Background and Purpose: Life expectancy data could identify men with favorable post-radiation prostate-specific antigen (PSA) failure kinetics unlikely to require androgen deprivation therapy (ADT).
Materials and Methods: Of 206 men with unfavorable-risk prostate cancer in a randomized trial of radiation versus radiation and ADT, 53 experienced a PSA failure and were followed without salvage ADT. Comorbidity, age and established prognostic factors were assessed for relationship to death using Cox regression analyses.
Results: The median age at failure, interval to PSA failure, and PSA doubling time were 76.6 years (interquartile range [IQR]: 71.8-79.3), 49.1 months (IQR: 37.7-87.4), and 25 months (IQR: 13.1-42.8), respectively. After a median follow up of 4.0 years following PSA failure, 45% of men had died, none from prostate cancer and no one had developed metastases. Both increasing age at PSA failure (HR: 1.14; 95% CI: 1.03-1.25; P = 0.008) and the presence of moderate to severe comorbidity (HR: 12.5; 95% CI: 3.81-41.0; P < 0.001) were significantly associated with an increased risk of death.
Conclusions: Men over the age of 76 with significant comorbidity and a PSA doubling time >2 years following post-radiation PSA failure appear to be good candidates for observation without ADT intervention.
Written by:
Martin NE, Chen MH, Beard CJ, Nguyen PL, Loffredo MJ, Renshaw AA, Kantoff PW, D'Amico AV. Are you the author?
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-I L2 Boston, MA 02115, USA; Department of Statistics, University of Connecticut, 215 Glenbrook Road, Storrs, CT 06269, USA; Department of Pathology, Baptist Hospital of Miami, 8900 N. Kendall Drive, Miami, FL 33176, USA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
Reference: Prostate Cancer. 2014;2014:912943.
doi: 10.1155/2014/912943
PubMed Abstract
PMID: 24701353
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