Impact of biochemical failure classification on clinical outcome: A secondary analysis ofRadiationTherapyOncologyGroup 9202 and 9413

Abstract

BACKGROUND Biochemical failure (BF) after radiation therapy is defined on the basis of a rising prostate-specific antigen (PSA) level (A1 failure) or any event that prompts the initiation of salvage androgen-deprivation therapy without PSA failure (A2). It was hypothesized that A2 failure may have a different prognosis. METHODS Data for 2799 eligible patients from Radiation Therapy Oncology Group (RTOG) 9202 and RTOG 9413 were analyzed. BF was defined according to the 1997 American Society for Therapeutic Radiology and Oncology consensus definition as A1 for PSA failure or as A2 for the start of salvage hormone therapy before 3 consecutive PSA rises. RESULTS Rates of all-cause mortality (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-2.0; P <.0001) and distant metastasis (DM; HR, 1.6; 95% CI, 1.3-2.0; P <.0001) were greater with A2 failure. The 5-year overall survival (OS) rates were 88.2% and 74.6% for A1 and A2, respectively (P <.0001), and the DM rates were 15.7% and 29.0%, respectively (P <.0001). The DM rate was greater at 5 years for A2 patients with DM as the first sign of failure versus patients with other A2 failures (87.3% vs 11.7%, P <.001), and this also correlated with worse OS at 5 years: 81.1% for A2 failure without DM and 52.8% with DM (P <.001). After the removal of patients with DM, the difference between A1 and A2 BF persisted for OS (P =.002) but not for DM (P =.16) CONCLUSIONS These results suggest that patients with rising PSA levels alone have less risk than those with A2 failures; although DM was the largest contributor of adverse risk to A2 failure, it did not account for all excess risk in A2 failure.

Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review

“….4 (95% CI 4.3-48.8) and 1.35 (95% CI 1.07-1.71) to 10.8 (95% CI 3.1-37.9). Similarly, for patients with RT as primary treatment, 8 out of 8[16,62,65,70,71,73,75,77], 5 out of 8[15 17,59,61,62,65,72] and 7 out of 9[15 17,58,59,61,62,64,71] studies showed a positive association between a higher Gleason score identified on prostate biopsies (bGS) and DM, PCSM and OM respectively with HRs ranging from 1.7 (95% CI 1.1-2.7) to 3.7 (95% CI 1.4-10.3), 2.11 (95% CI 1.03-4.34) to 14.8 (95% CI 2-110) and 1.8 (95% CI 1.3-2.4) to 17.9 (95% CI 9.6-33) respectively. Only a limited number of studies used the recently introduced ISUP grading in their MVA, allowing for a comparison between ISUP grade 2 and 3.…”

Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: A systematic review

“…For DM and PCSM, 12 out of 14[7,8,22,23,26 28,38,39,41,43,52,53,56] and 10 out of 13[7,22,25,31,33,36,38 40,48 50,52] studies showed a positive association with HR ranging from 1.2 (95% CI 1-1.5) to 14.4 (95% CI 4.3-48.8) and 1.35 (95% CI 1.07-1.71) to 10.8 (95% CI 3.1-37.9). Similarly, for patients with RT as primary treatment, 8 out of 8[16,62,65,70,71,73,75,77], 5 out of 8 [15 17,59,61,62,65,72] and 7 out of 9 [15 17,58,59,61,62,64,71] studies showed a positive association between a higher Gleason score identified on prostate biopsies (bGS) and DM, PCSM and OM respectively with HRs ranging from 1.7 (95% CI 1.1-2.7) to 3.7 (95% CI 1.4-10.3), 2.11 (95% CI 1.03-4.34) to 14.8 (95% CI 2-110) and 1.8 (95% CI 1.3-2.4) to 17.9 (95% CI 9.6-33) respectively. Only a limited number of studies used the recently introduced ISUP grading in their MVA, allowing for a comparison between ISUP grade 2 and 3.…”