Failure to achieve a PSA level <or=1 ng/mL after neoadjuvant LHRHa therapy predicts for lower biochemical control rate and overall survival in localized prostate cancer treated with radiotherapy.
OBJECTIVE
To investigate whether failure to suppress the prostate-specific antigen (PSA) level to <or=1 ng/mL after >or=2 months of neoadjuvant luteinizing hormone-releasing hormone agonist therapy in patients scheduled to undergo external beam radiotherapy for localized prostate carcinoma is associated with reduced biochemical failure-free survival.


METHODS
A retrospective case note review of consecutive patients with intermediate- or high-risk localized prostate cancer treated between January 2001 and December 2002 with neoadjuvant hormonal deprivation therapy, followed by concurrent hormonal therapy and radiotherapy was performed. Patient data were divided for analysis according to whether the PSA level in Week 1 of radiotherapy was <or=1.0 ng/mL. Biochemical failure was determined using the American Society for Therapeutic Radiology and Oncology (Phoenix) definition.


RESULTS
A total of 119 patients were identified. The PSA level after neoadjuvant hormonal deprivation therapy was <or=1 ng/mL in 67 patients and >1 ng/mL in 52. At a median follow-up of 49 months, the 4-year actuarial biochemical failure-free survival rate was 84% vs. 60% (p = 0.0016) in favor of the patients with a PSA level after neoadjuvant hormonal deprivation therapy of <or=1 ng/mL. The overall survival rate was 94% vs. 77.5% (p = 0.0045), and the disease-specific survival rate at 4 years was 98.5% vs. 82.5%.


CONCLUSIONS
The results of our study have shown that patients with a PSA level >1 ng/mL at the beginning of external beam radiotherapy after >or=2 months of neoadjuvant luteinizing hormone-releasing hormone agonist therapy have a significantly greater rate of biochemical failure and lower survival rate compared with those with a PSA level of <or=1 ng/mL. Patients without adequate PSA suppression should be considered a higher risk group and considered for dose escalation or the use of novel treatments.
Mitchell
Darren M
DM
Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland. dmmitchell@doctors.org.uk
McAleese
Jonathan
J
Park
Richard M
RM
Stewart
David P
DP
Stranex
Stephen
S
Eakin
Ruth L
RL
Houston
Russell F
RF
O'Sullivan
Joe M
JM
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D020266:Radiotherapy, Conformal; D012016:Reference Values; D012189:Retrospective Studies; D015996:Survival Rate
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen