Why are pretreatment prostate-specific antigen levels and biochemical recurrence poor predictors of prostate cancer survival?

Abstract

BACKGROUND: The value of pretreatment (initial) prostate-specific antigen (iPSA) and biochemical recurrence (BR) as prognostic factors for survival remains unclear. The authors sought to determine why using randomized trial data with 7-year minimum follow-up. METHODS: In the Trans-Tasman Radiation Oncology Group 96.01 trial, 802 men with T2b, T2c, T3, or T4 N0 prostate cancer (PC) were randomized to radiotherapy alone or with 3 or 6 months neoadjuvant androgen deprivation between 1996 and 2000. Cox modeling was used to identify outcome predictors at follow-up landmark points. RESULTS: Higher iPSA was found to be a potent predictor of BR-free survival (P /=4 years; however, it dropped to 44% ..