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Seminal vesicle biopsy and laparoscopic pelvic lymph node dissections implications for patient selection in the radiotherapeutic management of prostate cancer
Radiation Oncology, Biology, Physics Volume 30, Supplement 1
254
1020 PSA DENSITY IS NOTAN INDEPENDENT PREDICTOR OF RESPONSE FOR PROSTATE CANCER TREATED BY CONFORMAL RADIOTHERAPY Steven R. Bonin, Benjamin W. Corn, Timothy Schultheiss, Conjoint Department
of Radiation
W. Robert Lee, Gary Hudes, Gerald E. Hanks
Oncology, Fox Chase Cancer Center/Medical
College of Pennsylvania,
Philadelphia,
PA
Purpose: Conflicting data exist in the literature regarding the prognostic value of Prostate Specific Antigen Density (PSAD). Although PSAD appears to be an important discriminator between benign and malignant prostatic disease, only one group (Zentner et al, IJROBP 27:47, 1993) has suggested that PSAD represents a new prognostic indicator of disease free survival for prostate cancer. The present study was undertaken to determine whether PSAD adds additional information to baseline PSA levels in predicting response to conformal radiotherapy for prostate cancer. Methods: Between April, 1989 and December, 1992, 170 patients with localized adenocarcinoma of the prostate were treated with computed tomography (CT) guided conformal radiotherapy techniques. PSAD was defined as the ratio of the pretreatment serum PSA (ng/ml) to the prostate volume (ml) as determined from treatment-planning CT scans. All volumetric determinations were made by 1 observer to minimize intrastudy variability. Pretreatment PSAD was calculated for each patient and ranged from 0.02-2.12 with mean and median values of 0.3 and 0.15, respectively. The endpoint selected was freedom from biochemical failure, defined as PSA normalization at one year. Separate analyses were performed for PSA returning to 4.0 and 1.5 “g/ml. A minimum follow-up of 12 months was available for all patients. Results: Using the endpoint of PSA normalization to 5 4, the mean PSAD of patients with freedom from biochemical failure at one year was 0.29 versus 0.57 among those who failed at one year (p 15) and the PSAD were significantly related to the probability of achieving PSA normalization at 1 year (p
1021 NED SURVIVAL USING STRICT BIOCHEMICAL CRITERIA IN 512 MEN TREATED WITH EXTERNAL BEAM RADIATION THERAPY ALONE W. Robert Lee, M.D., Gerald E. Hanks, M.D., Timothy E. Schultheiss, Ph.D., Benjamin W. Corn, M.D., Margie A. Hunt, M.S. Fox Chase Cancer Center, Philadelphia, PA 19 111 PURPOSEIOBJECTIVE: To determine the Eve-year rate of NED survival using strict biochemical criteria in 5 12 men with prostate cancer treated with external beam radiotherapy alone and to examine possible clinical and treatment factors that predict the likelihood of survival with no evidence of disease. MATERIALS & METHODS: 596 men with clinically localized prostate cancer consecutively treated with external beam radiotherapy alone with no prior, concomitant or adjuvant endocrine therapy were identified. 5 12 patients had serial serum PSA values after treatment and 450 patients also had pretreatment PSA values. The median follow-up is 36 months. To be considered NED a patient must have no clinical, radiographic or biochemical evidence of recurrent disease, Biochemical failure after irradiation was defined as a sequentially rising PSA or a PSA greater than 1.5 n&L (Hybritech assay) one year or more from the completion of radiotherapy. RESULTS: The five-year rate of NED survival for the 5 12 patients with serial posttreatment PSA values was 5 1%. According to T stage the five-year rates of NED survival are Tl 62% (Tlaib 618, Tic 75%), T2 53% (T2a/b 59%, T2c 49%), T3 34% (T3a 42%, T3c 15%), T4 0% . On multivariate analysis the most important predictors of NED survival were pretreatment PSA level < 15 ng/mL (pc.0001, See Table) and use of conformal treatment (pc.02). In patients with a pretreatment PSA < 15 ng/mL the three year rates of NED survival with standard technique or conformal technique were 68% and 86%, respectively (p<.O2).
CONCLUSION: External beam radiation alone can produce acceptable rates of survival without clinical, radiologic or biochemical evidence of disease in patients with clinically organ-confined tumors and a pretreatment PSA of < 15 ng/mL. Conformal techniques have improved the rate of NED survival compared to standard techniques and this improvement is most marked in patients with Tl-2 tumors and low PSA at presentation. To produce. acceptable results in those patients with T3/4 tumors and/or PSA levels > 15 ng/rnL effective adjuvant treatments in addition to more aggressive local treatments are necessary.
254
1020 PSA DENSITY IS NOTAN INDEPENDENT PREDICTOR OF RESPONSE FOR PROSTATE CANCER TREATED BY CONFORMAL RADIOTHERAPY Steven R. Bonin, Benjamin W. Corn, Timothy Schultheiss, Conjoint Department
of Radiation
W. Robert Lee, Gary Hudes, Gerald E. Hanks
Oncology, Fox Chase Cancer Center/Medical
College of Pennsylvania,
Philadelphia,
PA
Purpose: Conflicting data exist in the literature regarding the prognostic value of Prostate Specific Antigen Density (PSAD). Although PSAD appears to be an important discriminator between benign and malignant prostatic disease, only one group (Zentner et al, IJROBP 27:47, 1993) has suggested that PSAD represents a new prognostic indicator of disease free survival for prostate cancer. The present study was undertaken to determine whether PSAD adds additional information to baseline PSA levels in predicting response to conformal radiotherapy for prostate cancer. Methods: Between April, 1989 and December, 1992, 170 patients with localized adenocarcinoma of the prostate were treated with computed tomography (CT) guided conformal radiotherapy techniques. PSAD was defined as the ratio of the pretreatment serum PSA (ng/ml) to the prostate volume (ml) as determined from treatment-planning CT scans. All volumetric determinations were made by 1 observer to minimize intrastudy variability. Pretreatment PSAD was calculated for each patient and ranged from 0.02-2.12 with mean and median values of 0.3 and 0.15, respectively. The endpoint selected was freedom from biochemical failure, defined as PSA normalization at one year. Separate analyses were performed for PSA returning to 4.0 and 1.5 “g/ml. A minimum follow-up of 12 months was available for all patients. Results: Using the endpoint of PSA normalization to 5 4, the mean PSAD of patients with freedom from biochemical failure at one year was 0.29 versus 0.57 among those who failed at one year (p
1021 NED SURVIVAL USING STRICT BIOCHEMICAL CRITERIA IN 512 MEN TREATED WITH EXTERNAL BEAM RADIATION THERAPY ALONE W. Robert Lee, M.D., Gerald E. Hanks, M.D., Timothy E. Schultheiss, Ph.D., Benjamin W. Corn, M.D., Margie A. Hunt, M.S. Fox Chase Cancer Center, Philadelphia, PA 19 111 PURPOSEIOBJECTIVE: To determine the Eve-year rate of NED survival using strict biochemical criteria in 5 12 men with prostate cancer treated with external beam radiotherapy alone and to examine possible clinical and treatment factors that predict the likelihood of survival with no evidence of disease. MATERIALS & METHODS: 596 men with clinically localized prostate cancer consecutively treated with external beam radiotherapy alone with no prior, concomitant or adjuvant endocrine therapy were identified. 5 12 patients had serial serum PSA values after treatment and 450 patients also had pretreatment PSA values. The median follow-up is 36 months. To be considered NED a patient must have no clinical, radiographic or biochemical evidence of recurrent disease, Biochemical failure after irradiation was defined as a sequentially rising PSA or a PSA greater than 1.5 n&L (Hybritech assay) one year or more from the completion of radiotherapy. RESULTS: The five-year rate of NED survival for the 5 12 patients with serial posttreatment PSA values was 5 1%. According to T stage the five-year rates of NED survival are Tl 62% (Tlaib 618, Tic 75%), T2 53% (T2a/b 59%, T2c 49%), T3 34% (T3a 42%, T3c 15%), T4 0% . On multivariate analysis the most important predictors of NED survival were pretreatment PSA level < 15 ng/mL (pc.0001, See Table) and use of conformal treatment (pc.02). In patients with a pretreatment PSA < 15 ng/mL the three year rates of NED survival with standard technique or conformal technique were 68% and 86%, respectively (p<.O2).
CONCLUSION: External beam radiation alone can produce acceptable rates of survival without clinical, radiologic or biochemical evidence of disease in patients with clinically organ-confined tumors and a pretreatment PSA of < 15 ng/mL. Conformal techniques have improved the rate of NED survival compared to standard techniques and this improvement is most marked in patients with Tl-2 tumors and low PSA at presentation. To produce. acceptable results in those patients with T3/4 tumors and/or PSA levels > 15 ng/rnL effective adjuvant treatments in addition to more aggressive local treatments are necessary.