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The 100-day PSA: usefulness as surrogate end point for biochemical disease-free survival after definitive radiotherapy of prostate cancer

Prostate Cancer and Prostatic Diseases volume 7, pages 263–267 (2004)Cite this article

Abstract

Overall and biochemical disease-free (bNED) survival data after definitive radiotherapy (RT) for prostate cancer (CaP) requires decades of patient follow-up. Surrogates involving dynamics of prostate-specific antigen (PSA) decline, PSA nadir and time thereto have been unrewarding. This study investigated the metric of the PSA value 100 days after RT (PSA100), analyzed with respect to 8-y bNED survival. A total of 214 patients with T1–3 CaP were treated with definitive RT (defined as dose >66 Gy) in our institution between 1/1/1988 and 12/31/2000. All were subject to continuous follow-up with routine PSA levels. Biochemical failure (77 patients) was defined by the ASTRO criteria (n=67) or by the date of first hormonal therapy for a rising PSA, which did not meet the ASTRO criteria (n=10). No patients were included if they received postoperative radiation, or if hormones were administered prior to bNED recurrence, if any. Patients were stratified by PSA100 values ⩽ or >4.0 ng/ml, and ⩽ or <2.5 ng/ml. Median follow-up was 64.3 months: follow-up data were calculated as of time to last PSA, with data collection as of 12/31/02. Patients with PSA100⩽4.0 ng/ml had 62% 8-y bNED survival, and those with PSA100>4.0 ng/ml had 20% 8-y bNED survival (P<0.001). Use of a PSA100 cutoff of 2.5 ng/ml yielded no significant difference in 8-y bNED survival (P=0.229). Cox proportional analysis revealed that initial PSA (P=0.006), stage (P=0.001) and PSA100⩽4.0 ng/ml (P=0.002) were significantly related to bNED survival, but that age (P=0.887), race (P=0.500), RT dose (P=0.669), Gleason sum (P=0.091), and PSA100⩽2.5 ng/ml (P=0.128) were not. In conclusion, PSA100 using a cutoff of 4 ng/ml is a valuable and reliable surrogate for bNED survival after definitive RT, requiring less follow-up than other metrics. Patients with less values will have only about a 1 in 3 chance of bNED failure at 8 y. Patients with greater values will have a 4 in 5 chance of bNED failure at 8 y.

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Acknowledgements

The opinions or assertions contained herein are those of the authors and should not be construed as representing the views of the United States Department of Defense or the United States Government. This analysis was supported by the Center for Prostate Disease Research, a program of the Uniformed Services University of the Health Sciences administered by the Henry M Jackson Foundation for the Advancement of Military Medicine and funded by the US Army Medical Research and Material Command.

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Authors and Affiliations

  1. Naval Medical Center, San Diego, California, USA

    P A S Johnstone, S R Williams & R H Riffenburgh

  2. Emory University, Atlanta, Georgia, USA

    P A S Johnstone

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  1. P A S Johnstone
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  2. S R Williams
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Correspondence to P A S Johnstone.

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Johnstone, P., Williams, S. & Riffenburgh, R. The 100-day PSA: usefulness as surrogate end point for biochemical disease-free survival after definitive radiotherapy of prostate cancer. Prostate Cancer Prostatic Dis 7, 263–267 (2004). https://doi.org/10.1038/sj.pcan.4500736

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