Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials

Christopher Hallemeier, Peixin Zhang, Thomas M. Pisansky, Gerald E. Hanks, David G. McGowan, Mack Roach, Kenneth L. Zeitzer, Selim Y. Firat, Siraj M. Husain, David P. D'Souza, Luis Souhami, Matthew B. Parliament, Seth A. Rosenthal, Himanshu R. Lukka, Marvin Rotman, Eric M. Horwitz, Edward F. Miles, Rebecca Paulus, Howard M. Sandler

Research output: Contribution to journalArticle

Abstract

Purpose: To validate whether prostate-specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external beam radiation therapy (RT) with concurrent short-term androgen suppression (AS) in patients with prostate cancer. Methods and Materials: This study included 2404 patients. The patients were treated with neoAS before RT and concurrent AS (without post-RT AS) and were pooled from NRG Oncology/RTOG trials 9202, 9408, 9413, and 9910. Multivariable models were used to test associations between the prespecified dichotomized post-neoAS, pre-RT PSA level (≤0.1 vs >0.1 ng/mL) groupings, and clinical outcomes. Results: The median follow-up for surviving patients was 9.4 years. The median post-neoAS, pre-RT PSA level was 0.3 ng/mL, with 32% of patients having levels ≤0.1 ng/mL. Race, Gleason score, tumor stage, node stage, pretreatment PSA level, and duration of neoAS were associated with the groups of patients with PSA levels ≤0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA level >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR], 2.04; P <.0001); local failure (HR, 2.51; P <.0001); distant metastases (HR, 1.73; P =.0006); cause-specific mortality (HR, 2.36; P <.0001); and all-cause mortality (HR, 1.24; P =.005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA level >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR, 2.00; P <.0001); local failure (HR, 2.33; P <.0001); and cause-specific mortality (HR, 1.75; P =.03). Conclusions: Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. The role of post-neoAS, pre-RT PSA level relative to PSA levels obtained along the continuum of medical care is not presently defined but could be tested in future clinical trials.

Original languageEnglish (US)
Pages (from-to)1057-1065
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume104
Issue number5
DOIs
StatePublished - Aug 1 2019

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ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Hallemeier, C., Zhang, P., Pisansky, T. M., Hanks, G. E., McGowan, D. G., Roach, M., Zeitzer, K. L., Firat, S. Y., Husain, S. M., D'Souza, D. P., Souhami, L., Parliament, M. B., Rosenthal, S. A., Lukka, H. R., Rotman, M., Horwitz, E. M., Miles, E. F., Paulus, R., & Sandler, H. M. (2019). Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials. International Journal of Radiation Oncology Biology Physics, 104(5), 1057-1065. https://doi.org/10.1016/j.ijrobp.2019.03.049