scholarly journals Stereotactic body radiation therapy for clinically localized prostate cancer

2018 ◽  
Vol 14 (2) ◽  
pp. 122-129
Author(s):  
N. A. Vorobyov ◽  
N. I. Martynova ◽  
A. V. Mikhailov ◽  
Yu. V. Gutsalo ◽  
A. V. Kubasov
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Specific Antigen ◽  
Free Survival ◽  
Psa Relapse ◽  
Robotic Radiosurgery ◽  
Number Of Patients ◽  
Psa Nadir ◽  
Cyberknife Robotic Radiosurgery

Background. In the last decade, we observed a significant increase in the number of patients undergoing radiotherapy for prostate cancer (PC). It became possible with the development of new equipment that can significantly increase radiation efficiency and reduce the frequency and severity of side effects. Active investigation of new fractionation regimens led to the development of stereotactic radiotherapy (StR) technique. In this article, we describe our own experience of using StR in patients with localized PC.Material and methods. The study included 48 patients treated with CyberKnife robotic radiosurgery system. The patients received a total dose of 36.25 Gy delivered in 5 fractions.Results. At a median follow-up of 24 months, the estimated four-year prostate-specific antigen (PSA) relapse-free survival rate was 95.8 %. The median PSA nadir was 0.48 ng/mL. We observed no grade III–IV side effects (either early or late).Conclusion. Our results suggest that the use of StR allows achieving good biochemical control comparable to that achieved by other methods and demonstrates comparable and sometimes even lower toxicity.

Prostate-specific antigen nadir: the optimum level after irradiation for prostate cancer.

1996 ◽  
Vol 14 (11) ◽  
pp. 2893-2900 ◽  
Author(s):  
F A Critz ◽  
A K Levinson ◽  
W H Williams ◽  
D A Holladay
Keyword(s):  
Prostate Cancer ◽  
Survival Rate ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Free Survival ◽  
Psa Nadir ◽  
Disease Free Survival Rate ◽  
Disease Free

PURPOSE The prostate-specific antigen (PSA) nadir that reflects potential cure of prostate cancer by irradiation has not been established. This report attempts to demonstrate the PSA nadir goal for radiotherapy. MATERIALS AND METHODS From January 1984 through April 1994, 536 stage T1T2NO prostate cancer patients were treated with radioactive iodine 125 (125I) prostate implants followed by external-beam radiation. All were staged node-negative: 68% by pelvic node dissection and the remainder by computed tomographic (CT) scan. The mean pretreatment PSA level was 12.4 ng/mL (median, 8.4 ng/mL; range, 0.3 to 188 ng/mL). The median follow-up duration is 40 months (range, 12 to 138). An increasing posttreatment PSA level defined recurrence. RESULTS Patients who achieved a PSA nadir < or = 0.5 ng/mL had a 95% (+/- 4%) 5-year and an 84% (+/- 12%) 10-year disease-free survival rate, compared with a 5-year disease-free survival rate of 29% (+/- 30%) for those who reached a nadir of 0.6 to 1.0 ng/mL (P = .0001). All patients with a nadir greater than 1.0 ng/mL ultimately failed. Eighty percent of all 536 patients are projected to achieve a nadir < or = 0.5 ng/mL and 90% of patients who achieve this PSA level do so within 48 months of treatment (median, 18 months). Compared with pretreatment PSA level and histologic grade, the PSA nadir is the most significant factor associated with disease-free survival. CONCLUSION For most patients to be successfully treated for prostate cancer with radiotherapy, at least with this combination technique, the PSA nadir should become undetectable (< or = 0.5 ng/mL), similar to that after radical prostatectomy. A PSA nadir of < or = 0.5 ng/mL after radiotherapy for prostate cancer may be used as a reasonable indicator of 10-year disease-free survival.

scholarly journals Prostate-specific antigen bounce after 125I-brachytherapy for prostate cancer is a favorable prognosticator in patients who are biochemical recurrence-free at 4 years and correlates with testosterone

2019 ◽  
Vol 50 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Yasushi Nakai ◽  
Nobumichi Tanaka ◽  
Isao Asakawa ◽  
Satoshi Anai ◽  
Makito Miyake ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Testosterone Levels ◽  
Psa Bounce ◽  
125I Brachytherapy ◽  
Psa Nadir ◽  
Free Rate

Abstract Background Because patients with prostate-specific antigen (PSA) bounce do not experience biochemical recurrence (BCR) until PSA bounce occurs, the period until PSA bounce ends can be considered the so-called lead-time bias. Therefore, we evaluated differences in BCR-free rate in prostate cancer patients who were BCR-free 4 years after 125I-brachytherapy alone. Furthermore, we evaluated predictors for PSA bounce and the correlation between testosterone and PSA bounce. Methods From 2004 to 2012, 256 patients with prostate adenocarcinoma underwent 125I-brachytherapy alone. PSA and testosterone levels were monitored prior to 125I-brachytherapy, at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54 and 60 months after 125I-brachytherapy and yearly after 5-year follow-up. PSA bounce was defined as ≥0.2 ng/ml increase above the interval PSA nadir, followed by a decrease to nadir or below. Results BCR-free rate in patients with PSA bounce (100% 7-year BCR-free rate) was significantly better (P &lt; 0.044) than that in patients without PSA bounce (95.7% 7-year BCR-free rate) in patients who were BCR-free 4 years after 125I-brachytherapy alone (n = 223). Age was the only predictor (odds ratio: 0.93, 95% confidence interval: 0.88–0.98, P = 0.004) for PSA bounce (n = 177). The testosterone level at PSA bounce was significantly higher (P = 0.036) than that at nadir before PSA bounce (87 cases). Conclusions Patients with PSA bounce had good BCR-free rate even in patients who were BCR-free 4 years after 125I-brachytherapy alone. Testosterone levels were higher at PSA bounce; increased testosterone levels may be a cause of PSA bounce.

Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial

2018 ◽  
Vol 36 (5) ◽  
pp. 446-453 ◽  
Author(s):  
Piet Ost ◽  
Dries Reynders ◽  
Karel Decaestecker ◽  
Valérie Fonteyne ◽  
Nicolaas Lumen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Specific Antigen ◽  
Phase Iii ◽  
Curative Intent ◽  
Free Survival ◽  
Local Progression ◽  
Randomized Phase Ii

Purpose Retrospective studies suggest that metastasis-directed therapy (MDT) for oligorecurrent prostate cancer (PCa) improves progression-free survival. We aimed to assess the benefit of MDT in a randomized phase II trial. Patients and Methods In this multicenter, randomized, phase II study, patients with asymptomatic PCa were eligible if they had had a biochemical recurrence after primary PCa treatment with curative intent, three or fewer extracranial metastatic lesions on choline positron emission tomography–computed tomography, and serum testosterone levels > 50 ng/mL. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions (surgery or stereotactic body radiotherapy). Surveillance was performed with prostate-specific antigen (PSA) follow-up every 3 months, with repeated imaging at PSA progression or clinical suspicion for progression. Random assignment was balanced dynamically on the basis of two factors: PSA doubling time (≤ 3 v > 3 months) and nodal versus non-nodal metastases. The primary end point was androgen deprivation therapy (ADT)–free survival. ADT was started at symptomatic progression, progression to more than three metastases, or local progression of known metastases. Results Between August 2012 and August 2015, 62 patients were enrolled. At a median follow-up time of 3 years (interquartile range, 2.3-3.75 years), the median ADT-free survival was 13 months (80% CI, 12 to 17 months) for the surveillance group and 21 months (80% CI, 14 to 29 months) for the MDT group (hazard ratio, 0.60 [80% CI, 0.40 to 0.90]; log-rank P = .11). Quality of life was similar between arms at baseline and remained comparable at 3-month and 1-year follow-up. Six patients developed grade 1 toxicity in the MDT arm. No grade 2 to 5 toxicity was observed. Conclusion ADT-free survival was longer with MDT than with surveillance alone for oligorecurrent PCa, suggesting that MDT should be explored further in phase III trials.

scholarly journals Event-Free Survival, a Prostate-Specific Antigen–Based Composite End Point, Is Not a Surrogate for Overall Survival in Men With Localized Prostate Cancer Treated With Radiation

2020 ◽  
Vol 38 (26) ◽  
pp. 3032-3041 ◽  
Author(s):  
Wanling Xie ◽  
Meredith M. Regan ◽  
Marc Buyse ◽  
Susan Halabi ◽  
Philip W. Kantoff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Event Free Survival ◽  
Free Survival ◽  
Patient Level ◽  
End Point

PURPOSE Recently, we have shown that metastasis-free survival is a strong surrogate for overall survival (OS) in men with intermediate- and high-risk localized prostate cancer and can accelerate the evaluation of new (neo)adjuvant therapies. Event-free survival (EFS), an earlier prostate-specific antigen (PSA)–based composite end point, may further expedite trial completion. METHODS EFS was defined as the time from random assignment to the date of first evidence of disease recurrence, including biochemical failure, local or regional recurrence, distant metastasis, or death from any cause, or was censored at the date of last PSA assessment. Individual patient data from trials within the Intermediate Clinical Endpoints in Cancer of the Prostate–ICECaP–database with evaluable PSA and disease follow-up data were analyzed. We evaluated the surrogacy of EFS for OS using a 2-stage meta-analytic validation model by determining the correlation of EFS with OS (patient level) and the correlation of treatment effects (hazard ratios [HRs]) on both EFS and OS (trial level). A clinically relevant surrogacy was defined a priori as an R2 ≥ 0.7. RESULTS Data for 10,350 patients were analyzed from 15 radiation therapy–based trials enrolled from 1987 to 2011 with a median follow-up of 10 years. At the patient level, the correlation of EFS with OS was 0.43 (95% CI, 0.42 to 0.44) as measured by Kendall’s tau from a copula model. At the trial level, the R2 was 0.35 (95% CI, 0.01 to 0.60) from the weighted linear regression of log(HR)-OS on log(HR)-EFS. CONCLUSION EFS is a weak surrogate for OS and is not suitable for use as an intermediate clinical end point to substitute for OS to accelerate phase III (neo)adjuvant trials of prostate cancer therapies for primary radiation therapy–based trials.

Significance of normal serum prostate-specific antigen in the follow-up period after definitive radiation therapy for prostatic cancer.

1995 ◽  
Vol 13 (2) ◽  
pp. 459-463 ◽  
Author(s):  
M J Zelefsky ◽  
S A Leibel ◽  
K E Wallner ◽  
W F Whitmore ◽  
Z Fuks
Keyword(s):  
Multivariate Analysis ◽  
Prostate Specific Antigen ◽  
Prostatic Cancer ◽  
Specific Antigen ◽  
Normal Serum ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Serum Prostate Specific Antigen ◽  
Psa Relapse

PURPOSE To determine the prognostic significance of a normal serum prostate-specific antigen (PSA) level in patients with prostatic cancer with long-term follow-up evaluation after radiotherapy. MATERIALS AND METHODS PSA information was available in 403 patients (38%) who were treated with pelvic lymph node dissection and retropubic radioactive iodine-125 implantation. One hundred eighty-two patients had a normal serum PSA level (< or = 4.0 ng/mL) the first time this test was conducted during the follow-up period, designated PSA-1. RESULTS Among patients with PSA-1 values < or = 1.0 ng/mL, the 5-year PSA relapse-free survival rate was 85% compared with 27%, respectively, among those with PSA values in the higher range of normal (P < .00001). Multivariate analysis demonstrated that only a PSA-1 value greater than 1.0 to < or 4.0 (P < .00001) and grade II/III histology (P = .009) had a negative impact on continued PSA relapse-free survival. The only independent variable identified by a multivariate analysis to affect local relapse-free survival (LRFS) was a PSA-1 value greater than 1.0 to < or = 4.0 ng/mL (P < .004), while high-grade histology (P < .0001) and local failure (P < .001) were the only significant variables to affect distant metastases-free survival (DMFS). CONCLUSION Patients with PSA values < or = 1.0 ng/mL are significantly less likely to have a subsequent relapse after therapy than those with levels greater than 1.0 to < or = 4.0 ng/mL. Continuously maintained PSA levels of < or = 1.0 ng/mL after treatment may serve as an end point for early evaluation of the efficacy of experimental radiotherapy protocols in prostate cancer.

Prostate specific antigen five years following stereotactic body radiation therapy (SBRT) for low and intermediate risk prostate cancer: An ablative procedure?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 123-123
Author(s):  
Shaan Kataria ◽  
Harsha Koneru ◽  
Shan Guleria ◽  
Malika Danner ◽  
Marilyn Ayoob ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
University Hospital ◽  
High Rate ◽  
Total Testosterone ◽  
Intermediate Risk ◽  
Biochemical Relapse ◽  
Risk Prostate Cancer ◽  
Psa Nadir

123 Background: Our previous work on early PSA kinetics following prostate SBRT showed that an initial rapid and then slow PSA decline may result in very low PSA nadirs. This retrospective study sought to evaluate the PSA nadir 5 years following SBRT for low and intermediate risk prostate cancer (PCa). Methods: 65 low and 80 intermediate risk PCa patients were treated definitively with SBRT at Georgetown University Hospital between January 2008 and October 2011. All patients were treated to 35-37.5 Gy in 5 fractions delivered via the CyberKnife Radiosurgical System. Patients who received androgen deprivation therapy were excluded from this study. Pre- and post-treatment PSA and total testosterone levels were obtained during routine follow up visits. Biochemical relapse was defined as a PSA rise > 2 ng/mL above the nadir and analyzed using the Kaplan Meier method. The PSA nadir was defined as the lowest PSA value prior to biochemical relapse or as the lowest value recorded during follow up. Prostate ablation was defined as a PSA nadir < 0.2 ng/mL. Univariate logistic regression analysis was used to evaluate relevant variables on the likelihood of achieving a PSA nadir < 0.2 ng/mL. Results: The median age at the start of SBRT was 72 years. These patients had a median prostate volume of 36 cc with a median 25% of total cores involved. At a median follow up of 5.8 years, 84% and 37% of patients achieved a PSA nadir ≤ 0.5 ng/mL and < 0.2 ng/mL, respectively. Five low and 8 intermediate risk patients experienced a biochemical relapse; those who did not experience a biochemical relapse, achieved a median PSA nadir of 0.2 ng/mL. There was no difference between the 5-year bRFS rate for low (96.6%) and intermediate risk (97.4%) patients and the median time to PSA nadir was 36 months. Initial PSA (p = 0.024) and a lower testosterone at the time of the PSA nadir (p = 0.049) were found to be significant predictors of achieving a PSA nadir < 0.2 ng/mL. Conclusions: SBRT for low and intermediate risk PCa is a convenient treatment option with low PSA nadirs and a high rate of early bRFS. Less than 40% of patients achieved an ablative PSA nadir. Thus, the role of further dose escalation is an area of active investigation.

PSA request analysis: how should this be interpreted? What may be overlooked / PSA istem analizi: Nasıl yorumlanmalı? Gözden kaçanlar nelerdir?

2016 ◽  
Vol 41 (2) ◽  
Author(s):  
Sema Nur Ayyıldız ◽  
Abdullah Çırakoğlu ◽  
Ali Ayyıldız ◽  
Erdal Benli
Keyword(s):  
Prostate Cancer ◽  
National Level ◽  
Specific Antigen ◽  
Diagnostic Uncertainty ◽  
Psa Testing ◽  
Number Of Patients ◽  
Organ Specific ◽  
Biopsy Examination ◽  
Urology Clinic

AbstractObjective: Prostate specific antigen is widely used for the diagnosis, treatment, and follow-up of prostate cancer. However, despite being organ-specific, PSA is not specific to cancer. As some patients with elevated PSA level have normal biopsy results and some others with low PSA levels have cancer diagnosed in biopsy examination, PSA creates diagnostic uncertainty both for clinicians and patients. Moreover, different PSA results received for the same subject at separate time points as well as smalllarge fluctuations in PSA levels perturb both sides. In a setting where there are so many unknowns we have PSA in our hands without any restrictions for ordering it. This study analyzed PSA orders, patient traffic, and economic burden within a 6-year period.Methods: The number of PSA tests and patient outcomes at a training and research hospital between October 2006 and May 2013 were evaluated.Results: Of 12107 tPSA orders, 73.6% were ordered by the urology clinic and 26.4% orders were made from other outpatient clinics. When patients at follow-up for prostate cancer are excluded because their tPSAs have to be more commonly checked, we detected that 28.22% of tests were ordered at intervals of less than 1 year. The average tPSA testing frequency was 91.84±1.21 days (0-330). The number of patients younger than 40 years who were tested for tPSA was 287. Of these, 25.43% were ordered by the urology clinic and the remaining by other medical branches.Conclusion: A state of chaos surrounds PSA order and interpretation. Neither patients nor physicians are aware of PSA-related outcomes. Therefore, each hospital should hold sessions on PSA testing and inform physicians about them. Furthermore, a detailed public education should be provided and seminars should be organized at the national level.

scholarly journals Prostate Cancer Burden at the Uganda Cancer Institute

2016 ◽  
Vol 2 (4) ◽  
pp. 181-185 ◽  
Author(s):  
Fred Okuku ◽  
Jackson Orem ◽  
George Holoya ◽  
Chris De Boer ◽  
Cheryl L. Thompson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Stage Iv ◽  
Cord Compression ◽  
Hormonal Manipulation ◽  
Number Of Patients ◽  
Stage Iv Disease ◽  
Metastatic Sites ◽  
Lost To Follow Up

Purpose In Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking. Methods A retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed. Results Our sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up. Conclusion UCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.

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