Journal article
Ten-year disease progression and mortality rates in men who experience biochemical recurrence versus persistence after radical prostatectomy and undergo salvage radiation therapy: A post-hoc analysis of RTOG 9601 trial data
Urologic oncology, Vol.38(6), pp.599.e1-599.e8
06/2020
DOI: 10.1016/j.urolonc.2020.02.024
PMID: 32229186
Abstract
•Patients with postoperative biochemical failure are frequently sorted into 1 of 2 groups: prostate-specific antigen recurrence or persistence.•Surprisingly, comparative data on disease progression and survival among these 2 groups are scarce.•We show that patients with biochemical persistence after radical prostatectomy (RP) are approximately 2.5 times more likely to experience local/metastatic failure and death, compared to patients with biochemical recurrence after RP.•These data may facilitate patient counseling and shared treatment selection, especially use of concomitant salvage anti-androgen therapy in addition to radiation therapy.
To compare local/metastatic disease progression and overall mortality rates in men with node-negative prostate cancer at radical prostatectomy (RP) that experience biochemical recurrence vs. persistence postoperatively and undergo salvage radiation therapy (sRT).
Data on 760 men who participated in the RTOG 9601 trial were extracted using the NCTN data archive platform. Patients were stratified into biochemical recurrence (nadir-PSA ≤0.4 ng/ml) or persistence (nadir-PSA >0.4 ng/ml) groups, based on the cut-off reported in the original trial. Inverse probability of treatment weighting (IPTW) methodology was utilized to minimize the baseline differences among groups. Competing-risk and Kaplan-Meier analyses estimated the impact of prostate-specific antigen (PSA) persistence vs. recurrence on local and metastatic disease progression and overall-mortality in the IPTW-adjusted model; a 2-sided P < 0.05 was considered significant.
All patients received sRT, and about 50% of the patients in either group received concomitant antiandrogen therapy (P = 0.951). The median follow-up was 12 years. After IPTW, the 2 groups were well-matched with standardized mean differences ∼10%. In the IPTW-adjusted cohort, the 10-year local and metastatic disease occurrence rates were 3.2% vs. 1.4% (Gray's P = 0.0001) and 28.6% vs. 10.1% (Gray's P < 0.0001) in patients with persistent vs. recurrent PSA, respectively. Similarly, the 10-year overall-mortality rates were 24.9% vs. 11.9% (Log-rank P = 0.029), respectively.
Patients with biochemical persistence after RP are approximately 2.5 times more likely to experience local/metastatic failure and death, compared to patients with biochemical recurrence after RP, despite equivalent sRT with/without antiandrogen therapy use. These data may facilitate patient counseling and shared treatment selection.
Details
- Title: Subtitle
- Ten-year disease progression and mortality rates in men who experience biochemical recurrence versus persistence after radical prostatectomy and undergo salvage radiation therapy: A post-hoc analysis of RTOG 9601 trial data
- Creators
- Akshay Sood - Henry Ford HospitalJacob Keeley - Henry Ford HospitalIsaac Palma-Zamora - Henry Ford HospitalSohrab Arora - Henry Ford HospitalDeepansh Dalela - Henry Ford HospitalPhil Olson - Henry Ford HospitalRenee Hanna - Henry Ford HospitalDaniel Cotter - Henry Ford HospitalWooju Jeong - Henry Ford HospitalMohamed Elshaikh - Henry Ford HospitalCraig G. Rogers - Henry Ford HospitalJames O. Peabody - Henry Ford HospitalMani Menon - Henry Ford HospitalFiras Abdollah - Henry Ford Hospital
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.38(6), pp.599.e1-599.e8
- DOI
- 10.1016/j.urolonc.2020.02.024
- PMID
- 32229186
- NLM abbreviation
- Urol Oncol
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 06/2020
- Academic Unit
- Urology
- Record Identifier
- 9984949471102771
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