Failure to Achieve PSA Level ≤1 ng/ml Following Neo-adjuvant LHRHa Therapy Predicts for a Lower Rate Biochemical Control and Lower Overall Survival in Localized Prostate Cancer Treated With Radiation Therapy

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Purpose/Objective(s) 

To investigate if failure to suppress PSA to ≤1 ng/ml after at least 2 months of neo-adjuvant LHRHa therapy in patients due to receive external beam radiotherapy for localized prostate carcinoma is associated with reduced biochemical failure free survival.

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Materials/Methods 

A retrospective case note review of consecutive patients with intermediate or high-risk localized prostate cancer treated between January 2001 and December 2002 with neo-adjuvant hormonal deprivation therapy (NAHD), followed by concurrent hormonal and radiotherapy was performed. Patients' data were divided for analysis, based upon whether or not the PSA in week 1 of radiotherapy was ≤1.0 ng/ml. Biochemical failure was determined using the ASTRO (Phoenix) Definition.

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Results 

One hundred and nineteen patients were identified, 67 with post NAHD PSA levels of ≤1 ng/ml and 52 with post NADH PSA levels of >1 ng/ml. At a median follow-up of 49 (4.2–67.8) months, the 4 year actuarial biochemical failure free survival was 84% vs. 60% (p = 0.0016) in favor of the patients with a post NAHD PSA of ≤1 ng/ml, and overall survival was 94% vs. 77.5% (p = 0.0045). Disease specific survival at 4 years was 98.5% vs. 82.5%. Post NAHD PSA nadir remained an independent statistically significant predictor of biochemical failure when examined using multivariate regression analysis (Figs. 1 and 2).

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Conclusions 

Patients who have a PSA >1 ng/ml at the beginning of external beam radiotherapy following at least 2 months of neo-adjuvant LHRHa therapy, have a significantly higher rate of biochemical failure, and a lower survival rate compared to those who have PSA ≤1 ng/ml. Patients who fail to achieve adequate suppression should be considered as a higher risk group and considered for dose escalation or the use of novel treatments.

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