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Prostate-specific antigen density: a new prognostic indicator for prostate cancer
P G Zentner1, L K Pao, M C Benson
1Department of Radiation Oncology, College of Physicians and Surgeons of Columbia University, New York, NY 10032.
International Journal of Radiation Oncology, Biology, Physics
|September 1, 1993
Summary
Prostate specific antigen density (PSA density) effectively predicts outcomes in prostate cancer patients treated with radiation therapy. Low PSA density indicates a favorable prognosis, suggesting less aggressive treatment protocols may be suitable.
Area of Science:
- Oncology
- Urology
- Radiotherapy
Background:
- Prostate specific antigen density (PSA density) is a ratio of serum PSA to prostate volume.
- PSA density aids in distinguishing benign from malignant prostate disease and identifying occult metastatic disease.
- Its predictive value for outcomes after definitive conformal radiation therapy (CRT) requires further investigation.
Purpose of the Study:
- To retrospectively evaluate prostate specific antigen density as a predictor of patient outcomes following definitive conformal radiation therapy for localized prostate cancer.
Main Methods:
- Seventy-three patients with localized prostate cancer treated with CRT between 1989 and 1991 were analyzed.
- Prostate specific antigen density was calculated using pretreatment serum PSA and prostate volume from CT scans.
- PSA failure was defined by rising PSA levels above normal or nadir.
Main Results:
- Patients with PSA density < or = 0.3 demonstrated 100% disease-free survival at 30 months.
- A PSA density > 0.3 was associated with significantly lower actuarial disease-free survival (62% at 30 months, p < 0.01).
- PSA density was a superior predictor of disease-free survival compared to clinical stage, Gleason's score, and pretreatment PSA.
Conclusions:
- Prostate specific antigen density is a strong predictor of disease-free survival in patients undergoing conformal radiation therapy for prostate cancer.
- Low PSA density (< or = 0.3) identifies patients with favorable outcomes, regardless of clinical stage or Gleason's score.
- These findings suggest that patients with low PSA density may not require high-risk treatment protocols.