Prostate‐specific antigen recurrence and mortality after conventional dose radiation therapy in select men with low‐risk prostate cancer

BACKGROUND. Prostate‐specific antigen (PSA) recurrence, prostate cancer‐specific mortality (PCSM), and all‐cause mortality (ACM) were evaluated for men age >70 years receiving conventional dose external beam radiation therapy (RT). METHODS. Between January 1, 1989, and December 1, 2002, 358 men were treated with RT for localized prostate cancer at a Harvard Medical School Affiliate in Fall River, MA. Median age was 71.2 (range, 43.2–83.5) years and patients were followed for a median of 4.0 (range, 0.2–13.5) years. RESULTS. Univariable analysis demonstrated that increasing pretreatment PSA velocity was significantly associated with increasing pretreatment PSA ( P < .0001), Gleason score ( P = .0002), and shorter post‐RT PSA doubling time ( P = .0007) but not with clinical T‐category ( P = .09) or percent positive biopsies ( P = .08). For the select cohort of men age >70 years with low‐risk disease and a pretreatment PSA velocity ≤1.0 ng/mL per year, all deaths observed to date have been from nonprostate cancer etiologies. Whereas PSA recurrence in this group reached 43.3% by 7 years, due to the advanced age of the cohort and less aggressive biology, competing causes of mortality predominated as the cause of death despite PSA failure. CONCLUSIONS. In men age >70 years with low‐risk prostate cancer and pretreatment PSA velocity ≤1.0 ng/mL/year, prostate cancer death was not observed despite a modest PSA recurrence rate. Cancer 2006. © 2006 American Cancer Society.