Long-term outcomes after treatment with external beam radiation therapy and palladium 103 for patients with higher risk prostate carcinoma
| العنوان: | Long-term outcomes after treatment with external beam radiation therapy and palladium 103 for patients with higher risk prostate carcinoma |
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| المؤلفون: | Lawrence True, Jennifer Cash, Kent Wallner, Richard Sorace, Michael Dattoli |
| المصدر: | Cancer. 97:979-983 |
| بيانات النشر: | Wiley, 2003. |
| سنة النشر: | 2003 |
| مصطلحات موضوعية: | Male, Cancer Research, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Acid Phosphatase, Brachytherapy, Urology, Prostate, Biomarkers, Tumor, medicine, Carcinoma, Humans, Aged, Radioisotopes, Gynecology, Proportional hazards model, business.industry, Prostatic Neoplasms, Cancer, Middle Aged, Prognosis, medicine.disease, Radiation therapy, Prostate-specific antigen, Treatment Outcome, medicine.anatomical_structure, Oncology, Prostatic acid phosphatase, Protein Tyrosine Phosphatases, business, Palladium |
| الوصف: | BACKGROUND The objective of this study was to define the long-term prognostic significance of prostatic acid phosphatase (PAP) levels in patients with higher risk, early-stage prostate carcinoma. METHODS One hundred sixty-one consecutive patients with Stage T1–T3 prostate carcinoma (according to the 1992 criteria of the American Joint Committee on Cancer) were treated from 1992 through 1996. Each patient had a Gleason score ≥ 7 and/or a prostate specific antigen (PSA) level > 10 ng/mL. The original biopsy slides for 130 of 161 patients were retrieved and rereviewed by a single pathologist (L.T.). Enzymatic PAP measurements were determined using a standard method. Values up to 2.5 Units were considered normal. Patients received 41 grays (Gy) of external beam radiation therapy to a limited pelvic field followed 4 weeks later by a palladium 103 (Pd-103) boost using transrectal ultrasound and fluoroscopic guidance as described previously. The prescribed minimum Pd-103 dose to the prostate was 80 Gy (pre-National Institute of Standards and Technology [NIST]-99). Freedom from biochemical failure was defined as a serum PSA level ≤0.2 ng/mL at last follow-up. RESULTS There was little correlation between pretreatment PSA levels, Gleason scores, and PAP measurements. Thirty-eight patients developed biochemical failure. The overall actuarial freedom from biochemical progression at 10 years is 79%, with 118 patients followed for > 5 years. In a multivariate Cox proportional hazards analysis that considered each factor as a continuous variable, the strongest predictor of failure was PAP (P = 0.0001), followed by Gleason score (P = 0.13), and PSA (P = 0.04). PAP was especially helpful in stratifying patients with pretreatment PSA levels between 4 ng/mL and 20 ng/mL, for whom the prognosis does not different when they are subdivided into PSA categories. When the PAP subgroup analysis was limited to this relatively favorable group, there was a wide range of prognoses. CONCLUSIONS The biochemical cure rate was remarkably high among the 161 patients evaluated. The fact that the PAP was the strongest predictor of long-term biochemical failure in patients with otherwise higher risk features reported here suggests that it may be a more accurate indicator of micrometastatic disease compared with the Gleason score and the PSA level. This report adds to the rationale for reintroducing PAP measurement into general practice. Cancer 2003;97:979–83. © 2003 American Cancer Society. DOI 10.1002/cncr.11154 |
| تدمد: | 1097-0142 0008-543X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::200b567580dc85cb65c30ff0c76af9c9 https://doi.org/10.1002/cncr.11154 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....200b567580dc85cb65c30ff0c76af9c9 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 10970142 0008543X |
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