BACKGROUND AND PURPOSE: We investigated whether earlier PSA failure following prostate brachytherapy is associated with increased rates of distant metastases (DM), prostate cancer-specific mortality (PCSM), and overall mortality.
MATERIALS AND METHODS: We retrospectively analyzed 2818 patients who underwent brachytherapy±external beam radiation therapy (EBRT)±androgen deprivation therapy (ADT). With median follow-up of 5.52years, 264 patients experienced PSA failure at a median time of 3.25years. Patients were stratified to early vs. late PSA failures at cutoffs of 1.5years, 3years, or 5years, and tested in univariate/multivariate analyses for freedom from DM, cause-specific survival (CSS), and overall survival (OS).
RESULTS: Among patients with PSA failures, 69 (26%) patients experienced DM, 47 (18%) PCSM, and 56 (21%) deaths from other causes. Patients with rapid PSA failures demonstrated increased rates of DM, PCSM, and overall mortality, despite higher total BED and longer ADT. In multivariate analysis with a PSA failure interval < 3years, the hazard ratio (HR) for DM was 3.92 (95% CI: 2.34-6.55; p=0.000); HR for PCSM was 2.79 (95% CI: 1.45-5.38; p=0.002); and HR for overall mortality was 2.28 (95% CI: 1.50-3.48; p=0.000).
CONCLUSION: Early PSA failure following radiation is a poor prognostic factor, as it is associated with increased DM, PCSM, and overall mortality.
Written by:
Ko EC, Liu JT, Stone NN, Stock RG. Are you the author?
Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States.
Reference: Radiother Oncol. 2013 Nov 30. pii: S0167-8140(13)00572-0.
doi: 10.1016/j.radonc.2013.11.003
PubMed Abstract
PMID: 24299969
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