Posttreatment Prostate Specific Antigen Nadir Predicts Prostate Cancer Specific and All Cause Mortality
2012; Lippincott Williams & Wilkins; Volume: 187; Issue: 6 Linguagem: Inglês
10.1016/j.juro.2012.01.073
ISSN1527-3792
AutoresYolanda D. Tseng, Ming‐Hui Chen, Clair J. Beard, Neil E. Martin, Peter F. Orio, Marian Loffredo, Andrew A. Renshaw, Toni K. Choueiri, Jim C. Hu, Philip W. Kantoff, Anthony V. D’Amico, Paul L. Nguyen,
Tópico(s)Urologic and reproductive health conditions
ResumoNo AccessJournal of UrologyAdult Urology1 Jun 2012Posttreatment Prostate Specific Antigen Nadir Predicts Prostate Cancer Specific and All Cause Mortality Yolanda D. Tseng, Ming-Hui Chen, Clair J. Beard, Neil E. Martin, Peter F. Orio, Marian Loffredo, Andrew A. Renshaw, Toni K. Choueiri, Jim C. Hu, Philip W. Kantoff, Anthony V. D'Amico, and Paul L. Nguyen Yolanda D. TsengYolanda D. Tseng Harvard Radiation Oncology Program, Boston, Massachusetts More articles by this author , Ming-Hui ChenMing-Hui Chen Department of Statistics, University of Connecticut, Storrs, Connecticut More articles by this author , Clair J. BeardClair J. Beard Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Neil E. MartinNeil E. Martin Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Peter F. OrioPeter F. Orio Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Marian LoffredoMarian Loffredo Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts More articles by this author , Andrew A. RenshawAndrew A. Renshaw Department of Pathology, Baptist Hospital of Miami, Miami, Florida More articles by this author , Toni K. ChoueiriToni K. Choueiri Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Jim C. HuJim C. Hu Department of Urology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Philip W. KantoffPhilip W. Kantoff Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , Anthony V. D'AmicoAnthony V. D'Amico Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author , and Paul L. NguyenPaul L. Nguyen Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.01.073AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated whether the prostate specific antigen nadir predicts prostate cancer specific and all cause mortality in men treated in a randomized trial of radiation with or without 6 months of androgen deprivation therapy. Materials and Methods: The study included 204 men with cT1b-T2bN0M0 prostate adenocarcinoma and at least 1 unfavorable factor, including prostate specific antigen less than 10 to 40 ng/ml, Gleason 7 or greater, or T3 on magnetic resonance imaging. We performed Fine and Gray regression, and Cox multivariable analysis to determine whether an increasing prostate specific antigen nadir was associated with prostate cancer specific and all cause mortality, adjusting for treatment, age, Adult Comorbidity Evaluation 27 score and cancer prognostic factors. Results: At a 6.9-year median followup median prostate specific antigen nadir was 0.7 ng/ml for radiation alone and 0.1 ng/ml for radiation plus androgen deprivation therapy. The prostate specific antigen nadir (adjusted HR 1.18/ng/ml increase, 95% CI 1.07–1.31, p = 0.001) and Gleason 8 or greater (adjusted HR 8.05, 95% CI 1.01–64.05, p = 0.049) significantly predicted increased prostate cancer specific mortality. Moderate/severe comorbidity carried a decreased risk (adjusted HR 0.13, 95% CI 0.02–0.96, p = 0.045). Higher prostate specific antigen nadir (adjusted HR 1.10/ng/ml increase, 95% CI 1.04–1.17), older age (adjusted HR 1.10/year, 95% CI 1.04–1.15) and interaction between comorbidity score and randomization arm (each p <0.001) increased the all cause mortality risk. Men who achieved a prostate specific antigen nadir of the median value or less had lower estimated prostate cancer specific and all cause mortality at 7 years (3.7% vs 18.3%, p = 0.0005 and 31.5% vs 55.0%, p = 0.002). Conclusions: Posttreatment prostate specific antigen nadir is significantly associated with the risk of prostate cancer specific and all cause mortality after radiation with or without androgen deprivation therapy. A suboptimal prostate specific antigen nadir may identify candidates for earlier intervention to prolong survival. References 1 : Natural history of progression after PSA elevation following radical prostatectomy. JAMA1999; 281: 1591. Crossref, Medline, Google Scholar 2 : Prostate specific antigen nadir following external beam radiation therapy for clinically localized prostate cancer: the relationship between nadir level and disease-free survival. J Urol1996; 156: 450. Link, Google Scholar 3 : Defining biochemical cure for prostate carcinoma patients treated with external beam radiation therapy. Cancer1999; 86: 1557. Crossref, Medline, Google Scholar 4 : Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. Int J Radiat Oncol Biol Phys2002; 53: 297. Google Scholar 5 : A comparison of the prognostic value of early PSA test-based variables following external beam radiotherapy, with or without preceding androgen deprivation: analysis of data from the TROG 96.01 randomized trial. Int J Radiat Oncol Biol Phys2011; 79: 385. Google Scholar 6 : PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys2006; 64: 1140. Google Scholar 7 : Prostate-specific antigen nadir within 12 months of prostate cancer radiotherapy predicts metastasis and death. Cancer2007; 109: 41. Google Scholar 8 : 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA2004; 292: 821. Google Scholar 9 : Interval to testosterone recovery after hormonal therapy for prostate cancer and risk of death. Int J Radiat Oncol Biol Phys2009; 75: 10. Google Scholar 10 : Nonparametric estimation from incomplete observations. J Am Stat Assoc1958; 53: 457. Crossref, Google Scholar 11 : Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med2004; 351: 1502. Google Scholar 12 : Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med2010; 363: 411. Google Scholar 13 : Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med2011; 364: 1995. Google Scholar 14 : Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst2003; 95: 1376. Google Scholar 15 : Surrogate end points for prostate cancer: what is the prostate-specific antigen telling us?. J Natl Cancer Inst2003; 95: 1352. Google Scholar 16 : Potential surrogate endpoints for prostate cancer survival: analysis of a phase III randomized trial. J Natl Cancer Inst2009; 101: 228. Google Scholar 17 : Why are pretreatment prostate-specific antigen levels and biochemical recurrence poor predictors of prostate cancer survival?. Cancer2009; 115: 4477. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTetreault-Laflamme A, Crook J, Hamm J, Pickles T, Keyes M, McKenzie M, Pai H, Bachand F and Morris J (2018) Long-Term Prostate Specific Antigen Stability and Predictive Factors of Failure after Permanent Seed Prostate BrachytherapyJournal of Urology, VOL. 199, NO. 1, (120-125), Online publication date: 1-Jan-2018. Volume 187Issue 6June 2012Page: 2068-2073 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsprostate-specific antigenmortalityprostateradiotherapyMetricsAuthor Information Yolanda D. Tseng Harvard Radiation Oncology Program, Boston, Massachusetts More articles by this author Ming-Hui Chen Department of Statistics, University of Connecticut, Storrs, Connecticut More articles by this author Clair J. Beard Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Neil E. Martin Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Peter F. Orio Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Marian Loffredo Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts More articles by this author Andrew A. Renshaw Department of Pathology, Baptist Hospital of Miami, Miami, Florida More articles by this author Toni K. Choueiri Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Jim C. Hu Department of Urology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Philip W. Kantoff Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Anthony V. D'Amico Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Paul L. Nguyen Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ...
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