Natural history of 'second' biochemical failure after salvage radiation therapy for prostate cancer: A multi-institution study

Vasu Tumati, William C. Jackson, Ahmed E. Abugharib, Ganesh Raj, Claus Roehrborn, Yair Lotan, Kevin D Courtney, Aditya Bagrodia, Jeffrey Gahan, Zachary S. Zumsteg, Michael R Folkert, Aaron M Laine, Raquibul Hannan, Daniel E. Spratt, Neil B Desai

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Abstract

Objectives: To describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) after prostatectomy. Patients and Methods: After undergoing SRT at one of two institutions between 1986 and 2013, 286 patients experienced a second BCR, defined as two rises in prostate-specific antigen (PSA) of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses. Results: At a median of 6.1 years after second BCR, DM, CRPC, PCSS and OS rates were 41%, 27%, 83% and 73%, respectively. On multivariable analysis, interval to second BCR <1 year (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.71-4.14; P < 0.001], Gleason score 8-10 (HR 1.65, 95% CI 1.07-2.54; P = 0.022), and concurrent ADT during SRT (HR 1.76, 95% CI 1.08-2.88; P = 0.024) were associated with FFDM, while PCSS was associated with interval to second BCR <1 year (HR 3.00, 95% CI 1.69-5.32; P < 0.001) and concurrent ADT during SRT (HR 2.15, CI 1.13-4.08; P = 0.019). These risk factors were used to stratify patients into three groups, with 6-year FFDM rates of 71%, 59% and 33%, and PCSS rates of 89%, 79%, and 65%, respectively. Conclusion: Following second BCR after SRT, clinical progression is enriched in a subgroup of patients with prostate cancer, while others remain without DM for long intervals. Stratifying patients into risk groups using prognostic factors may aid counselling and future trial design.

Original languageEnglish (US)
JournalBJU International
DOIs
StateAccepted/In press - 2017

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Salvage Therapy
Natural History
Prostatic Neoplasms
Radiotherapy
Recurrence
Confidence Intervals
Neoplasm Metastasis
Survival
Castration
Survival Rate
Neoplasm Grading
Prostate-Specific Antigen
Prostatectomy
Counseling

Keywords

  • Biochemical failure
  • Natural history
  • Prostate cancer
  • Radical prostatectomy
  • Salvage radiation

ASJC Scopus subject areas

  • Urology

Cite this

@article{f25e7b0345794e4c80df05792c178738,
title = "Natural history of 'second' biochemical failure after salvage radiation therapy for prostate cancer: A multi-institution study",
abstract = "Objectives: To describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) after prostatectomy. Patients and Methods: After undergoing SRT at one of two institutions between 1986 and 2013, 286 patients experienced a second BCR, defined as two rises in prostate-specific antigen (PSA) of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses. Results: At a median of 6.1 years after second BCR, DM, CRPC, PCSS and OS rates were 41{\%}, 27{\%}, 83{\%} and 73{\%}, respectively. On multivariable analysis, interval to second BCR <1 year (hazard ratio [HR] 2.66, 95{\%} confidence interval [CI] 1.71-4.14; P < 0.001], Gleason score 8-10 (HR 1.65, 95{\%} CI 1.07-2.54; P = 0.022), and concurrent ADT during SRT (HR 1.76, 95{\%} CI 1.08-2.88; P = 0.024) were associated with FFDM, while PCSS was associated with interval to second BCR <1 year (HR 3.00, 95{\%} CI 1.69-5.32; P < 0.001) and concurrent ADT during SRT (HR 2.15, CI 1.13-4.08; P = 0.019). These risk factors were used to stratify patients into three groups, with 6-year FFDM rates of 71{\%}, 59{\%} and 33{\%}, and PCSS rates of 89{\%}, 79{\%}, and 65{\%}, respectively. Conclusion: Following second BCR after SRT, clinical progression is enriched in a subgroup of patients with prostate cancer, while others remain without DM for long intervals. Stratifying patients into risk groups using prognostic factors may aid counselling and future trial design.",
keywords = "Biochemical failure, Natural history, Prostate cancer, Radical prostatectomy, Salvage radiation",
author = "Vasu Tumati and Jackson, {William C.} and Abugharib, {Ahmed E.} and Ganesh Raj and Claus Roehrborn and Yair Lotan and Courtney, {Kevin D} and Aditya Bagrodia and Jeffrey Gahan and Zumsteg, {Zachary S.} and Folkert, {Michael R} and Laine, {Aaron M} and Raquibul Hannan and Spratt, {Daniel E.} and Desai, {Neil B}",
year = "2017",
doi = "10.1111/bju.13926",
language = "English (US)",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Natural history of 'second' biochemical failure after salvage radiation therapy for prostate cancer

T2 - A multi-institution study

AU - Tumati, Vasu

AU - Jackson, William C.

AU - Abugharib, Ahmed E.

AU - Raj, Ganesh

AU - Roehrborn, Claus

AU - Lotan, Yair

AU - Courtney, Kevin D

AU - Bagrodia, Aditya

AU - Gahan, Jeffrey

AU - Zumsteg, Zachary S.

AU - Folkert, Michael R

AU - Laine, Aaron M

AU - Hannan, Raquibul

AU - Spratt, Daniel E.

AU - Desai, Neil B

PY - 2017

Y1 - 2017

N2 - Objectives: To describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) after prostatectomy. Patients and Methods: After undergoing SRT at one of two institutions between 1986 and 2013, 286 patients experienced a second BCR, defined as two rises in prostate-specific antigen (PSA) of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses. Results: At a median of 6.1 years after second BCR, DM, CRPC, PCSS and OS rates were 41%, 27%, 83% and 73%, respectively. On multivariable analysis, interval to second BCR <1 year (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.71-4.14; P < 0.001], Gleason score 8-10 (HR 1.65, 95% CI 1.07-2.54; P = 0.022), and concurrent ADT during SRT (HR 1.76, 95% CI 1.08-2.88; P = 0.024) were associated with FFDM, while PCSS was associated with interval to second BCR <1 year (HR 3.00, 95% CI 1.69-5.32; P < 0.001) and concurrent ADT during SRT (HR 2.15, CI 1.13-4.08; P = 0.019). These risk factors were used to stratify patients into three groups, with 6-year FFDM rates of 71%, 59% and 33%, and PCSS rates of 89%, 79%, and 65%, respectively. Conclusion: Following second BCR after SRT, clinical progression is enriched in a subgroup of patients with prostate cancer, while others remain without DM for long intervals. Stratifying patients into risk groups using prognostic factors may aid counselling and future trial design.

AB - Objectives: To describe the natural history of prostate cancer in men who experience a second biochemical recurrence (BCR) after salvage radiotherapy (SRT) after prostatectomy. Patients and Methods: After undergoing SRT at one of two institutions between 1986 and 2013, 286 patients experienced a second BCR, defined as two rises in prostate-specific antigen (PSA) of ≥0.2 ng/mL above nadir. Event rates for distant metastasis (DM) or freedom from DM (FFDM), castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (PCSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression was used for comparative analyses. Results: At a median of 6.1 years after second BCR, DM, CRPC, PCSS and OS rates were 41%, 27%, 83% and 73%, respectively. On multivariable analysis, interval to second BCR <1 year (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.71-4.14; P < 0.001], Gleason score 8-10 (HR 1.65, 95% CI 1.07-2.54; P = 0.022), and concurrent ADT during SRT (HR 1.76, 95% CI 1.08-2.88; P = 0.024) were associated with FFDM, while PCSS was associated with interval to second BCR <1 year (HR 3.00, 95% CI 1.69-5.32; P < 0.001) and concurrent ADT during SRT (HR 2.15, CI 1.13-4.08; P = 0.019). These risk factors were used to stratify patients into three groups, with 6-year FFDM rates of 71%, 59% and 33%, and PCSS rates of 89%, 79%, and 65%, respectively. Conclusion: Following second BCR after SRT, clinical progression is enriched in a subgroup of patients with prostate cancer, while others remain without DM for long intervals. Stratifying patients into risk groups using prognostic factors may aid counselling and future trial design.

KW - Biochemical failure

KW - Natural history

KW - Prostate cancer

KW - Radical prostatectomy

KW - Salvage radiation

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U2 - 10.1111/bju.13926

DO - 10.1111/bju.13926

M3 - Article

C2 - 28581200

AN - SCOPUS:85021843653

JO - BJU International

JF - BJU International

SN - 1464-4096

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