Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer
Purpose : To evaluate the prognostic value of prostate-specific antigen nadir (nPSA) after high-dose-rate (HDR) brachytherapy in clinically non-metastatic high-risk prostate cancer patients. Material and methods : Data from 216 patients with high-risk or locally advanced prostate cancer who under...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Termedia Publishing House
2016-04-01
|
Series: | Journal of Contemporary Brachytherapy |
Subjects: | |
Online Access: | https://www.termedia.pl/Prostate-specific-antigen-nadir-after-high-dose-rate-brachytherapy-predicts-long-term-survival-outcomes-in-high-risk-prostate-cancer,54,27482,1,1.html |
_version_ | 1811241872385900544 |
---|---|
author | Hideyasu Tsumura Takefumi Satoh Hiromichi Ishiyama Ken-ichi Tabata Shouko Komori Akane Sekiguchi Masaomi Ikeda Shinji Kurosaka Tetsuo Fujita Masashi Kitano Kazushige Hayakawa Masatsugu Iwamura |
author_facet | Hideyasu Tsumura Takefumi Satoh Hiromichi Ishiyama Ken-ichi Tabata Shouko Komori Akane Sekiguchi Masaomi Ikeda Shinji Kurosaka Tetsuo Fujita Masashi Kitano Kazushige Hayakawa Masatsugu Iwamura |
author_sort | Hideyasu Tsumura |
collection | DOAJ |
description | Purpose : To evaluate the prognostic value of prostate-specific antigen nadir (nPSA) after high-dose-rate (HDR) brachytherapy in clinically non-metastatic high-risk prostate cancer patients.
Material and methods : Data from 216 patients with high-risk or locally advanced prostate cancer who underwent HDR brachytherapy and external beam radiation therapy with long-term androgen deprivation therapy (ADT) between 2003 and 2008 were analyzed. The median prostate-specific antigen (PSA) level at diagnosis was 24 ng/ml (range: 3-338 ng/ml). The clinical stage was T1c-2a in 55 cases (26%), T2b-2c in 48 (22%), T3a in 75 (35%), and T3b-4 in 38 (17%). The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After 5 fractions, external beam radiation therapy with 10 fractions of 3 Gy was administered. All patients initially underwent neoadjuvant ADT for at least 6 months, and adjuvant ADT was continued for 36 months. The median follow-up was 7 years from the start of radiotherapy.
Results : The 7-year PSA relapse-free rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 94%, compared with 23% for patients with higher nPSA values (HR = 28.57; 95% CI: 12.04-66.66; p < 0.001). Multivariate analysis revealed that the nPSA value after radiotherapy was a significant independent predictor of biochemical failure, whereas pretreatment predictive values for worse biochemical control including higher level of initial PSA, Gleason score ≥ 8, positive biopsy core rate ≥ 67%, and T3b-T4, failed to reach independent predictor status. The 7-year cancer-specific survival rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 99%, compared with 82% for patients with higher nPSA values (HR = 32.25; 95% CI: 3.401-333.3; p = 0.002).
Conclusions : A post-radiotherapy nPSA value of ≤ 0.02 ng/ml was associated with better long-term biochemical tumor control even if patients had pretreatment predictive values for worse control. |
first_indexed | 2024-04-12T13:42:42Z |
format | Article |
id | doaj.art-1f031a50f2b140a0bc9ce1687060b1c8 |
institution | Directory Open Access Journal |
issn | 1689-832X 2081-2841 |
language | English |
last_indexed | 2024-04-12T13:42:42Z |
publishDate | 2016-04-01 |
publisher | Termedia Publishing House |
record_format | Article |
series | Journal of Contemporary Brachytherapy |
spelling | doaj.art-1f031a50f2b140a0bc9ce1687060b1c82022-12-22T03:30:47ZengTermedia Publishing HouseJournal of Contemporary Brachytherapy1689-832X2081-28412016-04-01829510310.5114/jcb.2016.5968627482Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancerHideyasu TsumuraTakefumi SatohHiromichi IshiyamaKen-ichi TabataShouko KomoriAkane SekiguchiMasaomi IkedaShinji KurosakaTetsuo FujitaMasashi KitanoKazushige HayakawaMasatsugu IwamuraPurpose : To evaluate the prognostic value of prostate-specific antigen nadir (nPSA) after high-dose-rate (HDR) brachytherapy in clinically non-metastatic high-risk prostate cancer patients. Material and methods : Data from 216 patients with high-risk or locally advanced prostate cancer who underwent HDR brachytherapy and external beam radiation therapy with long-term androgen deprivation therapy (ADT) between 2003 and 2008 were analyzed. The median prostate-specific antigen (PSA) level at diagnosis was 24 ng/ml (range: 3-338 ng/ml). The clinical stage was T1c-2a in 55 cases (26%), T2b-2c in 48 (22%), T3a in 75 (35%), and T3b-4 in 38 (17%). The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After 5 fractions, external beam radiation therapy with 10 fractions of 3 Gy was administered. All patients initially underwent neoadjuvant ADT for at least 6 months, and adjuvant ADT was continued for 36 months. The median follow-up was 7 years from the start of radiotherapy. Results : The 7-year PSA relapse-free rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 94%, compared with 23% for patients with higher nPSA values (HR = 28.57; 95% CI: 12.04-66.66; p < 0.001). Multivariate analysis revealed that the nPSA value after radiotherapy was a significant independent predictor of biochemical failure, whereas pretreatment predictive values for worse biochemical control including higher level of initial PSA, Gleason score ≥ 8, positive biopsy core rate ≥ 67%, and T3b-T4, failed to reach independent predictor status. The 7-year cancer-specific survival rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 99%, compared with 82% for patients with higher nPSA values (HR = 32.25; 95% CI: 3.401-333.3; p = 0.002). Conclusions : A post-radiotherapy nPSA value of ≤ 0.02 ng/ml was associated with better long-term biochemical tumor control even if patients had pretreatment predictive values for worse control.https://www.termedia.pl/Prostate-specific-antigen-nadir-after-high-dose-rate-brachytherapy-predicts-long-term-survival-outcomes-in-high-risk-prostate-cancer,54,27482,1,1.htmlbrachytherapy high-dose-rate prostate cancer PSA nadir |
spellingShingle | Hideyasu Tsumura Takefumi Satoh Hiromichi Ishiyama Ken-ichi Tabata Shouko Komori Akane Sekiguchi Masaomi Ikeda Shinji Kurosaka Tetsuo Fujita Masashi Kitano Kazushige Hayakawa Masatsugu Iwamura Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer Journal of Contemporary Brachytherapy brachytherapy high-dose-rate prostate cancer PSA nadir |
title | Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer |
title_full | Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer |
title_fullStr | Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer |
title_full_unstemmed | Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer |
title_short | Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer |
title_sort | prostate specific antigen nadir after high dose rate brachytherapy predicts long term survival outcomes in high risk prostate cancer |
topic | brachytherapy high-dose-rate prostate cancer PSA nadir |
url | https://www.termedia.pl/Prostate-specific-antigen-nadir-after-high-dose-rate-brachytherapy-predicts-long-term-survival-outcomes-in-high-risk-prostate-cancer,54,27482,1,1.html |
work_keys_str_mv | AT hideyasutsumura prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT takefumisatoh prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT hiromichiishiyama prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT kenichitabata prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT shoukokomori prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT akanesekiguchi prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT masaomiikeda prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT shinjikurosaka prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT tetsuofujita prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT masashikitano prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT kazushigehayakawa prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer AT masatsuguiwamura prostatespecificantigennadirafterhighdoseratebrachytherapypredictslongtermsurvivaloutcomesinhighriskprostatecancer |