Mortality Risk and PSA Failure in Localized Versus Locally Advanced Prostate Cancer
Posted: Tuesday, July 13, 2021
According to research presented in JAMA Network Open, prostate-specific antigen (PSA) failure, or increased PSA levels following treatment, may be associated with increased mortality risk in patients with prostate cancer that is locally advanced versus localized. The secondary analysis included information from the Dana-Farber Cancer Institute (DFCI) 95-096 trial and the European Organisation for Research and Treatment of Cancer (EORTC) 22961 trial.
“This finding supports the study of treatment intensification with the use of novel antiandrogen agents in addition to androgen-deprivation therapy at the time of PSA failure after treatment for locally advanced disease,” concluded Anthony V. D’Amico, MD, PhD, of the Dana-Farber Cancer Institute, Boston, and colleagues.
The DFCI 95-096 trial included 206 men with localized prostate cancer who were randomly assigned to receive 0 versus 6 months of androgen-deprivation therapy with external-beam radiotherapy between December 1, 1995, and April 15, 2001. The EORTC 22961 trial included 970 men with locally advanced disease who were randomly assigned to receive 6 versus 36 months of androgen-deprivation therapy with external-beam radiotherapy between October 30, 1997, and May 1, 2002. Overall, 1,173 men (with a median age of 70) were evaluated.
At a median follow-up of 18.2 years, 161 deaths, 30 (18.6%) of which were disease-related, had occurred among patients with localized disease in the DFCI 95-096 trial. In that study, 108 men experienced PSA failure, with a median PSA doubling time of 13 months. Among patients with locally advanced disease in the EORTC 22961 trial, 75 disease-related deaths (32.6%) of an overall 230 deaths had occurred at a median follow-up of 6.4 years. The median PSA doubling time among the 290 men in that study who experienced PSA failure was 5 months. Overall, PSA failure was associated with an increased risk of all-cause mortality among patients with locally advanced disease versus those with localized disease (adjusted hazard ratios, 3.98; P < .001 vs 1.51; P = .04).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.