Defining 'Cured' for Prostate Cancer

Dawn O'Shea

December 08, 2021

Prostate cancer patients with 4-year prostate-specific antigen (PSA) levels at 0.2 ng/mLl or less after low dose rate (LDR) prostate brachytherapy can be considered cured, according to a study led by the Edinburgh Cancer Centre.

The research team used data from patients attending Western General Hospital, Edinburgh, for LDR brachytherapy for prostate cancer between 2001 and 2020 to validate a biochemical definition of cure, first proposed in a study last year, which found that PSA ≤0.2 ng/mLl or less is associated with 97-99 per cent% freedom from prostate cancer recurrence at 10 to 15 years.

In this new study, a total of 632 patients were included, of whom 248 were available for analysis at year 10, and 46 at year 15. The median cohort age was 63 years; the median follow-up was 9.1 years (range 3.5 to -18.7). Sixty-four patients (10.1%) relapsed during the study period.

The primary end point was disease-free survival (DFS), defined as freedom from clinical, radiological, or PSA progression requiring androgen deprivation therapy. Four-year PSA was categorised as ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml.

The 10-year DFS for four-year PSA categories ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml were 97.5% (95% CI 95.4% to 99.6%), 89.0% (95% CI 82.4% to 96.1%), 81.5% (95% CI 70.5% to 94.2%) and 41.8% (95% CI 29.7% to 58.9%), respectively.

The 10-year DFS results for low, favourable-intermediate, and unfavourable-intermediate risk disease were 93.1% (95% CI 89.6% to 96.7%), 92.1% (95% CI 87.6% to 96.9%) and 75.9% (95% CI 67.8% to 84.9%), respectively.

The authors concluded that patients with 4-year PSA ≤0.2 ng/ml may be considered cured and couldcan be discharged to a GP for follow-up. They said the study also suggests that LDR brachytherapy is an excellent treatment option for patients with low and favourable-intermediate risk prostate cancer, but intensified treatment strategies should be considered for men with unfavourable-intermediate risk disease.

Noble DJ, Doyle E, Tramonti G, Law AB, Sundaramurthy A, Brush JP, et al. Defining Biochemical Cure After Low Dose Rate Prostate Brachytherapy: External Validation of 4-year Prostate-specific Antigen Nadir as a Predictor of 10- and 15-year Disease-free Survival. Clin Oncol (R Coll Radiol). 2021 Nov 28:S0936-6555(21)00428-3. doi: 10.1016/j.clon.2021.11.009. Epub ahead of print. PMID: 34848134.

Crook JM, Tang C, Thames H, Blanchard P, Sanders J, Ciezki J, Keyes M, Morris WJ, Merrick G, Catton C, Raziee H, Stock R, Sullivan F, Anscher M, Millar J, Frank S. A biochemical definition of cure after brachytherapy for prostate cancer. Radiother Oncol. 2020 Aug;149:64-69. doi: 10.1016/j.radonc.2020.04.038. Epub 2020 Apr 27. PMID: 32442822; PMCID: PMC7442607.



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