Combination Radiotherapy Plus Androgen Deprivation Associated With Improved Outcome For Patients With A Rapid PSA Velocity Before Diagnosis

Previous studies have shown that a serum PSA velocity of 2 ng/ml or greater before diagnosis is associated with an increased incidence of prostate cancer recurrence, prostate cancer-specific mortality, and all-cause mortality.

In the September 1st issue of the JCO, D'Amico and colleagues from Brigham and Women's Hospital and Dana Farber present their data on 241 men with a PSA velocity before diagnosis of 2 ng/ml who were treated with either radiation therapy alone or radiation therapy in combination with 6 months of androgen deprivation therapy. The RT-only group consisted of 150 men with a median PSA of 11.9 ng/ml, median age of 72.7 years, 44% clinical stage T1c, and 45% with Gleason 6 disease or lower. The group of 91 men treated with RT plus ADT had a median PSA of 13.9 ng/ml, median age of 70.9 years, 38% clinical stage T1c, and only 25% with Gleason score 6 or less.

Interestingly, despite a longer follow-up (5.8 vs. 3.3 years), higher PSAs, and a higher proportion of Gleason score 7 (48% vs. 40%) and Gleason score 8-10 disease (26% vs. 15%), patients in the RT plus ADT exhibited a decreased risk of PSA recurrence after adjusting for confounding variables (adjusted hazard ratio 0.22, 95% CI 0.14 to 0.35). Furthermore, despite their more aggressive cancers patients treated with ADT demonstrated a reduced risk of prostate cancer-specific survival (hazard ratio = 0.23, 95% CI 0.14 to 0.35) and all-cause mortality (adjusted HR = 0.30, 95% CI 0.16 to 0.58).

Despite the fact that this non-randomized study contained an uneven distribution of tumor stages and grades between groups, it is dramatic that patients in the higher risk group exhibited improved survival with the addition of 6 months of androgen deprivation. Additional studies are needed to evaluate preoperative variables such as PSA velocity to improve risk stratification in patients with "intermediate risk" prostate cancer.

By Ricardo F. Sбnchez-Ortiz, MD

Journal of Clinical Oncology, Vol 24, No 25 (September 1), 2006: pp. 4190-4195
© 2006 American Society of Clinical Oncology
DOI: 10.1200/JCO.2006.06.8239
Anthony V. D'Amico, Marian Loffredo, Andrew A. Renshaw, Brittany Loffredo, Ming-Hui Chen
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