title: The Importance of Prostate-specific Antigen (PSA) Nadir and Early Identification of PSA Relapse after 10 Years of Prostate Iodine 125 Seed Brachytherapy in Edinburgh.
abstract: OBJECTIVE
  To analyse our 5 and 10 year prostate brachytherapy outcome data and to assess the impact of PSA nadir on relapse free survival and whether an alternative definition of PSA relapse could detect men destined to fail by the Phoenix definition at an earlier time point.
  
  
  METHODS
  474 men were treated over a 10 year period between 20012 and 2011 and divided into 2 five year cohorts for the purpose of the analysis.
  
  
  RESULTS
  The risk of relapse is strongly predicted by post treat prostate-specific antigen (PSA) nadir. After 3 years post-treatment, PSA nadir plus 0.4 ng/ml identified men at risk of relapse 17 months earlier than the Phoenix definition.
  
  
  CONCLUSIONS
  The Phoenix definition of nadir plus 2.0 ng/ml does not allow the early identification of men destined to relapse. The initiation of salavage therapy at the earliest opportunity could potentially affect subsequent survival and an outline randomised controlled trial proposal is presented.
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK. Electronic address: duncan.mclaren@luht.scot.nhs.uk.
authors.forename: D B
authors.initials: DB
authors.lastname: McLaren
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: G
authors.initials: G
authors.lastname: Kerr
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: A B
authors.initials: AB
authors.lastname: Law
authors.affiliation: Western General Hospital, Edinburgh, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Brush
authors.affiliation: Western General Hospital, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Keanie
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Malik
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: W
authors.initials: W
authors.lastname: Keough
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: T
authors.initials: T
authors.lastname: Ronaldson
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Edinburgh Cancer Centre, Edinburgh, UK.
authors.forename: T
authors.initials: T
authors.lastname: Kehoe
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy*
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
keywords: Iodine(125) seed brachytherapy; PSA nadir; prostate cancer; relapse; salvage treatment