UroToday - The Phoenix Definition of Biochemical Failure Predicts for Overall Survival in Patients with Prostate Cancer

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Thursday, 03 January 2008

BERKELEY, CA

(UroToday.com) - The Phoenix definition of prostate cancer biochemical failure

(BF) following radiotherapy (XRT) is a more robust determinant of patient

outcome compared with the ASTRO definition according to a report in the online

version of Cancer, by Dr. Abramowitz and colleagues.

The ASTRO

definition of BF is 3 consecutive rises in the PSA after the post-treatment PSA

nadir backdated to the midpoint between the nadir and the first rise. The Phoenix definition is the

nadir PSA + 2. The present study compared the two definitions as determinants

of distant metastasis (DM), cause-specific mortality (CSM), and overall

mortality (OM).

A total

of 1,831 patients treated at Fox

Chase Cancer

Center with at least 60GY

of XRT were evaluated. The median follow-up was 71 months, median XRT dose was

72Gy, and the median patient age was 69years. The average initial PSA (iPSA)

was 7.1ng/ml and 90% were clinical stage T1-T2. Androgen deprivation therapy

was used in some form in only 16% for a median length of 7.7 months.

Using the

Phoenix

definition, 389 patients (21%) had BF, 84 men (4.6%) had DM, and 48 men (3%)

died of CaP. The Phoenix definition as a

time-dependent covariate in multivariate analysis was the most significant predictor

of DM, CSM, and OM. On multivariate analysis

for OM, the authors report that BF, age,

Gleason score, and stage were all found to significantly increase the hazard

ratio for death. Stage and Gleason score were also predictive of DM, CSM, and

OM. iPSA was not found to predict for DM, CSM, or OM.

Using the

ASTRO definition, 460 patients (25%) had BF. Regarding DM, ASTRO BF, Gleason

score, and stage were significant predictors. For CSM, ASTRO BF, iPSA, stage

and, Gleason score were predictive. The ASTRO definition was not found to be an

independent predictor of OM but age, iPSA,

Gleason score, stage and XRT dose were.

This

study is the first to demonstrate that the Phoenix

definition of BF is superior to the ASTRO definition with regard to early

prediction of OM, CSM, and DM.

Abramowitz

MC, Li T, Buyyounouski MK, Ross E, Uzzo RG, Pollack A, Horwitz EM

Cancer;

112(1):55-60, Jan 2008

doi:10.1002/cncr.23139

PubMed

Abstract

PMID: 17968996