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Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference

      In 1996 the American Society for Therapeutic Radiology and Oncology (ASTRO) sponsored a Consensus Conference to establish a definition of biochemical failure after external beam radiotherapy (EBRT). The ASTRO definition defined prostate specific antigen (PSA) failure as occurring after three consecutive PSA rises after a nadir with the date of failure as the point halfway between the nadir date and the first rise or any rise great enough to provoke initiation of therapy. This definition was not linked to clinical progression or survival; it performed poorly in patients undergoing hormonal therapy (HT), and backdating biased the Kaplan-Meier estimates of event-free survival. A second Consensus Conference was sponsored by ASTRO and the Radiation Therapy Oncology Group in Phoenix, Arizona, on January 21, 2005, to revise the ASTRO definition. The panel recommended: (1) a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT; (2) the date of failure be determined “at call” (not backdated). They recommended that investigators be allowed to use the ASTRO Consensus Definition after EBRT alone (no hormonal therapy) with strict adherence to guidelines as to “adequate follow-up.” To avoid the artifacts resulting from short follow-up, the reported date of control should be listed as 2 years short of the median follow-up. For example, if the median follow-up is 5 years, control rates at 3 years should be cited. Retaining a strict version of the ASTRO definition would allow comparisons with a large existing body of literature.

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      Linked Article

      • In reply to Dr. Cheung
        International Journal of Radiation Oncology • Biology • PhysicsVol. 66Issue 4
        • Preview
          Dr. Cheung is absolutely correct. Using the so-called “Phoenix” definition (defined as nadir + 2 ng/mL) significantly changes the biochemical failure pattern compared with using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition (1). In addition to his retrospective studies, at least one Phase III randomized trial demonstrated that the use of the Phoenix definition could have an impact on the interpretation of dose–response data (2–4). In the Dutch trial reported by Peeters et al.
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