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Biochemical failure and the temporal kinetics of prostate-specific antigen after radiation therapy with androgen deprivation.
Int J Radiat Oncol Biol Phys 2005; 61(5):1291-8IJ

Abstract

PURPOSE

The accuracy of the American Society of Therapeutic Radiation Oncology consensus definition of biochemical failure (BF) after radiation therapy (RT) and androgen deprivation (AD) has been questioned, because posttreatment prostate-specific antigen (PSA) levels typically rise after release from AD, and misclassification of BF may be made. The temporal kinetics of posttreatment PSA levels was examined to define the error in the classification of BF.

METHODS AND MATERIALS

Between December 1, 1991 and April 30, 1998, 688 men with T1c-T3 NX/0 M0 prostate cancer received three-dimensional conformal RT alone (n = 586) or in combination with either short-term (STAD: 3 to 12 months, n = 82) or long-term (LTAD: 12 to 36 months, n = 20) AD. Follow-up, calculated from the end of all treatment, was >/=48 months. The mean posttreatment PSA was calculated in 3-month intervals.

RESULTS

The median posttreatment clinical follow-up period was 76 months (range, 48-152 months). The posttreatment PSA values from the end of all treatment for the RT+STAD-BF group showed an initial period of rise followed by a period of decline at 30 months and then a continued rise again. The decline in the mean posttreatment PSA is explained in part by stabilization in PSA level after 3 consecutive rises. Nonbiochemical failures (NBF) after RT+STAD had a relatively constant mean PSA over time of approximately 0.5 ng/mL. Unlike the RT+STAD-NBF profile, the RT+LTAD-NBF profile rose continuously and steadily to a level approaching 1 ng/mL. The RT+LTAD-BF profile rose continuously but at a slower rate over time. Nine RT+STAD-NBF patients (22%) and 2 RT+LTAD-BF (29%) patients experienced 3 consecutive rises followed by a subsequent decline and stabilization of PSA compared to 10 RT-BF patients (5%). Redistributing these misclassified patients to their respective NBF groups changed the mean posttreatment PSA profiles as follows: The RT+LTAD-BF profile rose constantly and steadily with a doubling time of approximately 16 months, and the RT+LAD-NF initially rose to a value of approximately 0.5 ng/mL, then at 36 months began to decline.

CONCLUSIONS

The temporal kinetics of posttreatment PSA after RT+AD and RT alone are different. The American Society of Therapeutic Radiation Oncology definition for biochemical failure overestimates BF in 20-30% after RT+AD compared to 5% after RT alone.

Authors+Show Affiliations

Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15817330

Citation

Buyyounouski, Mark K., et al. "Biochemical Failure and the Temporal Kinetics of Prostate-specific Antigen After Radiation Therapy With Androgen Deprivation." International Journal of Radiation Oncology, Biology, Physics, vol. 61, no. 5, 2005, pp. 1291-8.
Buyyounouski MK, Hanlon AL, Horwitz EM, et al. Biochemical failure and the temporal kinetics of prostate-specific antigen after radiation therapy with androgen deprivation. Int J Radiat Oncol Biol Phys. 2005;61(5):1291-8.
Buyyounouski, M. K., Hanlon, A. L., Horwitz, E. M., Uzzo, R. G., & Pollack, A. (2005). Biochemical failure and the temporal kinetics of prostate-specific antigen after radiation therapy with androgen deprivation. International Journal of Radiation Oncology, Biology, Physics, 61(5), pp. 1291-8.
Buyyounouski MK, et al. Biochemical Failure and the Temporal Kinetics of Prostate-specific Antigen After Radiation Therapy With Androgen Deprivation. Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1291-8. PubMed PMID: 15817330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biochemical failure and the temporal kinetics of prostate-specific antigen after radiation therapy with androgen deprivation. AU - Buyyounouski,Mark K, AU - Hanlon,Alexandra L, AU - Horwitz,Eric M, AU - Uzzo,Robert G, AU - Pollack,Alan, PY - 2004/01/20/received PY - 2004/08/13/revised PY - 2004/08/16/accepted PY - 2005/4/9/pubmed PY - 2005/5/11/medline PY - 2005/4/9/entrez SP - 1291 EP - 8 JF - International journal of radiation oncology, biology, physics JO - Int. J. Radiat. Oncol. Biol. Phys. VL - 61 IS - 5 N2 - PURPOSE: The accuracy of the American Society of Therapeutic Radiation Oncology consensus definition of biochemical failure (BF) after radiation therapy (RT) and androgen deprivation (AD) has been questioned, because posttreatment prostate-specific antigen (PSA) levels typically rise after release from AD, and misclassification of BF may be made. The temporal kinetics of posttreatment PSA levels was examined to define the error in the classification of BF. METHODS AND MATERIALS: Between December 1, 1991 and April 30, 1998, 688 men with T1c-T3 NX/0 M0 prostate cancer received three-dimensional conformal RT alone (n = 586) or in combination with either short-term (STAD: 3 to 12 months, n = 82) or long-term (LTAD: 12 to 36 months, n = 20) AD. Follow-up, calculated from the end of all treatment, was >/=48 months. The mean posttreatment PSA was calculated in 3-month intervals. RESULTS: The median posttreatment clinical follow-up period was 76 months (range, 48-152 months). The posttreatment PSA values from the end of all treatment for the RT+STAD-BF group showed an initial period of rise followed by a period of decline at 30 months and then a continued rise again. The decline in the mean posttreatment PSA is explained in part by stabilization in PSA level after 3 consecutive rises. Nonbiochemical failures (NBF) after RT+STAD had a relatively constant mean PSA over time of approximately 0.5 ng/mL. Unlike the RT+STAD-NBF profile, the RT+LTAD-NBF profile rose continuously and steadily to a level approaching 1 ng/mL. The RT+LTAD-BF profile rose continuously but at a slower rate over time. Nine RT+STAD-NBF patients (22%) and 2 RT+LTAD-BF (29%) patients experienced 3 consecutive rises followed by a subsequent decline and stabilization of PSA compared to 10 RT-BF patients (5%). Redistributing these misclassified patients to their respective NBF groups changed the mean posttreatment PSA profiles as follows: The RT+LTAD-BF profile rose constantly and steadily with a doubling time of approximately 16 months, and the RT+LAD-NF initially rose to a value of approximately 0.5 ng/mL, then at 36 months began to decline. CONCLUSIONS: The temporal kinetics of posttreatment PSA after RT+AD and RT alone are different. The American Society of Therapeutic Radiation Oncology definition for biochemical failure overestimates BF in 20-30% after RT+AD compared to 5% after RT alone. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/15817330/Biochemical_failure_and_the_temporal_kinetics_of_prostate_specific_antigen_after_radiation_therapy_with_androgen_deprivation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(04)02286-2 DB - PRIME DP - Unbound Medicine ER -