Prognostic value of neuroendocrine serum markers and PSA in irradiated patients with pN0 localized prostate cancer.
BACKGROUND
The prognosis of patients with localized prostate cancer depends on clinical stage, histological grade, and pretreatment prostate-specific antigen (PSA). We evaluated the additional prognostic impact of serum levels of neuron-specific enolase (NSE) and chromograninA (CgA) after curative radiotherapy and the importance of serum PSA, analyzed 3 months after irradiation.


METHODS
From 1988 to 1995, 161 patients with localized T1-4, pN0M0, prostate adenocarcinoma were treated with external radiation (66Gy, 2Gy/5 fractions per week). Frozen serum samples were assessed for CgA, NSE, and PSA before and 3 months after radiotherapy. CgA was analyzed in only 100 patients. NSE and CgA were determined by a immunometric assay. Total PSA was measured by a time-resolved fluoro-immunometric assay.


RESULTS
Prior to radiotherapy CgA was elevated in 16 of 100 patients, and NSE was elevated in 33 of the 161 patients. There was no association between grade, T category or pretreatment PSA and the levels of neuroendocrine markers. Pretreatment-elevated serum NSE, but not initial CgA, identified patients with an unfavorable prognosis. A < 50% reduction of PSA 3 months after radiotherapy was associated with decreased failure-free 10 years urvival. Multivariate analysis demonstrated an increased risk of failure for patients with elevated pretreatment NSE and PSA values, T3 category, and decline of PSA less than 50% 3 months after radiotherapy. The presence of none or several risk factors (1-4) defined clearly separable groups.


CONCLUSIONS
Together with T category and pretreatment serum PSA values, serum NSE values before radiotherapy and decrease of serum PSA 3 months after radiotherapy represent easily assessable prognostic parameters in patients undergoing curative radiation treatment for prostate cancer.
Lilleby
W
W
Department of Oncology and Radiotherapy, Norwegian Radium Hospital, N-0310 Oslo, Norway. wolfgang.lilleby@klinmed.uio.no
Paus
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Skovlund
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E
Fosså
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SD
D000230:Adenocarcinoma / Q000097:blood* / Q000276:immunology / Q000532:radiotherapy; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D053379:Chromogranin A; D002864:Chromogranins / Q000097:blood*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy
D014408:Biomarkers, Tumor; D053379:Chromogranin A; D002864:Chromogranins; D017430:Prostate-Specific Antigen; D010751:Phosphopyruvate Hydratase