What happens to men with prostate cancer whose PSA starts to rise while on neo-adjuvant androgen ablation therapy prior to external radiation?
Bibliographic record
Abstract
4644 Background: The purpose of this study is to assess the impact of a rising PSA after an initial response while on neo-adjuvant androgen ablation (NAAA) prior to external beam radiation therapy (EBRT) for prostate cancer. Methods: Between January 1995 and June 2000, from a prospectively collected database of 858 patients, we identified 183 patients who received between 3 and 12 months of NAAA prior to definitive EBRT and who had at least three PSA readings during this time. 151 (82.5%) had PSA values which continued to fall (Group 1) but 32 patients (17.5%) had a PSA that started to rise, after an initial fall (Group 2). A rise was defined as a PSA above the previous level, of magnitude at least 2 standard deviations greater than the assay sensitivity. The two groups were compared using Mann Whitney U and Pearson Chi squared tests. Kaplan-Meier and Log Rank analyses were performed for biochemical failure (bNED, using the Houston criterion), cause-specific survival (CSS) and overall survival (OS). Results: There was no statistically significant difference between the two groups in terms of radiation dose (68Gy), duration of hormonal therapy, T stage, Gleason score or risk group stratification. Base-line PSA, prior to any treatment, was significantly higher in Group 2 (median 21 v 13, p=0.017) and men in this group were 2.5 years younger (p= 0.02). The era of treatment was the same for both groups and the median follow-up was 63.5 months for Group 1 and 50 months for Group 2. Patients who sustained a PSA rise during the NAAA period had an increased incidence of PSA relapse (bNED 41% v 57% at 7 years, p=0.018), a trend towards poorer CSS (7 year rate 79% v 88%, p=0.091), and poorer overall survival (66% v 81%, p=0.037 at 7 years). Conclusions: A subset of patients treated with NAAA prior to EBRT develop a rising PSA profile that may represent androgen resistance. This is associated with a significantly worse outcome. PSA monitoring during the NA period is recommended. Such men may benefit from intensification of therapy and/or experimental intervention such as clustering anti-sense oligonucleotide therapy. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".