Post-treatment PSA ≤0.2 ng/ml defines disease freedom after radiotherapy for prostate cancer using modern techniques

Critz, Frank A; Williams, W.Hamilton; Holladay, Clinton T; Levinson, A.Keith; Benton, James B; Holladay, David A; Schnell, Frederick J; Maxa, Leela S; Shrake, Philip D

« Previous Next »Urology
Volume 54, Issue 6 , Pages 968-971, December 1999

Post-treatment PSA ≤0.2 ng/ml defines disease freedom after radiotherapy for prostate cancer using modern techniques

Frank A Critz
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
- Reprint requests: Frank A. Critz, M.D., 2349 Lawrenceville Highway, Decatur, GA 30033
W.Hamilton Williams
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
Clinton T Holladay
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
A.Keith Levinson
- Georgia Urology, Decatur, Georgia, USA
James B Benton
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
David A Holladay
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
Frederick J Schnell Jr
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
Leela S Maxa
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA
Philip D Shrake
- Radiotherapy Clinics of Georgia, Decatur, Georgia, USA

Received 15 June 1999; received in revised form 20 July 1999; accepted 20 July 1999.

Abstract

Objectives. The prostate-specific antigen (PSA) definition of disease freedom after radiotherapy for prostate cancer is still in dispute. This report focuses on the PSA nadir achieved in men treated by modern radiotherapy techniques.

Methods. From 1984 to 1994, 489 consecutive men with clinical Stage T1-T2 prostate cancer were treated by simultaneous radiation: prostate iodine-125 implant followed by external beam radiation. A transperineal implant was performed on 143 men with Stage T1-T2NX, the focus of this study; 346 men with Stage T1-T2N0 had a retropubic implant. The median pretreatment PSA was 8.3 ng/mL (range 0.3 to 188). A rising PSA was defined as one that rose on three consecutive occasions above whatever nadir was achieved. A minimum 5-year follow-up (range 5 to 15) was reached by 453 men.

Results. After a minimum 5-year follow-up, 336 men had a nonrising PSA, and of this group, 107 had undergone simultaneous radiation by the transperineal implant technique. A PSA nadir of 0.2 ng/mL or less was achieved by 97% of the transperineally implanted men, and 3% had a nadir of 0.3 to 1.0 ng/mL. Of the 489 men, those who had a nadir of 0.2 ng/mL or less had a 92% nonrising PSA rate (P = 0.001) 10 years after treatment compared with a 41% rate for men who had a nadir of 0.3 to 1.0 ng/mL. All men whose nadir was greater than 1.0 ng/mL had recurrence. The median time to achieve the PSA nadir of 0.2 ng/mL was 27 months (range 3 to 102).

Conclusions. Primarily on the basis of the results from men treated with simultaneous radiation using the transperineal technique, the definition of disease freedom for radiotherapy should be men who achieve and maintain a PSA nadir of 0.2 ng/mL or less.