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Prostate-Specific Antigen (PSA) Bounce After Dose-Escalated External Beam Radiation Therapy Is an Independent Predictor of PSA Recurrence, Metastasis, and Survival in Prostate Adenocarcinoma Patients.

Abstract To evaluate the difference in prostate-specific antigen (PSA) recurrence-free, distant metastasis-free, overall, and cancer-specific survival between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated external beam radiation therapy (DE-EBRT).
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title international journal of radiation oncology, biology, physics
Publication Year Start




PMID- 29254782
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 100
IP  - 1
DP  - 2018 Jan 1
TI  - Prostate-Specific Antigen (PSA) Bounce After Dose-Escalated External Beam
      Radiation Therapy Is an Independent Predictor of PSA Recurrence, Metastasis, and 
      Survival in Prostate Adenocarcinoma Patients.
PG  - 59-67
LID - S0360-3016(17)33854-3 [pii]
LID - 10.1016/j.ijrobp.2017.09.003 [doi]
AB  - PURPOSE: To evaluate the difference in prostate-specific antigen (PSA)
      recurrence-free, distant metastasis-free, overall, and cancer-specific survival
      between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated
      external beam radiation therapy (DE-EBRT). METHODS AND MATERIALS: During
      1990-2010, 1898 prostate adenocarcinoma patients were treated with DE-EBRT to
      >/=75 Gy with >/=5 years follow-up. Patients receiving neoadjuvant/concurrent
      androgen-deprivation therapy (n=1035) or with fewer than 4 PSA values obtained 6 
      months or more after post-EBRT completion (n=87) were excluded. The evaluable 776
      patients were treated (median, 81.0 Gy). Prostate-specific antigen bounce was
      defined as a >/=0.2-ng/mL increase above the interval PSA nadir, followed by a
      decrease to nadir or below. Prostate-specific antigen relapse was defined as
      post-radiation therapy PSA nadir + 2 ng/mL. Median follow-up was 9.2 years
      (interquartile range, 6.9-11.3 years). RESULTS: One hundred twenty-three patients
      (15.9%) experienced PSA-B after DE-EBRT at a median of 24.6 months (interquartile
      range, 16.1-38.5 months). On multivariate analysis, younger age (P=.001), lower
      Gleason score (P=.0003), and higher radiation therapy dose (P=.0002)
      independently predicted PSA-B. Prostate-specific antigen bounce was independently
      associated with decreased risk for PSA relapse (hazard ratio [HR] 0.53; 95%
      confidence interval [CI] 0.33-0.85; P=.008), distant metastatic disease (HR 0.34;
      95% CI 0.12-0.94; P=.04), and all-cause mortality (HR 0.53; 95% CI 0.29-0.96;
      P=.04) on multivariate Cox analysis. Because all 50 prostate cancer-specific
      deaths in patients without PSA-B were in the non-bounce cohort, competing-risks
      analysis was not applicable. A nonparametric competing-risks test demonstrated
      that patients with PSA-B had superior cancer-specific survival compared with
      patients without PSA-B (P=.004). CONCLUSIONS: Patients treated with
      dose-escalated radiation therapy for prostate adenocarcinoma who experience
      posttreatment PSA-B have improved PSA recurrence-free survival, distant
      metastasis-free survival, overall survival, and cancer-specific survival
      outcomes.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Romesser, Paul B
AU  - Romesser PB
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York.
FAU - Pei, Xin
AU  - Pei X
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York.
FAU - Shi, Weiji
AU  - Shi W
AD  - Department of Statistics and Epidemiology, Memorial Sloan Kettering Cancer
      Center, New York, New York.
FAU - Zhang, Zhigang
AU  - Zhang Z
AD  - Department of Statistics and Epidemiology, Memorial Sloan Kettering Cancer
      Center, New York, New York.
FAU - Kollmeier, Marisa
AU  - Kollmeier M
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York.
FAU - McBride, Sean M
AU  - McBride SM
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York.
FAU - Zelefsky, Michael J
AU  - Zelefsky MJ
AD  - Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
      York, New York. Electronic address: [email protected]
LA  - eng
PT  - Journal Article
DEP - 20171013
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Adenocarcinoma/*blood/mortality/*radiotherapy/secondary
MH  - Age Factors
MH  - Aged
MH  - Follow-Up Studies
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Neoplasm Grading
MH  - Neoplasm Recurrence, Local/*blood/mortality
MH  - Prostate-Specific Antigen/*blood
MH  - Prostatic Neoplasms/*blood/mortality/pathology/*radiotherapy
MH  - Radiotherapy Dosage
MH  - Retrospective Studies
EDAT- 2017/12/20 06:00
MHDA- 2018/01/05 06:00
CRDT- 2017/12/20 06:00
PHST- 2017/05/01 00:00 [received]
PHST- 2017/09/01 00:00 [revised]
PHST- 2017/09/06 00:00 [accepted]
PHST- 2017/12/20 06:00 [entrez]
PHST- 2017/12/20 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - S0360-3016(17)33854-3 [pii]
AID - 10.1016/j.ijrobp.2017.09.003 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):59-67. doi:
      10.1016/j.ijrobp.2017.09.003. Epub 2017 Oct 13.