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Two-years Postradiotherapy Biopsies: Lessons from MRC RT01 Trial.

Antoine Kass-Iliyya1, Gordana Jovic2, Claire Murphy2

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Two-year postradiotherapy prostate biopsies offer limited value for patients with controlled PSA levels. However, a positive biopsy or elevated PSA indicates a higher risk of future biochemical progression, suggesting selected biopsies for salvage treatment.

Keywords:
BiopsyConformal radiotherapyProstate cancer

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Area of Science:

  • Oncology
  • Radiotherapy
  • Urology

Background:

  • The clinical significance of prostate biopsies conducted two years after radiotherapy remains unclear.
  • Assessing the utility of these biopsies is crucial for refining treatment strategies.

Purpose of the Study:

  • To evaluate the prognostic value of two-year post-radiotherapy prostate biopsies in a randomized trial.
  • To determine the association between biopsy results and long-term oncological outcomes.

Main Methods:

  • A randomized trial involving 843 men with localized prostate cancer receiving conformal radiotherapy (CFRT) with or without dose escalation.
  • Prostate biopsies were performed at two years post-CFRT in eligible patients.
  • Outcomes, including biochemical progression-free survival (bPFS) and overall survival, were analyzed using a landmark approach from the two-year biopsy.

Main Results:

  • A positive two-year biopsy was strongly prognostic of worse bPFS (HR=4.81).
  • Elevated prostate-specific antigen (PSA) levels (1.01-2.09 ng/ml) at two years were associated with increased risk of PSA failure, bPFS events, and prostate cancer-specific survival.
  • Routine biopsies showed limited value in patients with PSA control.

Conclusions:

  • Two-year postradiotherapy biopsies have limited value when PSA levels are controlled.
  • Positive biopsy results and elevated PSA levels are significant predictors of future bPFS events.
  • Selective biopsy in patients with unfavorable PSA may facilitate early salvage interventions.