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Change Determinants In PSA Over Time - Its Association With Recurrence After External Beam Radiation Therapy For Prostate Cancer In 5 Large Cohorts

August 16, 2019

UroToday - In the November 1, 2008 issue of International Journal of Radiation Oncology, Biology, Physics, Dr. C├ęcile Proust-Lima and colleagues presented a linear mixed model to construct patient PSA profiles after radiotherapy (XRT) for prostate cancer (CaP). The included XRT data from 5 patient cohorts where men with CaP were treated for clinically localized disease. Two or 3-dimensional XRT was given to the prostate and seminal vesicles and whole-pelvic radiotherapy was not routinely performed. Prognostic factors evaluated included Gleason score, T-stage, pre-treatment initial PSA (iPSA), age and XRT dosage.

Evolution of PSA after XRT was analyzed by linear mixed model (LMM) with 3 components: post-therapy PSA at the end of XRT (ptPSA), short-term evolution in the first year after XRT (f1(t)), and the long-term evolution denoted as f2(t). Once the LMM was defined, a Cox proportional hazards regression model with time-varying covariates was used to assess the association of pre-treatment prognostic factors and post-treatment pattern of PSA with the time to recurrence of CaP after XRT.

A total of 4,247 patients were analyzed and 339 (12.2%) had clinical recurrences. The median number of PSA measurements was 9. Regarding PSA pattern and its determinants, for ptPSA only iPSA was of statistical significance with higher pretreatment PSA levels corresponding to higher post-treatment PSA levels. iPSA and T-stage were significantly associated with the short-term PSA decline after XRT. iPSA, T-stage and Gleason score all had higher values, corresponding to higher rates of long-term PSA rise. Regarding risk of recurrence, both higher current PSA levels and the rate of PSA change were highly significant in predicting clinical failure. Men with T-stage 3 or 4 had a 39% higher risk of clinical recurrence compared with stage T1 or T2 patients. Men with a Gleason score of 7 had a 62% higher risk of recurrence compared with those having a Gleason score