Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995

Thames, Howard D.; Kuban, Deborah A.; Levy, L.B.; Horwitz, Eric M.; Kupelian, Patrick A.; Martínez, Álvaro; Michalski, J.; Pisansky, Thomas M.; Sandler, Howard M.; Shipley, William U.; Zeléfsky, Michael J.; Zietman, Anthony L.

doi:10.1016/s0360-3016(03)00631-x

Cited by 184 publications

(77 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings support the more routine use of postradiotherapy biopsies at 2-3 years, since positive biopsies strongly predict for eventual BF (32,33). Interval hazard rates for biochemical failure during each 2-year time interval after radiotherapy, according to the ASTRO definition (3 consecutive rises in PSA, backdated) (16) and the Nadir +2 definition (PSA ≥ nadir + 2 ng/mL) (17)(18)(19)(20)(21)(22). Interval hazard rates for distant metastasis during each 2-year time interval after radiotherapy.…”

Section: Discussionmentioning

confidence: 70%

“…The Phoenix definition, the PSA nadir + 2 ng/mL after RT, is a better approximation of eventual clinical failure (17)(18)(19)(20)(21)(22). A primary reason for making the comparison here is that, because the ASTRO definition incorporates backdating, the interval hazard function for ASTRO BF will not be an accurate reflection of the risk of BF at a given interval of time, while the Nadir+2 definition will.…”

Section: Resultsmentioning

confidence: 99%

“…Two definitions of biochemical failure (BF) were applied to the study cohort: the American Society of Therapeutic Radiation Oncology (ASTRO) consensus definition (three consecutive rises in PSA with backdating to between the nadir and the first rise) (16) and the Phoenix (Nadir+2) definition (rise of at least 2 ng/mL greater than the PSA nadir after RT) (17)(18)(19)(20)(21)(22). The classification of distant metastasis (DM) was determined based on radiological evidence of hematogenous spread.…”

Section: Patient Selection and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Radiation dose and late failures in prostate cancer

Morgan

Hanlon

Horwitz

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose-To quantify the impact of radiotherapy (RT) dose escalation on the timing of biochemical failure (BF) and distant metastasis (DM) for prostate cancer treated with RT alone.Methods and Materials-A total of 667 men with clinically localized intermediate and high risk prostate cancer treated with 3D-conformal RT alone were retrospectively analyzed. The interval hazard rates of DM and biochemical failure (BF), using ASTRO and Phoenix (Nadir+2) definitions, were determined. Median follow-up was 77 months.Results-Multivariate analysis showed that increasing RT dose was independently associated with decreased ASTRO BF (P<.0001), Nadir+2 BF (P=.001), and DM (P=.006). The preponderance (85%) of ASTRO BF occurred at ≤4 years after RT, while Nadir+2 BF was more evenly spread over years 1-10, with 55% BF in ≤4 years. RT dose escalation caused a shift in the BF from earlier to later years. The interval hazard function for DM appeared to be biphasic (early and late peaks) overall and for the <74 Gy group. In patients receiving ≥74 Gy, there was a reduction in the risk of DM in both the early and late waves, although the late wave appears reduced to a greater degree.Conclusions-The ASTRO definition of BF systematically underestimates late BF due to backdating. RT dose escalation diminished and delayed BF; the delay suggests that there may still be local persistence in some patients. For DM, higher RT dose reduced both the early and late waves, suggesting that persistence of local disease contributes to both.

show abstract

Section: Discussionmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Patient Selection and Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Radiation dose and late failures in prostate cancer

Morgan

Hanlon

Horwitz

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…7 A PSA value exceeding 2.0ng/ml over the current nadir (nadir + 2) with date of failure reported as the call date is included, the so-called Phoenix definition. [8][9][10] Biochemical disease-free survival rates by the ASTRO definition and Phoenix criteria are reported with respect to a three tiered risk categorization that utilizes pretreatment PSA, biopsy Gleason score and clinical tumor stage as described by D'Amico. 11…”

Section: D Treatment Planningmentioning

confidence: 99%

Clinical outcome of patients treated with 3D conformal radiation therapy 3D-CRT for prostate cancer on RTOG 9406

Michalski

Winter

Roach

et al. 2004

International Journal of Radiation OncologyBiologyPhysics

View full text Add to dashboard Cite

Purpose-Report of clinical cancer control outcomes on RTOG 9406, a 3D conformal radiation therapy (3DCRT) dose escalation trial for localized adenocarcinoma of the prostate.Methods and Materials-RTOG 9406 is a Phase I/II multi-institutional dose escalation study of 3DCRT for men with localized prostate cancer. Patients were registered on five sequential dose levels: 68.4Gy, 73.8Gy, 79.2Gy, 74Gy and 78Gy with 1.8Gy/day (levels I through III) or 2.0Gy/ day (levels IV & V). Neoadjuvant hormone therapy (NHT) from 2 to 6 months was allowed. Protocol specific, ASTRO, and Phoenix biochemical failure definitions are reported. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of interest statement:Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. No commercial products are described or endorsed by the authors. The authors have no relationship with organizations that would influence the results reported in this manuscript. NIH Public Access Author ManuscriptInt J Radiat Oncol Biol Phys. Author manuscript; available in PMC 2013 July 01. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-Thirty-four institutions enrolled 1084 patients and 1051 patients are analyzable. Median follow-up for levels I, II, III, IV and V was 11.7, 10.4, 11.8, 10.4, and 9.2 years, respectively. Thirty-six percent of patients received NHT. The 5-year overall survival was 90%, 87%, 88%, 89%, and 88% for dose levels I-V. The 5-year clinical disease-free survival (excluding protocol PSA definition) for levels I-V is 84%, 78%, 81%, 82%, and 82%, respectively. By ASTRO definition, the 5-year disease-free survivals were 57%, 59%, 52%, 64% and 75% (low risk); 46%, 52%, 54%, 56%, and 63% (intermediate risk); and 50%, 34%, 46%, 34%, and 61% (high risk) for levels I-V, respectively. By the Phoenix definition, the 5-year disease-free survivals were 68%, 73%, 67%, 84%, and 80% (low risk); 70%, 62%, 70%, 74%, and 69% (intermediate risk); and 42%, 62%, 68%, 54%, and 67% (high risk) for levels I-V, respectively.Conclusion-Dose escalated 3DCRT yields favorable outcomes for localized prostate cancer. This multi-institutional experience allows comparison to other experiences with modern radiation therapy.

show abstract

“…[4][5][6][7][8] While the ASTRO consensus criteria requires a minimum observation period of 2 y, these techniques, which are based on the level of PSA nadir, time to PSA nadir, and absolute PSA thresholds, also require extended follow-up, limiting their clinical utility. 9,10 We have recently demonstrated that time and PSA threshold modeling is effective in prognosticating probability of biochemical recurrence free survival (bRFS) as early as 3 months following curative intent external beam radiation therapy (EBRT). 11 The time and PSA threshold model stratifies patients based upon reaching or failing to reach given PSA thresholds by defined time parameters in follow-up, stratifying the analyzed population by a dichotomous variable at the same relative moment post-therapy.…”

Section: Introductionmentioning

confidence: 99%

Time and PSA threshold model prognosticates long-term overall and disease-specific survival in prostate cancer patients as early as 3 months after external beam radiation therapy

Cavanaugh

Fuller

Kupelian

et al. 2005

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

The specific aim of this analysis was to evaluate the capability of a time and prostate-specific antigen (PSA) threshold model to prognosticate overall survival (OS) and disease-specific survival (DSS) based on early PSA kinetics after radiotherapy for prostate cancer by retrospective review of outcomes in 918 patients. Crossing below analyzed PSA thresholds at specific defined time points reduced disease-specific death hazard ratios to relative to the cohort above threshold. The time and PSA threshold model demonstrates the ability to prognosticate OS and DSS as early as 3 months post-radiotherapy for prostate cancer.

show abstract

Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995

Cited by 184 publications

References 11 publications

Radiation dose and late failures in prostate cancer

Radiation dose and late failures in prostate cancer

Clinical outcome of patients treated with 3D conformal radiation therapy 3D-CRT for prostate cancer on RTOG 9406

Time and PSA threshold model prognosticates long-term overall and disease-specific survival in prostate cancer patients as early as 3 months after external beam radiation therapy

Contact Info

Product

Resources

About