FCCC LOGO Faculty Publications
Ray ME , Levy LB , Horwitz EM , Kupelian PA , Martinez AA , Michalski JM , Pisansky TM , Zelefsky MJ , Zietman AL , Kuban DA
Nadir prostate-specific antigen within 12 months after radiotherapy predicts biochemical and distant failure
Urology. 2006 Dec;68(6) :1257-1262
PMID: ISI:000242869900024   
Back to previous list
Objectives. To determine whether nadir prostate-specific antigen (PSA) levels within 12 months (nadir PSA12) after completion of radiotherapy (RT) can be used as an early marker of recurrence risk. Methods. A total of 4839 patients were treated with RT and without hormonal therapy from 1986 to 1995 for Stage T1-T2 prostate cancer at nine institutions. Of these 4839 patients, 4833, with a median follow-up of 6.3 years, met the criteria for analysis. The study endpoints included freedom from PSA failure, initiation of androgen deprivation, or documented local or distant failure (PSA-DFS); freedom from clinically apparent distant metastasis (DMFS); and overall survival (OS). Results. Patients with a nadir PSA12 of 2.0 ng/mL or less had an 8-year PSA-DFS, DMFS, and OS rate of 55%, 95%, and 73%, respectively, compared with 40%, 88%, and 69%, respectively, for patients with a nadir PSA12 of more than 2.0 ng/mL. Multivariate analysis confirmed that a nadir PSA12 of greater than 2 ng/mL was an independent predictor of PSA-DFS, DMFS, and OS. Classification and regression tree analysis identified the nadir PSA12 levels after RT associated with PSA-DFS, DMFS, and OS. Nadir PSA12, combined with the pretreatment PSA level, identified patients at particularly high risk of distant metastasis. Conclusions. The results of this large, multi-institutional study have demonstrated that nadir PSA12 is predictive of clinical outcomes for patients with localized prostate cancer after RT. A high pretreatment PSA level and high nadir PSA12 will identify patients at particularly high risk who might benefit from early adjuvant therapy.
ISI Document Delivery No.: 117JR Times Cited: 0 Cited Reference Count: 24 Cited References: BREIMAN L, 1984, CLASSIFICATION REGRE, P358 CAVANAUGH SX, 2004, CANCER, V101, P96 COX JD, 1997, INT J RADIAT ONCOL, V37, P1035 CRITZ FA, 1996, J CLIN ONCOL, V14, P2893 CRITZ FA, 1997, UROLOGY, V49, P322 CRITZ FA, 1997, UROLOGY, V49, P668 CRITZ FA, 1999, J UROLOGY, V161, P1199 CROOK JM, 1997, CANCER, V79, P328 CROOK JM, 1998, UROLOGY, V51, P566 DEWITT KD, 2003, UROLOGY, V62, P492 HANLON AL, 2002, INT J RADIAT ONCOL, V53, P297 KAMINSKI JM, 2002, INT J RADIAT ONCOL, V52, P888 KESTIN LL, 1999, CANCER, V86, P1557 KUBAN D, 2005, INT J RADIAT ONCOL, V61, P409 KUBAN DA, 2003, INT J RADIAT ONCOL, V57, P915 KUBAN DA, 2005, J UROLOGY, V173, P1871 LEE WR, 1996, J UROLOGY 1, V156, P450 PEREZ CA, 2001, INT J RADIAT ONCOL, V49, P1287 POLLACK A, 2002, INT J RADIAT ONCOL, V54, P677 POLLACK A, 2004, J CLIN ONCOL, V22, P4569 RAY ME, 2006, INT J RADIAT ONCOL, V64, P1140 THAMES H, 2003, INT J RADIAT ONCOL, V57, P929 ZELEFSKY MJ, 2001, J UROLOGY, V166, P876 ZIETMAN AL, 1996, RADIOTHER ONCOL, V40, P159