Optimal PSA Threshold for Androgen-Deprivation Therapy in Patients with Prostate Cancer following Radical Prostatectomy and Adjuvant Radiation Therapy
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Purpose: The benefits of early administration of androgen-deprivation therapy (ADT) in patients with prostate-specific antigen(PSA)-only recurrent prostate cancer (PCa) following radical prostatectomy (RP) are controversial. We investigated the impact ofearly versus delayed ADT on survival outcomes in patients with non-metastatic, localized or locally advanced PCa who receivedradiation therapy (RT) following RP and later developed distant metastasis. Materials and Methods: A retrospective analysis was performed on 69 patients with non-metastatic, localized or locally advancedPCa who received RT following RP and later developed distant metastasis between January 2006 and December 2012. Patientswere stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL). Study endpointswere progression to castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival (CSS). Results: Patients were stratified according to the criteria of 2 ng/mL of PSA at which ADT was administered, based on the Youdensensitivity analysis. Delayed ADT at PSA ≥2 ng/mL was an independent prognosticator of cancer-specific mortality (p=0.047), anda marginally significant prognosticator of progression to CRPC (p=0.051). During the median follow-up of 81.0 (interquartilerange 54.2–115.7) months, patients who received early ADT at PSA <2 ng/mL had significantly higher CSS rates compared to patientswho received delayed ADT at PSA ≥2 ng/mL (p=0.002). Progression to CRPC-free survival was comparable between the twogroups (p=0.331). Conclusion: Early ADT at the PSA level of less than 2 ng/mL confers CSS benefits in patients with localized or locally advancedPCa who were previously treated with RP.
Abstract
Purpose: The benefits of early administration of androgen-deprivation therapy (ADT) in patients with prostate-specific antigen(PSA)-only recurrent prostate cancer (PCa) following radical prostatectomy (RP) are controversial. We investigated the impact ofearly versus delayed ADT on survival outcomes in patients with non-metastatic, localized or locally advanced PCa who receivedradiation therapy (RT) following RP and later developed distant metastasis. Materials and Methods: A retrospective analysis was performed on 69 patients with non-metastatic, localized or locally advancedPCa who received RT following RP and later developed distant metastasis between January 2006 and December 2012. Patientswere stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL). Study endpointswere progression to castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival (CSS). Results: Patients were stratified according to the criteria of 2 ng/mL of PSA at which ADT was administered, based on the Youdensensitivity analysis. Delayed ADT at PSA ≥2 ng/mL was an independent prognosticator of cancer-specific mortality (p=0.047), anda marginally significant prognosticator of progression to CRPC (p=0.051). During the median follow-up of 81.0 (interquartilerange 54.2–115.7) months, patients who received early ADT at PSA <2 ng/mL had significantly higher CSS rates compared to patientswho received delayed ADT at PSA ≥2 ng/mL (p=0.002). Progression to CRPC-free survival was comparable between the twogroups (p=0.331). Conclusion: Early ADT at the PSA level of less than 2 ng/mL confers CSS benefits in patients with localized or locally advancedPCa who were previously treated with RP.
참고문헌 (31)
- Tan L, "Survival outcomes of younger men(< 55 years)undergoing radical prostatectomy", Prostate Int, 6, pp.31~35 (2018)
- Mohler JL, "Prostate cancer, version 2. 2019, NCCN clinical practice guidelines in oncology", J Natl Compr Canc Netw, 17, pp.479~505 (2019)
- 구교철, "Treatment of Oligometastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Review", Yonsei Medical Journal, 59(5), pp.567~579 (2018), 연세대학교의과대학[DOI]
- Bolla M, "Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer(an EORTC study) : a phase III randomised trial", Lancet, 360, pp.103~106 (2002)
- Ahn S, "Comparative quality-adjusted survival analysis between radiation therapy alone and radiation with androgen deprivation therapy in patients with locally advanced prostate cancer : a secondary analysis of Radiation Therapy Oncology Group 85-31 with novel decision analysis methods", Prostate Int, 6, pp.140~144 (2018)
- Pilepich MV, "Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma--long-term results of phase III RTOG 85-31", Int J Radiat Oncol Biol Phys, 61, pp.1285~1290 (2005)
- Warde P, "Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer : a randomised, phase 3trial", Lancet, 378, pp.2104~2111 (2011)
- Widmark A, "Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer(SPCG-7", SFUO-3) : an open randomised phase III trial, 2009, pp.373, 301~308
- Bolla M, "External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk : 10-year results of an EORTC randomised study", Lancet Oncol, 11, pp.1066~1073 (2010)
- 박재원, "Impact of Early Salvage Androgen Deprivation Therapy in Localized Prostate Cancer after Radical Prostatectomy: A Propensity Score Matched Analysis", Yonsei Medical Journal, 59(5), pp.580~587 (2018), 연세대학교의과대학[DOI]
- Fizazi K, "Darolutamide in nonmetastatic, castration-resistant prostate cancer", N Engl J Med, 380, pp.1235~1246 (2019)
- Nørgaard M, "Skeletal related events, bone metastasis and survival of prostate cancer : a population based cohort study in Denmark(1999 to 2007)", J Urol, 184, pp.162~167 (2010)
- Coleman RE, "Clinical features of metastatic bone disease and risk of skeletal morbidity", Clin Cancer Res, 12(20 Suppl), pp.6243s~6249s (2006)
- Scher HI, "Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone : recommendations of the Prostate Cancer Clinical Trials Working Group", J Clin Oncol, 26, pp.1148~1159 (2008)
- Boehmer D, "Guidelines for primary radiotherapy of patients with prostate cancer", Radiother Oncol, 79, pp.259~269 (2006)
- Mottet N, "EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1 : screening, diagnosis, and local treatment with curative intent", Eur Urol, 71, pp.618~629 (2017)
- Amling CL, "Defining prostate specific antigen progression after radical prostatectomy : what is the most appropriate cut point", J Urol, 165, pp.1146~1151 (2001)
- Freedland SJ, "Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate-specific antigen", Urology, 61, pp.365~369 (2003)
- Siddiqui SA, "Timing of androgen deprivation therapy and its impact on survival after radical prostatectomy : a matched cohort study", J Urol, 179, pp.1830~1837 (2008)
- : a randomised, multicentre, non-blinded, phase 3trial, "Lancet Oncol", 2016, 727~737
- Moul JW, "Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy", J Urol, 171, pp.1141~1147 (2004)
- van den Bergh RC, "Role of hormonal treatment in prostate cancer patients with nonmetastatic disease recurrence after local curative treatment : a systematic review", Eur Urol, 69, pp.802~820 (2016)
- Algarra R, "Survival analysis of patients with biochemical relapse after radical prostatectomy treated with androgen deprivation : castration-resistance influential factors", Can Urol Assoc J, 8, pp.E333~E341 (2014)
- Choueiri TK, "Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death", Cancer, 116, pp.1887~1892 (2010)
- Keizman D, "The change of PSA doubling time and its association with disease progression in patients with biochemically relapsed prostate cancer treated with intermittent androgen deprivation", Prostate, 71, pp.1608~1615 (2011)
- Kim-Sing C, "Intervention after PSA failure : examination of intervention time and subsequent outcomes from a prospective patient database", Int J Radiat Oncol Biol Phys, 60, pp.463~469 (2004)
- Moreira DM, "Predicting bone scan positivity after biochemical recurrence following radical prostatectomy in both hormone-naive men and patients receiving androgen-deprivation therapy : results from the SEARCH database", Prostate Cancer Prostatic Dis, 17, pp.91~96 (2014)
- Spratt DE, "Predictors of castration-resistant prostate cancer after dose-escalated external beam radiotherapy", Prostate, 75, pp.175~182 (2015)
- Shipley WU, "Early initiation of salvage hormone therapy influences survival in patients who failed initial radiation for locally advanced prostate cancer : a secondary analysis of RTOG protocol 86-10", Int J Radiat Oncol Biol Phys, 64, pp.1162~1167 (2006)
- Rodrigues NA, "Predictors of mortality after androgen-deprivation therapy in patients with rapidly rising prostate-specific antigen levels after local therapy for prostate cancer", Cancer, 107, pp.514~520 (2006)
- Hull GW, "Cancer control with radical prostatectomy alone in 1, 000 consecutive patients", J Urol, 167, pp.528~534 (2002)