Soumyajit Roy, Assistant Professor and Physician Scientist at University Hospitals, shared on LinkedIn:
“Two papers in localized prostate cancer in the same week, asking two sides of the same question: what does PSA actually tell us after curative-intent radiotherapy for prostate cancer?
In our new Red Journal paper, we examined PSA kinetics after testosterone recovery following radiotherapy + ADT.
The central finding was that faster PSA kinetics were directionally associated with progression, but their relationship with distant metastasis was inconsistent and imprecise.
The implication is important: a rising PSA trajectory after testosterone recovery should not automatically be interpreted as equivalent to metastatic potential.
Our RAPTOR study, now published in European Urology Oncology, approached the question from the other end of the timeline: if a patient remains free of biochemical recurrence for years after radiotherapy, when can we begin to think about ‘functional cure’?
Using individual-patient data from 3,120 men across 11 randomized trials, we found that among men with intermediate-risk prostate cancer treated with high-dose radiotherapy alone, remaining BCR-free at 5 years was associated with an 8-year distant metastasis risk of 6.6% and 10-year prostate cancer–specific mortality of just 2.5%.
In the higher-risk cohorts treated with short- or long-term ADT, however, residual metastatic risk remained above 10% despite being BCR-free at 5 years.
Taken together, these two studies reinforce a concept that I think will become increasingly important: PSA is not simply ‘recurrent versus not recurrent.’
Its prognostic meaning is dynamic and context-dependent and shaped by timing, testosterone recovery, baseline disease risk, treatment intensity, and, critically, the clinical outcome we are trying to predict.
The next step is to move beyond isolated PSA thresholds toward dynamic, individualized risk assessment, integrating longitudinal PSA behavior with clinical, molecular, imaging, and other biomarkers.
Very grateful to all of our collaborators, statisticians, trial investigators, and, most importantly, the patients whose participation made these studies possible.
And somehow, these are two of three papers published this week. Quite a week for our prostate cancer biomarker work!”
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Title: Differential Association of Post–Testosterone Recovery PSA Kinetics with Progression and Metastatic Outcomes in Non-metastatic Prostate Cancer
Authors: Samuel Lichtman-Mikol, Serageldin Kamel Attia, Yilun Sun, Shawn Malone, Scott Grimes, Amar U. Kishan, Nicholas G. Zaorsky, Daniel E. Spratt, Scott C. Morgan, Angela Y. Jia, Soumyajit Roy
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Title: Natural History After Likely Cure Versus Recurrence After Prostate Radiotherapy (RAPTOR)
Authors: Soumyajit Roy, Tahmineh Romero, Mack Roach, III, Jeff M. Michalski, David J. Joseph, David Dearnaley, Alison C. Tree, Emma Hall, Matthew R. Sydes, Luca Incrocci, Wilma Heemsbergen, Floris de Pos, Michel Bolla, Philippe Maingon, Theo de Reijke, Abdenour Nabid, John G. Armstrong, Scott C. Morgan, Xavier Maldonado, Wee L. Ong, Jarad Martin, Eric M. Horwitz, Jessica K. Wong, Michael Steinberg, Luca Valle, Kekoa Taparra, Angela Y. Jia, Nicholas G. Zaorsky, Stefano Arcangeli, Giuseppe Sanguineti, Almudena Zapatero, Howard Sandler, Paul L. Nguyen, Yilun Sun, Daniel E. Spratt, Amar U. Kishan
You can also read:
NRG-GU005: SBRT vs Moderately Hypofractionated IMRT in Localized Prostate Cancer
