BACKGROUND:The most important task in the field of improving the results of treatment of patients with prostate cancer (PCa) is their correct stratification by risk groups. Modern stratification systems do not fully provide an adequate risk assessment for all patients with prostate cancer. Further development of algorithms for predicting the clinical course of prostate cancer for a particular patient can positively affect the course and outcome of the disease. AIM:Determination of the clinical and prognostic value of the density of prostate-specific antigen (PSAD) in patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy. MATERIALS AND METHODS:The effect of the PSAD parameter on the tumor-specific survival rates, as well as the clinical and morphological parameters of the tumor process, was assessed in 272 patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy from January 1996 to July 2007. RESULTS:The high clinical significance of the PSAD indicator has been demonstrated. An increase in PSAD correlated with an increase in serum PSA concentration, a decrease in PSA doubling time, and a decrease in tumor differentiation. The prognostic value of PSAD was confirmed in patients with localized prostate cancer who received combined hormone-radiation therapy. Using ROC-analysis, the threshold value of the PSAD index was determined 0.36 ng / ml / cm3, the excess of which was associated with a statistically significant decrease in the level of tumor-specific survival. The area under the curve was 0.703 (95% CI 0.2360.434;p 0.001). The risk of tumor-specific mortality and recurrence increased as the PSAD value increased. CONCLUSION:The PSAD parameter is a reliable biomarker of prostate cancer with high rates of clinical and prognostic significance, the use of which is not associated with the introduction of costly and cumbersome methods of laboratory and instrumental diagnostics.
Purpose. To evaluate prostate specifc antigen density (PSAD) as a predictor of overall (OS) and cancerspecifc survival (CSS) in patients with prostate cancer (PC) who have undergone combined hormonal-radiation therapy.Material and Methods. In order to assess the prognostic signifcance of PSAD we retrospectively analyzed outcomes of 714 PCa patients who received combined hormonal-radiation therapy at the A.M. Granov Russian Scientifc Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russia, between January 1996 and December 2016. Since the prognosis and management differ according to the extent of tumor involvement, patients were categorized into localized (n=272), locally advanced (n=231) and metastatic (n=211) PC groups. We equentially applied ROC-analysis, Kaplan-Meier product limit estimator and Cox proportional hazards model to assess the prognostic relevance and establish threshold values of PSAD that had a signifcant impact on survival rates.Results. In the localized PC group, PSAD threshold values of 0.34 ng/mL/cc and 0.36 ng/mL/cc were associated with a decrease in OS and CSS, respectively. Patients with “low” PSAD had signifcantly better OS and CSS survival rates in both uni- and multivariate analyses. In locally advanced PC group, PSAD threshold values were 0.28 ng/mL/cc and 0.63 ng/mL/cc for OS and CSS, respectively. However, exceeding the specifed values, in the locally advanced PC group, was not accompanied by a statistically signifcant decrease in survival rates. Finally, in the metastatic PC group, established PSAD threshold values were 2.25 ng/mL/cc and 2.30 ng/mL/ccfor OS and CSS, respectively. According to the results of univariate analysis, patients with “low” PSA tend to demonstrate statistically signifcant better OS and CSS rates. The results of multivariate analysis, however, failed to prove PSAD as an independent prognostic factor within the metastatic PC cohort. Conclusion. PSA density is a reliable tool for assessing survival rates in patients with localized PC who have undergone combined hormonal-radiation therapy.
Background. Prostate cancer is amongst one of the most prevalent cancers in men worldwide. Combined hormonal-radiation therapy has become a standard of care for localized prostate cancer definitive treatment. As many as 30 % of men are at risk for disease progression within 10 years following radical treatment.Aim. To assess the significance of prostate-specific antigen (PSA) density as a predictor of recurrence-free survival following combined hormonal-radiation therapy in patients with localized prostate cancer.Materials and methods. We conducted a retrospective study of 272 patients with clinically localized prostate cancer treatment results who received combined hormonal-radiation therapy between January 1996 and December 2016.Results. On the basis of our study, we confirmed high prognostic value of PSA density among patients with localized prostate cancer who received combined hormonal-radiation treatment. We utilized ROC-analysis in order to determine the threshold value of the PSA density index – 0.376 ng/ml/cm3, exceeding of which was associated with statistically significant reduction in the recurrence-free survival rate. The area under the curve was 0.711 (95 % confidence interval 0.653–0.764; p <0.0001). The risk of recurrence increased with rising of PSA density.Conclusion. PSA density has proven to be a reliable tool for assessing the risk of prostate cancer recurrence among patients with localized prostate cancer who have undergone combined hormonal-radiation therapy.
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