J Clin Oncol. 1992 Aug;10(8):1208-17. doi: 10.1200/JCO.1992.10.8.1208.

Prostate-specific antigen as a predictor of radiotherapy response and patterns of failure in localized prostate cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

M A Ritter, E M Messing, T G Shanahan, S Potts, R J Chappell, T J Kinsella

PMID: 1378886 DOI: 10.1200/JCO.1992.10.8.1208

Abstract

PURPOSE: A study of preradiation and postradiation, serial serum prostate-specific antigen (PSA) levels was performed in patients who had clinically localized prostate cancer. The prognostic value of the PSA in pretreatment evaluation and posttreatment follow-up was assessed.

PATIENTS AND METHODS: Sixty-three patients who presented with clinically localized prostate cancer and who were treated with external-beam radiation therapy were followed-up for a median of 25 months. A serum PSA and physical examination were performed at 3-month intervals, and a bone scan was done yearly. An increase in PSA triggered an additional metastatic workup. Prostate rebiopsy was performed for new, palpable nodules or for a serial increase in PSA in the context of a negative metastatic workup.

RESULTS: Forty-one patients remained recurrence-free and 22 recurred clinically, 15 distantly and seven locally. The PSA was the strongest, independent, pretreatment prognostic indicator (P = .019) among pretreatment PSA, stage, and grade, but lost significance when the serum prostatic acid phosphatase (PAP) status was included. The initial rate of the PSA decrease after radiation (median half-life, 2.6 months) failed to predict outcome. Recurrence-free patients reached postradiation PSA levels that were equivalent to those reported in disease-free male populations; failure of the PSA to reach such normal levels was a multivariate predictor of subsequent failure (P less than .037). All clinicopathologic documentations of failure were preceded by an increase in PSA levels during follow-up. Delayed versus early PSA increase was associated with clinically localized versus metastatic first recurrence.

CONCLUSIONS: The serum PSA is an independent pretreatment and posttreatment predictor of outcome. Additionally, for a median follow-up of 25 months, delayed PSA failure is associated with clinically localized rather than metastatic recurrence, a relationship that may help in selection for local salvage therapy.

Similar articles

Cited by

Substances

• Antigens, Neoplasm
• Biomarkers, Tumor
• Prostate-Specific Antigen

MeSH terms

• Aged
• Aged, 80 and over
• Antigens, Neoplasm / blood
• Biomarkers, Tumor / blood
• Humans
• Least-Squares Analysis
• Male
• Middle Aged
• Neoplasm Staging
• Predictive Value of Tests
• Prostate-Specific Antigen
• Prostatic Neoplasms / immunology
• Prostatic Neoplasms / pathology
• Prostatic Neoplasms / radiotherapy
• Recurrence
• Treatment Outcome

Publication Types

• Journal Article
• Research Support, Non-U.S. Gov't

LinkOut - more resources

• Full Text Sources
  • Atypon
  • Ovid Technologies, Inc.
• Medical
  • Genetic Alliance
  • MedlinePlus Health Information
• Miscellaneous
  • NCI CPTAC Assay Portal
• Research Materials
  • NCI CPTC Antibody Characterization Program