1423: The Impact of Gleason Score on the Predictive Value of PSA Doubling Time

2007 ◽  
Vol 177 (4S) ◽  
pp. 469-470 ◽  
Author(s):  
Stephen A. Boorjian ◽  
Sameer A. Siddiqui ◽  
Brant A. Inman ◽  
Jeffrey M. Slezak ◽  
R. Jeffrey Karnes ◽  
...  
Keyword(s):  
Gleason Score ◽  
Predictive Value ◽  
Doubling Time ◽  
Psa Doubling Time ◽  
The Impact

PSA doubling time of ≤6 months as the optimal cutoff for predicting clinically relevant outcomes for men receiving salvage radiation therapy post radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 167-167
Author(s):  
William C. Jackson ◽  
Skyler B. Johnson ◽  
Benjamin Foster ◽  
Corey Foster ◽  
Yeohan Song ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Predictive Value ◽  
Doubling Time ◽  
Univariate Analysis ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Data Set ◽  
Psa Doubling Time ◽  
The Impact

167 Background: Short PSA doubling time (PSADT) after biochemical recurrence (BR) post radical prostatectomy (RP) is known to predict worse outcomes following salvage external beam radiation therapy (SRT). The ideal PSADT cut-off, however, in this context remains uncertain. In this study, we sought to identify the best PSADT cut-off for predicting clinical outcomes following SRT for BR after RP. Methods: 575 patients who received SRT at a single institution for BR after RP were retrospectively reviewed in an IRB approved analysis. The impact of PSADT on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) was assessed using Kaplan-Meier and Cox Proportional Hazards models. Results: Median follow up was 56.7 months post SRT. PSADTs could be calculated for 277 patients. PSADT strongly predicted BF, DM, PCSM, and OS on univariate analysis regardless of cut-off point. There was no statistical difference in BF, DM, PCSM, or OS between patients with PSADT <3 (n=40) and 3-6 months (n=61) or between 6-10 (n=62) and >10 months (n=114). A difference existed in BF (p<0.01 HR: 2.2 [95%CI: 1.4-3.5]) and DM (p=0.02 HR: 2.2 [95%CI: 1.2-4.3]) between PSADT of 3-6 and 6-10 months. PSADT ≤6 had the largest positive predictive value (PPV) for BF (70%), DM (36%), and PCSM (13%) at 5 years. There was no difference in negative predictive value between a PSADT >10 vs. >6 months for BF, DM, PCSM, and OS with 5 year rates of (60% vs. 60%, 86% vs. 86%, 99% vs. 98%, and 95 vs. 94% respectively). On multivariate analysis PSADT ≤6 was a strong predictor of BF (p<0.01 HR: 2.1 [95%CI: 1.5-3.0]), DM (p=0.01 HR: 2.0 [95%CI: 1.2-3.4]), and PCSM (p=0.04 HR: 2.3 [95%CI: 1.1-5.2]), with a trend towards predicting OS (p=0.12 HR: 1.5 [95%CI: 0.9-2.6]). Conclusions: A PSADT ≤6 months was the best predictor of outcomes in our data set, particularly for DM and PCSM. Currently, the most common predictive nomogram for SRT uses PSADT <10 months as the cut-off point for BF. These results suggest that using a PSADT of ≤6 months may improve the ability to predict clinically significant outcomes and hence identify men who may benefit from additional therapy.

scholarly journals Disease-specific outcomes of Radical Prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time

BMC Urology ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Sigve Andersen ◽  
Elin Richardsen ◽  
Yngve Nordby ◽  
Nora Ness ◽  
Øystein Størkersen ◽  
...  
Keyword(s):  
Doubling Time ◽  
Northern Norway ◽  
Psa Doubling Time ◽  
The Impact ◽  
Disease Specific

The effect of Gleason score on the predictive value of prostate-specific antigen doubling time

2009 ◽  
Vol 105 (10) ◽  
pp. 1381-1385 ◽  
Author(s):  
Matthew K. Tollefson ◽  
Michael L. Blute ◽  
Laureano J. Rangel ◽  
Erik J. Bergstralh ◽  
Stephen A. Boorjian ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Predictive Value ◽  
Doubling Time ◽  
Specific Antigen

Ultrasensitive PSA nadir on testosterone inactivating pharmaceuticals accurately predicts early prostate cancer progression

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14531-14531 ◽  
Author(s):  
M. C. Scholz ◽  
R. Lam ◽  
B. Guess ◽  
S. Strum ◽  
H. Johnson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Gleason Score ◽  
Doubling Time ◽  
Median Response ◽  
Cox Regression Analysis ◽  
Psa Doubling Time ◽  
Tip Resistance ◽  
Early Progression ◽  
Psa Nadir

14531 Background: Prostate cancer has a variable natural history. Researchers and clinicians sorely need a marker identifying men destined for early progression to bone metastasis (EPBM). Prostate cancer is uniquely sensitive to testosterone inactivating pharmaceuticals (TIP) especially when TIP is initiated prior to the onset of bone metastasis. Moul 1 reported 10 year median response in men with a rising PSA after surgery. With such effective therapy, predicting EPBM requires a marker signaling TIP resistance. Elevated PSA nadir is a likely candidate. Methods: Retrospective chart review of 159 men with prostate cancer started on TIP before 1/1/00 with negative bone scan and PSA < 100. The predictive value of Gleason score, initial PSA, PSA doubling-time (DT), clinical stage, and ultra-sensitive PSA nadir were evaluated for their ability to predict EPBM within 72 months of starting TIP. TIP consisted of an antiandrogen and LHRH agonist. Results: Median follow was 9.25 years. Median values for patient age, initial PSA, PSA nadir, and PSA doubling time were 65.9, 9.6, 0.03 and 10 months respectively. Sixty men were staged as: T1c-T3b, 46 PSA relapse, and 53 stages T3c, D0 or D1. Thirty-five men developed EPBM. PSA nadir was the most accurate predictor of EPBM (see Table). Only 8% of men with PSA nadir ≤0.05 had EPBM compared to 78% with high nadirs. Cox regression analysis indicated that PSA nadir, Gleason score, and PSA doubling time < 12 months independently predicted EPBM. Median and maximum time to PSA nadir were 4 and 8 months respectively. Conclusions: Ultra-sensitive PSA nadir is a more accurate indicator of early progression to bone metastasis (90%) than Gleason score (75%) as well as being more sensitive and specific (72% vs. 37%) and (95% vs. 86%) respectively. This prognostic information provided by PSA nadir is obtainable within the first 8 months of starting TIP in virtually all patients (97%). 1. Moul JW et al. J Urol 2005, 171: 1141–7. [Table: see text] No significant financial relationships to disclose.

Impact of comorbidity and PSA doubling time on the risk of death in men experiencing PSA failure following radiation therapy with or without androgen deprivation therapy for unfavorable-risk prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 68-68
Author(s):  
Sagar Anil Patel ◽  
Ming-Hui Chen ◽  
Marian Loffredo ◽  
Andrew A. Renshaw ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Androgen Deprivation Therapy ◽  
Doubling Time ◽  
Androgen Deprivation ◽  
Psa Doubling Time ◽  
Psa Failure ◽  
Severe Comorbidity ◽  
The Impact

68 Background: The optimal management of men with PSA failure following initial prostate cancer therapy based on comorbidity is unknown. We investigated the impact that PSA doubling time (DT) and comorbidity had on the risk of all cause (AC), prostate cancer-specific (PCS) and other cause mortality (OCM) following PSA failure. Methods: Between 1995 and 2001, 206 men with unfavorable-risk PC were randomized to receive radiation therapy alone or in combination with 6 months of androgen deprivation therapy (ADT). After a median follow up of 16.2 years, 108 men experienced PSA failure (85, no or minimal; 23, moderate to severe comorbidity) and formed the study cohort. Cox and Fine-Gray regression analysis was used to determine whether PSA DT was associated with the risk of ACM and PCSM/OCM respectively, stratified by ACE-27 comorbidity score. Results: After a median follow up of 13.71 years following PSA failure, 81 of the 108 men (75%) died. Longer PSA DT was associated with a decreased risk of PCSM in men with no/minimal (AHR 0.33, 95% CI 0.17-0.65, p= 0.001) and moderate/severe comorbidity (AHR 0.014, 95% CI 0.002-0.129, p= 0.0002) with a trend toward an increased risk of OCM in men with no/minimal (AHR 1.42, 95% CI 0.94-2.16, p= 0.10) and moderate/severe comorbidity (AHR 1.68, 95% CI 0.85-3.35, p= 0.14). However, increasing PSA DT was only associated with a decreased risk of ACM in men with no/minimal (AHR 0.69, 95% CI 0.50-0.96, p = 0.03) but not moderate/severe comorbidity (AHR 0.95, 95% CI 0.51-1.78, p= 0.87). Conclusions: The extent and natural history of comorbidity as well as PSA DT should be taken into consideration when deciding on appropriate management and/or clinical trial eligibility at the time of PSA failure. Specifically, randomized studies are needed to determine whether survival is prolonged in men with life-shortening comorbidity with salvage ADT at the time of PSA failure versus surveillance and reserving ADT use for symptomatic progression. For all other men, trials comparing ADT with or without novel agents shown to prolong survival in men with metastatic castrate resistant PC is warranted.

A phase II trial of thalidomide, bevacizumab, and docetaxel in patients (pts) with metastatic androgen-independent prostate cancer (AIPC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5114-5114 ◽  
Author(s):  
Y. M. Ning ◽  
P. Arlen ◽  
J. Gulley ◽  
L. Latham ◽  
E. Jones ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Doubling Time ◽  
Vital Role ◽  
Colon Perforation ◽  
Antiangiogenic Agents ◽  
Psa Doubling Time ◽  
Measurable Disease ◽  
Psa Response ◽  
Grade 3

5114 Background: Angiogenesis plays a vital role in the progression of prostate cancer. Antiangiogenic agents thalidomide (T) and bevacizumab (Bv) may enhance docetaxel (Doc) activity in metastatic AIPC. However, T and Bv have different antiangiogenic mechanisms. Since tumor angiogenesis is a complex interplay of multiple angiogenic factors, we reasoned that combination of mechanistically different antiangiogenic agents T and Bv with Doc might be associated with an adequately high and durable PSA response to merit further study. Methods: Pts are required to have progressive metastatic AIPC and no prior chemotherapy for AIPC. Treatment consists of Doc 75 mg/m2 plus Bv 15 mg/kg day 1, q 21 days as a cycle (C), plus T 200 mg qhs and prednisone 10 mg qd. Enoxaparin is used for thrombosis prevention and pegfilgrastim initiated after detection of grade ≥3 neutropenia. PSA is assayed q C and staging studies are done at C 0, C 2, & then q 3 Cs. Results: 39 pts were enrolled, median age 66 [54–79], Gleason score 8 [74% Gs 10∼8, 26% Gs 7∼6], on-study PSA 92 ng/ml [5.9–4399] and pre-study PSA doubling time 1.6 months [0.3–18.2, 87 % <3 months]. Median treatment Cs is 14 [1- 28]. 34 pts (87%) had PSA declines of ≥50%, with median ≥50% PSA-duration 12 Cs [0∼28]. 3 pts have PSA declines around 40% and 2 stable. 26 pts (67%) had >80% PSA declines. 17 pts with measurable disease were evaluable: 1 CR, 9 PR, & 7 SD, with 59% ORR. Significant toxicities: febrile neutropenia (5/39), syncope (4/39), colon perforation or fistula (2/39), grade 3 bleeding (2/39), thrombosis (2/39). Conclusions: This trial is the first study to combine antiangiogenic agents of different mechanisms with Doc in metastatic AIPC. Most of the accrued patients have unfavorable characteristics as evidenced by a high Gleason score and a short PSA doubling time. However, the combination of T and Bv with Doc appears to result in both a high durable PSA decline rate (87%) and a high response in measurable disease (59%) with acceptable toxicities. No significant financial relationships to disclose.

Survival following early hormone therapy for men with rapid PSA doubling time within 2 years following radical prostatectomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5065-5065
Author(s):  
B. Trock ◽  
M. Han ◽  
E. B. Humphreys ◽  
A. W. Partin ◽  
M. A. Eisenberger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Prostatectomy ◽  
Hormonal Therapy ◽  
Salvage Therapy ◽  
Biochemical Recurrence ◽  
Doubling Time ◽  
Early Recurrence ◽  
Psa Doubling Time ◽  
The Impact

5065 Background: Early hormonal therapy has been used in the salvage setting for men with biochemical recurrence following radical prostatectomy (RP), but no studies to date have been able to evaluate whether such treatment prolongs survival. We examined the impact of salvage hormonal therapy on overall survival (OS) in a cohort with long-term follow-up, and attempted to identify the subgroup most likely to benefit. Methods: Retrospective analysis of a cohort of 488 men undergoing RP at Johns Hopkins Hospital from 1982–2004, who experienced biochemical recurrence and received no salvage therapy (n = 386) or salvage hormonal therapy (n = 102); no one received adjuvant therapy. Survival was defined from biochemical recurrence to death from all causes, and analyzed with proportional hazards models with time-dependent covariates. Results: With median follow-up of 6 years after recurrence and 9 years after RP, there were 143 deaths (29%), including 105 from prostate cancer. After adjusting for PSA doubling time (PSADT), RP Gleason score, and year of surgery, hormonal therapy did not significantly improve OS for all men, compared to no salvage therapy: hazard ratio (HR) = 0.72 (95% confidence interval (CI): 0.45–1.17), p = 0.187. However, when restricted to men with early recurrence, i.e. within 2 years of RP, and with a rapid PSADT<6 months, hormonal therapy was associated with a large, significant improvement in OS: HR = 0.25 (95% CI: 0.08–0.71), p = 0.0095. This subgroup comprised 22% of the cohort. In contrast, there was no benefit of salvage hormonal therapy in men with early recurrence and PSADT>6 months: HR = 1.96 (95% CI: 0.89–4.31), p = 0.093, nor those who recurred more than 2 years after RP, regardless of PSADT. Conclusions: This study suggests that early salvage hormonal therapy may significantly and substantially prolong overall survival in the subgroup of men who experience an early biochemical recurrence with a rapid PSADT. These results are consistent with early recurrences being indicative of metastatic disease, while later recurrences are more likely to represent local recurrence. If validated, these results may provide useful stratification criteria for clinical trials. No significant financial relationships to disclose.

Predictors of outcome using salvage androgen deprivation therapy after radical prostatectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 74-74
Author(s):  
M. K. Tollefson ◽  
E. J. Bergstralh ◽  
L. J. Rangel ◽  
R. J. Karnes
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Treatment Failure ◽  
Disease Progression ◽  
Androgen Deprivation Therapy ◽  
Gleason Score ◽  
Doubling Time ◽  
Systemic Disease ◽  
Psa Doubling Time ◽  
Salvage Androgen Deprivation Therapy

74 Background: Nearly all men that experience recurrence of prostate cancer after radical prostatectomy are placed on salvage androgen deprivation therapy (sADT) in an attempt to control the disease. Yet, little is known regarding the efficacy of the treatment, the therapeutic duration or the predictors of treatment failure. Therefore, we examined our experience with sADT after radical prostatectomy in a cohort of patients with no evidence of systemic disease. Methods: We identified 1,373 patients that were treated with sADT after radical prostatectomy prior to the development of systemic disease. Clinical and pathologic variables predicting systemic progression and cancer death were evaluated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the impact of these variables on disease progression and survival. Results: Patients were treated with sADT at a median of 4.2 years after surgery. The median PSA at initiation of sADT was 1.6 ng/mL. The majority (1,234, 90%) of patients had a calculable PSA doubling time prior to the initiation of sADT. 275 patients (20.0%) experienced systemic progression at a median of 3.1 years after the start of sADT. 175 patients (12.7%) died of prostate cancer at a median of 4.7 years after the start of sADT. Factors that predicted disease progression after sADT on multivariate analysis included either neoadjuvant or adjuvant ADT (HR - 2.0, p<0.0001), increasing pathologic Gleason Score (HR - 1.18, p=0.009), increasing pathologic stage (HR - 1.3, p<0.0001), PSA at start of sADT (HR - 1.3, p<0.0001) and PSA doubling time (1.65, p<0.0001). Conclusions: Most men treated with sADT after radical prostatectomy prior to the development of systemic progression experience a lengthy disease-free interval. Multivariate predictors of treatment failure include prior adjuvant or neoadjuvant ADT, pathologic Gleason Score, pathologic stage, PSA level at initiation of sADT and PSA doubling time before sADT. No significant financial relationships to disclose.

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