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Sheth N, Youssef I, Osborn V, et al. Association of Nadir Prostate-specific Antigen >0.5 ng/mL after Dose-escalated External Beam Radiation with Prostate Cancer-specific Endpoints. Cureus. 2018;10(6):e2790doi: 10.7759/cureus.2790.
Sheth, N., Youssef, I., Osborn, V., Lee, A., Safdieh, J., & Schreiber, D. (2018). Association of Nadir Prostate-specific Antigen >0.5 ng/mL after Dose-escalated External Beam Radiation with Prostate Cancer-specific Endpoints. Cureus, 10(6), e2790. https://doi.org/10.7759/cureus.2790
Sheth, Niki, et al. "Association of Nadir Prostate-specific Antigen >0.5 ng/mL after Dose-escalated External Beam Radiation with Prostate Cancer-specific Endpoints." Cureus vol. 10,6 (2018): e2790. doi: https://doi.org/10.7759/cureus.2790
Sheth N, Youssef I, Osborn V, Lee A, Safdieh J, Schreiber D. Association of Nadir Prostate-specific Antigen >0.5 ng/mL after Dose-escalated External Beam Radiation with Prostate Cancer-specific Endpoints. Cureus. 2018 Jun 12;10(6):e2790. doi: 10.7759/cureus.2790. PMID: 30112266; PMCID: PMC6089484.
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Cureus. 2018 Jun 12;10(6):e2790. doi: 10.7759/cureus.2790.

Association of Nadir Prostate-specific Antigen >0.5 ng/mL after Dose-escalated External Beam Radiation with Prostate Cancer-specific Endpoints.

Cureus

Niki Sheth, Irini Youssef, Virginia Osborn, Anna Lee, Joseph Safdieh, David Schreiber

Affiliations

  1. Radiation Oncology, SUNY Downstate Medical Center, New York, USA.
  2. Radiation Oncology, SUNY Downstate Medical Center & Veterans Affairs, New York Harbor Healthcare System.
  3. Radiation Oncology, Kings County Hospital Center.
  4. Radiation Oncology, New York Harbor Healthcare System.

PMID: 30112266 PMCID: PMC6089484 DOI: 10.7759/cureus.2790

Abstract

Objective Prior studies have suggested that prostate-specific antigen (PSA) nadir of 0.5 ng/mL is an important surrogate endpoint for prostate cancer-specific and all-cause mortality. This study analyzed our well-followed patient cohort to assess whether this endpoint was associated with differences in prostate cancer-specific endpoints in patients receiving dose-escalated radiation. Methods Patients with intermediate- or high-risk prostate cancer (≥T2b, or prostate-specific antigen >10 ng/mL, or Gleason score ≥7) who were treated with external beam radiation to a minimum dose of 7560 cGy +/- androgen deprivation between 2003 and 2011 were identified. Biochemical control, distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were compared between those who achieved a nadir PSA ≤0.5 ng/mL with those who did not via Kaplan-Meier analysis. Univariable and multivariable Cox regression was performed on all endpoints to assess their impact on OS. Results There were 367 patients identified with a median follow-up of 99.5 months. Two hundred five patients (55.9%) received androgen deprivation for a median of 24 months (range 1-81 months). Most patients (n = 308, 83.9%) achieved a nadir PSA ≤0.5 ng/mL, which was associated with improvement across all endpoints at 10 years. This included biochemical control (68.0% versus 24.0%, p < 0.001), DMFS (89.6% versus 80.8%, p = 0.019), PCSS (91.1% versus 85.7%, p = 0.01), and OS (55.7% versus 45.8%, p = 0.048). On multivariable analysis, nadir PSA >0.5 ng/mL remained strongly associated with worse outcomes across all endpoints. Conclusions Achievement of nadir PSA ≤0.5 ng/mL after completion of dose-escalated radiation therapy was associated with improvement of all prostate cancer endpoints.

Keywords: high-risk prostate cancer; intermediate-risk prostate cancer; prostate adenocarcinoma; prostate cancer; prostate cancer-specific endpoints; psa; psa nadir

Conflict of interest statement

The authors have declared that no competing interests exist.

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