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Annals of Oncology Advance Access published online on October 13, 2009
Annals of Oncology, doi:10.1093/annonc/mdp365
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Early PSA decrease is an independent predictive factor of clinical failure and specific survival in patients with localized prostate cancer treated by radiotherapy with or without androgen deprivation therapy

R. de Crevoisier1,2,*, K. Slimane3, T. Messai1, P. Wibault1, F. Eschwege1, A. Bossi1, S. Koscielny4, A. Bridier1, C. Massard3 and K. Fizazi3

1 Department of Radiation, Institut Gustave-Roussy, Villejuif
2 Departement de Radiotherapie, Centre Eugène Marquis, Avenue Bataille Flandre Dunkerque, Rennes
3 Department of Medicine
4 Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, Villejuif, France

* Correspondence to: Prof. R. de Crevoisier, Departement de Radiotherapie, Centre Eugène Marquis, Avenue Bataille Flandre Dunkerque, 35042 Rennes, France. Tel: +33-2-99-25-30-35; Fax: +33-2-99-25-30-33; E-mail: brdecrevoisier2000{at}yahoo.fr

Background: The aim was to identify predictors of outcome in patients with localized prostate cancer treated with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT).

Materials and methods: A total of 448 patients with prostate cancer received EBRT alone (n = 361, group 1) or ADT followed by EBRT (n = 87, group 2). In group 2, ADT was initiated 3 months before EBRT. After baseline prostate-specific antigen (PSA) determination (PSApreRT), PSA was assessed during the 6th week of the EBRT course (PSA6wRT) in group 1. In group 2, PSA was measured again 3 months after the start of ADT, before EBRT (PSAADT-preRT).

Results: In group 1, median PSA6wRT/PSApreRT was 0.72 and median prostate-specific antigen velocity (PSAV) was –1.5 ng/ml/month. In the multivariate analysis, prognostic groups and PSA6wRT/PSApreRT (or PSAV) independently predicted biochemical failure (BF), clinical failure (CF), and prostate cancer-specific survival. In group 2, the median PSAADT-preRT was 1.3 ng/ml. In the high-risk group, an undetectable PSAADT-preRT (≤0.2 ng/ml) predicted BF (P < 0.01) and CF (P = 0.007).

Conclusion: A PSA decline 6 weeks after the start of EBRT when used as monotherapy and 3 months after the start of ADT in patients treated with combined ADT and EBRT is predictive of progression and specific survival.

androgen deprivation, prostate cancer, radiotherapy

Received for publication October 10, 2008. Revision received May 28, 2009. Revision received June 16, 2009. Accepted for publication June 22, 2009.


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