ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2025
PSA reduction as predictor of biochemical relapse in low and favourable intermediate prostate cancer treated with radical radiotherapy.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRadiation therapy (RT) is standard treatment for localized prostate cancer (PCa). Prostate-specific antigen (PSA) kinetics, particularly PSA reduction (PSAr) after RT, are emerging as significant prognostic indicators for biochemical control. This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS). This retrospective multi-institutional study explores the correlation between PSAr and biochemical relapse-free survival (BRFS).
methods251 low-to-intermediate risk PCa patients treated with RT only were analyzed. Isoeffective RT schedules were: 39 fractions × 2 Gy, 28 × 2.55 Gy, 16 × 3.5 Gy, 5 × 7 Gy. Main objective was BRFS, defined as the time from PSA nadir (PSAn) to PSAn plus 2 ng/ml. PSAr was defined as the percentage of total PSA reduction from baseline. The optimal PSAr cut-off value was defined as 90%. Patients were stratified by PSAr, baseline PSA, Gleason Score (GS), and RT schedules.
resultsGS was 3 + 3 in 120 (48%) patients and 3 + 4 in 131 (52%) patients. After a median follow-up of 36 months (30-48), 2 and 5-year BRFS were 97.3% and 95.2%, respectively, in patients with PSAr ≥ 90% and 89.5%, 61.5% in patients with PSAr < 90% (p = 0.00). In the responder population, median time to PSAr 90% was 24 months and the median time to PSAn was 28.7 months (20-38). At univariate and multivariate analyses, PSAr was the only significant predictor of BRFS [HR 6.519 (95% IC 1.9-22.2), p = 0.003].
conclusionsPSAr could be a reliable prognostic factor for long-term biochemical control. This study underscores the potential of PSAr as a tool for risk stratification and personalized follow-up strategies in PCa management.
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