Prostate-specific antigen kinetics and biochemical control following stereotactic body radiation therapy, high dose rate brachytherapy, and low dose rate brachytherapy: A multi-institutional analysis of 3502 patients

Rebecca Levin-Epstein, Ryan R. Cook, J. Karen Wong, Richard G. Stock, D. Jeffrey Demanes, Sean P. Collins, Nima Aghdam, Simeng Suy, Constantine Mantz, Alan J. Katz, Nicholas G. Nickols, Leszek Miszczyk, Aleksandra Napieralska, Agnieszka Namysl-Kaletka, Nicholas D. Prionas, Hilary Bagshaw, Mark K. Buyyounouski, Minsong Cao, Brandon A. Mahal, David ShabsovichAudrey Dang, Ye Yuan, Matthew B. Rettig, Albert J. Chang, William C. Jackson, Daniel E. Spratt, Eric J. Lehrer, Nicholas G. Zaorsky, Patrick A. Kupelian, Michael L. Steinberg, Eric M. Horwitz, Naomi Y. Jiang, Amar U. Kishan

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: Stereotactic body radiation therapy (SBRT), low dose rate brachytherapy (LDR-BT) and high dose rate brachytherapy (HDR-BT) are ablative-intent radiotherapy options for prostate cancer (PCa). These vary considerably in dose delivery, which may impact post-treatment prostate-specific antigen (PSA) patterns and biochemical control. We compared PSA kinetics between SBRT, HDR-BT, and LDR-BT, and assessed their relationships to biochemical recurrence-free survival (BCRFS). Methods and materials: Retrospective PSA data were analyzed for 3502 men with low-risk (n = 2223; 63.5%), favorable intermediate-risk (n = 869; 24.8%), and unfavorable intermediate-risk (n = 410; 11.7%) PCa treated with SBRT (n = 1716; 49.0%), HDR-BT (n = 512; 14.6%), or LDR-BT (n = 1274; 36.4%) without upfront androgen deprivation therapy at 10 institutions from 1990 to 2017. We compared nadir PSA (nPSA), time to nPSA, achievement of nPSA <0.2 ng/mL and <0.5 ng/mL, rates of nPSA <0.4 ng/mL at 4 years, and BCRFS. Results: Median follow-up was 72 months. Median nPSA and nPSA <0.2 ng/mL were stratified by risk group (interaction p ≤ 0.001). Median nPSA and time to nPSA were 0.2 ng/mL at 44 months after SBRT, 0.1–0.2 ng/mL at 37 months after HDR-BT, and 0.01–0.2 ng/mL at 51 months after LDR-BT (mean log nPSA p ≤ 0.009 for LDR-BT vs. SBRT or HDR-BT for low/favorable intermediate-risk). There were no differences in nPSA <0.4 ng/mL at 4 years (p ≥ 0.51). BCRFS was similar for all three modalities (p ≥ 0.27). Continued PSA decay beyond 4 years was predictive of durable biochemical control. Conclusion: LDR-BT led to lower nPSAs with longer continued decay compared to SBRT and HDR-BT, but no differences in BCRFS.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalRadiotherapy and Oncology
Volume151
DOIs
StatePublished - Oct 2020

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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