Journal of Contemporary Brachytherapy

Abstract

1/2022 vol. 14
Original paper

Prostate-specific antigen kinetics and metastasis-free survival in patients treated with external beam radiotherapy combined with high-dose-rate brachytherapy boost and androgen deprivation therapy for localized prostate cancer

Marcin Miszczyk 1
,
Łukasz Magrowski 1
,
Oliwia Masri 1
,
Iwona Jabłońska 1
,
Zuzanna Nowicka 2
,
Tomasz Krzysztofiak 3
,
Piotr Wojcieszek 3
,
Aleksandra Lipka-Rajwa 1
,
Jakub Ciepał 1
,
Gabriela Depowska 1
,
Krystyna Chimiak 1
,
Gabriela Bylica 1
,
Katarzyna Płoszka 2
,
Mateusz Łaszczych 2
,
Wojciech Majewski 4
  1. 3rd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  2. Department of Biostatistics and Translational Medicine, Medical University of Lodz
  3. Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Poland
  4. Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
J Contemp Brachytherapy 2022; 14, 1: 15–22
DOI: https://doi.org/10.5114/jcb.2022.113546
Online publish date: 2022/02/18
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Introduction

Serum prostate-specific antigen (PSA) kinetics has been linked to prognosis in prostate cancer (PCa) patients. Our goal was to analyze the association between PSA kinetics and metastasis-free survival (MFS) in patients with localized PCa treated with high-dose-rate (HDR) brachytherapy (BT) boost combined with external beam radiotherapy (EBRT).

Material and methods

We retrospectively analyzed multiple PSA kinetics related to PSA nadir (nPSA), PSA bouncing, and biochemical recurrence (BCR) in 186 PCa patients treated with neoadjuvant androgen deprivation therapy (ADT), followed by EBRT combined with HDR-BT boost. Uni- and multivariate Cox regression models were calculated to assess the value of PSA-related parameters for the prediction of MFS.

Results

5- and 10-year MFS were 95% and 84%, respectively. Median nPSA was 0.011 (IQR, 0.007-0.057) ng/ml and predicted MFS in multivariable analysis. Implementation of nPSA improved c-index of baseline model from 0.8 to 0.68. nPSA of 0.2 ng/ml offered the most optimal discriminatory ability for identifying patients with better prognoses. Time to nPSA (median, 11 months; IQR, 8-18 months) and PSA bounce, which occurred in 12.4% of patients, were not significantly associated with MFS.

Conclusions

Lower values of nPSA are significantly associated with decreased risk of developing metastases in patients treated with EBRT combined with HDR-BT boost and ADT, and improve the accuracy of a clinical model for MFS.

Keywords

prostate cancer, radiotherapy, brachytherapy, PSA bounce, PSA nadir

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