TY  - EJOU
AU  - Tyldesley, S. 
AU  - Coldman, A. 
AU  - Pickles, T. 

TI  - PSA doubling time post radiation: the effect of neoadjuvant androgen ablation
T2  - Canadian Journal of Urology

PY  - 2004
VL  - 11
IS  - 4
SN  - 1488-5581

AB  - <b>Objective:</b> To determine whether men who relapse after neoadjuvant androgen ablation (NAA) and high-dose radiation therapy (RT) have faster PSA doubling times (PSAdt) than those who are treated with RT alone.<br/>
<b>Materials and methods:</b> From a prospective database of 1880 patients treated with RT for localized prostate cancer, patients were selected for further study if they had a rising PSA profile >1 ng/ml, and were treated with either no NAA, or prolonged NAA (defined as 3-12 months NAA) with a minimum 5 years follow-up. The PSAdt was calculated from the exponential line of best fit from the first post-nadir value >1 ng/ml to the last PSA prior to secondary intervention. Those patients with a rising PSA profile at 5 years of follow-up were further examined with linear regression to determine factors of possible independent adverse effect.<br/>
<b>Results:</b> There were 251 patients eligible with rising PSA profiles. Patients treated with NAA had higher pre-treatment Gleason scores (p<0.001), PSA (p<0.001), and T stage (p<0.001). Median duration of NAA was 5.1 months. Rising PSA profiles occurred in 78% of the RT-only group and 70% of the NAA group. In regression analysis, factors predictive of more rapid PSAdt were pre-treatment Gleason score (p<0.001), pre-treatment PSA (p=0.025), and T stage (p=0.017). The use of NAA (p=0.4) was not significant.<br/>
<b>Conclusion:</b> The use of prolonged NAA in men treated with RT does not itself cause a more rapid PSAdt when relapse occurs. Faster relapse observed in these men is due to intrinsically more aggressive tumors prior to treatment.
KW  - androgen ablation
KW  -  prostate neoplasms
KW  -  prostate specific antigen
KW  -  radiotherapy

DO  -