25-Year disease-free survival rate after irradiation for prostate cancer calculated with the prostate specific antigen definition of recurrence used for radical prostatectomy.

PURPOSE: We addressed whether there is durable control of prostate cancer, defined as a prostate specific antigen cutoff of less than 0.2 ng/ml, greater than 20 years after irradiation for this disease. We also evaluated late recurrence, defined as recurrence after 10-year followup. MATERIALS AND METHODS: A total of 3,546 consecutive hormone naïve men were treated with a (125)I prostate implant (retropubic and later transperineal), followed by external beam irradiation, from 1984 to 2000. Recurrence was defined as a prostate specific antigen increase of greater than 0.20 ng/ml or a prostate specific antigen nadir of greater than 0.20 ng/ml. Median followup was 11 years (range 3 months to 26 years). RESULTS: In all men 10, 15, 20 and 25-year disease-free survival rates were 75%, 73%, 73% and 73%, respectively. Longest time to recurrence was at the 15.5-year followup. In 313 men with recurrence who were treated 16 to 25 years ago 5% of recurrences were late. In men implanted by the transperineal method since 1995 the 15-year disease-free survival rate was 79%. CONCLUSIONS: With this irradiation program cancer control, defined using the recurrence definition for radical prostatectomy, was durable with no further recurrence between 15.5 and 25 years of followup. This study also suggests that at least 15 years of followup are necessary to fully evaluate any prostate cancer treatment. Furthermore, if prostate specific antigen is less than 0.20 ng/ml 15 years after treatment, later recurrence should be unlikely.

Prostate specific antigen bounce after simultaneous irradiation for prostate cancer: the relationship to patient age.

PURPOSE: We report on the relationship of patient age to prostate specific antigen (PSA) bounce after brachytherapy for prostate cancer. MATERIALS AND METHODS: From 1992 to 1997, 1,011 consecutive men with stage T1-T2NxM0 prostate cancer were treated with simultaneous irradiation, transperineal prostate I-125 implant followed by external beam irradiation. No patients received neoadjuvant hormones. There were 251, 491 and 269 men 60 years old or younger, 61 to 70 and 71 or older, respectively, at implant. PSA bounce is defined by a postirradiation PSA increase of 0.1 ng/ml or more above the level before bounce followed by a decrease to or below that level. Disease freedom is defined by a PSA cut point of 0.2 ng/ml. Median followup is 6 years (range 3 months to 10 years). RESULTS: The frequency of PSA bounce according to age 60 or younger, 61 to 70 and 71 or older is 57%, 41% and 26%, respectively, a significant difference (p <0.000), average time to bounce onset is 19, 20 and 25 months for these 3 age groups, respectively, a significant difference (p = 0.002), and average bounce duration is 11, 8 and 8 months, respectively, a significant difference (p <0.000). On multivariate analysis of age, pretreatment PSA, Gleason score, stage, implant dose, prostate volume, diabetes and race, only age is significantly associated with PSA bounce (p <0.0001). After adjusting for the inherent bias caused by PSA bounce, there is no significant difference in disease-free survival between men with and without bounce. CONCLUSIONS: Young men with prostate cancer treated with brachytherapy have a significantly higher frequency, earlier onset and longer duration of PSA bounce than older men.