Time between treatment and relapse PSA predicts death from cancer of the prostate

Men whose prostate-specific antigen (PSA) increase in 18 months after radiotherapy are likely to spread and led by their disease, according to an international survey of radiation oncologists Fox Chase Cancer Center Buyyounouski Mark K., MD, MS, and today at the annual meeting of the American Society for Radiation Oncology (ASTRO).

"SAP is the gold standard for patients after prostate cancer after receiving radiotherapy or surgery. But we do not know if PSA rises only once a patient has a greater risk of dying of cancer of the prostate, but in May it would seem logical, "says Buyyounouski.

With a single institution database Buyyounouski and his colleagues have shown that men who have suffered early biochemical failure, defined as the lowest PSA plus 2 ng / ml, a higher risk of dying of cancer prostate. The new study confirms these results with a multi-national database and shows that the measure is ready to be used in the clinic.

"We can now use the simple criteria of the study, which is widely available to all, the PSA test, people who recognize the chance of over 25% of dying from prostate cancer during the five years. It's huge. There is nothing else to do, "said Buyyounouski.

A total of 2132 men were examined with clinically localized cancer of the prostate, which supported biochemical failure after treatment. The median time between treatment and biochemical failure was 35.2 months for group study. However, 19% of patients developed biochemical failure at 18 months or less. The five-year cancer-specific survival of these men was 69.5% compared to 89.8% for men who developed biochemical failure after 18 months.

Multivariate analysis showed that the interval to biochemical failure is correlated with survival rates from cancer, did as the Gleason score, tumor stage, age and the doubling time of PSA. However, the interval to biochemical failure had the best predictive value for cancer mortality compared with other variables.

Currently, most doctors do not start treatment with biochemical failure only expected, but until the PSA reached a high level or is there other evidence of tumor. "The potential impact of this finding is that patients can start treatment sooner, without waiting for other signs or symptoms of prostate cancer," said Buyyounouski. "If a biochemical failure patients at 16 months rather than wait and find out later that the PSA increases sharply and the risk of developing distant metastases can be started more based on the increased risk of death."