Racial differences in the PSA bounce in predicting prostate cancer outcomes after brachytherapy: Evidence from the Department of Veterans Affairs
African American men have historically had poorer prostate cancer biochemical and survival outcomes than Caucasians. However, emerging data suggest nononcologic factors drive much of this disparity. Prior evidence has suggested an association between a transient prostate specific antigen (PSA) bounc...
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description | African American men have historically had poorer prostate cancer biochemical and survival outcomes than Caucasians. However, emerging data suggest nononcologic factors drive much of this disparity. Prior evidence has suggested an association between a transient prostate specific antigen (PSA) bounce and improved biochemical control. However, racial differences in this relationship have remained relatively unexplored.
We identified 4477 men treated for low- or intermediate-risk prostate cancer within the U.S. Department of Veterans Affairs (VA) from 2000 to 2010 with brachytherapy alone or in combination with external beam radiotherapy without androgen deprivation. Longitudinal PSA data were used to define to biochemical failure and PSA bounce. Cox proportional hazard models were used explore racial differences in the relationship between the PSA bounce and time to biochemical failure.
Thirty-one percent of our sample experienced a PSA bounce, with African Americans more likely to experience a bounce (42%) compared with Caucasians (29%); p < 0.001. Despite this, African Americans had a higher likelihood of biochemical failure (hazard ratio [HR] 1.4; p = 0.006). However, African American men experiencing a PSA bounce were less likely to experience a biochemical failure (HR = 0.64; p = 0.046), whereas this relationship was not statistically significant for Caucasians (HR = 0.78; p = 0.092). On multivariate analysis, African Americans receiving brachytherapy alone were most sensitive to the protective benefit of the PSA bounce (HR = 0.64).
A PSA bounce was associated with improved biochemical control among patients receiving brachytherapy as part of their treatment for low- or intermediate-risk prostate cancer at the VA. African American men treated with brachytherapy had a particularly pronounced biochemical control benefit of a PSA bounce. |
doi_str_mv | 10.1016/j.brachy.2019.08.008 |
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We identified 4477 men treated for low- or intermediate-risk prostate cancer within the U.S. Department of Veterans Affairs (VA) from 2000 to 2010 with brachytherapy alone or in combination with external beam radiotherapy without androgen deprivation. Longitudinal PSA data were used to define to biochemical failure and PSA bounce. Cox proportional hazard models were used explore racial differences in the relationship between the PSA bounce and time to biochemical failure.
Thirty-one percent of our sample experienced a PSA bounce, with African Americans more likely to experience a bounce (42%) compared with Caucasians (29%); p < 0.001. Despite this, African Americans had a higher likelihood of biochemical failure (hazard ratio [HR] 1.4; p = 0.006). However, African American men experiencing a PSA bounce were less likely to experience a biochemical failure (HR = 0.64; p = 0.046), whereas this relationship was not statistically significant for Caucasians (HR = 0.78; p = 0.092). On multivariate analysis, African Americans receiving brachytherapy alone were most sensitive to the protective benefit of the PSA bounce (HR = 0.64).
A PSA bounce was associated with improved biochemical control among patients receiving brachytherapy as part of their treatment for low- or intermediate-risk prostate cancer at the VA. African American men treated with brachytherapy had a particularly pronounced biochemical control benefit of a PSA bounce.</description><identifier>ISSN: 1538-4721</identifier><identifier>EISSN: 1873-1449</identifier><identifier>DOI: 10.1016/j.brachy.2019.08.008</identifier><identifier>PMID: 31611160</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>African Americans ; Aged ; Biochemical failure ; Brachytherapy ; European Continental Ancestry Group ; Humans ; Kallikreins - blood ; Life Sciences & Biomedicine ; Male ; Middle Aged ; Oncology ; Predictive Value of Tests ; Proportional Hazards Models ; Prostate brachytherapy ; Prostate-Specific Antigen - blood ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - ethnology ; Prostatic Neoplasms - radiotherapy ; PSA bounce ; Racial disparities ; Radiology, Nuclear Medicine & Medical Imaging ; Science & Technology ; Treatment Outcome ; United States ; United States Department of Veterans Affairs ; Veterans affairs</subject><ispartof>Brachytherapy, 2020-01, Vol.19 (1), p.6-12</ispartof><rights>2020 American Brachytherapy Society</rights><rights>Copyright © 2020 American Brachytherapy Society. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>5</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000512217700002</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c463t-b29365cdef673452a2d8943f96cae4b3be209047731d69d8256573dcbcede21e3</citedby><cites>FETCH-LOGICAL-c463t-b29365cdef673452a2d8943f96cae4b3be209047731d69d8256573dcbcede21e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.brachy.2019.08.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,781,785,886,3551,27929,27930,28253,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31611160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Slade, Alexander N.</creatorcontrib><creatorcontrib>Dahman, Bassam</creatorcontrib><creatorcontrib>Chang, Michael G.</creatorcontrib><title>Racial differences in the PSA bounce in predicting prostate cancer outcomes after brachytherapy: Evidence from the Department of Veterans Affairs</title><title>Brachytherapy</title><addtitle>BRACHYTHERAPY</addtitle><addtitle>Brachytherapy</addtitle><description>African American men have historically had poorer prostate cancer biochemical and survival outcomes than Caucasians. However, emerging data suggest nononcologic factors drive much of this disparity. Prior evidence has suggested an association between a transient prostate specific antigen (PSA) bounce and improved biochemical control. However, racial differences in this relationship have remained relatively unexplored.
We identified 4477 men treated for low- or intermediate-risk prostate cancer within the U.S. Department of Veterans Affairs (VA) from 2000 to 2010 with brachytherapy alone or in combination with external beam radiotherapy without androgen deprivation. Longitudinal PSA data were used to define to biochemical failure and PSA bounce. Cox proportional hazard models were used explore racial differences in the relationship between the PSA bounce and time to biochemical failure.
Thirty-one percent of our sample experienced a PSA bounce, with African Americans more likely to experience a bounce (42%) compared with Caucasians (29%); p < 0.001. Despite this, African Americans had a higher likelihood of biochemical failure (hazard ratio [HR] 1.4; p = 0.006). However, African American men experiencing a PSA bounce were less likely to experience a biochemical failure (HR = 0.64; p = 0.046), whereas this relationship was not statistically significant for Caucasians (HR = 0.78; p = 0.092). On multivariate analysis, African Americans receiving brachytherapy alone were most sensitive to the protective benefit of the PSA bounce (HR = 0.64).
A PSA bounce was associated with improved biochemical control among patients receiving brachytherapy as part of their treatment for low- or intermediate-risk prostate cancer at the VA. African American men treated with brachytherapy had a particularly pronounced biochemical control benefit of a PSA bounce.</description><subject>African Americans</subject><subject>Aged</subject><subject>Biochemical failure</subject><subject>Brachytherapy</subject><subject>European Continental Ancestry Group</subject><subject>Humans</subject><subject>Kallikreins - blood</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Prostate brachytherapy</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - ethnology</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>PSA bounce</subject><subject>Racial disparities</subject><subject>Radiology, Nuclear Medicine & Medical Imaging</subject><subject>Science & Technology</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans affairs</subject><issn>1538-4721</issn><issn>1873-1449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNUduO0zAQjRCIXRb-ACE_IqEUXxIn4QGpKruAtBKI26vl2OOtqybu2k5RP2P_mCktBV4QTx7PnHM8PqconjI6Y5TJl6tZH7VZ7macsm5G2xml7b3inLWNKFlVdfexrkVbVg1nZ8WjlFYUaZ0QD4szwSRjTNLz4u6TNl6vifXOQYTRQCJ-JHkJ5OPnOenDhK19ZxPBepP9eINlSFlnIEbjMJIwZRMGJGqX8XpYCxWi3uxekcutt3td4mIYfgq_gY2OeYAxk-DIN0CSHhOZO6d9TI-LB06vEzw5nhfF16vLL4t35fWHt-8X8-vSVFLksuedkLWx4GQjqpprbtuuEq6TRkPVix447WjVNIJZ2dmW17JuhDW9AQucgbgoXh90N1M_gDW4TtRrtYl-0HGngvbq78nol-ombFXT1UwIigLPjwIx3E6Qshp8MrBe6xHClBQXtG6poJIjtDpADVqXIrjTM4yqfZpqpQ62qX2airYK00Tasz9XPJF-xYeA9gD4Dn1wyfi90ScYpbRmnLOmwYryhcfQfBgXmGlG6ov_p_42CzCRrYeojgzrI5isbPD__soPql_W9Q</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Slade, Alexander N.</creator><creator>Dahman, Bassam</creator><creator>Chang, Michael G.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200101</creationdate><title>Racial differences in the PSA bounce in predicting prostate cancer outcomes after brachytherapy: Evidence from the Department of Veterans Affairs</title><author>Slade, Alexander N. ; Dahman, Bassam ; Chang, Michael G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-b29365cdef673452a2d8943f96cae4b3be209047731d69d8256573dcbcede21e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>African Americans</topic><topic>Aged</topic><topic>Biochemical failure</topic><topic>Brachytherapy</topic><topic>European Continental Ancestry Group</topic><topic>Humans</topic><topic>Kallikreins - blood</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Prostate brachytherapy</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - ethnology</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>PSA bounce</topic><topic>Racial disparities</topic><topic>Radiology, Nuclear Medicine & Medical Imaging</topic><topic>Science & Technology</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans affairs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Slade, Alexander N.</creatorcontrib><creatorcontrib>Dahman, Bassam</creatorcontrib><creatorcontrib>Chang, Michael G.</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Brachytherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Slade, Alexander N.</au><au>Dahman, Bassam</au><au>Chang, Michael G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial differences in the PSA bounce in predicting prostate cancer outcomes after brachytherapy: Evidence from the Department of Veterans Affairs</atitle><jtitle>Brachytherapy</jtitle><stitle>BRACHYTHERAPY</stitle><addtitle>Brachytherapy</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>19</volume><issue>1</issue><spage>6</spage><epage>12</epage><pages>6-12</pages><issn>1538-4721</issn><eissn>1873-1449</eissn><abstract>African American men have historically had poorer prostate cancer biochemical and survival outcomes than Caucasians. However, emerging data suggest nononcologic factors drive much of this disparity. Prior evidence has suggested an association between a transient prostate specific antigen (PSA) bounce and improved biochemical control. However, racial differences in this relationship have remained relatively unexplored.
We identified 4477 men treated for low- or intermediate-risk prostate cancer within the U.S. Department of Veterans Affairs (VA) from 2000 to 2010 with brachytherapy alone or in combination with external beam radiotherapy without androgen deprivation. Longitudinal PSA data were used to define to biochemical failure and PSA bounce. Cox proportional hazard models were used explore racial differences in the relationship between the PSA bounce and time to biochemical failure.
Thirty-one percent of our sample experienced a PSA bounce, with African Americans more likely to experience a bounce (42%) compared with Caucasians (29%); p < 0.001. Despite this, African Americans had a higher likelihood of biochemical failure (hazard ratio [HR] 1.4; p = 0.006). However, African American men experiencing a PSA bounce were less likely to experience a biochemical failure (HR = 0.64; p = 0.046), whereas this relationship was not statistically significant for Caucasians (HR = 0.78; p = 0.092). On multivariate analysis, African Americans receiving brachytherapy alone were most sensitive to the protective benefit of the PSA bounce (HR = 0.64).
A PSA bounce was associated with improved biochemical control among patients receiving brachytherapy as part of their treatment for low- or intermediate-risk prostate cancer at the VA. African American men treated with brachytherapy had a particularly pronounced biochemical control benefit of a PSA bounce.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>31611160</pmid><doi>10.1016/j.brachy.2019.08.008</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | African Americans Aged Biochemical failure Brachytherapy European Continental Ancestry Group Humans Kallikreins - blood Life Sciences & Biomedicine Male Middle Aged Oncology Predictive Value of Tests Proportional Hazards Models Prostate brachytherapy Prostate-Specific Antigen - blood Prostatic Neoplasms - blood Prostatic Neoplasms - ethnology Prostatic Neoplasms - radiotherapy PSA bounce Racial disparities Radiology, Nuclear Medicine & Medical Imaging Science & Technology Treatment Outcome United States United States Department of Veterans Affairs Veterans affairs |
title | Racial differences in the PSA bounce in predicting prostate cancer outcomes after brachytherapy: Evidence from the Department of Veterans Affairs |
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