The Importance of Prostate-specific Antigen (PSA) Nadir and Early Identification of PSA Relapse after 10 Years of Prostate Iodine125 Seed Brachytherapy in Edinburgh

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 27; no. 9; pp. 519 - 526
• Main Authors: McLaren, D.B, Kerr, G, Law, A.B, Brush, J.P, Keanie, J, Malik, J, Keough, W, Ronaldson, T, Lee, J, Kehoe, T
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-09-2015
• Subjects: Hematology, Oncology and Palliative Medicine; Iodine125 seed brachytherapy; prostate cancer; PSA nadir; Radiology; relapse; salvage treatment; PSA nadir; prostate cancer; Iodine 125 seed brachytherapy; relapse; salvage treatment; Iodine125 seed brachytherapy
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2015.05.003

Abstract Aims To analyse our 5 and 10 year prostate brachytherapy outcome data and to assess the impact of PSA nadir on relapse free survival and whether an alternative definition of PSA relapse could detect men destined to fail by the Phoenix definition at an earlier time point. Materials and methods 474 men were treated over a 10 year period between 20012 and 2011and divided into 2 five year cohorts for the purpose of the analysis. Results The risk of relapse is strongly predicted by post treat prostate-specific antigen (PSA) nadir. After 3 years post-treatment, PSA nadir plus 0.4 ng/ml identified men at risk of relapse 17 months earlier than the Phoenix definition. Conclusion The Phoenix definition of nadir plus 2.0 ng/ml does not allow the early identification of men destined to relapse. The initiation of salavage therapy at the earliest opportunity could potentially affect subsequent survival and an outline randomised controlled trial proposal is presented.