Four-year Prostate-specific Antigen Response Rate as a Predictive Measure in Intermediate-risk Prostate Cancer Treated With Ablative Therapies: The SPRAT Analysis

R M Glicksman; A U Kishan; A J Katz; C A Mantz; S P Collins; D B Fuller; M L Steinberg; D Shabsovich; L Zhang; A Loblaw

doi:10.1016/j.clon.2021.11.004

Four-year Prostate-specific Antigen Response Rate as a Predictive Measure in Intermediate-risk Prostate Cancer Treated With Ablative Therapies: The SPRAT Analysis

Clin Oncol (R Coll Radiol). 2022 Jan;34(1):36-41. doi: 10.1016/j.clon.2021.11.004. Epub 2021 Nov 24.

Authors

R M Glicksman¹, A U Kishan², A J Katz³, C A Mantz⁴, S P Collins⁵, D B Fuller⁶, M L Steinberg², D Shabsovich², L Zhang⁷, A Loblaw⁸

Affiliations

¹ Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
² Department of Radiation Oncology, University of California, Los Angeles, California, USA.
³ St. Francis Hospital, Roslyn, New York, USA.
⁴ 21st Century Oncology, Fort Myers, Florida, USA.
⁵ Department of Radiation Oncology, Georgetown University, Washington, DC, USA.
⁶ Division of Genesis Healthcare Partners Inc, Cyberknife Centres of San Diego Inc, San Diego, California, USA.
⁷ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁸ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. Electronic address: andrew.loblaw@sunnybrook.ca.

PMID: 34836735
DOI: 10.1016/j.clon.2021.11.004

Abstract

Aims: There is a lack of early predictive measures of outcome for patients with intermediate-risk prostate cancer (PCa) treated with stereotactic body radiotherapy (SBRT). The aim of the present study was to explore 4-year prostate-specific antigen response rate (4yPSARR) as an early predictive measure.

Materials and methods: Individual patient data from six institutions for patients with intermediate-risk PCa treated with SBRT between 2006 and 2016 with a 4-year (42-54 months) PSA available were analysed. Cumulative incidences of biochemical failure and metastasis were calculated using Nelson-Aalen estimates and overall survival was calculated using the Kaplan-Meier method. Biochemical failure-free survival was analysed according to 4yPSARR, with groups dichotomised based on PSA <0.4 ng/ml or ≥0.4 ng/ml and compared using the Log-rank test. A multivariable competing risk analysis was carried out to predict for biochemical failure and the development of metastases.

Results: Six hundred and thirty-seven patients were included, including 424 (67%) with favourable and 213 (33%) with unfavourable intermediate-risk disease. The median follow-up was 6.2 years (interquartile range 4.9-7.9). The cumulative incidence of biochemical failure and metastasis was 7 and 0.6%, respectively; overall survival at 6 years was 97%. The cumulative incidence of biochemical failure at 6 years if 4yPSARR <0.4 ng/ml was 1.7% compared with 27% if 4yPSARR ≥0.4 ng/ml (P < 0.0001). On multivariable competing risk analysis, 4yPSARR was a statistically significant predictor of biochemical failure-free survival (subdistribution hazard ratio 15.3, 95% confidence interval 7.5-31.3, P < 0.001) and metastasis-free survival (subdistribution hazard ratio 31.2, 95% confidence interval 3.1-311.6, P = 0.003).

Conclusion: 4yPSARR is an encouraging early predictor of outcome in patients with intermediate-risk PCa treated with SBRT. Validation in prospective trials is warranted.

Keywords: 4-year PSA response rate; SBRT; prostate cancer.

MeSH terms

Humans
Male
Proportional Hazards Models
Prospective Studies
Prostate-Specific Antigen
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery
Radiosurgery*

Substances

Prostate-Specific Antigen