PSA response to neoadjuvant androgen deprivation is an independent prognostic marker and may identify patients who benefit from treatment escalation

Andrew M. McDonald, Rojymon Jacob, Eddy S. Yang, Michael C. Dobelbower, Sean Vanlandingham, John B. Fiveash

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: To determine whether prostate-specific antigen (PSA) measurement after initiation of androgen deprivation therapy (ADT) but prior to the start of radiotherapy (RT) pPSA is an independent predictor of biochemical relapse-free survival (bRFS). We also sought to determine the effect, if any, of factors affecting bRFS for patients who did not achieve pPSA<0.5. ng/mL. Methods and materials: A total of 105 patients with National Comprehensive Cancer Network intermediate- or high-risk prostate cancer treated with neoadjuvant ADT (median = 3.9. mo) and external beam RT had pPSA data available and met the inclusion criteria. Pretreatment and treatment characteristics were included in a Cox proportional hazards model to determine effect on bRFS. Results: Median follow-up was 5.4 years. On multivariable analysis, pPSA≥0.5. ng/mL was associated with worsened bRFS (hazard ratio [HR] = 2.7, P = 0.013). For the subgroup of patients with at most 1 high-risk factor, pPSA remained a statistically significant prognostic factor. For patients within this subgroup who had pPSA≥0.5. ng/mL, the addition of pelvic RT was associated with a trend toward improved outcome (HR = 0.609, P = 0.083). Conclusion: For patients with intermediate- or high-risk prostate cancer receiving neoadjuvant ADT, achieving pPSA<0.5. ng/mL was associated with improved rates of bRFS. Additionally, pPSA measurement may identify patients who may be able to benefit from escalated treatment such as pelvic RT.

Original languageEnglish
Pages (from-to)687-693
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number5
DOIs
StatePublished - Jul 2014

Keywords

  • Androgen deprivation
  • External beam radiation
  • PSA
  • PSA response to androgen deprivation
  • Pelvic radiation

ASJC Scopus subject areas

  • Oncology
  • Urology

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