistant prostate cancer (CRPC) who have progressed after docetaxel

5139 Background: Chemotherapy for pts with CRPC who have progressed after docetaxel remains to be defined. Patupilone is an epothilone with broad spectrum pre-clinical activity including in taxane resistant models. Methods: Multicenter, 2-stage design. Pts with metastatic CRPC with progressive disease during or within 6 months of receiving docetaxel were eligible. Patupilone was initially given 10mg/m 2 IV every 3 weeks. PSA response rate (≥50% decline) was the primary endpoint (H0 = 15%, H1 = 25%, α = 0.1, β = 0.2). Secondary endpoints were measurable disease response, serial pain and analgesics scores, progression free survival (PFS) and overall survival (OS). Results: 83 pts were enrolled from March 2007-June 2008. 401 cycles administered (median 5, range 1–15). Baseline characteristics (range): median age 67 (47–85), PSA 212 (2.6–11520), hemoglobin 118 (89–160), median time to progression after docetaxel 1.0 months (0.0–6.0), number of prior chemotherapy regimens 1:2:3+ in 45:28:10 pts, ECOG PS 0–1:2 in 73:10 pts, disease in bone/lymph nodes/viscera in 76/47/14 pts respectively. In the first 6 pts, gastrointestinal serious adverse events (AE) occurred in 4 pts (diarrhea and vomiting) which lead to a dose reduction of patupilone to 8 mg/m2 for subsequent patients. Grade 3/4 related adverse events at this dose included fatigue (16%), diarrhea (13%) and anorexia (5%). There were no grade 3/4 hematologic AEs. In 78 pts evaluable for PSA response, PSA declines of ≥30% and ≥50% have occurred in 44/78 (56%) and 35/78 (45%) with a confirmed PSA response in 25 pts (32%). Partial response occurred in 5% and stable disease in 64% of 44 evaluable pts. Pain response (2 point decline on 6 point scale) occurred in 36 (51%) of 71 pts eligible for analysis. Median PFS for PSA and non-PSA outcomes (measurable disease/symptomatic progression or death) was 7.6 months (3.7–11.5) and 5.6 months (3.9–7.3) respectively. Follow up for OS is continuing. Conclusions: Patupilone 8 mg/m2 every 3 weeks was well tolerated and associated with encouraging PFS, PSA and pain responses in pts with docetaxel resistant/refractory disease. Further investigation of patupilone in this population is warranted. [Table: see text]

Postoperative radiotherapy for prostate cancer: Sooner or later?

e16157 Background: To report our experience with adjuvant or salvage radiotherapy for prostate cancer and to assess the tolerance of the patients. Methods: The charts of 139 men who received postoperative radiotherapy (RT) after radical prostatectomy (RP) between 1997–2007 in two institutions were retrospectively analyzed. Thirty-seven percent received adjuvant RT and 63% salvage RT. The median age was 65 years (range: 43–80). Pathologic Gleason score was 2–6 in 24%, 7 in 56%, and 8–10 in 20%. Seminal vesicle involvement was reported in 34%, positive surgical margins in 72%, lymph node involvement in 7%, capsular perforation in 61%, and perineural invasion in 73% of the patients. The median PSA level before RT was 0.29ng/ml (range: 0–19ng/mL). Median time from RP to RT was 3 months (range, 1–12 months) in the adjuvant setting, and 27 months (range, 2–96 months) in the salvage setting. Nineteen percent received radiation to the pelvis, 81% to the prostate bed only. The median dose to the prostatic bed was 66.6Gy (range: 60–76Gy). Before, during or after RT 49% received androgen deprivation for a median of 6 months (range, 3–48 months). Biochemical failure is defined as a post-RT PSA level &gt;0.2ng/mL. Results: The median follow up time was 41 months (range, 12–133 months). At 4 years, for the entire cohort biochemical control, metastasis free survival, and overall survival was 68%, 92%, and 94%, respectively. Although there was a significant difference in favor of the adjuvantly treated group for biochemical control (81% vs 60%, p = 0.03) in univariate analysis, multivariate analysis demonstrated that higher preoperative PSA level (p = 0.02), and lymph node involvement (p = 0.02) predicted for a worse PSA outcome. No grade 3 acute gastrointestinal (GI) or genitourinary (GU) toxicity was reported during the treatment. At 4 years, 4% of patients had Grade 2 late GI toxicity, 0.7% had grade 3 late GI, and 0.7% brade 4 late GI toxicity, while 16% of patients reported late grade 2 GU, and 4% had late grade 3 GU toxicity. Conclusions: Our results suggest that adjuvant RT may offer a better biochemical outcome in patients who underwent radical prostatectomy for prostate cancer. Overall, the number of high grade toxicities for postoperative RT was low. Therefore it can safely be used in appropriate setting. No significant financial relationships to disclose.

Evaluation of pT2 subdivisions in the TNM staging system for prostate cancer

To evaluate the subclassifications of pT2 diseases in tumour-nodes-metastases (TNM) staging system for prostate cancer. We retrospectively analysed the data of 372 patients who underwent radical retropubic prostatectomy (RRP) for pathologically organ-confined prostate cancer at our institution. Pathological staging of all subjects were re-evaluated using the 1997 and the 2002 TNM staging system for prostate cancer. Various clinicopathological features along with biochemical recurrence-free survival (BRFS) of pT2 subgroups were assessed. Using the 2002 TNM staging criteria, 87 of the tumours (23.4%) were pT2a, and 284 (76.3%) were pT2c. Of all subjects, there was only one (0.3%) pathological 2002 T2b tumour identified. When subjects were classified according to the 1997 versions of the T2 subclassification (pT2a vs pT2b), the 1997 pT2a and pT2b cases showed no significant difference regarding BRFS (log-rank P = 0.645) among those who were followed-up for >2 years after RRP. Also, pathological stage (1997 pT2a vs pT2b) was not a significant predictor of BRFS in either uni- or multivariate analysis (P = 0.289 and P = 0.241, respectively). Only preoperative serum PSA level and pathological Gleason score along with positive surgical margin were significant predictors of PSA outcome after RRP on multivariate analysis. Our results suggest that two- or three-tiered subclassification of pT2 organ-confined prostate cancer via methods used in the previous or current TNM staging system may not be appropriate. Efforts should be made to upgrade the current TNM staging system for prostate cancer.

Equivalent PSA Outcomes for Younger (≤55) vs. Older Men With Radiation Treatment of Prostate Cancer

Equivalent PSA Outcomes for Younger (≤55) vs. Older Men With Radiation Treatment of Prostate Cancer

A seven-year experience of HDR brachytherapy boost for localized prostate cancer: Biopsy and PSA outcome

Purpose: To evaluate PSA failure-free survival and 24-month prostate biopsy outcome in patients with localized prostate cancer treated with inverse-planned HDR brachytherapy boost.

Early biochemical outcomes following permanent interstitial brachytherapy as monotherapy in 1050 patients with clinical T1–T2 prostate cancer

Background and purpose Five European centres (France, Finland, Italy, Spain and the UK) have pooled data to generate a large patient series involving 1175 patients treated with prostate brachytherapy. This paper reports preliminary data on PSA outcome up to 4 years. Patients and methods Out of 1175 in the database, 1050 patients with localised prostate cancer who had received transperineal seed implantation as monotherapy between May 1998 and August 2003 were stage T1–T2. A total of 668 (63.6%) patients met the low-risk group definition, 297 (28.3%) as intermediate-risk definition and 66 (6.3%) the high-risk group definition. The majority of patients were Gleason score 6 or less ( n = 951) and disease stage was T1c in 557 patients. Results Of the 1050 patients, PSA data up to 4 years were available for 210 patients, while 364 patients with PSA values up to 36 months were evaluable by the Kaplan–Meier method for freedom from biochemical failure. The biochemical progression-free rate at 3 years was estimated to be 91%, with a 93% and 88% rate for low- and intermediate-risk groups, respectively, versus 80% for the high-risk group. PSA kinetics provide encouraging evidence of treatment efficacy. Conclusion These data on 4-year PSA follow-up on patients treated with prostate brachytherapy reflect those previously reported in the literature. This patient series will be followed to provide long-term outcome in the future.

Histopathologic Outcomes of Robotic Radical Prostatectomy

Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and shortterm PSA outcomes of 500 robotic radical prostatectomies. Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM stage, Gleason’s grade, tumor location, volume, specimen weight, seminal vesicle involvement, and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data were collected every 3 months for the first year, then every 6 months for a year, then yearly. The average preoperative PSA was 6.9 (1–90) with Gleason’s score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), and 9 (2%); postoperatively, histopathologic analysis showed Gleason's 6 (44%), 7 (42%), 8 (10%), and 9 (4%); 10, 5, 63, 15, 5, and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b, and T4, respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1–100), 8% (101–200), 13% (201–300), 5% (301–400), and 8% (401–500). By stage, it was 2, 4, and 2.5% for T2a, T2b, T2c tumors; 23% (T3a), 46% (T3b), and 53% (T4a). For organ-confined disease (T2), the margin rate was 2.5% and it was 31% for nonorgan-confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle, and 11 (23%) multifocal. Ninety-five percent of patients (n = 500) have undetectable PSA (<0.1) at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months), 95% have undetectable PSA (<0.1). Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Shortterm biochemical recurrence-free survival has also been good. We believe that the precise dissection allowed by the advantages of laparoscopic robotic surgery will translate into excellent long-term oncologic outcomes. At this time, the lack of maturity of the PSA data prevent definitive comparison to the open approach.

The men’s cycle plus docetaxel (Doc) in prostate cancer patients with rising PSAs in the non-castrate state

4564 Background: Continuous androgen ablation is standard for patients (pts) with rising PSAs following definitive local therapy or untreated metastatic disease. We have shown that androgen ablation followed by intermittent testosterone administration is feasible and can induce successive declines in PSA peaks and troughs (ASCO 2004). This trial tests the hypothesis that Doc given to proliferating cells followed by androgen withdrawal will give a greater response than Doc administered to non-proliferating cells. Methods: Sixty pts with a rising PSA with or without radiographic metastases, and ≤ 6 months of prior hormone exposure were eligible. Pts received six 4-week cycles consisting of monthly Leuprolide and Doc given on Day 1 of week 1 followed by application of topical Androgel for 7 days prior to initiation of the subsequent cycle. The primary endpoint was the proportion of pts at 6 and 18 months after the start of therapy who achieved the following: PSA ≤ 0.05ng/ml following RRP, PSA ≤0.5 ng/ml following RT, or PSA ≤ 2.0 ng/ml for pts with untreated metastatic disease. Results: Of 60 pts accrued, 22 had a rising PSA alone and 38 had radiographic metastases. Of the pts with a rising PSA alone, 4 of 9 (44%) evaluable patients achieved the primary endpoint at 6 months. Of the pts with radiographic metastases, 9 of 24 evaluable pts (38%) have reached the primary endpoint at 6 months. No pts progressed while on treatment and successive declines in PSA peaks and troughs were seen. Toxicities for all evaluable pts included grade 3/ 4 neutropenia in 91% (30 of 33), and grade 3/ 4 hyperglycemia in 18% (6 of 33). One pt was removed from study for grade 3 mental status changes. Conclusions: Rapid hormonal cycling with Doc results in successive declines in PSA peaks and troughs. PSA troughs of ≤0.05 ng/ml following prostatectomy or ≤0.5 ng/ml following radiation can be achieved. This unique approach may facilitate a higher proportion of pts who achieve an undectectable PSA. The increased incidence of neutropenia may be related to decrease clearance of docetaxel in the setting of non-castrate testosterone levels (Baker, SD; ASCO, 2005). PSA outcomes at 18 months and impact on survival are pending. Supported by Aventis, CA-05816 and PepsiCo. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration sanofi-aventis sanofi-aventis

1026: The Relationship Between PSA Nadir and Outcome in Patients with Clinically Localized Prostate Cancer Treated with Combination Radiotherapy

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 24, 2005, 8:00 am - 12:00 pm1 Apr 20051026: The Relationship Between PSA Nadir and Outcome in Patients with Clinically Localized Prostate Cancer Treated with Combination Radiotherapy Lee R. Schachter, Ervin Teper, Adley Raboy, and Peter Albert Lee R. SchachterLee R. Schachter More articles by this author , Ervin TeperErvin Teper More articles by this author , Adley RaboyAdley Raboy More articles by this author , and Peter AlbertPeter Albert More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35182-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1026: The Relationship Between PSA Nadir and Outcome in Patients with Clinically Localized Prostate Cancer Treated with Combination Radiotherapy." The Journal of Urology, 173(4S), pp. 278–279 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 278-279 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Lee R. Schachter More articles by this author Ervin Teper More articles by this author Adley Raboy More articles by this author Peter Albert More articles by this author Expand All Advertisement Loading ...

Long-term outcome of detectable PSA levels after radical prostatectomy

Detectable prostate-specific antigen levels (PSA) following radical prostatectomy (RP) are believed to represent treatment failure. In this retrospective review, we characterize long-term PSA outcomes following RP (n = 204) in a non-referral hospital performed between 1984 and 1994. With an average follow-up of 10 y, 90 (44%) patients developed a PSA recurrence: 15 (17%) died of prostate cancer despite hormonal intervention, 39 (43%) responded to hormonal therapy with stable remission and 36 (40%) were observed without intervention. Following RP many patients may have a detectable PSA that does not require treatment. PSA doubling time (< 12 months) was the best predictor of disease progression.

Case selection for radical prostatectomy in the UK.

Radical prostatectomy is an increasingly popular treatment option for clinically localised prostate cancer, yet PSA outcome figures are rare in the UK. This makes it difficult to establish appropriate criteria for case selection. We conducted an audit of PSA recurrence of 5 large centres in the south of England and investigated the use of pre-operative PSA to improve case selection and outcome. 854 patients notes were audited for pre-operative staging parameters and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment as well as patients with incomplete data and follow-up were excluded. Median follow-up was 52 months for the remaining 663 patients. Median PSA was 10 ng/ml. A large improvement of PSA recurrence free survival rates was observed from 1988 to 1998 as a result of change in case selection and stage migration. Overall Kaplan-Meier PSA recurrence free survival probability at 1, 3, 5 and 8 years was 0.83, 0.69, 0.60 and 0.48, respectively. Five-year PSA recurrence free survival probability for PSA ranges <4 ng/ml, 4.1-10 ng/ml, 10.1-20 ng/ml and >20 ng/ml was 0.82, 0.73, 0.59 and 0.20, respectively (Wilcoxon, p < 0.0001). A simulation of biochemical recurrence free survival for patient cohorts with stepwise reduced inclusion PSAs suggests an improved outcome for patients with a pre-operative inclusion PSA of <12 ng/ml. Further reduction of the inclusion PSA does not improve outcome. Intermediate PSA recurrence free survival has improved over time in England. PSA recurrence free survival estimates are less optimistic compared to frequently quoted American figures. A reduced pre-operative PSA cut-off for case selection may be used to improve outcome.

The impact of a delay in initiating radiation therapy on prostate-specific antigen outcome for patients with clinically localized prostate cancer

4503 Background: While a delay in initiating external beam radiation therapy (RT) following diagnosis is known to decrease local control in patients with breast or head and neck cancer, its effect on PSA outcome in prostate cancer is unknown. Methods: We studied 460 patients who received 3D conformal RT without hormonal therapy for clinically localized prostate cancer from 1994–2001. The primary endpoint was PSA failure (ASTRO definition); estimates of PSA control were made using the Kaplan-Meier method. Delay was defined as the time between diagnosis and RT start date. Cox multivariable regression was used to determine the ability of treatment delay to predict time to PSA failure after adjusting for the distribution of baseline PSA, clinical T-category, Gleason score, and percent of cores positive for tumor. Results: Treatment delay independently predicted for time to PSA failure (p=0.013) after controlling for baseline PSA, clinical T-category, Gleason score, and percent of cores positive. Patients with...

Defining a new threshold for PSA outcomes in untreated prostate cancer

4587 Background: To assess the relationship between tumor burden and sensitivity to hormonal therapy, we evaluated post-therapy PSA changes in patients in the rising PSA state (Scher et al, Urol 2000) and in patients with clinical metastases: non-castrate disease. The objective was to determine the proportion that achieved an undetectable PSA following treatment. Methods: We identified 473 patients who experienced a rising PSA following local therapy from two available databases at MSKCC. The first database was a series of 233 patients enrolled on vaccine trials between 1995–200; the second was a series of 2652 patients undergoing prostatectomy at MSKCC from 1996–2002. One hundred forty-one patients were initiated on hormonal therapy with CAB, an antiandrogen alone or a GNRH analogue alone, between 1/93 and 6/03. As their primary therapy, 34 received radiation and 106 received radical prostatectomy. Sixty-eight were in a rising PSA clinical state and 73 had non-castrate metastatic disease. Results: A greater number of patients with a rising PSA only achieved an undetectable PSA compared with metastatic patients (57 vs 38%, p=0.03). Rising PSA only patients: Age, Gleason grade, and doubling time did not predict for an undetectable PSA. Achievement of an undetectable PSA was statistically associated with prior prostatectomy, treatment with a GNRH analogue, a lower pretreatment PSA and a shorter time interval from local therapy (p<0.05). Metastatic patients: Achievement of an undetectable PSA was not associated with prior prostatectomy, treatment with a GNRH or the time interval from local therapy. A lower pretreatment PSA and shorter PSA doubling time were statistically associated with an undetectable PSA (p<0.05). Patients with metastatic disease and a detectable PSA nadir were more likely to exhibit progression of disease on imaging with follow-up (p=0.01). Conclusions: The rate of achieving an undetectable PSA with hormonal therapy is dependent upon the pretreatment PSA and the presence of metastatic disease. Achievement of an undetectable PSA is associated with a delay of disease progression on imaging in metastatic patients. Support: MSKCC SPORE P50 CA 92629–01; Koch Foundation No significant financial relationships to disclose.