Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherapy

Abstract

ObjectiveTo evaluate the relationship between two year PSA nadir (PSAn) after brachytherapy and biochemical recurrence rates in prostate cancer patients.Materials and MethodsIn the period from January 1998 to August 2007, 120 patients were treated with iodine-125 brachytherapy alone. The results analysis was based on the definition of biochemical recurrence according to the Phoenix Consensus.ResultsBiochemical control was observed in 86 patients (71.7%), and biochemical recurrence, in 34 (28.3%). Mean PSAn was 0.53 ng/ml. The mean follow-up was 98 months. The patients were divided into two groups: group 1, with two year PSAn < 0.5 ng/ml after brachytherapy (74 patients; 61.7%), and group 2, with two year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%). Group 1 presented biochemical recurrence in 15 patients (20.3%), and group 2, in 19 patients (43.2%) (p < 0.02). The analysis of biochemical disease-free survival at seven years, stratified by the two groups, showed values of 80% and 64% (p < 0.02), respectively.ConclusionLevels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly correlated with a poor prognosis. This fact may help to identify patients at risk for disease recurrence.

Adjuvant hormone therapy after radical prostatectomy in high-risk localized and locally advanced prostate cancer: First multicenter, observational study in China

“…PSA fluctuations are not rare; however, PSA levels gradually decline after 18−24 months of treatment (17). It has been observed that the reference time span of 2 years is a better discriminator for PCa-associated metastases and mortality (18).…”

Multiparametric magnetic resonance imaging of the prostate: current concepts

“…Consequently, there has been a constant increase in the interest of the radiological community for prostate imaging modalities, with many studies also recently published in Brazil (5-8) . Among those modalities, magnetic resonance (MR) imaging stands out as the most robust and the one that is better related to the clinical outcomes involved on the management of PCa.…”

“…In such a context, the diagnostic imaging modalities are increasingly being used as a means to refine the detection and staging of PCa, and to ultimately provide a better treatment selection. Consequently, there has been a constant increase in the interest of the radiological community for prostate imaging modalities, with many studies also recently published in Brazil ( 5 - 8 ) . Among those modalities, magnetic resonance (MR) imaging stands out as the most robust and the one that is better related to the clinical outcomes involved on the management of PCa.…”

Ressonância magnética multiparamétrica de próstata: a evolução de uma técnica

“…Currently, one can mention several applications of MRI in the management of patients with prostate cancer, as follows: 1 - in the diagnosis, particularly for patients with high suspicion of cancer and repeated US-guided prostate biopsies with negative results ( 9 ) ; 2 - in the staging of prostate tumors - MRI has been recognized as the most promising method for determining the extent of extracapsular tumors ( 10 ) ; 3 - In several situations, the therapy planning may be changed as a function of information provided by MRI ( 11 , 12 ) . Even in cases where MRI would not be usually indicated, for example, in cases of low-grade tumors (due to the low probability of extraglandular extension), with the development of new therapeutic options such as "watchful waiting", where one must be certain about the tumor grade and extent, its use has been defended ( 13 ) ; 4 - in the follow-up and evaluation of tumor response, in cases of surgical approach and, principally, in cases of non-surgical management, chemo-, radio-and hormone therapy ( 14 ) , situations where the use of quantitative MRI techniques has been fundamental ( 15 , 16 ) ; and 5 - characterization of the tumor aggressiveness potential, particularly by means of the diffusion-weighted technique ( 17 ) , that is still being developed, but at principle might result in a better selection of patients, avoiding unnecessary aggressive treatments, taking the indolent nature of prostate tumors into consideration.…”