Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials.

Autor:	Hallemeier CL; Mayo Clinic, Rochester, Minnesota. Electronic address: hallemeier.christopher@mayo.edu., Zhang P; NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania., Pisansky TM; Mayo Clinic, Rochester, Minnesota., Hanks GE; Fox Chase Cancer Center, Philadelphia, Pennsylvania., McGowan DG; Cross Cancer Institute, Edmonton, Alberta, Canada., Roach M 3rd; University of California, San Francisco, San Francisco, California., Zeitzer KL; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Firat SY; Medical College of Wisconsin-Zablocki VA Medical Center, Milwaukee, Wisconsin., Husain SM; Tom Baker Cancer Centre, Calgary, Alberta, Canada., D'Souza DP; London Regional Cancer Program, London, Ontario, Canada., Souhami L; McGill University Health Centre, Montreal, Quebec, Canada., Parliament MB; Cross Cancer Institute, Edmonton, Alberta, Canada., Rosenthal SA; Radiological Associates of Sacramento, Sacramento, California., Lukka HR; McMaster University, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada., Rotman M; Brooklyn MB-CCOP/SUNY Downstate, Brooklyn, New York., Horwitz EM; Fox Chase Cancer Center, Philadelphia, Pennsylvania., Miles EF; Naval Medical Center Accruals Dartmouth Hitchcock Medical Center, Portsmouth, Virginia., Paulus R; NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania., Sandler HM; Cedars-Sinai Medical Center, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2019 Aug 01; Vol. 104 (5), pp. 1057-1065. Date of Electronic Publication: 2019 Apr 06.
DOI:	10.1016/j.ijrobp.2019.03.049
Abstrakt:	Purpose: To validate whether prostate-specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external beam radiation therapy (RT) with concurrent short-term androgen suppression (AS) in patients with prostate cancer. Methods and Materials: This study included 2404 patients. The patients were treated with neoAS before RT and concurrent AS (without post-RT AS) and were pooled from NRG Oncology/RTOG trials 9202, 9408, 9413, and 9910. Multivariable models were used to test associations between the prespecified dichotomized post-neoAS, pre-RT PSA level (≤0.1 vs >0.1 ng/mL) groupings, and clinical outcomes. Results: The median follow-up for surviving patients was 9.4 years. The median post-neoAS, pre-RT PSA level was 0.3 ng/mL, with 32% of patients having levels ≤0.1 ng/mL. Race, Gleason score, tumor stage, node stage, pretreatment PSA level, and duration of neoAS were associated with the groups of patients with PSA levels ≤0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA level >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR], 2.04; P < .0001); local failure (HR, 2.51; P < .0001); distant metastases (HR, 1.73; P = .0006); cause-specific mortality (HR, 2.36; P < .0001); and all-cause mortality (HR, 1.24; P = .005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA level >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR, 2.00; P < .0001); local failure (HR, 2.33; P < .0001); and cause-specific mortality (HR, 1.75; P = .03). Conclusions: Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. The role of post-neoAS, pre-RT PSA level relative to PSA levels obtained along the continuum of medical care is not presently defined but could be tested in future clinical trials. (Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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