The “c” word.

Top Line: The vast majority of men treated with brachytherapy for prostate cancer see a PSA nadir ≤0.2.
The Study: But what level should we be looking to achieve? This large multi-institution retrospective review of PSA nadir following LDR brachy with (n=2503) or without (n=11,717) external beam radiation for prostate cancer of all risk levels asks what PSA level at 4 years indicates long term disease control. That means patients who recurred before 4 years were excluded. Why the somewhat arbitrary timepoint? To avoid the messiness of benign PSA bounces. First of all, 77% of remaining patients had a PSA ≤0.2 at 4 years, and they achieved remarkable rates free from recurrence at 10 and 15 years, respectively, at 99% and 96%. Those rates following a 4-year PSA of >0.2-0.5 were 94% and 87%, following a 4-year PSA of >0.5-1.0 were 86% and 78%, and a following a 4-year PSA of >1.0 were 48% and 33%.
TBL: The authors suggest a PSA level ≤0.2 at 4 years out from brachytherapy indicates, that’s right, a cure from prostate cancer. | Crook, Radiother Oncol 2020



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