- Title
- Prostate-specific antigen response to androgen deprivation therapy in the neoadjuvant setting for high-risk prostate adenocarcinoma (PIRANHA): Pooled analysis of two randomized clinical trials
- Creator
- Nikitas, John; Ong, Wee Loon; Valle, Luca; McGuire, Sean E.; Spratt, Daniel E.; Souhami, Luis; Roy, Soumyajit; Martin, Jarad M.; Joseph, David; Nabid, Abdenour; Kishan, Amar U.; Carrier, Nathalie; Romero, Tahmineh; Millar, Jeremy; Steinberg, Michael L.; Rettig, Matthew B.; Boutros, Paul C.; Reiter, Robert; Nickols, Nicholas G.
- Relation
- International Journal of Radiation: Oncology - Biology - Physics Vol. 119, Issue 3, p. 826-831
- Publisher Link
- http://dx.doi.org/10.1016/j.ijrobp.2023.12.022
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2024
- Description
- Purpose: A suboptimal prostate-specific antigen (PSA) response to neoadjuvant androgen deprivation therapy (ADT) among men who go on to receive definitive radiation therapy for prostate cancer might suggest the existence of castration-resistant disease or altered androgen receptor signaling. This in turn may portend worse long-term clinical outcomes, especially in men with high-risk disease. We set out to evaluate the prognostic impact of poor PSA response to neoadjuvant ADT in men with high-risk prostate cancer. Methods and Materials: This was a post hoc analysis of the multicenter TROG 03.04 RADAR and PCS IV randomized clinical trials. Inclusion criteria for this analysis were patients with high-risk prostate cancer (defined as Gleason score ≥8, initial PSA ≥20 ng/mL, or cT3a disease or higher) who received definitive radiation therapy, at least 18 months of ADT, and had a preradiation therapy PSA level drawn after at least 3 months of neoadjuvant ADT. Poor PSA response was defined as PSA >0.5 ng/mL. Cox regression and Fine-Gray models were used to test whether poor PSA response was associated with metastasis-free survival, biochemical recurrence, prostate-cancer specific mortality, and overall survival. Results: Nine hundred thirty men met inclusion criteria for this analysis. Median follow-up was 130 months (interquartile range [IQR], 89-154 months). After a median of 3 months (IQR, 3-4.2 months) of neoadjuvant ADT, the median PSA was 0.60 ng/mL (IQR, 0.29-1.59). Overall, 535 men (57%) had a PSA >0.5 ng/mL. Poor PSA response was associated with significantly worse metastasis-free survival (hazard ratio [HR], 3.93; P =.02), worse biochemical recurrence (subdistribution HR, 2.39; P =.003), worse prostate-cancer specific mortality (subdistribution HR, 1.50; P =.005), and worse overall survival (HR, 4.51; P =.05). Conclusions: Patients with PSA >0.5 mg/mL after at least 3 months of neoadjuvant ADT had worse long-term clinical outcomes and should be considered for treatment intensification.
- Subject
- prostate-specific antigen; androgen deprivation therapy; definitive radiation therapy; prostate cancer; randomized clinical trials; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1507080
- Identifier
- uon:55957
- Identifier
- ISSN:0360-3016
- Language
- eng
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