Abstract
ABSTRACTObjective:To build a model to evaluate the impact of salvage radiotherapy (SRT) in men with PSA rise or persistent PSA after undergoing radical prostatectomy (RP).Materials and Methods:The study included 107 node-negative patients treated with SRT after RP at a single institution. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP. All patients received local radiation to the prostate / seminal vesicle bed. The primary measured outcome was the biochemical recurrence (BCR) free survival. Multivariable Cox regression analysis was used to develop a risk-stratification group to identify predictive factors associated with the probability of BCR at 5yr.Results:At a median follow-up of 52 months, the BCR free survival rate and overall survival in 5 years was 73% and 94%, respectively. At multivariable analysis, pre-SRT PSA level > 0.35ng / mL (p = 0.023), negative margins (p = 0.038), and seminal vesicles invasion (p = 0.001) were significantly associated with BCR free survival. Three risk groups using regression analysis for SRT administration was built. Low-, intermediate- and the high-risk groups had a BCR free survival in 5-years of 96%, 84%, and 44% (p = 0.0001), respectively.Conclusions:We developed a risk group stratification to show the impact of SRT based on prostate cancer characteristics. SRT showed to be extremely beneficial for patients with low- and intermediate-risk tumors. Moreover, the risk-group built could identify patients classified as high-risk who might benefit from more aggressive treatment for SRT.
Highlights
The treatment of biochemical recurrence (BCR) after radical prostatectomy (RP) is a clinically significant issue for radiation oncologists
Among the available treatment options for BCR after RP, salvage radiation therapy (SRT) is considered one of the most common treatment options employed in clinical practice
Patients submitted to pelvic radiotherapy or combined treatment with androgen blockage were excluded from this cohort
Summary
The treatment of biochemical recurrence (BCR) after radical prostatectomy (RP) is a clinically significant issue for radiation oncologists. It is estimated that about 30% of patients undergoing RP develop an increase in prostate-specific antigen (PSA) after radical surgery [1]. Among the available treatment options for BCR after RP, salvage radiation therapy (SRT) is considered one of the most common treatment options employed in clinical practice. Its use is recommended, its effectiveness has been found to be profoundly dependent on the PSA level at the time of treatment [2, 3]. Based ibju | Salvage radiotherapy for biochemical recurrence on these findings, eSRT is indicated at a PSA level < 0.5ng / mL [2, 3]
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