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Purpose <p>Radiation therapy (RT) is standard treatment for localized prostate cancer (PCa). Prostate-specific antigen (PSA) kinetics, particularly PSA reduction (PSAr) after RT, are emerging as significant prognostic indicators for biochemical control. This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS). This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS).</p> Methods <p>251 low-to-intermediate risk PCa patients treated with RT only were analyzed. Isoeffective RT schedules were: 39 fractions × 2&#xa0;Gy, 28 × 2.55&#xa0;Gy, 16 × 3.5&#xa0;Gy, 5 × 7&#xa0;Gy. Main objective was BRFS, defined as the time from PSA nadir (PSAn) to PSAn plus 2&#xa0;ng/ml. PSAr was defined as the percentage of total PSA reduction from baseline. The optimal PSAr cut-off value was defined as 90%. Patients were stratified by PSAr, baseline PSA, Gleason Score (GS), and RT schedules.</p> Results <p>GS was 3 + 3 in 120 (48%) patients and 3 + 4 in 131 (52%) patients. After a median follow-up of 36&#xa0;months (30–48), 2 and 5-year BRFS were 97.3% and 95.2%, respectively, in patients with PSAr ≥ 90% and 89.5%, 61.5% in patients with PSAr &lt; 90% (<i>p</i> = 0.00). In the responder population, median time to PSAr 90% was 24&#xa0;months and the median time to PSAn was 28.7&#xa0;months (20–38). At univariate and multivariate analyses, PSAr was the only significant predictor of BRFS [HR 6.519 (95% IC 1.9–22.2), <i>p</i> = 0.003].</p> Conclusions <p>PSAr could be a reliable prognostic factor for long-term biochemical control. This study underscores the potential of PSAr as a tool for risk stratification and personalized follow-up strategies in PCa management.</p>

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PSA reduction as predictor of biochemical relapse in low and favourable intermediate prostate cancer treated with radical radiotherapy

  • 期刊论文

  • 发表日期：

    2025年4月12日

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  • Andrea Gaetano Allegra,
  • Luca Nicosia,
  • Alessandro Molinari,
  • Chiara De-Colle,
  • Christian Fierro,
  • Niccolò Giaj-Levra,
  • Francesca Giannetti,
  • Claudia Menichelli,
  • Carolina Orsatti,
  • Gabriella Pastore,
  • Edoardo Pastorello,
  • Francesco Ricchetti,
  • Michele Rigo,
  • Andrea Romei,
  • Paola Zuccoli,
  • Alessandro Fanelli,
  • Filippo Alongi

摘要

Purpose

Radiation therapy (RT) is standard treatment for localized prostate cancer (PCa). Prostate-specific antigen (PSA) kinetics, particularly PSA reduction (PSAr) after RT, are emerging as significant prognostic indicators for biochemical control. This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS). This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS).

Methods

251 low-to-intermediate risk PCa patients treated with RT only were analyzed. Isoeffective RT schedules were: 39 fractions × 2 Gy, 28 × 2.55 Gy, 16 × 3.5 Gy, 5 × 7 Gy. Main objective was BRFS, defined as the time from PSA nadir (PSAn) to PSAn plus 2 ng/ml. PSAr was defined as the percentage of total PSA reduction from baseline. The optimal PSAr cut-off value was defined as 90%. Patients were stratified by PSAr, baseline PSA, Gleason Score (GS), and RT schedules.

Results

GS was 3 + 3 in 120 (48%) patients and 3 + 4 in 131 (52%) patients. After a median follow-up of 36 months (30–48), 2 and 5-year BRFS were 97.3% and 95.2%, respectively, in patients with PSAr ≥ 90% and 89.5%, 61.5% in patients with PSAr < 90% (p = 0.00). In the responder population, median time to PSAr 90% was 24 months and the median time to PSAn was 28.7 months (20–38). At univariate and multivariate analyses, PSAr was the only significant predictor of BRFS [HR 6.519 (95% IC 1.9–22.2), p = 0.003].

Conclusions

PSAr could be a reliable prognostic factor for long-term biochemical control. This study underscores the potential of PSAr as a tool for risk stratification and personalized follow-up strategies in PCa management.