Journal of Clinical Oncology, Vol 12, 1402-1407, Copyright © 1994 by American Society of Clinical Oncology
Prostate-specific antigen decline: a major prognostic factor for prostate cancer treated with radiation therapy
B Chauvet, C Felix-Faure, N Lupsascka, J Fijuth, Y Brewer, JL Davin, S Kirscher and F Reboul
Department of Urological Oncology, Clinique Ste Catherine, Avignon, France.
PURPOSE: To assess the prognostic significance of serum prostate- specific
antigen (PSA) in the monitoring of patients with localized prostate cancer
treated with primary radiation therapy, we analyzed the data from 179
patients treated at our institution between 1987 and 1990. PATIENTS AND
METHODS: One hundred seventy-nine previously untreated patients received
radiation at 69 Gy to the prostate with curative intent for prostate
adenocarcinoma. The median follow-up duration is now 41 months. PSA levels
were measured before radiotherapy and then evaluated periodically. RESULTS:
Baseline levels were greater than 4 ng/mL in 83% of cases and were
significantly correlated with clinical tumor stage (P = .002). Six months
after completion of therapy, PSA values had returned to normal in 53% of
the patients with initially elevated values. At the time of analysis, 32
patients have relapsed, including three of 30 patients (10%) with normal
initial and 6-month values, five of 79 patients (6%) with initially
elevated but normal 6-month values, and 24 of 69 patients (35%) with
persistently elevated PSA levels at 6 months. Actuarial 4-year relapse-free
survival was significantly correlated with initial and 6-month PSA values
(84% in patients with normal 6-month values v 60% in patients with
persistently elevated levels). Furthermore, when the relative decline
between initial and 6-month PSA values exceeded 50%, the crude rate of
recurrence was 14% as opposed to 34% when it failed to exceed 50%. The
4-year relapse-free survival rates were 77% and 59%, respectively (P =
.008). By multivariate analysis restricted to the patients with elevated
baseline PSA levels, the rate of decline of PSA values reached the highest
prognostic significance (P < .0001). Age at diagnosis, clinical tumor
stage, and Gleason score only reached statistical significance in
univariate analysis. CONCLUSION: PSA values are of major prognostic
significance in assessing the 4-year results of radical radiation therapy
for localized prostate cancer. The rate of decline of PSA values is the
strongest predictor of outcome and might help to identify a subset of
patients with poorer prognosis who may benefit from early hormonal therapy.
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