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Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: the importance of accurately defining biochemical disease status.
Int J Radiat Oncol Biol Phys. 2004 Oct 01; 60(2):453-62.IJ

Abstract

PURPOSE

We analyzed our experience treating localized prostate cancer to determine the impact of androgen deprivation (AD) on clinical outcome if administered at the time of isolated biochemical failure (BF) vs. after clinical failure (clinical failure), and the associated impact of various BF definitions.

METHODS

A total of 1,201 patients with stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) to a median dose of 66.6 Gy. Early AD was defined as administration of AD after BF, without evidence of clinical failure. Delayed AD was defined as administration of AD after clinical failure. Multiple BF definitions were tested for capacity to predict subsequent clinical failure. For each BF definition, outcome was compared for BF patients receiving early AD vs. no or delayed AD.

RESULTS

Five-year clinical failure (from date of BF) was 60% for patients who experienced a prostate-specific antigen rise to >/=3 ng/mL above nadir. For these patients, early AD was associated with decreased 5-year local failure (4% vs. 33%), distant metastasis (13% vs. 44%), cause-specific death (9% vs. 24%), and death due to any cause (32% vs. 48%), despite poorer prognostic factors in patients receiving early AD. On multivariate analysis, early AD remained independently significant for each of these end points.

CONCLUSION

The efficacy of AD after BF varies depending on the BF definition. When an optimal BF definition is applied, early AD decreases distant metastasis and improves survival. Prostate-specific antigen elevation to >/=2 or >/=3 ng/mL above nadir seems optimal in establishing clinically significant BF and the timing of AD intervention.

Authors+Show Affiliations

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA. lkestin@beaumont.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15380579

Citation

Kestin, Larry L., et al. "Potential Survival Advantage With Early Androgen Deprivation for Biochemical Failure After External Beam Radiotherapy: the Importance of Accurately Defining Biochemical Disease Status." International Journal of Radiation Oncology, Biology, Physics, vol. 60, no. 2, 2004, pp. 453-62.
Kestin LL, Vicini FA, Martinez AA. Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: the importance of accurately defining biochemical disease status. Int J Radiat Oncol Biol Phys. 2004;60(2):453-62.
Kestin, L. L., Vicini, F. A., & Martinez, A. A. (2004). Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: the importance of accurately defining biochemical disease status. International Journal of Radiation Oncology, Biology, Physics, 60(2), 453-62.
Kestin LL, Vicini FA, Martinez AA. Potential Survival Advantage With Early Androgen Deprivation for Biochemical Failure After External Beam Radiotherapy: the Importance of Accurately Defining Biochemical Disease Status. Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):453-62. PubMed PMID: 15380579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential survival advantage with early androgen deprivation for biochemical failure after external beam radiotherapy: the importance of accurately defining biochemical disease status. AU - Kestin,Larry L, AU - Vicini,Frank A, AU - Martinez,Alvaro A, PY - 2003/08/29/received PY - 2004/02/23/revised PY - 2004/03/12/accepted PY - 2004/9/24/pubmed PY - 2004/11/4/medline PY - 2004/9/24/entrez SP - 453 EP - 62 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 60 IS - 2 N2 - PURPOSE: We analyzed our experience treating localized prostate cancer to determine the impact of androgen deprivation (AD) on clinical outcome if administered at the time of isolated biochemical failure (BF) vs. after clinical failure (clinical failure), and the associated impact of various BF definitions. METHODS: A total of 1,201 patients with stage T1-T3N0M0 prostate cancer were treated with external beam radiotherapy (EBRT) to a median dose of 66.6 Gy. Early AD was defined as administration of AD after BF, without evidence of clinical failure. Delayed AD was defined as administration of AD after clinical failure. Multiple BF definitions were tested for capacity to predict subsequent clinical failure. For each BF definition, outcome was compared for BF patients receiving early AD vs. no or delayed AD. RESULTS: Five-year clinical failure (from date of BF) was 60% for patients who experienced a prostate-specific antigen rise to >/=3 ng/mL above nadir. For these patients, early AD was associated with decreased 5-year local failure (4% vs. 33%), distant metastasis (13% vs. 44%), cause-specific death (9% vs. 24%), and death due to any cause (32% vs. 48%), despite poorer prognostic factors in patients receiving early AD. On multivariate analysis, early AD remained independently significant for each of these end points. CONCLUSION: The efficacy of AD after BF varies depending on the BF definition. When an optimal BF definition is applied, early AD decreases distant metastasis and improves survival. Prostate-specific antigen elevation to >/=2 or >/=3 ng/mL above nadir seems optimal in establishing clinically significant BF and the timing of AD intervention. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/15380579/Potential_survival_advantage_with_early_androgen_deprivation_for_biochemical_failure_after_external_beam_radiotherapy:_the_importance_of_accurately_defining_biochemical_disease_status_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360301604004791 DB - PRIME DP - Unbound Medicine ER -