title: Local prostate cancer radiotherapy after prostate-specific antigen progression during primary hormonal therapy.
abstract: BACKGROUND
  The outcome of patients after radiotherapy (RT) for localized prostate cancer in case of prostate-specific antigen (PSA) progression during primary hormonal therapy (HT) is not well known.
  
  
  METHODS
  A group of 27 patients presenting with PSA progression during primary HT for local prostate cancer RT was identified among patients who were treated in the years 2000-2004 either using external-beam RT (EBRT; 70.2 Gy; n=261) or Ir-192 brachytherapy as a boost to EBRT (HDR-BT; 18 Gy + 50.4 Gy; n=71). The median follow-up period after RT was 68 months.
  
  
  RESULTS
  Median biochemical recurrence free (BRFS), disease specific (DSS) and overall survival (OS) for patients with PSA progression during primary HT was found to be only 21, 54 and 53 months, respectively, with a 6-year BRFS, DSS and OS of 19%, 41% and 26%. There were no significant differences between different RT concepts (6-year OS of 27% after EBRT and 20% after EBRT with HDR-BT).Considering all 332 patients in multivariate Cox regression analysis, PSA progression during initial HT, Gleason score>6 and patient age were found to be predictive for lower OS (p<0.001). The highest hazard ratio resulted for PSA progression during initial HT (7.2 in comparison to patients without PSA progression during primary HT). PSA progression and a nadir >0.5 ng/ml during initial HT were both significant risk factors for biochemical recurrence.
  
  
  CONCLUSIONS
  An unfavourable prognosis after PSA progression during initial HT needs to be considered in the decision process before local prostate radiotherapy. Results from other centres are needed to validate our findings.
authors.affiliation: Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany. mpinkawa@ukaachen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Pinkawa
authors.forename: Marc D
authors.initials: MD
authors.lastname: Piroth
authors.forename: Richard
authors.initials: R
authors.lastname: Holy
authors.forename: Victoria
authors.initials: V
authors.lastname: Djukic
authors.forename: Jens
authors.initials: J
authors.lastname: Klotz
authors.forename: David
authors.initials: D
authors.lastname: Pfister
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D005500:Follow-Up Studies; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007496:Iridium Radioisotopes / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D012189:Retrospective Studies
chemical_list: D006728:Hormones; D007496:Iridium Radioisotopes; D017430:Prostate-Specific Antigen