Metastasis-Free Survival Versus Treatment-Free Survival in Biochemically Recurrent Prostate Cancer: The EMBARK Trial.

Serum tumor markers can be a blessing and a curse. After definitive local therapy for prostate cancer, prostate-specific antigen (PSA) is quite sensitive and specific, and can detect micrometastatic disease well before any radiographic or symptomatic evidence of disease. When biochemical recurrence (BCR) occurs, early detection can guide curative-intent salvage therapies such as salvage radiation.

But once curative-intent options have been exhausted, patients and physicians face a more difficult question of whether and when to act on a rising PSA with palliative therapies. Should we treat a number? Does treating early matter? Is spending more time on treatment now worth the potential for treatment-related toxicity or for long-term benefits? What would happen if we simply watch carefully? The concept of treatment-free survival (TFS) offers a novel end point for capturing these difficult questions, one that must be weighed against end points such as metastasis-free survival (MFS) in clinical research and practice.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology.
2024 May 16 [Epub ahead of print]

David J Einstein, Meredith M Regan, Julia S Stevens, David F McDermott, Ravi A Madan

Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA., Harvard Medical School, Boston, MA., Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA., Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.