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- W2078444677 abstract "In the current issue of European Urology, Zumsteg and colleagues help to fill an unmet need in defining parameters that allow us to better understand the natural history of patients experiencing biochemical failure following highdose radiation for clinically localized prostate cancer [1]. With a median follow-up of 122 mo in a cohort of 609 failing patients, Gleason score (GS) 8–10, T3–4 disease, and prostate-specific antigen doubling time (PSA-DT)<3mo were all powerful independent predictors of distant metastases (DM) and prostate cancer–specific mortality (PCSM). Thus, although their findings provided no surprises, they provide insights and opportunities for speculation and perhaps interventions. This group lead by Dr. Zelefsky provides quantitative insights intohow long it takes formanifestationofmetastatic disease after biochemical failure (5.4 yr) and how long patients might be expected to survive after this event (10.5 yr). Given the size of their study and the follow-up, these may be the best data for making such estimates at present. However, I would argue that the latter estimate (death from prostate cancer) is probably more accurate than time tometastasis, becauseneitherbone scansnor computed tomography or magnetic resonance imaging are very sensitive at picking up minimal microscopic disease. My point is, an individual for whom metastatic disease is detected on such imaging within 1–2 yr after biochemical failure is very likely to have had micrometastatic disease at the time of failure, consistent with the predictive power of PSA-DT<3 mo. The authors imply that such patients are not well suited for local salvage therapy alone, and I agree." @default.
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- W2078444677 date "2015-06-01" @default.
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- W2078444677 title "Natural History after Biochemical Failure Following Dose-escalated External Beam Radiation: An Opportunity to Improve Outcomes?" @default.
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- W2078444677 doi "https://doi.org/10.1016/j.eururo.2014.10.015" @default.
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