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Prostate Cancer Disease Activity Following Definitive Radiation Therapy in Radical Cystoprostatectomy Specimens
David J Kaplan*, Paul L Crispen, Richard E. Greenberg, David Y.T. Chen, Robert G. Uzzo
Fox Chase Cancer Center, Philadelphia, PA
Introduction:
Prostate cancer(CaP) disease activity following definitive radiation therapy is difficult to define clinically with the use of prostate specific antigen(PSA). Here we investigate the relationship between PSA and CaP activity following definitive radiation therapy in radical cystoprostatectomy(RCP) specimens.
Methods:
A review of our prostate cancer database identified patients receiving definitive radiation therapy for CaP prior to undergoing RCP for invasive bladder cancer. Pre-radiation variables reviewed included: PSA, gleason score, and treatment modality. Post-radiation variables reviewed included: PSA, CaP activity in RCP specimen, and gleason score.
Results:
We identified 18 patients meeting our inclusion criteria. Pre-radiation gleason score was 5(n=2),6(n=7),7(n=4),9(n=1), and unavailable in 4 patients. Average pre-radiation PSA was 14.8(range 3.13-80). 3 patients underwent brachytherapy, 15 patients underwent external beam. Average PSA prior to RCP in all patients was 1.4(range 0.1-6.8). 72%(13/18) of patients demonstrated active CaP in the RCP specimen. Post-radiation gleason score was 5(n=1),6(N=2),7(n=3),8(n=2),9(n=1) and unavailable in 3 patients. Average PSA in patients with active CaP(1.8) at RCP was not significantly different from patients without active CaP(0.5), p=0.28.
Conclusions:
Active CaP was noted at RCP in the majority(72%) of patients despite undergoing definitive radiation therapy. PSA values did not differ significantly between patients with or without active CaP at RCP. The clinical significance of active CaP in this select population is likely inconsequential, however our findings demonstrate the limitations of PSA in monitoring CaP disease activity following definitive radiation therapy.
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