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A Critical Analysis of the Interpretation of Biochemical Failure in Surgically Treated Patients Using the American Society for Therapeutic Radiation and Oncology Criteria

2002; Lippincott Williams & Wilkins; Volume: 168; Issue: 4 Part 1 Linguagem: Inglês

10.1016/s0022-5347(05)64464-3

1527-3792

Matthew Gretzer, Bruce J. Trock, Misop Han, Patrick C. Walsh,

Advanced Radiotherapy Techniques

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002A Critical Analysis of the Interpretation of Biochemical Failure in Surgically Treated Patients Using the American Society for Therapeutic Radiation and Oncology Criteriais corrected byErrata Matthew B. Gretzer, Bruce J. Trock, Misop Han, and Patrick C. Walsh Matthew B. GretzerMatthew B. Gretzer , Bruce J. TrockBruce J. Trock , Misop HanMisop Han , and Patrick C. WalshPatrick C. Walsh View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64464-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The use of prostate specific antigen (PSA) to indicate biochemical failure has become an accepted procedure to measure the effectiveness of therapy. Because long-term randomized studies comparing radiation modalities to radical prostatectomy are not available, use of biochemical recurrence as a surrogate measure of efficacy is increasing. Unfortunately, the definition of failure is not uniform among therapies. We evaluate how the American Society for Therapeutic Radiation and Oncology (ASTRO) criteria affect the interpretation of failure when applied to radical prostatectomy. Materials and Methods: We retrospectively reviewed data from 2,691 men who underwent anatomical radical prostatectomy for localized disease between 1985 and 2000. All patients had regular followup visits ranging from 6 months to 15 years (mean 6). No patients were treated with radiation or hormonal therapy preoperatively or postoperatively until clinical recurrence. Biochemical failure was defined as any measurable PSA 0.2 ng./ml. or greater. We evaluated how elements of the ASTRO criteria affected the failure rate when applied to this series. We looked at 1) backdating the failure date to the midpoint between nadir and first PSA greater than 0.2 ng./ml., 2) early censoring if only 1 or 2 increasing values were available and 3) defining failure after 3 consecutive PSA increases and backdating failure time (midpoint of nadir and first PSA increase). Results: Using actuarial analysis of the data defining failure as the first PSA 0.2 ng./ml. or greater, biochemical freedom from failure at 5, 10 and 15 years was 85%, 77% and 68%, respectively. In contrast, when backdating was used in this series, almost all failures occurred early with rare late failures (freedom from failure 82%, 80% and 80% at 5, 10 and 15 years, respectively). The difference in failure became even more pronounced when ASTRO criteria were applied requiring 3 consecutive increases, and backdating failure to the midpoint between nadir and first PSA (freedom from failure 90%, 90% and 90% at 5, 10 and 15 years, respectively). Conclusions: The application of ASTRO criteria to a mature series of surgically treated patients with localized prostate cancer produced an apparent improvement in the probability of being biochemically free of disease at 15 years from 68% to 90%. Until prospective trials comparing these different therapies become available, caution should be exercised when interpreting outcomes between series due to the inherent differences in definition of biochemical failure. References 1 : Era specific biochemical recurrence-free survival following radical prostatectomy for clinically localized prostate cancer. J Urol2001; 166: 416. Link, Google Scholar 2 : The value of serum prostate specific antigen determinations before and after radical prostatectomy. J Urol1989; 141: 873. Link, Google Scholar 3 : Is prostate specific antigen of clinical importance in evaluating outcome after radical prostatectomy. J Urol1993; 149: 516. 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Google Scholar From The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byCritz F, Benton J, Shrake P and Merlin M (2018) 25-Year Disease-Free Survival Rate After Irradiation for Prostate Cancer Calculated with the Prostate Specific Antigen Definition of Recurrence Used for Radical ProstatectomyJournal of Urology, VOL. 189, NO. 3, (878-883), Online publication date: 1-Mar-2013.Aus G (2018) Cryosurgery for Prostate CancerJournal of Urology, VOL. 180, NO. 5, (1882-1883), Online publication date: 1-Nov-2008.Cookson M, Aus G, Burnett A, Canby-Hagino E, D’Amico A, Dmochowski R, Eton D, Forman J, Goldenberg S, Hernandez J, Higano C, Kraus S, Moul J, Tangen C, Thrasher J and Thompson I (2018) Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical OutcomesJournal of Urology, VOL. 177, NO. 2, (540-545), Online publication date: 1-Feb-2007.VICINI F, VARGAS C, ABNER A, KESTIN L, HORWITZ E and MARTINEZ A (2018) LIMITATIONS IN THE USE OF SERUM PROSTATE SPECIFIC ANTIGEN LEVELS TO MONITOR PATIENTS AFTER TREATMENT FOR PROSTATE CANCERJournal of Urology, VOL. 173, NO. 5, (1456-1462), Online publication date: 1-May-2005.KUBAN D, THAMES H and SHIPLEY W (2018) DEFINING RECURRENCE AFTER RADIATION FOR PROSTATE CANCERJournal of Urology, VOL. 173, NO. 6, (1871-1878), Online publication date: 1-Jun-2005.KRYGIEL J, SMITH D, HOMAN S, SUMNER W, NEASE R, BROWNSON R and CATALONA W (2018) INTERMEDIATE TERM BIOCHEMICAL PROGRESSION RATES AFTER RADICAL PROSTATECTOMY AND RADIOTHERAPY IN PATIENTS WITH SCREEN DETECTED PROSTATE CANCERJournal of Urology, VOL. 174, NO. 1, (126-130), Online publication date: 1-Jul-2005.Walsh P (2018) UROLOGICAL ONCOLOGY: PROSTATE CANCERJournal of Urology, VOL. 172, NO. 1, (392-398), Online publication date: 1-Jul-2004.CRITZ F and LEVINSON K (2018) 10-YEAR DISEASE-FREE SURVIVAL RATES AFTER SIMULTANEOUS IRRADIATION FOR PROSTATE CANCER WITH A FOCUS ON CALCULATION METHODOLOGYJournal of Urology, VOL. 172, NO. 6 Part 1, (2232-2238), Online publication date: 1-Dec-2004.Walsh P (2018) Urological Oncology: Prostate cancerJournal of Urology, VOL. 169, NO. 4, (1588-1598), Online publication date: 1-Apr-2003.HORWITZ E, UZZO R, HANLON A, GREENBERG R, HANKS G and POLLACK A (2018) Modifying the American Society for Therapeutic Radiology and Oncology Definition of Biochemical Failure to Minimize the Influence of Backdating in Patients With Prostate Cancer Treated With 3-dimensional Conformal Radiation Therapy AloneJournal of Urology, VOL. 169, NO. 6, (2153-2159), Online publication date: 1-Jun-2003.Related articlesJournal of Urology9 Nov 2018Errata Volume 168Issue 4 Part 1October 2002Page: 1419-1422 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsprostatectomyprostatic neoplasmsprostate-specific antigenradiotherapyrecurrenceMetricsAuthor Information Matthew B. Gretzer More articles by this author Bruce J. Trock More articles by this author Misop Han More articles by this author Patrick C. Walsh More articles by this author Expand All Advertisement PDF downloadLoading ...