Risk of short-term prostate-specific antigen recurrence and failure
Researchers sought to determine which factors lead to a shorter time to PSA failure, which is a sign of prostate cancer worsening. Their goal was to identify patients who may need more aggressive treatments and to test specified treatments in future clinical trials.
The researchers looked at data from 350 men with nonmetastatic, high-risk prostate cancer who were part of a clinical trial. These men were randomly assigned to receive either hormonal therapy, called androgen deprivation therapy (ADT) and radiation therapy (RT) plus a chemotherapy drug called docetaxel, or just ADT and RT without the chemotherapy. The study analyzed how long it took for PSA levels to rise after treatment, which signals that the cancer might be returning.
PSA failure was defined as a rise of PSA by 2 ng/mL above the lowest level reached after treatment or when patients started additional treatments. The researchers wanted to understand which factors made PSA failure happen sooner.
After following the patients for an average of about 10 years, they found that several factors were linked to a shorter time to PSA failure. Men with a PSA level between 10 ng/mL and 20 ng/mL, and those with a high Gleason score (a measure of how aggressive the cancer is, with 8 to 10 being the most severe), experienced a shorter time to PSA failure. Interestingly, younger men had a higher risk of PSA failure than older men.
These findings suggest that younger men with higher PSA and a Gleason score of 8 to 10 are at higher risk for early PSA failure. This group of patients might benefit from more intensive treatments, such as drugs that block androgen receptors or chemotherapy. The researchers believe that this high- risk group should be the focus of future clinical trials to further explore potential treatment options.
Sayan M et al JAMA Netw Open. 2023 Oct 2;6(10):e2336390. doi: 10.1001/jamanetworkopen.2023. 36390. PMID: 37801315
