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PSA Failure Seems to Be Linked to Poorer Survival in Men With Unfavorable-Risk Prostate Cancer and No/Minimal Comorbidity

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Key Points

  • PSA failure was associated with an increased risk of mortality among men with unfavorable-risk prostate cancer who had no/minimal comorbidity on ACE-27.
  • No significant effect was observed among men with moderate-to-severe comorbidity.

In an analysis of a clinical trial population reported in the Journal of Clinical Oncology, Giacalone et al found that prostate-specific antigen (PSA) failure was associated with an increased risk of mortality among men with unfavorable-risk prostate cancer who had no or minimal comorbidity burden.

Study Details

The study involved follow-up of patients in a trial (NCT00116220) in which 206 men with localized (T1b to 2b) intermediate- and high-risk prostate cancer were randomized between 1995 and 2001 to receive radiation therapy or radiation therapy and 6 months of androgen-deprivation therapy. Cox regression was used to assess whether PSA failure as a time-dependent covariate was associated with an increased risk of all-cause mortality among men with Adult Comorbidity Evaluation-27 (ACE-27)–defined no or minimal vs moderate-to-severe comorbidity after adjustment for age, prognostic factors, and treatment.

Mortality Risk

After median follow-up of 16.6 years, 156 men (76%) had died, with 29 (19%) dying due to prostate cancer. PSA failure was associated with an increased risk of mortality among men with no or minimal comorbidity (adjusted hazard ratio [HR] = 1.59, P = .04) but not among those with moderate or severe comorbidity (adjusted HR = 1.75, P = .19).

The investigators concluded: “Recommending treatment on the basis of reduced PSA failure observed from early results of [randomized controlled trials] is unlikely to prolong survival in men with moderate-to-severe comorbidity but may prolong survival in men with no or minimal comorbidity, providing evidence to support discussing the early results with these men.”

Nicholas J. Giacalone, MD, of the Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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