BackgroundThe aim of this study was to evaluate the long-term prognostic significance of rising PSA levels, particularly focussing on overall survival.MethodsTwo hundred ninety-five patients with localized prostate cancer were either treated with low-dose-rate (LDR) brachytherapy with I-125 seeds as monotherapy (n = 94; 145Gy), high-dose-rate (HDR) brachytherapy with Ir-192 as a boost to external beam RT (n = 66; 50.4Gy in 1.8Gy fractions EBRT + 18Gy in 9Gy fractions HDR) or EBRT alone (70.2Gy in 1.8Gy fractions; n = 135). “PSA bounce” was defined as an increase of at least 0.2 ng/ml followed by spontaneous return to pre-bounce level or lower, biochemical failure was defined according to the Phoenix definition.ResultsMedian follow-up after the end of radiotherapy was 108 months. A PSA bounce showed to be a significant factor for biochemical control (BC) and overall survival (OS) after ten years (BC10 of 83% with bounce vs. 34% without, p < 0.01; OS10 of 82% with bounce vs. 59% without bounce, p < 0.01). The occurrence of a bounce, a high nadir and the therapy modality (LDR-BT vs. EBRT and HDR-BT + EBRT vs. EBRT) proved to be independent factors for PSA recurrence in multivariate Cox regression analysis. A bounce was detected significantly earlier than a PSA recurrence (median 20 months vs. 32 months after RT; p < 0.01; median PSA doubling time 5.5 vs. 5.0 months, not significant). PSA doubling time was prognostically significant in case of PSA recurrence (OS10 of 72% vs. 36% with PSA doubling time ˃ 5 months vs. ≤ 5 months; p < 0.01).ConclusionsRising PSA levels within the first two years can usually be classified as a benign PSA bounce, with favourable recurrence-free and overall survival rates. PSA doubling time is an important predictor for overall survival following the diagnosis of a recurrence.
In addition to the cure rate, quality of life is now very important in cancer therapy. For prostate cancer patients, urinary and intestinal symptoms after radiation therapy including intensity-modulated radiation therapy and proton therapy (PT) have been discussed. However, testosterone levels and sexual function after PT have not been well studied. This is a prospective evaluation of serum testosterone level and sexual function before and after PT. Materials/Methods: Between February 2013 and July 2014, 198 patients were treated with proton therapy. Among them, 171 patients consented to testosterone measurement, provided a sufficient response to a questionnaire, and received treatment exactly per protocol; they were fully evaluable for this study. There were 36 low-risk patients, 60 intermediate-risk patients and 75 high-risk patients, according to the National Comprehensive Cancer Network. For low-risk patients, 74 GyE/37 Fr was delivered without combined androgen blockade therapy (CAB). Intermediate-risk patients received 78 GyE/39 Fr after neo-adjuvant CAB for 6-8 months. High-risk patients received 78 GyE/39 Fr after neo-adjuvant CAB. They were basically treated with CAB for more than 1 year after PT. The serum testosterone, IIEF-5 (International Index of Erectile Function-5) and EHS (Erection Hardness Score) were evaluated before and after PT. Results: In low-risk patients, the average serum testosterone level was 428 (ng/dl) before PT, 450 at 3 months after PT (P Z 0.21), 442 at 6 months (P Z 0.46), 439 at 9 months (P Z 0.6), and 444 at 12 months (P Z 0.47). The median IIEF-5 score was 14 before PT and at 1 and 6 months, and 12 at 12 months (P < 0.001). The median EHS was 2 before PT and at 1 and 6 months, and 1 at 12 months (P Z 0.003). In intermediate-risk patients, the average serum testosterone was 8.2 (ng/dl) before PT, 145 at 3 months (P < 0.001), 244 at 6 months (P < 0.001), 295 at 9 months (P < 0.001), and 335 at 12 months (P < 0.001). The median IIEF-5 score did not change from 9 before and after PT. The median EHS score was 0 before PT and at 1 month, and 1 at 6 (P Z 0.01) and 12 months (P Z 0.006). In high-risk patients, the average serum testosterone was 6.6 (ng/dl) before PT, 21.2 at 3 months (P Z 0.13), 28.4 at 6 months (P Z 0.07), 41.1 at 9 months (P Z 0.02), 42.2 at 12 months (P Z 0.04), 82.3 at 15 months (P Z 0.004), and 98.8 at 18 months (P Z 0.002). The median IIEF-5 score and EHS did not change from 9 and 0, respectively. Conclusion: Without CAB, PT did not decrease the serum testosterone level and had a smaller influence on sexual function. The serum testosterone returned quickly to the normal level after the treatment in intermediate-risk patients, but sexual quality did not improve remarkably. In high-risk patients, the testosterone was suppressed and sexual function did not change in worse scores while they were treated with CAB. Combination of CAB and PT seems to have a greater influence on sexual function.
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