Prostate-specific antigen persistence after radical prostatectomy as a predictive factor of clinical relapse-free survival and overall survival: 10-Year data of the ARO 96-02 trial - Abstract

OBJECTIVE: The ARO 96-02 trial primarily compared wait-and-see (WS, arm A) with adjuvant radiation therapy (ART, arm B) in prostate cancer patients who achieved an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP).

Here, we report the outcome with up to 12 years of follow-up of patients who retained a post-RP detectable PSA and received salvage radiation therapy (SRT, arm C).

METHODS AND MATERIALS: For the study, 388 patients with pT3-4pN0 prostate cancer with positive or negative surgical margins were recruited. After RP, 307 men achieved an undetectable PSA (arms A + B). In 78 patients the PSA remained above thresholds (median 0.6, range 0.05-5.6 ng/mL). Of the latter, 74 consented to receive 66 Gy to the prostate bed, and SRT was applied at a median of 86 days after RP. Clinical relapse-free survival, metastasis-free survival, and overall survival were determined by the Kaplan-Meier method.

RESULTS: Patients with persisting PSA after RP had higher preoperative PSA values, higher tumor stages, higher Gleason scores, and more positive surgical margins than did patients in arms A + B. For the 74 patients, the 10-year clinical relapse-free survival rate was 63%. Forty-three men had hormone therapy; 12 experienced distant metastases; 23 patients died. Compared with men who did achieve an undetectable PSA, the arm-C patients fared significantly worse, with a 10-year metastasis-free survival of 67% versus 83% and overall survival of 68% versus 84%, respectively. In Cox regression analysis, Gleason score ≥8 (hazard ratio [HR] 2.8), pT ≥ 3c (HR 2.4), and extraprostatic extension ≥2 mm (HR 3.6) were unfavorable risk factors of progression.

CONCLUSIONS: A persisting PSA after prostatectomy seems to be an important prognosticator of clinical progression for pT3 tumors. It correlates with a higher rate of distant metastases and with worse overall survival. A larger prospective study is required to determine which patient subgroups will benefit most from which treatment option.

Written by:
Wiegel T, Bartkowiak D, Bottke D, Thamm R, Hinke A, Stöckle M, Rübe C, Semjonow A, Wirth M, Störkel S, Golz R, Engenhart-Cabillic R, Hofmann R, Feldmann HJ, Kälble T, Siegmann A, Hinkelbein W, Steiner U, Miller K.   Are you the author?
Department of Radiation Oncology, University Hospital Ulm, Germany; WiSP, Research Institute Pharma GmbH, Langenfeld, Germany; Department of Urology, University Hospital Homburg/Saar, Germany; Department of Radiation Oncology, University Hospital Homburg/Saar, Germany; Department of Urology, University Hospital Münster, Germany; Department of Urology, University Hospital Dresden, Germany; Department of Pathology, HELIOS Hospital Wuppertal, Germany; Department of Radiation Oncology, University Hospital Giessen-Marburg, Germany; Department of Urology, University Hospital Giessen-Marburg, Germany; Department of Radiation Oncology, General Hospital Fulda, Germany; Department of Urology, General Hospital Fulda, Germany; Department of Radiation Oncology, University Hospital Berlin, Germany; Department of Urology, University Hospital Berlin, Germany.  

Reference: Int J Radiat Oncol Biol Phys. 2014 Nov 20. pii: S0360-3016(14)04192-3.
doi: 10.1016/j.ijrobp.2014.09.039


PubMed Abstract
PMID: 25445556

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