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...

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Main Authors: 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
Format: Article
Language:English
Published: Termedia Publishing House 2016-04-01
Series:Journal of Contemporary Brachytherapy
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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
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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.
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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
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