Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost

Anurag K. Singh, Peter Guion, Robert C. Susil, Deborah E. Citrin, Holly Ning, Robert W. Miller, Karen Ullman, Sharon Smith, Nancy Sears Crouse, Denise J. Godette, Bronwyn R. Stall, C. Norman Coleman, Kevin Camphausen, Cynthia Ménard

Research output: Contribution to journalArticle

Abstract

Purpose: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Materials and methods: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise > 35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Results: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. Conclusion: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.

Original languageEnglish (US)
Article number28
JournalRadiation Oncology
Volume1
Issue number1
DOIs
StatePublished - Aug 16 2006
Externally publishedYes

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Brachytherapy
Prostate-Specific Antigen
Radiotherapy
Magnetic Resonance Imaging
Hormones
Prostatic Neoplasms
Salvage Therapy
Incidence
Observation
Guidelines
Radiation
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost. / Singh, Anurag K.; Guion, Peter; Susil, Robert C.; Citrin, Deborah E.; Ning, Holly; Miller, Robert W.; Ullman, Karen; Smith, Sharon; Crouse, Nancy Sears; Godette, Denise J.; Stall, Bronwyn R.; Coleman, C. Norman; Camphausen, Kevin; Ménard, Cynthia.

In: Radiation Oncology, Vol. 1, No. 1, 28, 16.08.2006.

Research output: Contribution to journalArticle

Singh, AK, Guion, P, Susil, RC, Citrin, DE, Ning, H, Miller, RW, Ullman, K, Smith, S, Crouse, NS, Godette, DJ, Stall, BR, Coleman, CN, Camphausen, K & Ménard, C 2006, 'Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost', Radiation Oncology, vol. 1, no. 1, 28. https://doi.org/10.1186/1748-717X-1-28
Singh, Anurag K. ; Guion, Peter ; Susil, Robert C. ; Citrin, Deborah E. ; Ning, Holly ; Miller, Robert W. ; Ullman, Karen ; Smith, Sharon ; Crouse, Nancy Sears ; Godette, Denise J. ; Stall, Bronwyn R. ; Coleman, C. Norman ; Camphausen, Kevin ; Ménard, Cynthia. / Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost. In: Radiation Oncology. 2006 ; Vol. 1, No. 1.
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abstract = "Purpose: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Materials and methods: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20{\%} of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise > 35{\%} of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Results: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55{\%} for definition 1, 44{\%} for definition 2, 55{\%} for definition 3, 33{\%} for definition 4, 11{\%} for definition 5, and 11{\%} for definition 6. Conclusion: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.",
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AU - Citrin, Deborah E.

AU - Ning, Holly

AU - Miller, Robert W.

AU - Ullman, Karen

AU - Smith, Sharon

AU - Crouse, Nancy Sears

AU - Godette, Denise J.

AU - Stall, Bronwyn R.

AU - Coleman, C. Norman

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AU - Ménard, Cynthia

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N2 - Purpose: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Materials and methods: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise > 35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Results: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. Conclusion: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.

AB - Purpose: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Materials and methods: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise > 35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Results: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. Conclusion: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.

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