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Evaluating the Influence of Prostate-specific Antigen Kinetics on Metastasis in Men with PSA Recurrence after Partial Gland Therapy

Institution:
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: martin_king@dfci.harvard.edu.
Publisher:
Elsevier Science
Publication Date:
Mar-2019
Journal:
Brachytherapy
Volume Number:
18
Issue Number:
2
Pages:
198-203
Citation:
Brachytherapy. 2019 Mar - Apr;18(2):198-203.
PubMed ID:
30638910
Keywords:
Brachytherapy, Focal therapy, Metastasis, PSA kinetics
Appears in Collections:
NCIGT, SPL
Sponsors:
P41 EB015898/EB/NIBIB NIH HHS/United States

Generated Citation:
King M.T., Nguyen P.L., Boldbaatar N., Yang D.D., Muralidhar V., Tempany C.M., Cormack R.A., Hurwitz M.D., Suh W.W., Pomerantz M.M., D'Amico A.V., Orio P.F. Evaluating the Influence of Prostate-specific Antigen Kinetics on Metastasis in Men with PSA Recurrence after Partial Gland Therapy. Brachytherapy. 2019 Mar - Apr;18(2):198-203. PMID: 30638910.
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PURPOSE: Although current Delphi Consensus guidelines do not recommend a specific definition of biochemical recurrence after partial gland therapy, these guidelines acknowledge that serial prostate-specific antigen (PSA) tests remain the best marker for monitoring disease after treatment. The purpose of this study was to determine whether PSA velocity at failure per the Phoenix (nadir + 2 ng/mL) definition is associated with metastasis and prostate cancer-specific mortality (PCSM) in a cohort of patients who experienced PSA failure after partial gland therapy. METHODS: Between 1997 and 2007, 285 patients with favorable risk prostate cancer underwent partial prostate brachytherapy to the peripheral zone. PSA velocity was calculated for 94 patients who experienced PSA failure per the Phoenix (nadir + 2) definition. Fine and Gray competing risks regression was performed to determine whether PSA velocity and other clinical factors were associated with metastasis and PCSM. RESULTS: The median time to PSA failure was 4.2 years (interquartile range: 2.2, 7.9), and the median followup time after PSA failure was 6.5 years (3.5-9.7). Seventeen patients developed metastases, and five experienced PCSM. On multivariate analysis, PSA velocity ≥3.0 ng/mL/year (adjusted hazard ratio 5.97; [2.57, 13.90]; p < 0.001) and PSA nadir (adjusted hazard ratio 0.39; [0.24, 0.64]; p < 0.001) were significantly associated with metastasis. PSA velocity ≥3.0 ng/mL/year was also associated with PCSM (HR 15.3; [1.8, 128.0]; p = 0.012) on univariate analysis. CONCLUSIONS: Rapid PSA velocity at PSA failure after partial gland treatment may be prognostic for long-term outcomes.