title: Association of early PSA failure time with increased distant metastasis and decreased survival in prostate brachytherapy patients.
abstract: OBJECTIVE
  We investigated whether earlier PSA failure following prostate brachytherapy is associated with increased rates of distant metastases (DM), prostate cancer-specific mortality (PCSM), and overall mortality.
  
  
  METHODS
  We retrospectively analyzed 2818 patients who underwent brachytherapy ± external beam radiation therapy (EBRT) ± androgen deprivation therapy (ADT). With median follow-up of 5.52 years, 264 patients experienced PSA failure at a median time of 3.25 years. Patients were stratified to early vs. late PSA failures at cutoffs of 1.5 years, 3 years, or 5 years, and tested in univariate/multivariate analyses for freedom from DM, cause-specific survival (CSS), and overall survival (OS).
  
  
  RESULTS
  Among patients with PSA failures, 69 (26%) patients experienced DM, 47 (18%) PCSM, and 56 (21%) deaths from other causes. Patients with rapid PSA failures demonstrated increased rates of DM, PCSM, and overall mortality, despite higher total BED and longer ADT. In multivariate analysis with a PSA failure interval <3 years, the hazard ratio (HR) for DM was 3.92 (95% CI: 2.34-6.55; p=0.000); HR for PCSM was 2.79 (95% CI: 1.45-5.38; p=0.002); and HR for overall mortality was 2.28 (95% CI: 1.50-3.48; p=0.000).
  
  
  CONCLUSIONS
  Early PSA failure following radiation is a poor prognostic factor, as it is associated with increased DM, PCSM, and overall mortality.
authors.affiliation: Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Ko
authors.affiliation: Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States.
authors.forename: Jerry T
authors.initials: JT
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States; Department of Urology, Mount Sinai Medical Center, New York, United States.
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
authors.affiliation: Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States. Electronic address: Richard.Stock@mountsinai.org.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Cause-specific survival; Distant metastases; Overall survival; PSA failure; Prostate cancer