[Biochemical control after external radiotherapy in localized prostatic cancer: results of a modern cohort]. / Control bioquímico tras radioterapia externa en el cáncer de próstata localizado: resultados de una cohorte moderna.

PURPOSE: The present study reports biochemical outcomes of a modern series of patients with localised prostate cancer treated with external beam radiation therapy, and analyses the implications of the nadir PSA levels in monitoring outcome after treatment. METHODS: From March 1993 to March 1997, eighty three patients with clinical stages T1-T3 NxM0 prostate cancer received definitive external radiation therapy, median dose 66 Gy (range 60 to 68 Gy). Adjuvant androgen deprivation was associated in 53 high risk patients. Initial response to treatment was defined as a decrease of serum PSA to levels of < or = 1.5 ng/ml, and biochemical failure as three consecutive PSA rises over post-treatment nadir PSA value. RESULTS: The 3-year actuarial BDFS was 78% +/- 7 for the whole series, 74% +/- 12 for patients treated with radiotherapy alone, and 71% +/- 10 for high risk patients treated with combination therapy (p = 0.27). Only nPSA emerged as a potential indicator of biochemical control. The probability of BDFS at 3 years was 82%, 83% and 40% for nPSA of < or = 1 ng/ml, 1-2 ng/ml and > 2 ng/ml respectively (p = 0.0409). In multivariate analysis, this correlation was independent on the effect of other variables and persisted after adjusting for the effect of hormonal therapy (p = 0.0540). CONCLUSION: Radiation therapy is a potentially curative treatment for prostate carcinoma. Our data indicate that the nadir PSA value after radiation can be an excellent early determinant of outcome.

Control bioquímico tras radioterapia externa en el cáncer de próstata localizado: resultados de una cohorte moderna / Biochemical control after external radiotherapy in localised prostate cancer: results from a modern cohort

FUNDAMENTO: En este trabajo presentamos los resultados de control bioquímico de una cohorte moderna de pacientes con cáncer de próstata localizado tratados con radioterapia, y las implicaciones del valor de nadir de PSA (nPSA) en la monitorización del tratamiento. MATERIAL Y MÉTODOS: Entre Marzo de 1993 y Marzo de 1997, 83 varones con adenocarcinoma de próstata T1-3 Nx M0, fueron tratados con radioterapia externa con intención radical (dosis total media de 66 Gy, rango 60-68 Gy). Se asoció deprivación androgénica en 53 pacientes de alto riesgo. Se ha definido la respuesta al tratamiento como un descenso del PSA a niveles ?1,5 ng/ml, y la recaída bioquímica como la presencia de tres elevaciones consecutivas de PSA sobre el valor de nPSA. RESULTADOS: La supervivencia libre de fracaso bioquímico (SLFB) actuarial a 3 años fue del 78 por ciento ñ 7 para toda la serie, 74 por ciento ñ 16 para los pacientes tratados con radioterapia exclusiva y 71 por ciento ñ 10 para los pacientes tratados con radioterapia y hormonoterapia adyuvante (p = 0,27). De los factores analizados, sólo el nivel de nPSA se correlacionó de forma significativa con la probabilidad de control bioquímico: la SLFB fue del 82 por ciento, 83 por ciento y 40 por ciento para valores de nPSA de ?1 ng/ml, 1-2 ng/ml y > 2 ng/ml respectivamente (p = 0,0409). En análisis multivariante, el valor pronóstico del nPSA se mantuvo independiente del resto de las variables y del efecto del tratamiento hormonal (p = 0,0540). CONCLUSIONES: La radioterapia externa es un tratamiento eficaz en los pacientes con cáncer de próstata localizado.El valor nadir de PSA tras radioterapia es un excelente predictor de los resultados del tratamiento (AU)

[Radiotherapy of localized cancer of the prostate: current status and new strategies]. / Tratamiento radioterápico del cáncer de próstata localizado: estado actual y nuevas estrategias.

Radiation therapy is a well established modality for the management of prostate cancer and the reported results are comparable to those obtained with radical prostatectomy. After the introduction of prostate specific antigen (PSA) determination, when results are analyzed on the basis of strict biochemical criteria, it is clearly evident that total and permanent eradication of the localized prostate cancer is obtained less frequently than what was thought in the las few decades. Although there are currently only a few series with radical radiation therapy with long results and with complete PSA determination during follow-up, disease free survival (DFS) for T1b-T2 Nx is approximately 65% at 4-5 years, whereas for T1-2 NO DFS at 9-10 years is maintained between 67% and 83%. New therapeutic strategies leading to improvement in the locoregional control are discussed, including dose escalation programs in the setting of new technologies of three-dimensional conforma radiation therapy, and neoadjuvant androgenic blockade.