PSA failure and the risk of death in prostate cancer patients treated with radiotherapy

Purpose: To determine the relationship between prostate-specific antigen (PSA) failure and cause-specific and overall survival in prostate cancer patients treated with radical radiotherapy. Methods and Materials: Patients with and without PSA failure were compared with respect to overall survival and cause-specific survival in a cohort of 1786 patients. The relationship between PSA failure and survival was further investigated among six subgroups defined by three tumor risk groups (high, intermediate, and low risk based on T stage, Gleason score, and presenting PSA) and two age groups (< 75 years and greater than or equal to 75 years). Results: The 5-year overall survival among patients who had PSA failure was 79.5% vs. 87.5% among patients who had not failed (p = 0.0003). The corresponding 5-year cause-specific survival was 84.4% vs. 99.0% (p < 0.0001). When the six subgroups are considered separately, PSA failure was associated with a worse cause-specific survival in the groups with intermediate- and high-risk disease. PSA failure was only associated with a worse overall survival in one subgroup: patients younger than 75 with high-risk disease. Deaths from nonprostate causes made the survival curves of patients with and without PSA failure in the other subgroups almost identical. Conclusion: PSA failure in prostate cancer patients treated with radiotherapy was associated with a poorer overall survival, which is seen mainly in younger patients with high-risk disease. (C) 2004 Elsevier Inc.