The Phoenix Definition Of Biochemical Failure Predicts For Overall Survival In Patients With Prostate Cancer (p NA)

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 11 Jan 2008 - 0:00 PDT

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UroToday.com- The Phoenix definition of prostate cancer biochemical failure (BF) following radiotherapy (XRT) is a more robust determinant of patient outcome compared with the ASTRO definition according to a report in the online version of Cancer, by Dr. Abramowitz and colleagues.

The ASTRO definition of BF is 3 consecutive rises in the PSA after the post-treatment PSA nadir backdated to the midpoint between the nadir and the first rise. The Phoenix definition is the nadir PSA + 2. The present study compared the two definitions as determinants of distant metastasis (DM), cause-specific mortality (CSM), and overall mortality (OM).

A total of 1,831 patients treated at Fox Chase Cancer Center with at least 60GY of XRT were evaluated. The median follow-up was 71 months, median XRT dose was 72Gy, and the median patient age was 69years. The average initial PSA (iPSA) was 7.1ng/ml and 90% were clinical stage T1-T2. Androgen deprivation therapy was used in some form in only 16% for a median length of 7.7 months.

Using the Phoenix definition, 389 patients (21%) had BF, 84 men (4.6%) had DM, and 48 men (3%) died of CaP. The Phoenix definition as a time-dependent covariate in multivariate analysis was the most significant predictor of DM, CSM, and OM. On multivariate analysis for OM, the authors report that BF, age, Gleason score, and stage were all found to significantly increase the hazard ratio for death. Stage and Gleason score were also predictive of DM, CSM, and OM. iPSA was not found to predict for DM, CSM, or OM.

Using the ASTRO definition, 460 patients (25%) had BF. Regarding DM, ASTRO BF, Gleason score, and stage were significant predictors. For CSM, ASTRO BF, iPSA, stage and, Gleason score were predictive. The ASTRO definition was not found to be an independent predictor of OM but age, iPSA, Gleason score, stage and XRT dose were.

This study is the first to demonstrate that the Phoenix definition of BF is superior to the ASTRO definition with regard to early prediction of OM, CSM, and DM.

Abramowitz MC, Li T, Buyyounouski MK, Ross E, Uzzo RG, Pollack A, Horwitz EM

Cancer. October 29, 2007
DOI: 10.1002/cncr.23139

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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