Impact of pathological tumor stage for salvage radiotherapy after radical prostatectomy in patients with prostate-specific antigen &lt; 1.0 ng/ml

Rei Umezawa,Kakutaro Narazaki,Haruo Matsushita,Yoshihiro Ogawa,Masaki Kubozono,Shogo Yamada,Hisanori Ariga,Toru Sakayauchi,Eiji Shimizu,Ken Takeda,Yoshihiro Takai,Keisuke Fujimoto,Keiichi Jingu,Toshiyuki Sugawara

doi:10.1186/1748-717x-6-150

Impact of pathological tumor stage for salvage radiotherapy after radical prostatectomy in patients with prostate-specific antigen < 1.0 ng/ml

Rei Umezawa, Kakutaro Narazaki + Show 12 more

Open Access

https://doi.org/10.1186/1748-717x-6-150

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Journal: Radiation Oncology	Publication Date: Nov 5, 2011
Citations: 41	License type: CC BY 2.0

Affiliation: Tohoku University

Abstract

BackgroundTo evaluate prognostic factors in salvage radiotherapy (RT) for patients with pre-RT prostate-specific antigen (PSA) < 1.0 ng/ml.MethodsBetween January 2000 and December 2009, 102 patients underwent salvage RT for biochemical failure after radical prostatectomy (RP). Re-failure of PSA after salvage RT was defined as a serum PSA value of 0.2 ng/ml or more above the postradiotherapy nadir followed by another higher value, a continued rise in serum PSA despite salvage RT, or initiation of systemic therapy after completion of salvage RT. Biochemical relapse-free survival (bRFS) was estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model.ResultsThe median follow-up period was 44 months (range, 11-103 months). Forty-three patients experienced PSA re-failure after salvage RT. The 4-year bRFS was 50.9% (95% confidence interval [95% CI]: 39.4-62.5%). In the log-rank test, pT3-4 (p < 0.001) and preoperative PSA (p = 0.037) were selected as significant factors. In multivariate analysis, only pT3-4 was a prognostic factor (hazard ratio: 3.512 [95% CI: 1.535-8.037], p = 0.001). The 4-year bRFS rates for pT1-2 and pT3-4 were 79.2% (95% CI: 66.0-92.3%) and 31.7% (95% CI: 17.0-46.4%), respectively.ConclusionsIn patients who have received salvage RT after RP with PSA < 1.0 ng/ml, pT stage and preoperative PSA were prognostic factors of bRFS. In particular, pT3-4 had a high risk for biochemical recurrence after salvage RT.

Highlights

To evaluate prognostic factors in salvage radiotherapy (RT) for patients with pre-RT prostate-specific antigen (PSA) < 1.0 ng/ml
The American Urological Association (AUA) defines biochemical recurrence following Radical prostatectomy (RP) as initial serum PSA of ≥ 0.2 ng/ml with a second confirmatory level of > 0.2 ng/ml [16], the main criterion for salvage RT in this study was that PSA after RP was 0.1 ng/ml or more or that PSA after RP was three consecutive increasing
Follow-up Re-failure of PSA after salvage RT was defined as a serum PSA value of 0.2 ng/ml or more above the postradiotherapy nadir followed by another higher value, a continued rise in serum PSA despite salvage RT, or initiation of systemic therapy after completion of salvage RT [17]

Summary

Introduction

To evaluate prognostic factors in salvage radiotherapy (RT) for patients with pre-RT prostate-specific antigen (PSA) < 1.0 ng/ml. Radical prostatectomy (RP) is one of the curative treatments for prostate cancer. Biochemical recurrence after radical prostatectomy occurs in approximately 15% to 40% of patients within 5 years [1,2]. One third of patients with biochemical recurrence will have distant metastases, and the median actuarial period to development of metastases following prostate-specific antigen (PSA) elevation is 8 years [3]. Many studies have demonstrated that salvage radiotherapy (RT) for biochemical recurrence after RP is effective and enables long-term suppression of PSA elevation [4]. The objective of this study was to evaluate prognostic factors in salvage RT after RP for patients with pre-RT PSA < 1.0 ng/ml

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Conclusion