Optimal Definition of Biochemical Recurrence in Patients Who Receive Salvage Radiotherapy Following Radical Prostatectomy for Prostate Cancer
Cancer Research and Treatment 2022³â 54±Ç 4È£ p.1191 ~ p.1199
À̼º¿í(Lee Sung-Uk) - National Cancer Center Proton Therapy Center
±èÀ缺(Kim Jae-Sung) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Radiation Oncology
±è¿µ¼®(Kim Young-Seok) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
Á¶ÀçÈ£(Cho Jae-Ho) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
ÃÖ¼Èñ(Choi Seo-Hee) - Yonsei University College of Medicine Yongin Severance Hospital Department of Radiation Oncology
³²ÅñÙ(Nam Taek-Keun) - Chonnam National University Medical School Chonnam National University Hwasun Hospital Department of Radiation Oncology
Á¤¼Û¹Ì(Jeong Song-Mi) - Ewha Womans University College of Medicine Ewha Womans University Medical Center Department of Radiation Oncology
±è¿µ°æ(Kim Young-Kyong) - Kyung Hee University College of Medicine Kyung Hee University Hospital Department of Radiation Oncology
ÃÖ¿µ¹Î(Choi Young-Min) - Dong-A University College of Medicine Dong-A University Hospital Department of Radiation Oncology
À̵¿Àº(Lee Dong-Eun) - National Cancer Center Research Institute and Hospital Biostatistics Collaboration Team
¹Ú¿ø(Park Won) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
Á¶°üÈ£(Cho Kwan-Ho) - National Cancer Center Proton Therapy Center
Abstract
Purpose: This study proposed the optimal definition of biochemical recurrence (BCR) after salvage radiotherapy (SRT) following radical prostatectomy for prostate cancer.
Materials and Methods: Among 1,117 patients who had received SRT, data from 205 hormone-naive patients who experienced post-SRT prostate-specific antigen (PSA) elevation were included in a multi-institutional database. The primary endpoint was to determine the PSA parameters predictive of distant metastasis (DM). Absolute serum PSA levels and the prostate-specific antigen doubling time (PSA-DT) were adopted as PSA parameters.
Results: When BCR was defined based on serum PSA levels ranging from 0.4 ng/mL to nadir+2.0 ng/mL, the 5-year probability of DM was 27.6%?33.7%. The difference in the 5-year probability of DM became significant when BCR was defined as a serum PSA level of 0.8 ng/ml or higher (1.0?2.0 ng/mL). Application of a serum PSA level of ¡Ã 0.8 ng/mL yielded a c-index value of 0.589. When BCR was defined based on the PSA-DT, the 5-year probability was 22.7%?39.4%. The difference was significant when BCR was defined as a PSA-DT ¡Â 3 months and ¡Â 6 months. Application of a PSA-DT ¡Â 6 months yielded the highest c-index (0.660). These two parameters complemented each other; for patients meeting both PSA parameters, the probability of DM was 39.5%?44.5%; for those not meeting either parameter, the probability was 0.0%?3.1%.
Conclusion: A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT. In addition, a PSA-DT ¡Â 6 months was significantly predictive of subsequent DM, and combined application of both parameters enhanced predictability.
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Prostatic neoplasms, Prostatectomy, Radiotherapy, Prostate-specific antigen
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À¯È¿¼º°á°ú(Recomendation)
A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT.