A prostate-specific antigen doubling time of <6 months is prognostic for metastasis and prostate cancer-specific death for patients receiving salvage radiation therapy post radical prostatectomy

被引:25
作者
Jackson, William C. [1 ]
Johnson, Skyler B. [1 ]
Li, Darren [1 ]
Foster, Corey [1 ]
Foster, Benjamin [1 ]
Song, Yeohan [1 ]
Schipper, Matthew [1 ]
Shilkrut, Mark [1 ]
Sandler, Howard M. [2 ]
Morgan, Todd M. [3 ]
Palapattu, Ganesh S. [3 ]
Hamstra, Daniel A. [1 ]
Feng, Felix Y. [1 ]
机构
[1] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48105 USA
[2] Cedars Sinai, Dept Radiat Oncol, Los Angeles, CA 90048 USA
[3] Univ Michigan, Dept Urol, Ann Arbor, MI 48105 USA
来源
RADIATION ONCOLOGY | 2013年 / 8卷
关键词
Prostate-specific antigen doubling time; Salvage radiation therapy; Prostate cancer; BIOCHEMICAL RECURRENCE; NATURAL-HISTORY; RADIOTHERAPY; MEN; PROGRESSION; PREDICTOR; FAILURE; RISK; PSA;
D O I
10.1186/1748-717X-8-170
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The ideal prostate-specific antigen (PSA) doubling time (PSADT) threshold for identifying patients at high-risk for poor clinical outcome following salvage radiation therapy (SRT) has not been well established. We sought to assess what PSADT threshold is most clinically prognostic in this setting. Methods: 575 patients who received SRT at a single institution for biochemical recurrence after radical prostatectomy were retrospectively reviewed. We assessed the impact of pre-SRT PSADT on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall mortality (OM). Kaplan-Meier methods, hazard ratio (HR) assessment, and Cox Proportional Hazard models were used to assess the discriminatory ability of various PSADT thresholds. Results: Sufficient data to calculate PSADTs were available for 277 patients. PSADT was prognostic for BF, DM, PCSM, and OM on univariate analysis regardless of threshold. HR assessment identified 6 months as a strong threshold. No statistically significant difference was observed in BF, DM, PCSM, or OM between patients with PSADT <3 (n=40) and 3-6 months (n=61) or between 6-10 (n=62) and >10 months (n=114). However significant differences were seen in BF (HR: 2.2, [95%CI: 1.4-3.5], p<0.01) and DM (HR: 2.2, [95% CI: 1.2-4.3], p=0.02) between a PSADT of 3-6 and 6-10 months. On multivariate analysis a PSADT <6 months predicted BF (HR: 2.0, [95% CI: 1.4-2.9], p=0.0001), DM (HR: 2.0, [95% CI: 1.2-3.4], p=0.01), and PCSM (HR: 2.6, [95% CI: 1.1-5.9], p=0.02). Conclusions: A pre-SRT PSADT <6 months was a strong predictor of outcomes in our data set, including PCSM. The most common nomogram for SRT uses a 10-month PSADT threshold for assigning points used to assess BF following SRT. If validated, our findings suggest that a PSADT threshold of <6 months should be considered for stratification of patients in future clinical trials in this setting.
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页数:8
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