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Abstract
BACKGROUND:
To evaluate the treatment outcome and prostate-specific antigen (PSA) change after stereotactic body radiotherapy (SBRT) for localized prostate cancer.

METHODS:
Patients with localized prostate cancer treated with SBRT at three academic hospitals were enrolled. Treatment was delivered using Cyberknife with dose range from 35 to 37.5 Gy in 5 fractions. Biochemical failure (BCF) was assessed with Phoenix definition and toxicities were scored with Radiation Therapy Oncology Group (RTOG) toxicity criteria. The PSA kinetics were analyzed in patients who received no androgen deprivation therapy (ADT) and showed no recurrence.

RESULTS:
Of the total 88 patients, 14 patients (15.9%) received ADT. After median follow-up of 63.8 months, the 5-year BCF free survival (BCFFS) was 94.7%. Two patients experienced late grade ≥ 3 GI toxicities (2.2%). The median nadir PSA was 0.12 ng/mL (range, 0.00-2.62 ng/mL) and the median time to nadir was 44.8 months (range, 0.40-85.7 months). Patients who reached nadir before 24 months showed poorer BCFFS than the others. The rate of PSA decline was maximum in the first year after treatment and gradually decreased with time. The pattern of PSA change was significantly different according to the risk groups (p = 0.011) with the slope of - 0.139, - 0.161 and - 0.253 ng/mL/month in low-, intermediate- and high-risk groups, respectively.

CONCLUSION:
SBRT for localized prostate cancer showed favorable efficacy with minimal toxicities. The time to PSA nadir was significantly associated with treatment outcome. PSA revealed rapid initial decline and slower decrease with longer follow-up and the patterns of PSA changes were different according to the risk groups

Author information

Park Y1, Park HJ2, Jang WI3, Jeong BK4, Kim HJ5, Chang AR6.
1
Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea.
2
Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
4
Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
5
Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea.
6
Department of Radiation Oncology/CyberKnife Center, Soonchunhyang University Seoul Hospital, Daesagwan-ro 59, Youngsan-gu, Seoul, 04401, Republic of Korea. changaram@schmc.ac.kr.