Natural History of Untreated Prostate Specific Antigen Radiorecurrent Prostate Cancer in Men with Favorable Prognostic Indicators. (20th February 2014)

• Record Type: Journal Article
• Authors: Martin, Neil E.; Chen, Ming-Hui; Beard, Clair J.; Nguyen, Paul L.; Loffredo, Marian J.; Renshaw, Andrew A.; Kantoff, Philip W.; D'Amico, Anthony V.
• Other Names: Zelefsky Michael Academic Editor.
• Is Part Of: Prostate cancer. Volume 2014(2014)
• Publication Date: 2014-02-20
• Subjects: Prostate -- Cancer -- Periodicals; Prostate -- Cancer -- Surgery -- Periodicals; 616.99463
• DOI: 10.1155/2014/912943
• Languages: English
• ISSNs: 2090-3111

Abstract

Abstract : Background and Purpose . Life expectancy data could identify men with favorable post-radiation prostate-specific antigen (PSA) failure kinetics unlikely to require androgen deprivation therapy (ADT). Materials and Methods . Of 206 men with unfavorable-risk prostate cancer in a randomized trial of radiation versus radiation and ADT, 53 experienced a PSA failure and were followed without salvage ADT. Comorbidity, age and established prognostic factors were assessed for relationship to death using Cox regression analyses. Results . The median age at failure, interval to PSA failure, and PSA doubling time were 76.6 years (interquartile range [IQR]: 71.8–79.3), 49.1 months (IQR: 37.7–87.4), and 25 months (IQR: 13.1–42.8), respectively. After a median follow up of 4.0 years following PSA failure, 45% of men had died, none from prostate cancer and no one had developed metastases. Both increasing age at PSA failure (HR: 1.14; 95% CI: 1.03–1.25; P = 0.008 ) and the presence of moderate to severe comorbidity (HR: 12.5; 95% CI: 3.81–41.0; P < 0.001 ) were significantly associated with an increased risk of death. Conclusions . Men over the age of 76 with significant comorbidity and a PSA doubling time >2 years following post-radiation PSA failure appear to be good candidates for observation without ADT intervention.