Salvage Radiotherapy for Recurrent Prostate Cancer: Can the Prognostic Grade Group System Inform Treatment Timing?

Kae Jack Tay, Thomas J. Polascik, Lauren E. Howard, Joseph K. Salama, Ariel A. Schulman, Zinan Chen, Christopher L. Amling, William J. Aronson, Matthew R. Cooperberg, Christopher J. Kane, Martha Kennedy Terris, Stephen J. Freedland

Research output: Contribution to journalArticle

Abstract

Purpose: In order to better time salvage radiotherapy (SRT) for post–radical prostatectomy biochemical failure, we examined the association between pre-SRT prostate-specific antigen (PSA) and PSA control as a function of the new prognostic grade group (PGG) system. Patients and Methods: Using the Shared Equal Access Regional Cancer Hospital database, we identified men after radical prostatectomy with PSA > 0.2 ng/mL and without cancer involvement of lymph nodes who underwent SRT alone. SRT failure was defined as post-SRT PSA nadir + 0.2 ng/mL or receipt of post-SRT hormone therapy. Men were stratified by pre-SRT PSA (0.2-0.49, 0.5-0.99, and ≥ 1.0 ng/mL). Multivariable Cox models were used to test the association between pre-SRT PSA and SRT failure, stratified by PGG. Results: A total of 358 men met the inclusion criteria and comprised our study cohort. Median post-SRT follow-up was 78 months. A total of 174 men (49%) had pre-SRT PSA 0.2-0.49 ng/mL, 97 (27%) PSA 0.5-0.99 ng/mL, and 87 (24%) PSA ≥ 1.0 ng/mL. On multivariable analysis among men with PGG 1-2, pre-SRT PSA 0.2-0.49 ng/mL had similar outcomes as PSA 0.5-0.99 ng/mL; those with PSA ≥ 1.0 ng/mL had higher recurrence risks (hazard ratio = 2.78, P <. 001). Among PGG 3-5, PSA 0.5-0.99 ng/mL or ≥ 1.0 ng/mL had a higher recurrence risk (hazard ratio = 2.15, P =. 021; and hazard ratio = 2.49, P =. 010, respectively) versus PSA 0.2-0.49 ng/mL. Conclusion: In men with higher-grade prostate cancer (PGG 3-5), SRT should be provided earlier (PSA < 0.5 ng/mL), while among men with lower-grade disease (PGG 1-2), SRT results in equal PSA control up to PSA 1.0 ng/mL.

Original languageEnglish (US)
Pages (from-to)e930-e938
JournalClinical Genitourinary Cancer
Volume17
Issue number5
DOIs
StatePublished - Oct 2019

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Prostate-Specific Antigen
Prostatic Neoplasms
Radiotherapy
Therapeutics
Prostatectomy
Odds Ratio
Cancer Care Facilities
Recurrence
Proportional Hazards Models

Keywords

  • Biochemical recurrence
  • Gleason
  • Radical prostatectomy
  • Sequence
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Tay, K. J., Polascik, T. J., Howard, L. E., Salama, J. K., Schulman, A. A., Chen, Z., ... Freedland, S. J. (2019). Salvage Radiotherapy for Recurrent Prostate Cancer: Can the Prognostic Grade Group System Inform Treatment Timing? Clinical Genitourinary Cancer, 17(5), e930-e938. https://doi.org/10.1016/j.clgc.2019.05.007

Salvage Radiotherapy for Recurrent Prostate Cancer : Can the Prognostic Grade Group System Inform Treatment Timing? / Tay, Kae Jack; Polascik, Thomas J.; Howard, Lauren E.; Salama, Joseph K.; Schulman, Ariel A.; Chen, Zinan; Amling, Christopher L.; Aronson, William J.; Cooperberg, Matthew R.; Kane, Christopher J.; Terris, Martha Kennedy; Freedland, Stephen J.

In: Clinical Genitourinary Cancer, Vol. 17, No. 5, 10.2019, p. e930-e938.

Research output: Contribution to journalArticle

Tay, KJ, Polascik, TJ, Howard, LE, Salama, JK, Schulman, AA, Chen, Z, Amling, CL, Aronson, WJ, Cooperberg, MR, Kane, CJ, Terris, MK & Freedland, SJ 2019, 'Salvage Radiotherapy for Recurrent Prostate Cancer: Can the Prognostic Grade Group System Inform Treatment Timing?', Clinical Genitourinary Cancer, vol. 17, no. 5, pp. e930-e938. https://doi.org/10.1016/j.clgc.2019.05.007
Tay, Kae Jack ; Polascik, Thomas J. ; Howard, Lauren E. ; Salama, Joseph K. ; Schulman, Ariel A. ; Chen, Zinan ; Amling, Christopher L. ; Aronson, William J. ; Cooperberg, Matthew R. ; Kane, Christopher J. ; Terris, Martha Kennedy ; Freedland, Stephen J. / Salvage Radiotherapy for Recurrent Prostate Cancer : Can the Prognostic Grade Group System Inform Treatment Timing?. In: Clinical Genitourinary Cancer. 2019 ; Vol. 17, No. 5. pp. e930-e938.
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abstract = "Purpose: In order to better time salvage radiotherapy (SRT) for post–radical prostatectomy biochemical failure, we examined the association between pre-SRT prostate-specific antigen (PSA) and PSA control as a function of the new prognostic grade group (PGG) system. Patients and Methods: Using the Shared Equal Access Regional Cancer Hospital database, we identified men after radical prostatectomy with PSA > 0.2 ng/mL and without cancer involvement of lymph nodes who underwent SRT alone. SRT failure was defined as post-SRT PSA nadir + 0.2 ng/mL or receipt of post-SRT hormone therapy. Men were stratified by pre-SRT PSA (0.2-0.49, 0.5-0.99, and ≥ 1.0 ng/mL). Multivariable Cox models were used to test the association between pre-SRT PSA and SRT failure, stratified by PGG. Results: A total of 358 men met the inclusion criteria and comprised our study cohort. Median post-SRT follow-up was 78 months. A total of 174 men (49{\%}) had pre-SRT PSA 0.2-0.49 ng/mL, 97 (27{\%}) PSA 0.5-0.99 ng/mL, and 87 (24{\%}) PSA ≥ 1.0 ng/mL. On multivariable analysis among men with PGG 1-2, pre-SRT PSA 0.2-0.49 ng/mL had similar outcomes as PSA 0.5-0.99 ng/mL; those with PSA ≥ 1.0 ng/mL had higher recurrence risks (hazard ratio = 2.78, P <. 001). Among PGG 3-5, PSA 0.5-0.99 ng/mL or ≥ 1.0 ng/mL had a higher recurrence risk (hazard ratio = 2.15, P =. 021; and hazard ratio = 2.49, P =. 010, respectively) versus PSA 0.2-0.49 ng/mL. Conclusion: In men with higher-grade prostate cancer (PGG 3-5), SRT should be provided earlier (PSA < 0.5 ng/mL), while among men with lower-grade disease (PGG 1-2), SRT results in equal PSA control up to PSA 1.0 ng/mL.",
keywords = "Biochemical recurrence, Gleason, Radical prostatectomy, Sequence, Survival",
author = "Tay, {Kae Jack} and Polascik, {Thomas J.} and Howard, {Lauren E.} and Salama, {Joseph K.} and Schulman, {Ariel A.} and Zinan Chen and Amling, {Christopher L.} and Aronson, {William J.} and Cooperberg, {Matthew R.} and Kane, {Christopher J.} and Terris, {Martha Kennedy} and Freedland, {Stephen J.}",
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T1 - Salvage Radiotherapy for Recurrent Prostate Cancer

T2 - Can the Prognostic Grade Group System Inform Treatment Timing?

AU - Tay, Kae Jack

AU - Polascik, Thomas J.

AU - Howard, Lauren E.

AU - Salama, Joseph K.

AU - Schulman, Ariel A.

AU - Chen, Zinan

AU - Amling, Christopher L.

AU - Aronson, William J.

AU - Cooperberg, Matthew R.

AU - Kane, Christopher J.

AU - Terris, Martha Kennedy

AU - Freedland, Stephen J.

PY - 2019/10

Y1 - 2019/10

N2 - Purpose: In order to better time salvage radiotherapy (SRT) for post–radical prostatectomy biochemical failure, we examined the association between pre-SRT prostate-specific antigen (PSA) and PSA control as a function of the new prognostic grade group (PGG) system. Patients and Methods: Using the Shared Equal Access Regional Cancer Hospital database, we identified men after radical prostatectomy with PSA > 0.2 ng/mL and without cancer involvement of lymph nodes who underwent SRT alone. SRT failure was defined as post-SRT PSA nadir + 0.2 ng/mL or receipt of post-SRT hormone therapy. Men were stratified by pre-SRT PSA (0.2-0.49, 0.5-0.99, and ≥ 1.0 ng/mL). Multivariable Cox models were used to test the association between pre-SRT PSA and SRT failure, stratified by PGG. Results: A total of 358 men met the inclusion criteria and comprised our study cohort. Median post-SRT follow-up was 78 months. A total of 174 men (49%) had pre-SRT PSA 0.2-0.49 ng/mL, 97 (27%) PSA 0.5-0.99 ng/mL, and 87 (24%) PSA ≥ 1.0 ng/mL. On multivariable analysis among men with PGG 1-2, pre-SRT PSA 0.2-0.49 ng/mL had similar outcomes as PSA 0.5-0.99 ng/mL; those with PSA ≥ 1.0 ng/mL had higher recurrence risks (hazard ratio = 2.78, P <. 001). Among PGG 3-5, PSA 0.5-0.99 ng/mL or ≥ 1.0 ng/mL had a higher recurrence risk (hazard ratio = 2.15, P =. 021; and hazard ratio = 2.49, P =. 010, respectively) versus PSA 0.2-0.49 ng/mL. Conclusion: In men with higher-grade prostate cancer (PGG 3-5), SRT should be provided earlier (PSA < 0.5 ng/mL), while among men with lower-grade disease (PGG 1-2), SRT results in equal PSA control up to PSA 1.0 ng/mL.

AB - Purpose: In order to better time salvage radiotherapy (SRT) for post–radical prostatectomy biochemical failure, we examined the association between pre-SRT prostate-specific antigen (PSA) and PSA control as a function of the new prognostic grade group (PGG) system. Patients and Methods: Using the Shared Equal Access Regional Cancer Hospital database, we identified men after radical prostatectomy with PSA > 0.2 ng/mL and without cancer involvement of lymph nodes who underwent SRT alone. SRT failure was defined as post-SRT PSA nadir + 0.2 ng/mL or receipt of post-SRT hormone therapy. Men were stratified by pre-SRT PSA (0.2-0.49, 0.5-0.99, and ≥ 1.0 ng/mL). Multivariable Cox models were used to test the association between pre-SRT PSA and SRT failure, stratified by PGG. Results: A total of 358 men met the inclusion criteria and comprised our study cohort. Median post-SRT follow-up was 78 months. A total of 174 men (49%) had pre-SRT PSA 0.2-0.49 ng/mL, 97 (27%) PSA 0.5-0.99 ng/mL, and 87 (24%) PSA ≥ 1.0 ng/mL. On multivariable analysis among men with PGG 1-2, pre-SRT PSA 0.2-0.49 ng/mL had similar outcomes as PSA 0.5-0.99 ng/mL; those with PSA ≥ 1.0 ng/mL had higher recurrence risks (hazard ratio = 2.78, P <. 001). Among PGG 3-5, PSA 0.5-0.99 ng/mL or ≥ 1.0 ng/mL had a higher recurrence risk (hazard ratio = 2.15, P =. 021; and hazard ratio = 2.49, P =. 010, respectively) versus PSA 0.2-0.49 ng/mL. Conclusion: In men with higher-grade prostate cancer (PGG 3-5), SRT should be provided earlier (PSA < 0.5 ng/mL), while among men with lower-grade disease (PGG 1-2), SRT results in equal PSA control up to PSA 1.0 ng/mL.

KW - Biochemical recurrence

KW - Gleason

KW - Radical prostatectomy

KW - Sequence

KW - Survival

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