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. 2020 Aug:149:64-69.
doi: 10.1016/j.radonc.2020.04.038. Epub 2020 Apr 27.

A biochemical definition of cure after brachytherapy for prostate cancer

Juanita M Crook  1 , Chad Tang  2 , Howard Thames  3 , Pierre Blanchard  3 , Jeremiah Sanders  4 , Jay Ciezki  5 , Mira Keyes  6 , W James Morris  7 , Gregory Merrick  8 , Charles Catton  9 , Hamid Raziee  10 , Richard Stock  11 , Frank Sullivan  12 , Mitch Anscher  3 , Jeremy Millar  13 , Steven Frank  14
Affiliations

A biochemical definition of cure after brachytherapy for prostate cancer

Juanita M Crook et al. Radiother Oncol. 2020 Aug.

Abstract

Background and purpose: To identify a PSA threshold value at an intermediate follow-up time after low dose rate (LDR) prostate brachytherapy associated with cure, defined as long-term (10-15 year) freedom from prostate cancer.

Materials and methods: Data from 7 institutions for 14,220 patients with localized prostate cancer treated with LDR brachytherapy, either alone (8552) or with external beam radiotherapy (n = 1175), androgen deprivation (n = 3165), or both (n = 1328), were analyzed. Risk distribution was 42.4% favorable, 49.2% intermediate, and 8.4% high-risk. Patients with clinical failure before 3.5 years were excluded. Kaplan-Meier analysis was used with clinical failure (local, distant, regional or biochemical triggering salvage) as an endpoint for each of four PSA categories: PSA ≤ 0.2, >0.2 to ≤0.5, >0.5 to ≤1.0, and >1.0 ng/mL. PSA levels at 4 years (±6 months) in 8746 patients without clinical failure were correlated with disease status at 10-15 years.

Results: For the 77.1% of patients with 4-year PSA ≤ 0.2, the freedom-from-recurrence (FFR) rates were 98.7% (95% CI 98.3-99.0) at 10 years and 96.1% (95% CI 94.8-97.2) at 15 years. Three independent validation cohorts confirmed 97-99% 10-year FFR rates with 4-year PSA ≤ 0.2. Successive PSA categories were associated with diminished disease-free rates at 10 and 15 years. PSA category was strongly associated with treatment success (p < 0.0005).

Conclusions: Since 98.7% of patients with PSA ≤ 0.2 ng/mL at 4 years after LDR prostate brachytherapy were disease-free beyond 10 years, we suggest adopting this biochemical definition of cure for patients with ≥4 years' follow-up after LDR brachytherapy.

Keywords: Adenocarcinoma of prostate; Brachytherapy; Low dose rate brachytherapy; PSA definition of cure; Prostate specific antigen.

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Figures

Fig. 1 —
Fig. 1 —
Disease-free survival rates by prostate-specific antigen (PSA) category at 4 years (A) and 5 years (B). PSA measurements before the interval of interest were excluded.
Fig. 1 —
Fig. 1 —
Disease-free survival rates by prostate-specific antigen (PSA) category at 4 years (A) and 5 years (B). PSA measurements before the interval of interest were excluded.
Fig 2 —
Fig 2 —
Disease-free survival by prostate-specific antigen (PSA) category at 4 years for the 3 validation cohorts. (A) Favorable risk (Australia: 75% favourable risk and 25% intermediate risk). (B) Intermediate risk (MD Anderson). (c) High risk (Ascende RT: 70% high risk and 30% upper tier intermediate risk).
Fig 2 —
Fig 2 —
Disease-free survival by prostate-specific antigen (PSA) category at 4 years for the 3 validation cohorts. (A) Favorable risk (Australia: 75% favourable risk and 25% intermediate risk). (B) Intermediate risk (MD Anderson). (c) High risk (Ascende RT: 70% high risk and 30% upper tier intermediate risk).
Fig 2 —
Fig 2 —
Disease-free survival by prostate-specific antigen (PSA) category at 4 years for the 3 validation cohorts. (A) Favorable risk (Australia: 75% favourable risk and 25% intermediate risk). (B) Intermediate risk (MD Anderson). (c) High risk (Ascende RT: 70% high risk and 30% upper tier intermediate risk).
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