Prostate-Specific Antigen Halving Time While on Neoadjuvant Androgen Deprivation Therapy Is Associated With Biochemical Control in Men Treated With Radiation Therapy for Localized Prostate Cancer

BACKGROUND:The most important task in the field of improving the results of treatment of patients with prostate cancer (PCa) is their correct stratification by risk groups. Modern stratification systems do not fully provide an adequate risk assessment for all patients with prostate cancer. Further development of algorithms for predicting the clinical course of prostate cancer for a particular patient can positively affect the course and outcome of the disease. AIM:Determination of the clinical and prognostic value of the density of prostate-specific antigen (PSAD) in patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy. MATERIALS AND METHODS:The effect of the PSAD parameter on the tumor-specific survival rates, as well as the clinical and morphological parameters of the tumor process, was assessed in 272 patients with localized prostate cancer who underwent combined external beam radiation with androgen deprivation therapy from January 1996 to July 2007. RESULTS:The high clinical significance of the PSAD indicator has been demonstrated. An increase in PSAD correlated with an increase in serum PSA concentration, a decrease in PSA doubling time, and a decrease in tumor differentiation. The prognostic value of PSAD was confirmed in patients with localized prostate cancer who received combined hormone-radiation therapy. Using ROC-analysis, the threshold value of the PSAD index was determined 0.36 ng / ml / cm3, the excess of which was associated with a statistically significant decrease in the level of tumor-specific survival. The area under the curve was 0.703 (95% CI 0.2360.434;p 0.001). The risk of tumor-specific mortality and recurrence increased as the PSAD value increased. CONCLUSION:The PSAD parameter is a reliable biomarker of prostate cancer with high rates of clinical and prognostic significance, the use of which is not associated with the introduction of costly and cumbersome methods of laboratory and instrumental diagnostics.

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Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials

Prostate Cancer and Prostatic Diseases ◽

10.1038/s41391-021-00432-2 ◽

2021 ◽

Author(s):

Tommy Jiang ◽

Daniela Markovic ◽

Jay Patel ◽

Jesus E. Juarez ◽

Ting Martin Ma ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Androgen Deprivation Therapy ◽

Dose Escalation ◽

Low Dose ◽

Androgen Deprivation ◽

Phase Iii ◽

Localized Prostate Cancer ◽

Treatment Intensification ◽

Meta Regression

Abstract Background While multiple randomized trials have evaluated the benefit of radiation therapy (RT) dose escalation and the use and prolongation of androgen deprivation therapy (ADT) in the treatment of prostate cancer, few studies have evaluated the relative benefit of either form of treatment intensification with each other. Many trials have included treatment strategies that incorporate either high or low dose RT, or short-term or long-term ADT (STADT or LTADT), in one or more trial arms. We sought to compare different forms of treatment intensification of RT in the context of localized prostate cancer. Methods Using preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines, we collected over 40 phases III clinical trials comparing different forms of RT for localized prostate cancer. We performed a meta-regression of 40 individual trials with 21,429 total patients to allow a comparison of the rates and cumulative proportions of 5-year overall survival (OS), prostate cancer-specific mortality (PCSM), and distant metastasis (DM) for each treatment arm of every trial. Results Dose-escalation either in the absence or presence of STADT failed to significantly improve any 5-year outcome. In contrast, adding LTADT to low dose RT significantly improved 5-year PCSM (Odds ratio [OR] 0.34, 95% confidence interval [CI] 0.22–0.54, p < 0.001) and DM (OR 0.35, 95% CI 0.20–0.63. p < 0.001) over low dose RT alone. Adding STADT also significantly improved 5-year PCSM over low dose RT alone (OR 0.55, 95% CI 0.41–0.75, p < 0.001). Conclusion While limited by between-study heterogeneity and a lack of individual patient data, this meta-analysis suggests that adding ADT, versus increasing RT dose alone, offers a more consistent improvement in clinical endpoints.

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