Cancer · 2025
Detectable prostate-specific antigen after radiotherapy for clinically localized prostate cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Falagario Ugo Giovanni, Pellegrino Francesco, Abbadi Ahmad, Björnebo Lars, Valdman Alexander, Eriksson Marie Hjelm, Zelic Renata, Carrieri Giuseppe, Gandaglia Giorgio, Briganti Alberto, Montorsi Francesco, Aly Markus, Palsdottir Thorgerdur, Eklund Martin, Nordström Tobias, Grönberg Henrik, Akre Olof, Wiklund Peter, Lantz Anna
Аннотация
BACKGROUND: This study assesses the incidence and timing of undetectable prostate-specific antigen (PSA) after radiotherapy (RT) ± androgen deprivation therapy (ADT) and its association with prostate cancer mortality.
METHODS: This is a population-based study including 5299 men undergoing RT (2006-2020) in the Stockholm County, Sweden with all their PSA tests until death or emigration. The authors calculated incidence and timing of undetectable PSA (PSA ≤0.1 ng/mL) and used competing risk regression to evaluate the association of detectable PSA at 6 and 12 months with prostate cancer mortality (PCSM).
RESULTS: Median follow-up for survivors was 81 (32, 130) months. PSA nadir values were reached before 6 and 12 months in 233 (23%) and 470 (36%) patients undergoing RT and 2871 (85%) and 3612 (90%) patients undergoing RT+ADT. No significant association was found between PSA at nadir, 6 and 12 months and PCSM in the radiotherapy group and evidence of association with higher PCSM in RT+ADT group (PSA at nadir: subdistribution hazard ratio [sHR], 2.23 [2.01-2.49]; PSA at 6 months: sHR, 6.91 [5.17-9.23]; and PSA at 12 months: sHR, 37.9 [23.0-62.5]). At 12 years after RT + ADT, PCSM rates were 27%, 15%, 13%, and 5% for patients with PSA at 6 months of ≥0.5, 0.2-0.5, 0.1-0.2, and ≤0.1 ng/mL, respectively; corresponding rates by PSA at 12 months were 34%, 18%, 12%, and 5%.
CONCLUSIONS: Most patients undergoing RT+ADT reached a PSA ≤0.1 ng/mL within 6 and 12 months. PSA>0.1 ng/mL at these time points indicated a higher risk of PCSM, emphasizing the need for timely restaging and intensified salvage treatments.
METHODS: This is a population-based study including 5299 men undergoing RT (2006-2020) in the Stockholm County, Sweden with all their PSA tests until death or emigration. The authors calculated incidence and timing of undetectable PSA (PSA ≤0.1 ng/mL) and used competing risk regression to evaluate the association of detectable PSA at 6 and 12 months with prostate cancer mortality (PCSM).
RESULTS: Median follow-up for survivors was 81 (32, 130) months. PSA nadir values were reached before 6 and 12 months in 233 (23%) and 470 (36%) patients undergoing RT and 2871 (85%) and 3612 (90%) patients undergoing RT+ADT. No significant association was found between PSA at nadir, 6 and 12 months and PCSM in the radiotherapy group and evidence of association with higher PCSM in RT+ADT group (PSA at nadir: subdistribution hazard ratio [sHR], 2.23 [2.01-2.49]; PSA at 6 months: sHR, 6.91 [5.17-9.23]; and PSA at 12 months: sHR, 37.9 [23.0-62.5]). At 12 years after RT + ADT, PCSM rates were 27%, 15%, 13%, and 5% for patients with PSA at 6 months of ≥0.5, 0.2-0.5, 0.1-0.2, and ≤0.1 ng/mL, respectively; corresponding rates by PSA at 12 months were 34%, 18%, 12%, and 5%.
CONCLUSIONS: Most patients undergoing RT+ADT reached a PSA ≤0.1 ng/mL within 6 and 12 months. PSA>0.1 ng/mL at these time points indicated a higher risk of PCSM, emphasizing the need for timely restaging and intensified salvage treatments.