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• W3094363946 abstract "After IMRT combined with androgen deprivation therapy (ADT) for prostate cancer, PSA levels generally decrease to the nadir; by withdrawing ADT, the PSA level gradually rises and reaches a plateau after a while. Following IMRT alone, the PSA level gradually decreases and reaches a plateau. In the present study, this plateau is named as “first plateau (P1)”. In some cases, however, PSA rises after the first plateau and reaches a second plateau (P2) without cancer recurrence. We assume this phenomenon reflects the recovery of normal prostate cells. The objective of this study is to investigate clinical features of the second plateau and to compare patients who experienced PSA failure to those who settled at the second plateau phase. Of 348 patients with T1-3N0M0 prostate cancer treated by IMRT with or without neoadjuvant/adjuvant ADT, 35 patients receiving ADT for > 3 years or intermittent ADT were excluded, and 313 patients followed for 79-129 (median 106) months were analyzed. The total dose was 72.6-78 Gy with daily fractions of 2.0, 2.1, or 2.2 Gy. PSA failure was defined as PSA rise of > 2.0 ng/mL above the nadir. “Plateau” was defined algorithmically as an interval where PSA value at any measurement point falls into a range of the preceding three values and “elevation” as a consequent PSA rise without satisfying the criteria of “plateau”. Cox proportional-hazard models were used to find predictors for P2. The slope of elevation after P1 (E1) was calculated as a regression coefficient in a linear regression. Mean PSA nadir, P1 and P2 levels were compared between the PSA-failure and non-failure groups. Of 313 patients, P1 was observed in 177 patients (56.5%). In 67 (21.4%), PSA levels did not elevate above nadir and in 69 (22.0%) PSA levels increased after nadir without satisfying the criteria of plateau. Eventually, PSA failure was observed in 50 patients (16.0%). P2 was observed in 52 (16.6%) and elevation after P2 (E2) was observed in 24 (7.7%). T3 and neoadjuvant ADT were associated with lower likelihood of the occurrence of P2 on multivariate analysis. In fully-analyzable cases (n = 93), mean PSA nadir, P1 and P2 levels, and E1 slope for the non-PSA-failure group (n = 74) were 0.11, 0.31, and 0.41 ng/mL, and 0.11 ng/mL/year, respectively. Those for the PSA-failure group (n = 19) were 0.26, 0.54, and 0.82 ng/mL, and 0.48 ng/mL/year, respectively. All these factors except the mean P2 level were significantly higher in the PSA-failure group. The ROC curve identified the E1 slope of 0.28 ng/mL/year as an optimal cut-off value predicting risks of PSA failure with the highest accuracy (AUC:0.88, 95% CI: 0.79-0.96). By applying the criteria of “plateau” proposed in this study, 52 of 313 patients (16.6%) treated by IMRT experienced the second plateau. A comparison of the E1 slope indicated PSA rise of >0.28 ng/mL/year after P1 could be a predictor discriminating PSA failure from second plateau." @default.
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• W3094363946 date "2020-11-01" @default.
• W3094363946 modified "2023-09-27" @default.
• W3094363946 title "PSA Levels after IMRT for Prostate Cancer: Discriminating Second Plateau from PSA Failure" @default.
• W3094363946 doi "https://doi.org/10.1016/j.ijrobp.2020.07.493" @default.
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