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Hallemeier CL , Zhang P , Pisansky TM , Hanks GE , McGowan DG , Roach M 3rd , Zeitzer KL , Firat SY , Husain SM , D'Souza DP , Souhami L , Parliament MB , Rosenthal SA , Lukka HR , Rotman M , Horwitz EM , Miles EF , Paulus R , Sandler HM
Prostate-specific antigen after neoadjuvant androgen suppression in prostate cancer patients receiving short-term androgen suppression and external beam radiotherapy: pooled analysis of four NRG Oncology RTOG randomized clinical trials
Int J Radiat Oncol Biol Phys. 2019 Aug 1;104(5) :1057-1065
PMID: 30959123    PMCID: PMC6646073    URL: https://www.ncbi.nlm.nih.gov/pubmed/30959123
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Abstract
PURPOSE: To validate if prostate specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external radiation therapy (RT) with concurrent short-term AS in prostate cancer patients. METHODS: 2404 patients treated with neoAS prior to RT and concurrent AS (without post-RT AS) were pooled from trials A, B, C, and D. Multivariable models were used to test associations between the pre-specified dichotomized post-neoAS, pre-RT PSA (</=0.1 vs. >0.1 ng/mL) groupings and clinical outcomes. RESULTS: Median follow-up for surviving patients was 9.4 years. Median post-neoAS, pre-RT PSA was 0.3 ng/mL, with 32% of patients </=0.1 ng/mL. Race, Gleason score, T-stage, N-stage, pre-treatment PSA, and duration of neoAS were associated with the groups of patients with PSA </=0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR] 2.04; p<0.0001), local failure (HR 2.51; p<0.0001), distant metastases (HR 1.73; p=0.0006), cause-specific mortality (HR 2.36; p<0.0001), and all-cause mortality (HR 1.24; p=0.005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR 2.00; p<0.0001), local failure (HR 2.33; p<0.0001), and cause-specific mortality (HR 1.75; p=0.03). CONCLUSION: Patients with PSA >0.1 ng/mL after neoAS and before RT start had less favorable clinical outcomes than patients with PSA was </=0.1 ng/mL. The role of post-neoAS, pre-RT PSA presently, relative to PSA obtained along the continuum of medical care, is not presently defined, but could be tested in future clinical trials.
Notes
1879-355x Hallemeier, Christopher L Zhang, Peixin Pisansky, Thomas M Hanks, Gerald E McGowan, David G Roach, Mack 3rd Zeitzer, Kenneth L Firat, Selim Y Husain, Siraj M D'Souza, David P Souhami, Luis Parliament, Matthew B Rosenthal, Seth A Lukka, Himanshu R Rotman, Marvin Horwitz, Eric M Miles, Edward F Paulus, Rebecca Sandler, Howard M U10 CA180822/CA/NCI NIH HHS/United States U10 CA180868/CA/NCI NIH HHS/United States Journal Article United States Int J Radiat Oncol Biol Phys. 2019 Apr 5. pii: S0360-3016(19)30610-8. doi: 10.1016/j.ijrobp.2019.03.049.