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Levin-Epstein R , Cook RR , Wong JK , Stock RG , Jeffrey Demanes D , Collins SP , Aghdam N , Suy S , Mantz C , Katz AJ , Nickols NG , Miszczyk L , Napieralska A , Namysl-Kaletka A , Prionas ND , Bagshaw H , Buyyounouski MK , Cao M , Mahal BA , Shabsovich D , Dang A , Yuan Y , Rettig MB , Chang AJ , Jackson WC , Spratt DE , Lehrer EJ , Zaorsky NG , Kupelian PA , Steinberg ML , Horwitz EM , Jiang NY , Kishan AU
Prostate-specific antigen kinetics and biochemical control following stereotactic body radiation therapy, high dose rate brachytherapy, and low dose rate brachytherapy: A multi-institutional analysis of 3502 patients
Radiother Oncol. 2020 Oct;151 :26-32
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BACKGROUND AND PURPOSE: Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). METHODS AND MATERIALS: Retrospective PSA data were analyzed for 3502 men with low-risk (n = 2223; 63.5%), favorable intermediate-risk (n = 869; 24.8%), and unfavorable intermediate-risk (n = 410; 11.7%) PCa treated with SBRT (n = 1716; 49.0%), HDR-BT (n = 512; 14.6%), or LDR-BT (n = 1274; 36.4%) without upfront androgen deprivation therapy at 10 institutions from 1990 to 2017. We compared nadir PSA (nPSA), time to nPSA, achievement of nPSA <0.2 ng/mL and <0.5 ng/mL, rates of nPSA <0.4 ng/mL at 4 years, and BCRFS. RESULTS: Median follow-up was 72 months. Median nPSA and nPSA <0.2 ng/mL were stratified by risk group (interaction p ≤ 0.001). Median nPSA and time to nPSA were 0.2 ng/mL at 44 months after SBRT, 0.1-0.2 ng/mL at 37 months after HDR-BT, and 0.01-0.2 ng/mL at 51 months after LDR-BT (mean log nPSA p ≤ 0.009 for LDR-BT vs. SBRT or HDR-BT for low/favorable intermediate-risk). There were no differences in nPSA <0.4 ng/mL at 4 years (p ≥ 0.51). BCRFS was similar for all three modalities (p ≥ 0.27). Continued PSA decay beyond 4 years was predictive of durable biochemical control. CONCLUSION: LDR-BT led to lower nPSAs with longer continued decay compared to SBRT and HDR-BT, but no differences in BCRFS.
1879-0887 Levin-Epstein, Rebecca Cook, Ryan R Wong, J Karen Stock, Richard G Jeffrey Demanes, D Collins, Sean P Aghdam, Nima Suy, Simeng Mantz, Constantine Katz, Alan J Nickols, Nicholas G Miszczyk, Leszek Napieralska, Aleksandra Namysl-Kaletka, Agnieszka Prionas, Nicholas D Bagshaw, Hilary Buyyounouski, Mark K Cao, Minsong Mahal, Brandon A Shabsovich, David Dang, Audrey Yuan, Ye Rettig, Matthew B Chang, Albert J Jackson, William C Spratt, Daniel E Lehrer, Eric J Zaorsky, Nicholas G Kupelian, Patrick A Steinberg, Michael L Horwitz, Eric M Jiang, Naomi Y Kishan, Amar U Journal Article Ireland Radiother Oncol. 2020 Jul 11;151:26-32. doi: 10.1016/j.radonc.2020.07.014.