Impact of postoperative prostate‐specific antigen disease recurrence and the use of salvage therapy on the risk of death

Abstract

We read with interest the article by Choueiri et al on the impact of salvage therapy on survival in men with biochemical recurrence (BCR) after prostate cancer surgery.1 They found, as had we,2, 3 that survival after BCR was better in men with PSA doubling time (PSADT) ≥6 months, and also in men who received salvage therapy. In our study, however, we found that the survival benefit of salvage radiotherapy or salvage androgen deprivation therapy (compared with no additional therapy) was only significant among men with PSADT <6 months; among men with PSADT of 6 months or greater salvage therapy did not significantly improve survival.2, 3 This appeared to be because men with PSADT ≥6 months had very good survival regardless of additional therapy, so the incremental benefit of salvage therapy was not significant. Was the effect of salvage hormonal or radiation therapy similarly dependent on PSADT in the study by Choueiri et al? Also, the article did not explicitly define the timing of administering salvage therapies, which begs the question: did salvage treatment include hormonal therapy administered at the time of metastases? Bruce J. Trock PhD*, Patrick C. Walsh MD*, * Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland.