scholarly journals Natural History of Untreated Prostate Specific Antigen Radiorecurrent Prostate Cancer in Men with Favorable Prognostic Indicators

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Neil E. Martin ◽  
Ming-Hui Chen ◽  
Clair J. Beard ◽  
Paul L. Nguyen ◽  
Marian J. Loffredo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Doubling Time ◽  
Cox Regression ◽  
Specific Antigen ◽  
Risk Of Death ◽  
Psa Doubling Time ◽  
Increased Risk ◽  
Psa Failure ◽  
Post Radiation

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.

Age, comorbidity, and the risk of death in men with PSA failure following radiation therapy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 82-82
Author(s):  
Neil E. Martin ◽  
Ming-Hui Chen ◽  
Clair Beard ◽  
Paul Linh Nguyen ◽  
Marian Loffredo ◽  
...  
Keyword(s):  
Doubling Time ◽  
Specific Antigen ◽  
Study Cohort ◽  
Risk Of Death ◽  
Psa Doubling Time ◽  
Increased Risk ◽  
Psa Failure ◽  
Severe Comorbidity ◽  
Post Radiation

82 Background: Life expectancy data based on age and comorbidity may identify men with favorable post-radiation prostate-specific antigen (PSA) failure kinetics unlikely to experience metastasis despite withholding androgen deprivation therapy (ADT). Methods: Of 206 men with unfavorable-risk prostate cancer (PC) enrolled on a randomized trial of radiation vs. radiation + ADT, 108 had a PSA failure and 53 who did not receive slavage ADT because the PSA had not meet a pre-specified criteria of 10 ng/mL (n=41) or had significant comorbidity (n=12) and were followed with q1 year (yr) bone scan and q6 month (mo) PSA formed the study cohort. Comorbidity, age and established prognostic factors were evaluated with Cox regression to determine factors associated with death after PSA failure. Results: Median age at and interval to PSA failure and PSA doubling time were 76.6 yr (interquartile range [IQR] 71.8-79.3), 49.1 mo (IQR: 37.7 – 87.4), and 25 mo (IQR: 13.1 – 42.8) respectively. After a median follow up of 4.0 yr (IQR: 2.0 – 12.5) post PSA failure, 24 (45%) men died, none from PC and no one developed metastases. The median last follow up PSA was 3.6 ng/mL (IQR: 1.8 - 8.3). Increasing age at PSA failure (adjusted hazard ratio [AHR]: 1.14; 95% CI: 1.03 – 1.25; p=0.008) and the presence of moderate to severe comorbidity (AHR: 12.5; 95% CI: 3.81 – 41.0; p<0.001) were significantly associated with an increased risk of death on multivariate analysis. At 4 yr, 86% above the median age at PSA failure and with moderate or severe comorbidity had died compared to 16% whose age was at the median or less and with no or minimal comorbidity (p< 0.001). Conclusions: Men over age 76 with significant comorbidity and a PSA doubling time > 2 yr following post-radiation PSA failure appear to be good candidates for surveillance. [Table: see text]

Public health impact of PSA doubling time after radical prostatectomy on prostate cancer specific and overall survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4568-4568
Author(s):  
S. J. Freedland ◽  
E. B. Humphreys ◽  
L. A. Mangold ◽  
M. Eisenberger ◽  
D. J. George ◽  
...  
Keyword(s):  
Public Health ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Doubling Time ◽  
Health Concern ◽  
Small Subset ◽  
Risk Of Death ◽  
Psa Doubling Time ◽  
Increased Risk ◽  
Psa Recurrence

4568 Background: Among patients treated with radical prostatectomy (RP) with a PSA recurrence, we previously found men with a PSA doubling time (PSADT) <3 months were at increased risk of prostate cancer death, though these men constituted a small subset of patients. We sought to determine the actual and predicted number of prostate cancer deaths stratified by PSADT. Methods: We retrospectively studied 379 men treated with RP between 1982 and 2000 with a PSA recurrence. We calculated the actual and 15-year actuarial number of prostate cancer deaths in each of the following PSADT categories: <3, 3.0–8.9, 9.0–14.9, and ≥15.0 months. Results: Median follow-up after PSA recurrence was 7 years. During this time, there were 76 prostate cancer deaths; the majority (51%) were among men with a PSADT of 3.0–8.9 months. Though men with a PSADT <3 months were at the greatest risk of death, this group accounted for only 20% (n=15) of all prostate cancer deaths. Using actuarial 15-year estimates of prostate cancer specific survival, 50% of all prostate cancer deaths were among men with a PSADT of 3.0–8.9 months while men with a PSADT <3 months accounted for only 13% of prostate cancer deaths. Using actuarial 15-year estimates of all-cause and prostate cancer specific mortality, among men with a PSADT <15 months, prostate cancer was estimated to be the cause of death in 94% (145/155). Only among men with a PSADT >15 months was the risk of competing causes of mortality high enough such that the majority of deaths were not attributed to prostate cancer. Conclusions: Among a select cohort of men treated with RP who experienced a PSA recurrence, prostate cancer was estimated to account for 75% of all deaths. Though men with a PSADT <3 months were at the greatest risk, the majority of deaths occurred among men with a PSADT of 3.0–8.9 months. Efforts to reduce prostate cancer mortality should focus on men with intermediate PSADT times (3.0–15.0 months) as they represent the greatest public health concern among men with PSA recurrence following RP. [Table: see text] No significant financial relationships to disclose.

Impact of prostate specific antigen doubling time on time to metastasis and overall survival in non-metastatic castration-resistant prostate cancer patients.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 211-211
Author(s):  
Stephen J. Freedland ◽  
Krishnan Ramaswamy ◽  
Stanislav Lechpammer ◽  
Jack Mardekian ◽  
Neil M. Schultz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Prostate Specific Antigen ◽  
Doubling Time ◽  
Index Date ◽  
Cox Regression ◽  
Specific Antigen ◽  
Prognostic Impact ◽  
Health Administration ◽  
Castration Resistant

211 Background: Prostate-Specific Antigen Doubling Time (PSADT) can help predict prostate cancer (PC) patient outcomes, particularly in hormone sensitive disease. However, PSADT has not been well validated in non-metastatic castration-resistant (nmCR) PC patients. This study examined the prognostic impact of PSADT on time to metastasis (TTM) and overall survival (OS) among nmCRPC patients in the Veterans Health Administration (VHA) database. Methods: VHA patients in this retrospective study were males with PC who had medical or surgical castration between Jan 1, 2012 and Dec 31, 2016. Patients actively receiving luteinizing hormone-releasing hormone treatment with ≥2 PSA post-castration increases were identified. The 3rd PSA value ≥25% and 2 ng/ml > the 1st PSA value was the CRPC (index) date; patients had continuous VHA enrollment for ≥12-months pre- to post-index date. Patients were followed until the earliest of death or disenrollment. PSADT was calculated as the natural log of 2 divided (Ln2) by the log slope of PSA using all PSA values after CRPC until metastases, and patients were categorized into 2-month cohorts. A demographically and clinically adjusted Cox regression model explored associations between PSADT cohorts and TTM and OS. Results: We identified 3,579 patients from which 1,389 (38.8%) progressed to mCRPC while 2,190 (61.2%) remained nmCRPC. Overall, patients averaged 73 years of age. PSADT was calculable in 2,800 patients with an average PSA value of 25.49 ng/mL. After a median follow-up of 820 days, the median PSADT was 17 months. Compared with the PSADT > 12 months cohort, PSADT ≤2, > 2 to ≤4, > 4 to ≤6, > 6 to ≤8, and > 8 to ≤10 month cohorts were associated with higher risk of metastasis (hazard ratio [HR]: 33.77, CI: 25.93-43.96; HR: 14.32, CI: 11.83-17.32; HR: 6.58, CI: 5.42-7.98, HR: 4.14, CI: 3.27-5.25; HR: 3.14, CI: 2.45-4.03, respectively) and death (HR: 12.27, CI: 9.20-16.35; HR: 5.32, CI: 4.26-6.64; HR: 3.50, CI: 2.74-4.47, HR: 2.29, CI: 1.68-3.14; HR: 1.64, CI: 1.14-2.37, respectively). Conclusions: Short PSADT strongly associated with TTM and poor OS in nmCRPC patients. Newer nmCRPC treatments are advisable for high-risk patients.

Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time

2009 ◽  
Vol 103 (7) ◽  
pp. 872-876 ◽  
Author(s):  
Michael K. Ng ◽  
Nicholas Van As ◽  
Karen Thomas ◽  
Ruth Woode-Amissah ◽  
Alan Horwich ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Doubling Time ◽  
Specific Antigen ◽  
Localized Prostate Cancer ◽  
Psa Kinetics ◽  
Psa Doubling Time ◽  
Psa Velocity

Prostate-Specific Antigen Nadir and Cancer-Specific Mortality Following Hormonal Therapy for Prostate-Specific Antigen Failure

2005 ◽  
Vol 23 (27) ◽  
pp. 6556-6560 ◽  
Author(s):  
Alexandra J. Stewart ◽  
Howard I. Scher ◽  
Ming-Hui Chen ◽  
David G. McLeod ◽  
Peter R. Carroll ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Cox Regression ◽  
Specific Antigen ◽  
Study Cohort ◽  
Psa Failure ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Psa Nadir ◽  
Clinically Significant

Purpose For men receiving androgen-suppression therapy (AST) for a rising postoperative or postradiation prostate-specific antigen (PSA), we evaluated whether a PSA nadir of more than 0.2 ng/mL was significantly associated with prostate cancer–specific mortality (PCSM). Patients and Methods The study cohort comprised 747 men with rising PSA and negative bone scan after surgery (n = 486) or radiation therapy (n = 261) who were treated with AST. Cox regression was used to evaluate whether a significant association existed between the PSA nadir level after 8 months of AST and the time to PCSM, controlling for treatment and known prognostic factors. Results The post-AST PSA nadir (pCox < .0001), the pre-AST PSA doubling time (DT) (pCox = .002), PSA level (P = .0001), and Gleason eight to 10 cancers (pCox = .01) were significantly associated with time to PCSM. The adjusted hazard ratio for PCSM was 20 (95% CI, 7 to 61; pCox < .0001), for men with a PSA nadir of more than 0.2 ng/mL as compared with all others. A PSA DT of less than 3 months was observed in 30% (224 of 747) of the study cohort. Of the 28 observed prostate cancer deaths, 21 (75%) occurred in men whose PSA nadir was more than 0.2 ng/mL and who had a PSA DT of less than 3 months. Conclusion A PSA nadir of more than 0.2 ng/mL after 8 months of AST given for postoperative or postradiation PSA failure is significantly associated with PCSM and is clinically significant because it accounted for 75% of the cancer deaths observed in this study.

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