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Anthony V Damico - One of the best experts on this subject based on the ideXlab platform.

  • time to prostate specific antigen Nadir and the risk of death from prostate cancer following radiation and androgen deprivation therapy
    Urology, 2019
    Co-Authors: Minghui Chen, Luke R G Pike, Jing Wu, Marian Loffredo, Andrew A Renshaw, John Pfail, Philip W Kantoff, Anthony V Damico
    Abstract:

    Abstract Objective To assess whether the time to prostate-specific antigen (PSA) Nadir (TTN) has differential prognostic value in men who reach an undetectable vs detectable PSA Nadir. Methods Two hundred and four men from a prospective randomized controlled trial involving radiation therapy with or without 6 months of androgen deprivation therapy in unfavorable risk Prostate cancer (CaP) at academic or community based centers in Massachusetts, enrolled between 1995 and 2001. Adjusted hazard ratios (AHR) of the risk of CaP-specific mortality calculated using Fine and Gray competing risk regression. Results After a median follow-up of 18.17years, 160 men died; 30 (18.75%) of CaP. Among men with a PSA Nadir ≥ 0.2ng/ml, a TTN Conclusion Men with both a short TTN and detectable PSA Nadir could be considered for entry on randomized controlled trials at a novel entry point prior to PSA failure at the time of PSA Nadir to completeplanned conventional androgen deprivation therapy vs that plus agent(s) shown to improve outcomes in men with or at high risk of having castrate-resistant CaP.

  • time to psa Nadir and the risk of death from prostate cancer following radiation and androgen deprivation therapy
    Journal of Clinical Oncology, 2019
    Co-Authors: Luke R G Pike, Minghui Chen, Jing Wu, Marian Loffredo, Andrew A Renshaw, John Pfail, Philip W Kantoff, Anthony V Damico
    Abstract:

    4Background: Whether the time to PSA Nadir (TTN) has differential prognostic value in men who reach an undetectable versus detectable PSA Nadir remains unknown. Methods: Two-hundred and four men fr...

  • time to prostate specific antigen Nadir after androgen suppression therapy for postoperative or postradiation psa failure and risk of prostate cancer specific mortality
    Urology, 2008
    Co-Authors: Christine S Chung, Minghui Chen, Jennifer Cullen, David G Mcleod, Peter R Carroll, Anthony V Damico
    Abstract:

    OBJECTIVES To examine whether the time to the prostate-specific antigen (PSA) Nadir was associated with prostate cancer-specific mortality (PCSM) in men with PSA failure after radical prostatectomy or radiotherapy who do not achieve an undetectable PSA level (PSA level of 0.2 ng/mL or less) after 8 months of androgen suppression therapy (AST). METHODS The cohort included 162 men with localized prostate cancer treated with AST for an increasing PSA level after radical prostatectomy or radiotherapy. Gray's analysis was used to evaluate for an association between the time to PSA Nadir after 8 months of AST and the time to PCSM, adjusting for established prognostic factors. The median age and follow-up after 8 months of AST was 71.2 and 1.8 years, respectively. RESULTS After adjusting for Gleason score, pre-AST PSA doubling time, PSA at AST, PSA Nadir value, time to PSA failure, initial treatment, and age, the time to PSA Nadir was significantly associated with PCSM (adjusted hazard ratio 2.53, 95% confidence interval 1.24 to 5.14, P = 0.01). Men with a PSA Nadir greater than the median value of 0.9 ng/mL and the time to PSA Nadir longer than the median of 4 months had significantly greater PCSM estimates (P <0.001) compared with men with a PSA Nadir of 0.9 ng/mL or less. CONCLUSIONS The time to PSA Nadir, combined with the PSA Nadir level, can be used to identify men who are at high risk of PCSM after a short course of AST for entry onto clinical trials using novel systemic agents with AST.

Christopher L. Amling - One of the best experts on this subject based on the ideXlab platform.

  • Timing of Prostate-specific Antigen Nadir After Radical Prostatectomy and Risk of Biochemical Recurrence.
    Urology, 2017
    Co-Authors: Stephanie L. Skove, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Lauren E. Howard, Matthew R. Cooperberg, Daniel M. Moreira, Stephen J. Freedland
    Abstract:

    Objective To evaluate the association between the prostate-specific antigen (PSA) Nadir level and the time to Nadir (TTN) with biochemical recurrence (BCR) risk after radical prostatectomy (RP) in the Shared Equal-Access Research Cancer Hospital (SEARCH) database. Materials and Methods This is a retrospective analysis of 1939 men from the SEARCH database treated with RP between 1998 and 2015 with available ultrasensitive PSA Nadir within 1-6 months after RP. Uni- and multivariable analyses of PSA Nadir and TTN with time from Nadir to BCR were performed with Cox models (adjusted for demographics, tumor features, and preoperative PSA). Results Among men with an undetectable PSA Nadir, the TTN was unrelated to BCR (1.0-2.9 vs 3-6 months: hazard ratio [HR] 0.86, P = .46). Regardless of TTN, men with detectable Nadir had an increased risk of BCR (TTN of 3-6 months: HR 1.81, P = .024; TTN of 1.0-2.99 months: HR 3.75, P  Conclusion In the post-RP setting, men with both a detectable Nadir and a shorter TTN had an increased risk of BCR. Intriguingly, about half of the men with a detectable PSA in the first 3 months after RP had a lower PSA level during follow-up between 3 and 6 months after RP. If confirmed in future studies, this has important implications for patients considering adjuvant therapy based on postoperative PSA values in the first 3 months after RP.

  • detectable prostate specific antigen Nadir during androgen deprivation therapy predicts adverse prostate cancer specific outcomes results from the search database
    European Urology, 2014
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • Detectable Prostate-Specific Antigen Nadir During Androgen-Deprivation Therapy Predicts Adverse Prostate Cancer–Specific Outcomes: Results from the SEARCH Database
    European urology, 2012
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • obesity prostate specific antigen Nadir and biochemical recurrence after radical prostatectomy biology or technique results from the search database
    European Urology, 2012
    Co-Authors: William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Leah R Gerber, Christopher L. Amling
    Abstract:

    Abstract Background Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective To examine whether obesity predicts higher prostate-specific antigen (PSA) Nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration–based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention All patients underwent RP. Outcome measurements and statistical analysis We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA Nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA Nadir. Results and limitations Mean BMI was 28.5kg/m 2 . Higher BMI was associated with higher PSA Nadir on both univariable ( p =0.001) and multivariable analyses ( p p =0.007). Adjusting for PSA Nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p =0.043). When stratified by PSA Nadir, obesity only significantly predicted BCR in men with an undetectable Nadir ( p =0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions Obese men are more likely to have a higher PSA Nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA Nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.

William J. Aronson - One of the best experts on this subject based on the ideXlab platform.

  • Timing of Prostate-specific Antigen Nadir After Radical Prostatectomy and Risk of Biochemical Recurrence.
    Urology, 2017
    Co-Authors: Stephanie L. Skove, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Lauren E. Howard, Matthew R. Cooperberg, Daniel M. Moreira, Stephen J. Freedland
    Abstract:

    Objective To evaluate the association between the prostate-specific antigen (PSA) Nadir level and the time to Nadir (TTN) with biochemical recurrence (BCR) risk after radical prostatectomy (RP) in the Shared Equal-Access Research Cancer Hospital (SEARCH) database. Materials and Methods This is a retrospective analysis of 1939 men from the SEARCH database treated with RP between 1998 and 2015 with available ultrasensitive PSA Nadir within 1-6 months after RP. Uni- and multivariable analyses of PSA Nadir and TTN with time from Nadir to BCR were performed with Cox models (adjusted for demographics, tumor features, and preoperative PSA). Results Among men with an undetectable PSA Nadir, the TTN was unrelated to BCR (1.0-2.9 vs 3-6 months: hazard ratio [HR] 0.86, P = .46). Regardless of TTN, men with detectable Nadir had an increased risk of BCR (TTN of 3-6 months: HR 1.81, P = .024; TTN of 1.0-2.99 months: HR 3.75, P  Conclusion In the post-RP setting, men with both a detectable Nadir and a shorter TTN had an increased risk of BCR. Intriguingly, about half of the men with a detectable PSA in the first 3 months after RP had a lower PSA level during follow-up between 3 and 6 months after RP. If confirmed in future studies, this has important implications for patients considering adjuvant therapy based on postoperative PSA values in the first 3 months after RP.

  • detectable prostate specific antigen Nadir during androgen deprivation therapy predicts adverse prostate cancer specific outcomes results from the search database
    European Urology, 2014
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • Detectable Prostate-Specific Antigen Nadir During Androgen-Deprivation Therapy Predicts Adverse Prostate Cancer–Specific Outcomes: Results from the SEARCH Database
    European urology, 2012
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • obesity prostate specific antigen Nadir and biochemical recurrence after radical prostatectomy biology or technique results from the search database
    European Urology, 2012
    Co-Authors: William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Leah R Gerber, Christopher L. Amling
    Abstract:

    Abstract Background Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective To examine whether obesity predicts higher prostate-specific antigen (PSA) Nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration–based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention All patients underwent RP. Outcome measurements and statistical analysis We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA Nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA Nadir. Results and limitations Mean BMI was 28.5kg/m 2 . Higher BMI was associated with higher PSA Nadir on both univariable ( p =0.001) and multivariable analyses ( p p =0.007). Adjusting for PSA Nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p =0.043). When stratified by PSA Nadir, obesity only significantly predicted BCR in men with an undetectable Nadir ( p =0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions Obese men are more likely to have a higher PSA Nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA Nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.

Martha K. Terris - One of the best experts on this subject based on the ideXlab platform.

  • Timing of Prostate-specific Antigen Nadir After Radical Prostatectomy and Risk of Biochemical Recurrence.
    Urology, 2017
    Co-Authors: Stephanie L. Skove, William J. Aronson, Martha K. Terris, Christopher J. Kane, Christopher L. Amling, Lauren E. Howard, Matthew R. Cooperberg, Daniel M. Moreira, Stephen J. Freedland
    Abstract:

    Objective To evaluate the association between the prostate-specific antigen (PSA) Nadir level and the time to Nadir (TTN) with biochemical recurrence (BCR) risk after radical prostatectomy (RP) in the Shared Equal-Access Research Cancer Hospital (SEARCH) database. Materials and Methods This is a retrospective analysis of 1939 men from the SEARCH database treated with RP between 1998 and 2015 with available ultrasensitive PSA Nadir within 1-6 months after RP. Uni- and multivariable analyses of PSA Nadir and TTN with time from Nadir to BCR were performed with Cox models (adjusted for demographics, tumor features, and preoperative PSA). Results Among men with an undetectable PSA Nadir, the TTN was unrelated to BCR (1.0-2.9 vs 3-6 months: hazard ratio [HR] 0.86, P = .46). Regardless of TTN, men with detectable Nadir had an increased risk of BCR (TTN of 3-6 months: HR 1.81, P = .024; TTN of 1.0-2.99 months: HR 3.75, P  Conclusion In the post-RP setting, men with both a detectable Nadir and a shorter TTN had an increased risk of BCR. Intriguingly, about half of the men with a detectable PSA in the first 3 months after RP had a lower PSA level during follow-up between 3 and 6 months after RP. If confirmed in future studies, this has important implications for patients considering adjuvant therapy based on postoperative PSA values in the first 3 months after RP.

  • detectable prostate specific antigen Nadir during androgen deprivation therapy predicts adverse prostate cancer specific outcomes results from the search database
    European Urology, 2014
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • Detectable Prostate-Specific Antigen Nadir During Androgen-Deprivation Therapy Predicts Adverse Prostate Cancer–Specific Outcomes: Results from the SEARCH Database
    European urology, 2012
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • obesity prostate specific antigen Nadir and biochemical recurrence after radical prostatectomy biology or technique results from the search database
    European Urology, 2012
    Co-Authors: William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Leah R Gerber, Christopher L. Amling
    Abstract:

    Abstract Background Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective To examine whether obesity predicts higher prostate-specific antigen (PSA) Nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration–based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention All patients underwent RP. Outcome measurements and statistical analysis We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA Nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA Nadir. Results and limitations Mean BMI was 28.5kg/m 2 . Higher BMI was associated with higher PSA Nadir on both univariable ( p =0.001) and multivariable analyses ( p p =0.007). Adjusting for PSA Nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p =0.043). When stratified by PSA Nadir, obesity only significantly predicted BCR in men with an undetectable Nadir ( p =0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions Obese men are more likely to have a higher PSA Nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA Nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.

Joseph C. Presti - One of the best experts on this subject based on the ideXlab platform.

  • detectable prostate specific antigen Nadir during androgen deprivation therapy predicts adverse prostate cancer specific outcomes results from the search database
    European Urology, 2014
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • Detectable Prostate-Specific Antigen Nadir During Androgen-Deprivation Therapy Predicts Adverse Prostate Cancer–Specific Outcomes: Results from the SEARCH Database
    European urology, 2012
    Co-Authors: Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland
    Abstract:

    Abstract Background A prostate-specific antigen (PSA) level Objective We examined the predictive value of small but detectable PSA Nadir values on prostate cancer (PCa)–specific outcomes in men treated with early ADT after radical prostatectomy (RP). Design, setting, and participants We performed a retrospective review of men treated with ADT after RP before metastases from the SEARCH database. We identified 402 men treated with ADT for elevated PSA following RP, of whom 294 men had complete data. Median follow-up after PSA Nadir was 49 mo. All men had a PSA Nadir Intervention ADT for an elevated PSA following RP with no radiographic evidence of metastatic disease. Outcome measurements and statistical analysis PSA Nadir on ADT was defined as the lowest PSA value during ADT. Proportional hazards models and the C index were used to test the association and predictive accuracy, respectively, between PSA Nadir and PCa-specific outcomes. Results and limitations Men with a PSA Nadir between 0.01 and 0.2 ng/ml had a greater risk of progression to castration-resistant PCa (CRPC) (hazard ratio [HR]: 5.14; p p =0.006), and PCa-specific mortality (PCSM) (HR: 5.33; p =0.003) than men with an undetectable Nadir. When data were restricted to men followed with ultrasensitive PSA values (sensitivity of 0.01 ng/ml), the C index of PSA Nadir alone for predicting CRPC, metastases, and PCSM was 0.88, 0.91, and 0.96, respectively. Conclusions A PSA Nadir on ADT, even at a very low level, strongly predicts progression to CRPC, metastases, and PCSM. Men with a detectable PSA Nadir during ADT should be considered for clinical trials.

  • obesity prostate specific antigen Nadir and biochemical recurrence after radical prostatectomy biology or technique results from the search database
    European Urology, 2012
    Co-Authors: William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher J. Kane, Leah R Gerber, Christopher L. Amling
    Abstract:

    Abstract Background Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective To examine whether obesity predicts higher prostate-specific antigen (PSA) Nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration–based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention All patients underwent RP. Outcome measurements and statistical analysis We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA Nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA Nadir. Results and limitations Mean BMI was 28.5kg/m 2 . Higher BMI was associated with higher PSA Nadir on both univariable ( p =0.001) and multivariable analyses ( p p =0.007). Adjusting for PSA Nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p =0.043). When stratified by PSA Nadir, obesity only significantly predicted BCR in men with an undetectable Nadir ( p =0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions Obese men are more likely to have a higher PSA Nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA Nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.