The prognostic impact of prostate-specific antigen at 6 months after post-prostatectomy radiotherapy: An individual patient data analysis of two NRG oncology randomized trials.
Bibliographic record
Abstract
254 Background: We sought to evaluate the prognostic impact of prostate-specific antigen (PSA) within 6 months of completion of salvage radiotherapy (RT) in patients treated with RT with or without hormone therapy (HT). Methods: Individual patient data were obtained from 2 randomized trials (NRG’s RTOG 0534 and RTOG 9601) evaluating salvage RT with or without HT. HT was either androgen deprivation therapy (ADT) for 4-6 months or bicalutamide for 2 years. The lowest PSA recorded within 6 months after RT completion was identified and categorized as ≤ or >0.1 ng/mL. The primary outcomes were metastasis-free survival (MFS) and overall survival (OS). Multivariable Cox proportional hazards regression was used to estimate hazard ratio (HR) with 95% confidence intervals to characterize the association of PSA within 6 months post-RT completion with OS and MFS while adjusting for age, Gleason score, trial, and HT use. Five-year MFS and 10-year OS rates were estimated using the Kaplan-Meier method. Results: Among a total of 2,373 patients, 1833 (77%) patients achieved a nadir PSA ≤0.1 and 540 (23%) did not. Among patients who did not get HT, 50% did not reach the milestone compared to only 6% of patients who got HT. PSA ≤0.1 ng/mL was associated with better OS (HR 0.27 [95% CI 0.12-0.6], p=0.001) and better MFS (HR 0.25 [95% CI 0.13-0.47], p<0.0001). The interaction test showed that the improved OS/MFS in patients who achieved the nadir was more prominent in those who did not receive HT compared to those who received HT. Five-year MFS rates among patients allocated to RT, RT+ADT, and RT+ bicalutamide were 94% vs 81%, 92% vs 87%, and 91% vs 93%, respectively, based on PSA ≤ vs >0.1. Ten-year OS rates among patients allocated to RT, RT+ADT, and RT+ bicalutamide were 87% vs 76%, 84% vs 84%, and 82% vs 83%, respectively, based on PSA ≤ vs >0.1. Conclusions: PSA >0.1 ng/mL within 6 months was prognostic for OS and MFS in patients treated with salvage RT in the post-prostatectomy setting. This finding allows better patient counseling and can guide clinical trial design for treatment intensification or de-intensification in patients receiving salvage RT.
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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 | 0.032 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.011 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".