Agressive Treatment of Men with detecable PSA post-prostatectomy pays off

Patients with detectable PSA post-prostatectomy should receive more aggressive radiation therapy - Medical News Today

Prostate Cancer Patients With Detectable PSA After Prostatectomy
Should Receive Aggressive Radiation Therapy
Radiation Therapy News

Ten-year post-treatment analysis of German ARO 96-02 indicates patients with detectable PSA after radical prostatectomy should receive more aggressive radiation therapy treatment - American Society for Radiation Oncology (ASTRO)

"After patients undergo radical prostatectomy, the marker for PSA should fall below detection limits. Our analysis demonstrates that patients who have detectable PSA post-prostatectomy may benefit from more aggressive, early and uniform treatment that could improve survival outcomes," said Thomas Wiegel, MD, director of the radiation oncology department at University Hospital Ulm in Ulm, Germany, and lead author of the study. "The impact of PSA persistence on 10-year overall survival is evident based on this new analysis. Improved imaging or surrogate markers beyond PSA are desirable to distinguish risk groups among men with PSA persistence. Larger, prospectively randomized clinical trials should examine additional treatment options to come to a standardized
therapy for prostate cancer patients with PSA persistence."

Kaplan-Meier plot of progression-free
survival (PFS)
(subgroup: positive surgical margins, pT3R1): univariate
analysis
(a) without review pathology (n=175) and
(b) with review pathology (n=170).
HR=hazard ratio; CI=confidence interval.

Prostate-Specific Antigen Persistence After Radical Prostatectomy as a Predictive Factor of Clinical Relapse-Free Survival and Overall Survival: 10-Year Data of  the ARO 96-02 Trial - International Journal of Radiation Oncology • Biology • Physics

Results

Patients with persisting PSA after RP had higher preoperative PSA values, higher tumor stages, higher Gleason scores, and more positive surgical margins than did patients in arms A + B. For the 74 patients, the 10-year clinical relapse-free survival rate was 63%. Forty-three men had hormone therapy; 12 experienced distant metastases; 23 patients died. Compared with men who did achieve an undetectable PSA, the arm-C patients fared significantly worse, with a 10-year metastasis-free survival of 67% versus 83% and overall survival of 68% versus 84%, respectively. In Cox regression
analysis, Gleason score ≥8 (hazard ratio [HR] 2.8), pT ≥ 3c (HR 2.4), and extraprostatic extension ≥2 mm (HR 3.6) were unfavorable risk factors of progression.

Conclusions

A persisting PSA after prostatectomy seems to be an important prognosticator of clinical progression for pT3 tumors. It correlates with a higher rate of distant metastases and with worse overall survival. A larger prospective study is required to determine which patient subgroups will benefit most from which treatment option.


yyyyy