Prostate-Specific Antigen Response to Androgen Deprivation Therapy in the Neoadjuvant Setting for High-Risk Prostate Adenocarcinoma (PIRANHA) : Pooled Analysis of Two Randomized Clinical Trials
Copyright © 2023 Elsevier Inc. All rights reserved..
PURPOSE: A suboptimal prostate-specific antigen (PSA) response to neoadjuvant androgen deprivation therapy (ADT) among men who go on to receive definitive radiation therapy for prostate cancer might suggest the existence of castration-resistant disease or altered androgen receptor signaling. This in turn may portend worse long-term clinical outcomes, especially in men with high-risk disease. We set out to evaluate the prognostic impact of poor PSA response to neoadjuvant ADT in men with high-risk prostate cancer.
METHODS AND MATERIALS: This was a post hoc analysis of the multicenter TROG 03.04 RADAR and PCS IV randomized clinical trials. Inclusion criteria for this analysis were patients with high-risk prostate cancer (defined as Gleason score ≥8, initial PSA ≥20 ng/mL, or cT3a disease or higher) who received definitive radiation therapy, at least 18 months of ADT, and had a preradiation therapy PSA level drawn after at least 3 months of neoadjuvant ADT. Poor PSA response was defined as PSA >0.5 ng/mL. Cox regression and Fine-Gray models were used to test whether poor PSA response was associated with metastasis-free survival, biochemical recurrence, prostate-cancer specific mortality, and overall survival.
RESULTS: Nine hundred thirty men met inclusion criteria for this analysis. Median follow-up was 130 months (interquartile range [IQR], 89-154 months). After a median of 3 months (IQR, 3-4.2 months) of neoadjuvant ADT, the median PSA was 0.60 ng/mL (IQR, 0.29-1.59). Overall, 535 men (57%) had a PSA >0.5 ng/mL. Poor PSA response was associated with significantly worse metastasis-free survival (hazard ratio [HR], 3.93; P = .02), worse biochemical recurrence (subdistribution HR, 2.39; P = .003), worse prostate-cancer specific mortality (subdistribution HR, 1.50; P = .005), and worse overall survival (HR, 4.51; P = .05).
CONCLUSIONS: Patients with PSA >0.5 mg/mL after at least 3 months of neoadjuvant ADT had worse long-term clinical outcomes and should be considered for treatment intensification.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
International journal of radiation oncology, biology, physics - (2023) vom: 25. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nikitas, John [VerfasserIn] |
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| Anmerkungen: |
Date Revised 17.01.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.ijrobp.2023.12.022 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366418408 |
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| 100 | 1 | |a Nikitas, John |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prostate-Specific Antigen Response to Androgen Deprivation Therapy in the Neoadjuvant Setting for High-Risk Prostate Adenocarcinoma (PIRANHA) |b Pooled Analysis of Two Randomized Clinical Trials |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 17.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: A suboptimal prostate-specific antigen (PSA) response to neoadjuvant androgen deprivation therapy (ADT) among men who go on to receive definitive radiation therapy for prostate cancer might suggest the existence of castration-resistant disease or altered androgen receptor signaling. This in turn may portend worse long-term clinical outcomes, especially in men with high-risk disease. We set out to evaluate the prognostic impact of poor PSA response to neoadjuvant ADT in men with high-risk prostate cancer | ||
| 520 | |a METHODS AND MATERIALS: This was a post hoc analysis of the multicenter TROG 03.04 RADAR and PCS IV randomized clinical trials. Inclusion criteria for this analysis were patients with high-risk prostate cancer (defined as Gleason score ≥8, initial PSA ≥20 ng/mL, or cT3a disease or higher) who received definitive radiation therapy, at least 18 months of ADT, and had a preradiation therapy PSA level drawn after at least 3 months of neoadjuvant ADT. Poor PSA response was defined as PSA >0.5 ng/mL. Cox regression and Fine-Gray models were used to test whether poor PSA response was associated with metastasis-free survival, biochemical recurrence, prostate-cancer specific mortality, and overall survival | ||
| 520 | |a RESULTS: Nine hundred thirty men met inclusion criteria for this analysis. Median follow-up was 130 months (interquartile range [IQR], 89-154 months). After a median of 3 months (IQR, 3-4.2 months) of neoadjuvant ADT, the median PSA was 0.60 ng/mL (IQR, 0.29-1.59). Overall, 535 men (57%) had a PSA >0.5 ng/mL. Poor PSA response was associated with significantly worse metastasis-free survival (hazard ratio [HR], 3.93; P = .02), worse biochemical recurrence (subdistribution HR, 2.39; P = .003), worse prostate-cancer specific mortality (subdistribution HR, 1.50; P = .005), and worse overall survival (HR, 4.51; P = .05) | ||
| 520 | |a CONCLUSIONS: Patients with PSA >0.5 mg/mL after at least 3 months of neoadjuvant ADT had worse long-term clinical outcomes and should be considered for treatment intensification | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Ong, Wee Loon |e verfasserin |4 aut | |
| 700 | 1 | |a Carrier, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Romero, Tahmineh |e verfasserin |4 aut | |
| 700 | 1 | |a Millar, Jeremy |e verfasserin |4 aut | |
| 700 | 1 | |a Steinberg, Michael L |e verfasserin |4 aut | |
| 700 | 1 | |a Rettig, Matthew B |e verfasserin |4 aut | |
| 700 | 1 | |a Boutros, Paul C |e verfasserin |4 aut | |
| 700 | 1 | |a Reiter, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Nickols, Nicholas G |e verfasserin |4 aut | |
| 700 | 1 | |a Valle, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a McGuire, Sean E |e verfasserin |4 aut | |
| 700 | 1 | |a Spratt, Daniel E |e verfasserin |4 aut | |
| 700 | 1 | |a Souhami, Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Roy, Soumyajit |e verfasserin |4 aut | |
| 700 | 1 | |a Martin, Jarad M |e verfasserin |4 aut | |
| 700 | 1 | |a Joseph, David |e verfasserin |4 aut | |
| 700 | 1 | |a Nabid, Abdenour |e verfasserin |4 aut | |
| 700 | 1 | |a Kishan, Amar U |e verfasserin |4 aut | |
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