Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer

Mark K. Buyyounouski, Alexandra L. Hanlon, Debra F. Eisenberg, Eric M. Horwitz, Steven J. Feigenberg, Robert G. Uzzo, Alan Pollack

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Purpose: To compare several characteristics of alternative definitions of biochemical failure (BF) in men with extended follow-up after radiotherapy (RT) with or with androgen deprivation therapy (ADT) for prostate cancer. Methods and Materials: From December 1, 1991, to April 30, 1998, 688 men with Stage T1c-T3NX-N0M0 prostate cancer received RT alone (n = 586) or RT plus ADT (n = 102) with a minimal follow-up of 4 years and five or more "ADT-free" posttreatment prostate-specific antigen levels. BF was defined by three methods: (1) the ASTRO definition (three consecutive rises in prostate-specific antigen level); (2) a modified American Society for Therapeutic Radiology Oncology (ASTRO) definition requiring two additional consecutive rises when a decline immediately subsequent to three consecutive rises occurred; and (3) the "Houston" or nadir plus 2-ng/mL definition (a rise of at least 2 ng/mL greater than the nadir). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were determined for each using clinical progression as the endpoint. Furthermore, the misclassification rates for a steadily rising prostate-specific antigen level, ability to satisfy the proportional hazards (RT with or without ADT), effects of short follow-up, and intervals to the diagnosis of BF were compared. Results: The misclassification rate for BF using the nadir plus 2-ng/mL definition was 2% for RT alone and 0% for RT plus ADT compared with 0% and 0% for the modified ASTRO definition, and 5% and 23% for the ASTRO definition, respectively. The hazard rates for RT alone and RT plus ADT were proportional only for the nadir plus 2 ng/mL definition and seemingly unaffected by the length of follow-up. For RT with or without ADT, the nadir plus 2 ng/mL definition was the most specific (RT, 80% vs. RT plus ADT, 75%) with the greatest positive predictive value (RT, 36% vs. RT plus ADT, 25%) and overall accuracy (RT, 81% vs. RT plus ADT, 77%). A greater proportion of BF was diagnosed in the first 2 years of follow-up with the nadir plus 2 ng/mL definition compared with the ASTRO definition (13% vs. 5%, p = 0.0138, chi-square test). Conclusion: The nadir plus 2 ng/mL definition was the best predictor of sustained, true, biochemical, and clinical failure, and was not affected by the use of ADT or follow-up length.

Original languageEnglish
Pages (from-to)1455-1462
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume63
Issue number5
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

deprivation
Androgens
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
therapy
Radiation Oncology
radiology
antigens
Prostate-Specific Antigen
Therapeutics
hazards
Houston (TX)
Chi-Square Distribution

Keywords

  • Androgen deprivation therapy
  • Prostate cancer
  • Prostate-specific antigen
  • Radiotherapy
  • Treatment failure

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. / Buyyounouski, Mark K.; Hanlon, Alexandra L.; Eisenberg, Debra F.; Horwitz, Eric M.; Feigenberg, Steven J.; Uzzo, Robert G.; Pollack, Alan.

In: International Journal of Radiation Oncology Biology Physics, Vol. 63, No. 5, 01.12.2005, p. 1455-1462.

Research output: Contribution to journalArticle

Buyyounouski, Mark K. ; Hanlon, Alexandra L. ; Eisenberg, Debra F. ; Horwitz, Eric M. ; Feigenberg, Steven J. ; Uzzo, Robert G. ; Pollack, Alan. / Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. In: International Journal of Radiation Oncology Biology Physics. 2005 ; Vol. 63, No. 5. pp. 1455-1462.
@article{ea928519e45542e1815d60edb964f5e3,
title = "Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer",
abstract = "Purpose: To compare several characteristics of alternative definitions of biochemical failure (BF) in men with extended follow-up after radiotherapy (RT) with or with androgen deprivation therapy (ADT) for prostate cancer. Methods and Materials: From December 1, 1991, to April 30, 1998, 688 men with Stage T1c-T3NX-N0M0 prostate cancer received RT alone (n = 586) or RT plus ADT (n = 102) with a minimal follow-up of 4 years and five or more {"}ADT-free{"} posttreatment prostate-specific antigen levels. BF was defined by three methods: (1) the ASTRO definition (three consecutive rises in prostate-specific antigen level); (2) a modified American Society for Therapeutic Radiology Oncology (ASTRO) definition requiring two additional consecutive rises when a decline immediately subsequent to three consecutive rises occurred; and (3) the {"}Houston{"} or nadir plus 2-ng/mL definition (a rise of at least 2 ng/mL greater than the nadir). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were determined for each using clinical progression as the endpoint. Furthermore, the misclassification rates for a steadily rising prostate-specific antigen level, ability to satisfy the proportional hazards (RT with or without ADT), effects of short follow-up, and intervals to the diagnosis of BF were compared. Results: The misclassification rate for BF using the nadir plus 2-ng/mL definition was 2{\%} for RT alone and 0{\%} for RT plus ADT compared with 0{\%} and 0{\%} for the modified ASTRO definition, and 5{\%} and 23{\%} for the ASTRO definition, respectively. The hazard rates for RT alone and RT plus ADT were proportional only for the nadir plus 2 ng/mL definition and seemingly unaffected by the length of follow-up. For RT with or without ADT, the nadir plus 2 ng/mL definition was the most specific (RT, 80{\%} vs. RT plus ADT, 75{\%}) with the greatest positive predictive value (RT, 36{\%} vs. RT plus ADT, 25{\%}) and overall accuracy (RT, 81{\%} vs. RT plus ADT, 77{\%}). A greater proportion of BF was diagnosed in the first 2 years of follow-up with the nadir plus 2 ng/mL definition compared with the ASTRO definition (13{\%} vs. 5{\%}, p = 0.0138, chi-square test). Conclusion: The nadir plus 2 ng/mL definition was the best predictor of sustained, true, biochemical, and clinical failure, and was not affected by the use of ADT or follow-up length.",
keywords = "Androgen deprivation therapy, Prostate cancer, Prostate-specific antigen, Radiotherapy, Treatment failure",
author = "Buyyounouski, {Mark K.} and Hanlon, {Alexandra L.} and Eisenberg, {Debra F.} and Horwitz, {Eric M.} and Feigenberg, {Steven J.} and Uzzo, {Robert G.} and Alan Pollack",
year = "2005",
month = "12",
day = "1",
doi = "10.1016/j.ijrobp.2005.05.053",
language = "English",
volume = "63",
pages = "1455--1462",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer

AU - Buyyounouski, Mark K.

AU - Hanlon, Alexandra L.

AU - Eisenberg, Debra F.

AU - Horwitz, Eric M.

AU - Feigenberg, Steven J.

AU - Uzzo, Robert G.

AU - Pollack, Alan

PY - 2005/12/1

Y1 - 2005/12/1

N2 - Purpose: To compare several characteristics of alternative definitions of biochemical failure (BF) in men with extended follow-up after radiotherapy (RT) with or with androgen deprivation therapy (ADT) for prostate cancer. Methods and Materials: From December 1, 1991, to April 30, 1998, 688 men with Stage T1c-T3NX-N0M0 prostate cancer received RT alone (n = 586) or RT plus ADT (n = 102) with a minimal follow-up of 4 years and five or more "ADT-free" posttreatment prostate-specific antigen levels. BF was defined by three methods: (1) the ASTRO definition (three consecutive rises in prostate-specific antigen level); (2) a modified American Society for Therapeutic Radiology Oncology (ASTRO) definition requiring two additional consecutive rises when a decline immediately subsequent to three consecutive rises occurred; and (3) the "Houston" or nadir plus 2-ng/mL definition (a rise of at least 2 ng/mL greater than the nadir). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were determined for each using clinical progression as the endpoint. Furthermore, the misclassification rates for a steadily rising prostate-specific antigen level, ability to satisfy the proportional hazards (RT with or without ADT), effects of short follow-up, and intervals to the diagnosis of BF were compared. Results: The misclassification rate for BF using the nadir plus 2-ng/mL definition was 2% for RT alone and 0% for RT plus ADT compared with 0% and 0% for the modified ASTRO definition, and 5% and 23% for the ASTRO definition, respectively. The hazard rates for RT alone and RT plus ADT were proportional only for the nadir plus 2 ng/mL definition and seemingly unaffected by the length of follow-up. For RT with or without ADT, the nadir plus 2 ng/mL definition was the most specific (RT, 80% vs. RT plus ADT, 75%) with the greatest positive predictive value (RT, 36% vs. RT plus ADT, 25%) and overall accuracy (RT, 81% vs. RT plus ADT, 77%). A greater proportion of BF was diagnosed in the first 2 years of follow-up with the nadir plus 2 ng/mL definition compared with the ASTRO definition (13% vs. 5%, p = 0.0138, chi-square test). Conclusion: The nadir plus 2 ng/mL definition was the best predictor of sustained, true, biochemical, and clinical failure, and was not affected by the use of ADT or follow-up length.

AB - Purpose: To compare several characteristics of alternative definitions of biochemical failure (BF) in men with extended follow-up after radiotherapy (RT) with or with androgen deprivation therapy (ADT) for prostate cancer. Methods and Materials: From December 1, 1991, to April 30, 1998, 688 men with Stage T1c-T3NX-N0M0 prostate cancer received RT alone (n = 586) or RT plus ADT (n = 102) with a minimal follow-up of 4 years and five or more "ADT-free" posttreatment prostate-specific antigen levels. BF was defined by three methods: (1) the ASTRO definition (three consecutive rises in prostate-specific antigen level); (2) a modified American Society for Therapeutic Radiology Oncology (ASTRO) definition requiring two additional consecutive rises when a decline immediately subsequent to three consecutive rises occurred; and (3) the "Houston" or nadir plus 2-ng/mL definition (a rise of at least 2 ng/mL greater than the nadir). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were determined for each using clinical progression as the endpoint. Furthermore, the misclassification rates for a steadily rising prostate-specific antigen level, ability to satisfy the proportional hazards (RT with or without ADT), effects of short follow-up, and intervals to the diagnosis of BF were compared. Results: The misclassification rate for BF using the nadir plus 2-ng/mL definition was 2% for RT alone and 0% for RT plus ADT compared with 0% and 0% for the modified ASTRO definition, and 5% and 23% for the ASTRO definition, respectively. The hazard rates for RT alone and RT plus ADT were proportional only for the nadir plus 2 ng/mL definition and seemingly unaffected by the length of follow-up. For RT with or without ADT, the nadir plus 2 ng/mL definition was the most specific (RT, 80% vs. RT plus ADT, 75%) with the greatest positive predictive value (RT, 36% vs. RT plus ADT, 25%) and overall accuracy (RT, 81% vs. RT plus ADT, 77%). A greater proportion of BF was diagnosed in the first 2 years of follow-up with the nadir plus 2 ng/mL definition compared with the ASTRO definition (13% vs. 5%, p = 0.0138, chi-square test). Conclusion: The nadir plus 2 ng/mL definition was the best predictor of sustained, true, biochemical, and clinical failure, and was not affected by the use of ADT or follow-up length.

KW - Androgen deprivation therapy

KW - Prostate cancer

KW - Prostate-specific antigen

KW - Radiotherapy

KW - Treatment failure

UR - http://www.scopus.com/inward/record.url?scp=27744477094&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=27744477094&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2005.05.053

DO - 10.1016/j.ijrobp.2005.05.053

M3 - Article

VL - 63

SP - 1455

EP - 1462

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -