PSA cut off level

Summary:

Maximum PSA level to omit local treatment

PSA cut off level

Alfonso Gomez 01 May 2011 15:48

Hi everyone,
I have lastly seen patients with very high PSA levels and negative staging studies. For example, in a young patient with a PSA of 400, Gleason 8, cT3b cN0 and no mets in staging studies. Can you recommend local treatment?? Do you know any references supporting radical treatment in these patients?

Re: PSA cut off level

AAM 01 May 2011 21:38

The controversy is whether PSA is part of staging.

If not, then the case is HIGH RISK and should be treated with the intent of cure with neoadjuvant hormones, primary radiotherapy and adjuvant hormones (probably lifetime).

If you think it is, then I'd like to be informed of the system as I haven't seen it published.

Even if you believe his metastatic rate is 100%, the local radiotherapy will mean that local failure is very very unlikely, so local treatment is not wasted. Hormones alone will see local failure in 5-7 years (what I call the "Trial of Death" approach!)

Re: PSA cut off level

Nikhilesh Patil 02 May 2011 03:22

I fully agree with Andrew, treat this gentleman with RT and Hormones. Atleast RT will delay local progression and hormones will help control the disease for some time.

Re: PSA cut off level

Rohit Malde 02 May 2011 21:37

I believe we have had a discussion in the past regarding this scenario.
And i mentioned about the ambitious STAMPEDE trial looking into this matter.
Its got a complex 6 arm trial. Find details on internet or in the past posts….

Recently i m not sure whether you guys are aware there was the practice changing results of a trial called PR07 trial reported in last years ASCO.

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=49170

And giving radiotherapy in addition to hormone therapy improves survival for men with locally advanced prostate cancer.

http://www.ctu.mrc.ac.uk/news_and_press_releases/news_archive/pr07_interim_analysis_010710.aspx

Re: PSA cut off level

Rohit Malde 02 May 2011 23:40

Another partially related and recently published trial is

Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial

Volume 12, Issue 5, May 2011, Pages 451-459

Conclusion: 6 months of neoadjuvant androgen deprivation combined radiotherapy is an effective treatment option for locally advanced prostate cancer, particularly in men without nodal metastases or pre-existing metabolic comorbidities that could be exacerbated by prolonged androgen deprivation.

This trial showed 6 months better than 3 months ADT

Notes: They allowed pts with PSA = 203.9 ng / ml into the trial…

Someone could look into the PR 07 trial , the highest PSA level enrolled in the study.

Re: PSA cut off level

AAM 03 May 2011 06:40

TROG was a 'local' trial here. The longer the duration of hormones the better the result has been the outcome of the vast majority of comparisons (starting with one from NZ - http://www.ncbi.nlm.nih.gov/pubmed/8600087). The follow up trial to 96.01 ("RADAR") uses 2 years of adjuvant androgen ablation, so you shouldn't use just 6 months in this man.

Last edited on 03 May 2011 06:41 by AAM Show more

Re: PSA cut off level

Alfonso Gomez 04 May 2011 20:42

Thank you guys for your posts, it has been very helpful again. I will take a look into the highest PSA level enrolled in PR 07 trial. I have decided to treat this patient with RT escalated doses and livetime ADT.

Re: PSA cut off level

radtuxabhishek 02 May 2011 04:01

A valid suggestion?

Get his PSA re-checked from a different lab AFTER making sure that there has been no "digital manipulation" of his prostate before we jump to conclusions.

I think it would be a worthwhile trial.

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