Skip to main content
SpringerLink
Log in

Radiation for prostate cancer: use of biochemical failure as an endpoint following radiotherapy

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

The introduction of prostate-specific antigen (PSA) as a reliable tumor marker for prostate cancer brought significant changes in endpoints after therapy and in outcome reporting. Over the last 15 years we have collected follow-up information in this new era and struggled with failure definitions using this new tool. Parameters for failure after radiation were especially controversial due to the fact that, unlike surgery, a variable amount of normal prostate function and PSA production remained. In 1996, the ASTRO Consensus Conference established a PSA failure definition based on the available information at the time. It was commonly used for outcome reporting subsequently although criticisms have been voiced and alternate definitions proposed. A recently assembled multi-institutional database was used both for long-term outcome reporting with external beam radiation and to test various other failure definitions. A summary of these results and the associated issues are presented here.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–c.
Fig. 2a–c.
Fig. 3.
Fig. 4a, b.
Fig. 5a–c.
Fig. 6a, b.
Fig. 7.
Fig. 8a–c.
Fig. 9.
Fig. 10.

Similar content being viewed by others

References

  1. American Society for Therapeutic Radiology and Oncology Consensus Panel (1997) Consensus statement: guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 37:1035–1041

    Article  PubMed  Google Scholar 

  2. Aref I, Eapen L, Agboola O, Cross P (1998) The relationship between biochemical failure and time to nadir in patients treated with external beam therapy for T1-T3 prostate carcinoma. Radiother Oncol 48:203–207

    Article  CAS  PubMed  Google Scholar 

  3. Critz FA (2002) A standard definition of disease freedom is needed for prostate cancer: undetectable prostate specific antigen compared with the American Society of Therapeutic Radiology and Oncology Consensus Definition. J Urol 167:1310–1313

    PubMed  Google Scholar 

  4. Critz FA (2002) Time to achieve a prostate specific antigen nadir of 0.2 ng./ml. After simultaneous irradiation for prostate cancer. J Urol 168:2434–2438

    PubMed  Google Scholar 

  5. D'Amico, Cote K, Loffredo M, Renshaw AA, Schultz D (2002) Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 20:4567–4573

    Article  PubMed  Google Scholar 

  6. Gretzer MB, Trock BJ, Han M, Walsh PC (2002) A critical analysis of the interpretation of biochemical failure in surgically treated patients using the American Society for Therapeutic Radiation and Oncology Criteria. J Urol 168:1419–1422

    PubMed  Google Scholar 

  7. Hanks GE, Hanlon AL, Epstein B, Horwitz EM (2002) Dose response in prostate cancer with 8–12 years follow-up. Int J Radiat Oncol Biol Phys 54:427–435

    Article  PubMed  Google Scholar 

  8. Hanlon AL, Hanks GE (2000) Scrutiny of the ASTRO consensus definition of biochemical failure in irradiated prostate cancer patients demonstrates its usefulness and robustness. Int J Radiat Oncol Biol Phys 46:559–566

    Article  CAS  PubMed  Google Scholar 

  9. Hanlon AL, Diratzouian H, Hanks GE (2002) Posttreatment prostate-specific antigen nadir highly predictive of distant failure and death from prostate cancer. Int J Radiat Oncol Biol Phys 53:297–303

    Article  PubMed  Google Scholar 

  10. Horwitz EM, Vicini FA, Ziaja E, Gonzalez J, Dmuchowski CF, Stromberg JS, Brabbins DS, Hollander J, Chen PY, Martinez AA (1996) Assessing the variability of outcome for patients treated with localized prostate irradiation using different definitions of biochemical control. Int J Radiat Oncol Biol Phys 36:565–571

    Article  CAS  PubMed  Google Scholar 

  11. Horwitz EM, Uzzo RG, Hanlon AL, Greenberg RE, Hanks GE, Pollack A (2003) Modifying the American Society for Therapeutic Radiology and Oncology definition of biochemical failure to minimize the influence of backdating in patients with prostate cancer treated with 3-dimenional conformal radiation therapy alone. J Urol 169:2153–2159

    PubMed  Google Scholar 

  12. Hung AY, Levy L, Kuban DA (2002) Stage T1c prostate cancer: a heterogeneous category with widely varying prognosis. Cancer J 8:440–444

    PubMed  Google Scholar 

  13. Jani AB, Chen MH, Vaida F, Ignacio L, Awan A, Weichselbaum RR, Vijayakumar S (1999) PSA-based outcome analysis after radiation therapy for prostate cancer: a new definition of biochemical failure after intervention. Urology 54:700–705

    Article  CAS  PubMed  Google Scholar 

  14. Kaminski JM, Hanlon AL, Horwitz EM, Pinover WH, Mitra RK, Hanks GE (2002) Relationship between prostate volume, prostate-specific antigen nadir, and biochemical control. Int J Radiat Oncol Biol Phys 52:888–892

    Article  PubMed  Google Scholar 

  15. Kattan MW, Fearn PA, Leibel S, Potters L (2000) The definition of biochemical failure in patients treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys 48:1469–1474

    Article  CAS  PubMed  Google Scholar 

  16. Kestin LL, Vicini FA, Ziaja EL, Stromberg JS, Frazier RC, Martinez AA (1999) Defining biochemical cure for prostate carcinoma patients treated with external beam radiation therapy. Cancer 86:1557–1566

    Article  CAS  PubMed  Google Scholar 

  17. Kestin LL, Vicini FA, Martinez AA (2002) Practical application of biochemical failure definitions: what to do and when to do it. Int J Radiat Oncol Biol Phys 53:304–315

    Article  PubMed  Google Scholar 

  18. Kuban DA, El-Mahdi AM, Schellhammer PF (1995) Prostate-specific antigen for pretreatment prediction and posttreatment evaluation of outcome after definitive irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 32:307–316

    Article  CAS  PubMed  Google Scholar 

  19. Kuban DA, El-Mahdi AM, Schellhammer PF (1998) PSA for outcome prediction and posttreatment evaluation following radiation for prostate cancer: do we know how to use it? Semin Radiat Oncol 8:72–80

    CAS  PubMed  Google Scholar 

  20. Kuban DA, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, Michalski JM, Pisansky TM, Sandler HW, Shipley WU, Zelefsky MJ, Zietman AL (2003) Long-term multi-institutional analysis of Stage T1-T2 prostate cancer treated with radiation in the PSA era. Int J Radiat Oncol Biol Phys, in press

  21. Kupelian PA, Buchsbaum JC, Patel C, Elshaikh M, Reddy CA, Zippe C, Klein EA (2002) Impact of biochemical failure on overall survival after radiation therapy for localized prostate cancer in the PSA. Int J Radiat Oncol Biol Phys 52:704–711

    Article  CAS  PubMed  Google Scholar 

  22. Lee WR, Hanks GE, Hanlon A (1997) Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations. J Clin Oncol 15:230–238

    CAS  PubMed  Google Scholar 

  23. Oesterling JE, Jacobsen SJ, Chute CG, Guess HA, Girman CJ, Panser LA, Lieber MM (1993) Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 270:860–864

    Article  CAS  PubMed  Google Scholar 

  24. Pickles T, Duncan GG, Kim-Sing C, McKenzie MR, Morris WJ (1999) PSA relapse definitions: the Vancouver rules show superior predictive power. Int J Radiat Oncol Biol Phys 43:699–700

    CAS  PubMed  Google Scholar 

  25. Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, von Eschenbach AC, Kuban DA, Rosen I (2002) Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 53:1097–1105

    Article  PubMed  Google Scholar 

  26. Pound CR, Partin AW, Eisenberger MA, Chan MA, Chan DW, Pearson JD, Walsh PC (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597

    Article  CAS  PubMed  Google Scholar 

  27. Sandler HM, Dunn RL, McLaughlin PW, Hayman JA, Sullivan MA, Taylor JMG (2000) Overall survival after prostate-specific-antigen-detected recurrence following conformal radiation therapy. Int J Radiat Oncol Biol Phys 48:629–633

    Article  CAS  PubMed  Google Scholar 

  28. Shipley WU, Thames HW, Sandler HM, Hanks GE, Zietman AL, Perez CA, Kuban DA, Hancock SL, Smith CD (1999) Radiation therapy for clinically localized prostate cancer: a multi-institutional pooled analysis. JAMA 281:1598–1604

    Article  PubMed  Google Scholar 

  29. Taylor JMG, Griffith KA, Sandler HM (2001) Definitions of biochemical failure in prostate cancer following radiation therapy. Int J Radiat Oncol Biol Phys 50:1212–1219

    Article  CAS  PubMed  Google Scholar 

  30. Thames H, Kuban D, Levy Larry, Horwitz EM, Kupelian P, Martinez A, Michalski J, Pisansky TM, Sandler H, Shipley W, Zelefsky M, Zietman A (2003) A comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995. Int J Radiat Oncol Biol Phys, in press

  31. Vicini FA, Kestin LL, Martinez AA (1999) The importance of adequate follow-up in defining treatment success after external beam irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 45:553–561

    Article  CAS  PubMed  Google Scholar 

  32. Zelefsky MJ, Fuks Z, Hunt M, Lee HJ, Lombardi D, Ling CC, Reuter VE, Venkatraman ES, Leibel SA (2001) High dose radiation delivered by modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 166:876–881

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the collaboration of the nine authors and eight institutions in addition to our own which made the 4839 patient combined analysis possible. In alphabetical order by authors name, they are: Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA, Patrick A. Kupelian, Cleveland Clinic, Cleveland, OH, Alvaro A. Martinez, William Beaumont Hospital, Detroit, MI, Jeff M. Michalski, Mallinkrodt Institute of Radiology Washington University, St. Louis, MO, Thomas M. Pisansky, Mayo Clinic-Rochester, MN, Howard M. Sandler, University of Michigan, Ann Arbor, MI, William U. Shipley, Massachusetts General Hospital, Boston, MA, Michael J. Zelefsky, Memorial Sloan Kettering Cancer, New York, NY, and Anthony L. Zietman, Massachusetts General Hospital, Boston, MA.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 97, Houston, TX 77030, USA

    Deborah A. Kuban

  2. Department of Biomathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

    Howard D. Thames & Larry B. Levy

Authors
  1. Deborah A. Kuban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Howard D. Thames
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Larry B. Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah A. Kuban.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuban, D.A., Thames, H.D. & Levy, L.B. Radiation for prostate cancer: use of biochemical failure as an endpoint following radiotherapy. World J Urol 21, 253–264 (2003). https://doi.org/10.1007/s00345-003-0361-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-003-0361-0

Keywords

Search

Navigation