Skip to main content
SpringerLink
Log in

Changes in prostate-specific antigen midway through salvage radiotherapy may be associated with long-term outcomes

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

To examine the relationship between changes in prostate-specific antigen (PSA) by midpoint of salvage radiotherapy (SRT) for biochemically recurrent prostate cancer and long-term clinical outcomes.

Methods

We conducted a retrospective study of men treated with SRT for biochemically recurrent prostate cancer at a single practice from 2004 to 2016. Patients were grouped based on PSA response at treatment midpoint: group 0, no change; group 1, decrease; group 2, increase. The primary endpoint was clinical failure measured from time of SRT completion and defined as serum PSA ≥ 0.2 ng/mL above post-radiotherapy nadir, initiation of androgen deprivation therapy, development of bone metastasis, or death from prostate cancer. The Kaplan-Meier method was used to estimate freedom from clinical failure for each group, and differences between groups were examined using pairwise multiple comparison.

Results

Median follow-up was 51.6 months (range, 3.3–138.0). Of 76 eligible men, 13.1% experienced no change in PSA at midpoint of SRT (group 0), 68.4% experienced a decrease (group 1), and 18.4% experienced an increase (group 2). Four-year freedom from clinical failure rates were as follows: group 0, 60.0%; group 1, 58.3%; and group 2, 41.7%. Median time to clinical failure was 71.7 months (95% confidence interval, 46.9–96.5) for group 1; 26.8 months (95% confidence interval, 0.0–55.9) for group 2; and was not reached for group 0. There was a significant difference in four-year freedom from clinical failure between groups 1 and 2 (p = 0.036).

Conclusions

PSA changes by the midpoint of SRT predict long-term prostate cancer control with increases in PSA associated with decreased freedom from disease progression.

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. 1
Fig. 2

Similar content being viewed by others

References

  1. Agarwal PK, Sadetsky N, Konety BR, Resnick MI, Carroll PR (2008) Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 112(2):307–314. https://doi.org/10.1002/cncr.23161

    Article  PubMed  Google Scholar 

  2. Sheets NC, Hendrix LH, Allen IM, Chen RC (2013) Trends in the use of postprostatectomy therapies for patients with prostate cancer: a surveillance, epidemiology, and end results Medicare analysis. Cancer 119(18):3295–3301. https://doi.org/10.1002/cncr.28222

    Article  PubMed  Google Scholar 

  3. Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS Jr, Faraday MM (2013) Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 190(2):441–449. https://doi.org/10.1016/j.juro.2013.05.032

    Article  PubMed  Google Scholar 

  4. Stephenson AJ, Shariat SF, Zelefsky MJ, Kattan MW, Butler EB, Teh BS, Klein EA, Kupelian PA, Roehrborn CG, Pistenmaa DA, Pacholke HD, Liauw SL, Katz MS, Leibel SA, Scardino PT, Slawin KM (2004) Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 291(11):1325–1332

    Article  CAS  PubMed  Google Scholar 

  5. Zumsteg ZS, Daskivich TJ, Sandler HM (2016) Salvage radiotherapy for biochemically recurrent prostate cancer after prostatectomy. J Clin Oncol 34:3829–3833. https://doi.org/10.1200/jco.2016.69.2509

    Article  PubMed  Google Scholar 

  6. Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, Forman JD, Zelefsky MJ, Kestin LL, Roehrborn CG, Catton CN, DeWeese TL, Liauw SL, Valicenti RK, Kuban DA, Pollack A (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25(15):2035–2041. https://doi.org/10.1200/jco.2006.08.9607

    Article  PubMed  Google Scholar 

  7. Patel AR, Stephenson AJ (2011) Radiation therapy for prostate cancer after prostatectomy: adjuvant or salvage? Nat Rev Urol 8(7):385–392. https://doi.org/10.1038/nrurol.2011.80

    Article  PubMed  Google Scholar 

  8. Neuhof D, Hentschel T, Bischof M, Sroka-Perez G, Hohenfellner M, Debus J (2007) Long-term results and predictive factors of three-dimensional conformal salvage radiotherapy for biochemical relapse after prostatectomy. Int J Radiat Oncol Biol Phys 67(5):1411–1417. https://doi.org/10.1016/j.ijrobp.2006.11.024

    Article  PubMed  Google Scholar 

  9. Wiegel T, Lohm G, Bottke D, Hocht S, Miller K, Siegmann A, Schostak M, Neumann K, Hinkelbein W (2009) Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome--results of a retrospective study. Int J Radiat Oncol Biol Phys 73(4):1009–1016. https://doi.org/10.1016/j.ijrobp.2008.06.1922

    Article  PubMed  Google Scholar 

  10. Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, Sartor O, Patel MP, Bahary JP, Zietman AL, Pisansky TM, Zeitzer KL, Lawton CA, Feng FY, Lovett RD, Balogh AG, Souhami L, Rosenthal SA, Kerlin KJ, Dignam JJ, Pugh SL, Sandler HM (2017) Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 376(5):417–428. https://doi.org/10.1056/NEJMoa1607529

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pollack A ea. Short term androgen deprivation therapy without or with pelvic lymph node treatment added to prostate bed only salvage radiotherapy: the NRG Oncology/RTOG 0534 SPPort trial. vol Abstract LBA-5. ASTRO 2018

  12. Yang DD, Muralidhar V, Mahal BA, Nezolosky MD, Labe SA, Vastola ME, Boldbaatar N, King MT, Martin NE, Orio PF 3rd, Choueiri TK, Trinh QD, Den RB, Spratt DE, Hoffman KE, Feng FY, Nguyen PL (2017) Low rates of androgen deprivation therapy use with salvage radiation therapy in patients with prostate cancer after radical prostatectomy. Urol Oncol 35(9):542.e525–542.e532. https://doi.org/10.1016/j.urolonc.2017.04.018

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank Madhava Baikadi, M.D.; Thomas Churilla, M.D.; Meghan Haggerty, M.D.; Leah Nawrocki, RN, MSN; Mushfiq Tarafder, Ph.D., MPH, MBBS; Jim Walker; and the nurses and staff of Northeast Radiation Oncology Center for providing support for the study.

Author information

Authors and Affiliations

  1. Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA, 18510, USA

    Jason M. Homza, John T. Nawrocki, Harmar D. Brereton & Christopher A. Peters

  2. Northeast Radiation Oncology Center, 1110 Meade St., Dunmore, PA, 18512, USA

    Harmar D. Brereton & Christopher A. Peters

Authors
  1. Jason M. Homza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John T. Nawrocki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harmar D. Brereton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher A. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher A. Peters.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Homza, J.M., Nawrocki, J.T., Brereton, H.D. et al. Changes in prostate-specific antigen midway through salvage radiotherapy may be associated with long-term outcomes. J Radiat Oncol 8, 171–175 (2019). https://doi.org/10.1007/s13566-019-00383-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-019-00383-1

Keywords

Search

Navigation