title: Early PSA decrease is an independent predictive factor of clinical failure and specific survival in patients with localized prostate cancer treated by radiotherapy with or without androgen deprivation therapy.
abstract: BACKGROUND
  The aim was to identify predictors of outcome in patients with localized prostate cancer treated with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT).
  
  
  METHODS
  A total of 448 patients with prostate cancer received EBRT alone (n = 361, group 1) or ADT followed by EBRT (n = 87, group 2). In group 2, ADT was initiated 3 months before EBRT. After baseline prostate-specific antigen (PSA) determination (PSA(preRT)), PSA was assessed during the 6th week of the EBRT course (PSA(6wRT)) in group 1. In group 2, PSA was measured again 3 months after the start of ADT, before EBRT (PSA(ADT-preRT)).
  
  
  RESULTS
  In group 1, median PSA(6wRT)/PSA(preRT) was 0.72 and median prostate-specific antigen velocity (PSAV) was -1.5 ng/ml/month. In the multivariate analysis, prognostic groups and PSA(6wRT)/PSA(preRT) (or PSAV) independently predicted biochemical failure (BF), clinical failure (CF), and prostate cancer-specific survival. In group 2, the median PSA(ADT-preRT) was 1.3 ng/ml. In the high-risk group, an undetectable PSA(ADT-preRT) (< or =0.2 ng/ml) predicted BF (P < 0.01) and CF (P = 0.007).
  
  
  CONCLUSIONS
  A PSA decline 6 weeks after the start of EBRT when used as monotherapy and 3 months after the start of ADT in patients treated with combined ADT and EBRT is predictive of progression and specific survival.
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif; Departement de Radiotherapie, Centre Eugène Marquis, Avenue Bataille Flandre Dunkerque, Rennes; Departments of. Electronic address: brdecrevoisier2000@yahoo.fr.
authors.forename: R
authors.initials: R
authors.lastname: de Crevoisier
authors.affiliation: Department of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Slimane
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif.
authors.forename: T
authors.initials: T
authors.lastname: Messai
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif.
authors.forename: P
authors.initials: P
authors.lastname: Wibault
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif.
authors.forename: F
authors.initials: F
authors.lastname: Eschwege
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif.
authors.forename: A
authors.initials: A
authors.lastname: Bossi
authors.affiliation: Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Koscielny
authors.affiliation: Department of Radiation, Institut Gustave-Roussy, Villejuif.
authors.forename: A
authors.initials: A
authors.lastname: Bridier
authors.affiliation: Department of Medicine.
authors.forename: C
authors.initials: C
authors.lastname: Massard
authors.affiliation: Department of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy; D003131:Combined Modality Therapy; D015536:Down-Regulation; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen