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Time to PSA recurrence predicts cancer death
Source: (cancerfacts.com)
Monday, November 09, 2009
CHICAGO – Nov. 9, 2009 – Men whose prostate specific antigen (PSA) levels rise within 18 months of radiotherapy are more likely to have the cancer spread to other organs and more likely to die of the disease, say researchers.
Led by Dr. Mark K. Buyyounouski, radiation oncologist at Fox Chase Chase Cancer Center, the researchers presented their findings from an international study last week at the annual meeting of the American Society for Radiation Oncology (ASTRO).
"PSA is the gold standard for following prostate cancer patients after they receive radiation or surgery. But we haven't known if having PSA rise sooner means a patient has a greater danger of dying of prostate cancer, though it seems logical," Buyyounouski says. "Now we can use the simple criteria from this study, which is widely available for anyone who has PSA testing, to identify men who have a greater than 25 percent chance of dying from prostate cancer in the next five years. That is huge. There is nothing else that can do that."
Using a single institution database, Buyyounouski and colleagues showed previously that men who suffered an early biochemical failure, which is defined as their lowest PSA level plus 2 ng/ml (nanograms per milliliter), were at greater risk of dying of prostate cancer. The new study confirms those results using a multinational database and shows that the measure is ready for use in the clinic.
A total of 2,132 men with prostate cancer confined to the prostate (localized), whose PSA rose after treatment (biochemical failure) indicating the cancer had returned, were studied. The median interval between treatment and biochemical failure was 35.2 months for the entire study group. However, 19 percent of patients developed biochemical failure at 18 months or less. For those men, 69.5 percent survived five years compared to 89.8 percent of the men whose PSA didn't rise until 18 months or more after treatment.
When they analyzed multiple variables, the researchers found that the amount of time before biochemical failure was linked with dying of the cancer, as were Gleason score, tumor stage, age, and PSA doubling time, which is the length of time it takes for the PSA level to double. However, the interval to biochemical failure was the most predictive for dying of prostate cancer compared with the other variables.
Currently, most physicians do not start treatment based on biochemical failure alone, but rather wait until the PSA reaches a high level or there is some other evidence of tumor spread.
"The potential impact of this finding is that patients can initiate treatment far sooner without waiting for other signs or symptoms of prostate cancer," Buyyounouski says. "If a patient has biochemical failure at 16 months, rather than wait and learn later that the PSA is rising sharply and risk the development of distant metastasis, therapy can be started sooner based on the increased risk of death."
SOURCE: adapted from press materials provided by Fox Chase Cancer Center
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