The performance characteristics of prostate-specific membrane antigen positron emission tomography improves with increasing prostate-specific antigen (PSA) level. This, coupled with insurance approval concerns if applied for too early, causes some physicians to delay post-radical prostatectomy salvage radiation therapy (sRT) until well after PSA failure, typically at PSA levels exceeding 0.30 ng/ml.
To determine whether such a delay increases mortality risk, a multinational group led by researchers from Dana-Farber Brigham Cancer Center studied radical prostatectomy and lymph node specimens from 25,551 patients with no more than one high-risk factor (prostatectomy Gleason score of 8–10 or evidence at surgery of extension of the cancer outside the prostate). They sought to identify a PSA level above which initiating sRT is associated with increased mortality risk.
The research team used multivariable Cox regression analysis beginning at a PSA level of 0.10 ng/mL and in 0.05 increments up to 0.50 ng/mL versus at or below that level. The model was adjusted for age at and year of surgery, established prostate cancer prognostic factors, institution, and time-dependent use of androgen deprivation therapy.
The study found that after a median follow-up of six years, patients who received sRT at a PSA level higher than 0.25 ng/mL had approximately a 50 percent higher risk of death compared with those who received sRT when the PSA was at or below 0.25 ng/ML.
"At Dana-Farber Brigham, we tend to be more medically conservative and not allow these restraints to drive patients to a lower cure rate," said principal investigator Anthony Victor D'Amico, MD, PhD, chief of Genitourinary Radiation Oncology, Dana-Farber Brigham Cancer Center. "Normally, we would want to start sRT at a PSA level of 0.2, or even 0.1 ng/ml in most cases, to decrease the risk of the cancer metastasizing or becoming resistant to existing salvage treatments such as radiation and androgen deprivation therapy and to maximize curability."
Read more in the Journal of Clinical Oncology.
Journal of Clinical Oncology
Method of Research
Subject of Research
Prostate-Specific Antigen Level at the Time of Salvage Therapy After Radical Prostatectomy for Prostate Cancer and the Risk of Death
Article Publication Date
Derya Tilki Honoraria: Janssen, Ipsen, Exact Sciences, Apogepha, AstraZeneca, Advanced Accelerator Applications, Roche, Takeda, miR Scientific Consulting or Advisory Role: miR Scientific, AstraZeneca, Roche Research Funding: Janssen Ming-Hui Chen Employment: Boehringer Ingelheim Markus Graefen Honoraria: Astellas Pharma, Bayer, Takeda, Janssen, Medtronic Consulting or Advisory Role: Medtronic Travel, Accommodations, Expenses: Astellas Pharma, Bayer, Janssen, Takeda Osama Mohamad Research Funding: Salesforce Janet E. Cowan Stock and Other Ownership Interests: GlaxoSmithKline, McKesson Felix Y. Feng Stock and Other Ownership Interests: Artera Consulting or Advisory Role: Janssen Biotech, Astellas Pharma, SerImmune, Foundation Medicine, Exact Sciences, Bristol Myers Squibb, Varian Medical Systems, Novartis, Roivant, Bayer, BlueStar Genomics, Myovant Sciences, Tempus, Artera Research Funding: Zenith Epigenetics Peter R. Carroll Stock and Other Ownership Interests: Nutcracker Therapeutics, Inc Honoraria: BioPharm Communications, Exact Sciences Consulting or Advisory Role: Nutcracker Therapeutics, Inc, Insightec, Progenics, Francis Medical, Alessa Therapeutics Research Funding: Intuitive Surgical (Inst)