Salvage Radiotherapy For Biochemical Recurrence Research Articles

European association of urology risk stratification predicts outcome in patients receiving PSMA-PET-planned salvage radiotherapy for biochemical recurrence following radical prostatectomy

PurposeThe European Association of Urology (EAU) proposed a risk stratification (high vs. low risk) for patients with biochemical recurrence (BR) following radical prostatectomy (RP). Here we investigated whether this stratification accurately predicts outcome, particularly in patients staged with PSMA-PET. MethodsFor this study, we used a retrospective database including 1222 PSMA-PET-staged prostate cancer patients who were treated with salvage radiotherapy (SRT) for BR, at 11 centers in 5 countries. Patients with lymph node metastases (pN1 or cN1) or unclear EAU risk group were excluded. The remaining cohort comprised 526 patients, including 132 low-risk and 394 high-risk patients. ResultsThe median follow-up time after SRT was 31.0 months. The 3-year biochemical progression-free survival (BPFS) was 85.7 % in EAU low-risk versus 69.4 % in high-risk patients (p = 0.002). The 3-year metastasis-free survival (MFS) was 94.4 % in low-risk versus 87.6 % in high-risk patients (p = 0.005). The 3-year overall survival (OS) was 99.0 % in low-risk versus 99.6 % in high-risk patients (p = 0.925). In multivariate analysis, EAU risk group remained a statistically significant predictor of BPFS (p = 0.003, HR 2.022, 95 % CI 1.262–3.239) and MFS (p = 0.013, HR 2.986, 95 % CI 1.262–7.058). ConclusionOur data support the EAU risk group definition. EAU risk grouping for BCR reliably predicted outcome in patients staged lymph node-negative after RP and with PSMA-PET before SRT. To our knowledge, this is the first study validating the EAU risk grouping in patients treated with PSMA-PET-planned SRT.

Effect of undetectable PSA following SRT for biochemical recurrence on BPFS, FFM, and OS.

367 Background: Salvage radiotherapy (SRT) alone or in combination with androgen deprivation therapy (ADT) is the only curative treatment option for patients with biochemical recurrence after radical prostatectomy (RP) for prostate cancer. An undetectable post SRT PSA in patients without ADT (<0.1 ng/ml) has been shown retrospectively to correlate significantly with long-term freedom from progression, metastasis free survival and overall survival. The aim of this study was to investigate whether the predictive power of a post SRT-nadir <0.1 ng/ml extends to all subgroups of SRT patients. Methods: Between 1998 and 2018, 698 patients (all pN0/cN0) with persisting PSA or increasing PSA out of the undetectable range (<0.1 ng/ ml) of two German university hospitals received SRT alone without ADT. Exclusion criteria were distant metastases and/or ADT in the interval between RP and/or in combination with SRT. ADT before RP was allowed. All patients received 3D-conformal or intensity-modulated SRT to a median dose of 70.2 Gy. The impact of post-SRT nadir <0.1 ng/ml on biochemical progression free survival (BPFS), freedom from metastases (FFM) and on overall survival (OS) was analyzed by Kaplan-Meier analysis and multivariate Cox regression analysis. 9 subgroups with at least 30 patients per group were analyzed separately (pT2 + R0, pT3 + R0, pT3 + R1, pT2 + Gleason Score ≤ 7, pT3 + Gleason Score ≤ 7, pT3 + Gleason Score ≥ 8, pT3 + Gleason Score ≥ 7 + R1, pT3 + Gleason Score ≥ 7 + pre-SRT-PSA-Wert ≤1,0 ng/ ml and pT2/3 + Gleason Score ≥ 8 + pre-SRT-PSA-Wert ≤1,0 ng/ ml). Results: Median follow-up was 5.6 years. Median PSA before SRT was 0.30 ng/ ml. A post SRT PSA <0.1ng/ml was achieved by 76.6% of patients. In univariate analysis of the entire cohort, post SRT PSA <0.1 ng/ ml was a significant predictor of BPFS (p<0.001), FFM (p<0.001) and OS (p=0.01). Regarding univariate analysis of the subgroups, post SRT PSA <0.1ng/ml was a significant predictor of BPFS in all subgroups (p<0.001), FFM in 6 subgroups (p<0.001 to p=0.03) and for OS in 3 subgroups (p<0.001 to p=0.02). In multivariate analysis of the entire cohort, post-SRT PSA <0.1ng/ml was an independent predictor for BPFS (HR: 7.25, 95%-CI: 5.36-9.81, p<0.001), FFM (HR: 4.21, 95%-CI: 2.00-8.84, p=0.002) and OS (HR: 2.59, 95%-CI: 1.28-5.23, p=0.008). Conclusions: Achieving an undetectable PSA after SRT is an independent predictor of BPFS, FFM and OS. This effect is present in subgroups with favorable (pT2+Gleason score ≤ 7) as well as in those with unfavorable characteristics (pT3+ Gleason score >8). Our findings indicate that ADT could be withheld in a proportion of patients that are candidates for ADT based on their risk factors but achieve an undetectable PSA after SRT. Prospective studies are needed to confirm these results.

P1186 - A novel prognostic model for patients undergoing salvage radiotherapy for biochemical recurrence after radical prostatectomy

INTRODUCTION AND OBJECTIVE:Biochemical recurrence (BCR) after radical prostatectomy (RP) for non-metastatic prostate cancer (PCa) leads to clinical progression only in a subpopulation. The aim of t...

Role of laparoscopic radical prostatectomy in locally advanced and high-risk prostate cancer: Whether safe and effective approach?

Introduction: Historically, patients with locally advanced and high-grade diseases have not been viewed as a good candidate for radical prostatectomy (RP). The role of RP for locally advanced and high-grade diseases is controversial and the focus of debate. The objective of this study is to evaluate the role of RP in the treatment of locally advanced and high-grade disease. Materials and Methods: In this retroprospective study, all the laparoscopic RPs done for prostate cancer between January 2014 and January 2016, in the Department of Urology, DRRMLIMS, Lucknow, were enrolled and followed for five years. A total of 116 patients were included in this study. They were divided into two groups: group 1 includes 78 patients with localized carcinoma prostate and group 2 includes 38 patients with locally advanced and high-grade prostate cancer. The following characteristics were noted in both groups: margin status, biochemical progression, local recurrence, distant metastasis, clinical progression, and overall and cancer-specific survival (CSS). The primary endpoints were CSS and overall survival. Postoperative survival was estimated using Kaplan–Meier method and compared using log-rank test. Univariate and multivariate analysis of features associated with outcomes were conducted using Cox proportional hazards regression models. Result: The resulting survival estimates at the last follow-up after RP were 83%, 81.58% and 76.92%, 76.31% in groups 1 and 2 for prostate CSS and overall survival, respectively. Overall, 3.85% in group 1 and 21.05% in group 2 patients received salvage radiotherapy for biochemical recurrence, whereas 7.69% in group 1 and 15.79% in group 2 patients were treated with salvage androgen deprivation therapy during clinical follow-up. Margin status was positive in 10.25% and 21.05% of cases in groups 1 and 2, respectively. Conclusion: RP forms an important part of the multimodality approach to locally advanced prostate cancer. It can provide a better outcome (combined with adjuvant and salvage treatment if needed) than radiotherapy (RT) or hormonal therapy (HT) alone or a combination of RT and HT.

The effects of PSA kinetics on the outcome of hypofractionated salvage radiotherapy for biochemical recurrence of prostate cancer after prostatectomy.

The feasibility and efficacy of hypofractionated salvage radiotherapy (HS-RT) for prostate cancer (PC) with biochemical recurrence (BR) after prostatectomy, and the usefulness of prostate-specific antigen (PSA) kinetics as a predictor of BR, were evaluated in 38 patients who received HS-RT without androgen deprivation therapy between May 2009 and January 2017. Their median age, PSA level and PSA doubling time (PSA-DT) at the start of HS-RT were 68 (53–74) years, 0.28 (0.20–0.79) ng/ml and 7.7 (2.3–38.5) months, respectively. A total dose of 60 Gy in 20 fractions (three times a week) was three-dimensionally delivered to the prostate bed. After a median follow-up of 62 (30–100) months, 19 (50%) patients developed a second BR after HS-RT, but only 1 patient died before the last follow-up. The 5-year overall survival and BR-free survival rates were 97.1 and 47.4%, respectively. Late grade 2 gastrointestinal and genitourinary morbidities were observed in 0 and 5 (13%) patients, respectively. The PSA level as well as pathological T-stage and surgical margin status were regarded as significant predictive factors for a second BR by multivariate analysis. BR developed within 6 months after HS-RT in 11 (85%) of 13 patients with a PSA-DT < 10 months compared with 1 (17%) of 6 with a PSA-DT ≥ 10 months (median time to BR: 3 vs 14 months, P < 0.05). Despite the small number of patients, our HS-RT protocol seems feasible, and PSA kinetics may be useful for predicting the risk of BR and determining the appropriate follow-up schedule.

Predictive value of Prostate Specific Antigen variations in the last week of salvage radiotherapy for biochemical recurrence of prostate cancer after surgery: A practical approach.

BackgroundAbout a third of patients who underwent radical prostatectomy for prostate cancer (Pca) develop a biochemical failure (BF) within 10 years from surgery, and about a half of them receive salvage radiation therapy (SRT). Factors to predict risk to relapse after SRT are still lacking. Dynamic models, based on the assessment of changes in Prostate Specific Antigen (PSA) postsurgery seem to show good reliability.AimsThe goal of the study was to identify a simple analytical method for the postsalvage radiation therapy biochemical failure (post‐SRTBF) prediction before the end of the SRT, regardless of the PSA value at the beginning of the treatment (PSA start), measuring the PSA values at the start and 1 week before the end of SRT.MethodsIn a series of 83 patients treated with SRT for BF of Pca we measured PSA values at the first day and 1 week before the end of SRT. These values were used to define an analytical method for the post‐SRTBF prediction.ResultsPSA value in patients without post‐SRTBF show a significant difference in term of difference during the SRT with respect to patients with post‐SRTBF. Starting from this difference, we identified a simple and practical analytical method for the post‐SRTBF prediction before the end of the SRT. The data corresponds with the model and the analytical method is highly predictive (Sensitivity = 81%, Specificity = 85%, Accuracy = 83%).ConclusionThis study offers a new tool to early predict Pca relapse overtime and to select patients who can benefit from an early additional systemic treatment.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: does the outcome depend on the prostate cancer characteristics?

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.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: experience of a single center

Background: The purpose of this study was to report the outcomes and prognostic factors of patients who underwent salvage radiotherapy (SRT) for biochemical recurrence (BCR) following radical prostatectomy (RP) at a single center. Methods: We retrospectively reviewed 48 patients who underwent SRT for BCR after RP between January 2004 and December 2012. The Kaplan-Meier method and Cox proportional hazard regression models were used to evaluate the BCR-free survivals and the prognostic factors for BCR after SRT. Results: After a median follow-up of 68.7 months (range, 34.0–143.3 months). The BCR-free survival rates at 3 and 5 years for the 48 patients after SRT were 72.9% and 68.4%, respectively. Multivariate analysis showed that pre-RT PSA (prostate specific antigen) level >0.5 ng/mL, Gleason score at RP ≥8, and seminal vesicle invasion were significantly predictive of PSA relapse after SRT (HR: 23.29, 7.92, and 21.73). The BCR-free rate at 5 years in the pre-RT PSA level ≤0.5 and >0.5 ng/mL group was 83.4% and 52.2% (P=0.007), respectively. No grade 3 or worse acute adverse events were noted. Conclusions: SRT was an effective treatment for BCR following RP with tolerable toxicities. Lower pre-RT PSA value, low Gleason score, and non-seminal vesicle invasion were significant predictors of favorable biochemical outcomes. Our results supported the current recommendations that SRT should be initiated before PSA reaches 0.5 ng/mL.

Use of Concomitant Androgen Deprivation Therapy in Patients Treated with Early Salvage Radiotherapy for Biochemical Recurrence After Radical Prostatectomy: Long-term Results from a Large, Multi-institutional Series

BackgroundHormonal manipulation concomitant to salvage radiotherapy (SRT) given for biochemical recurrence (BCR) after radical prostatectomy (RP) improved outcomes in two randomized trials. However, neither of these studies focused on men treated at low prostate-specific antigen (PSA) levels. ObjectiveTo test if the impact of androgen deprivation therapy (ADT) on metastasis in patients undergoing early SRT varies according to prostate cancer (PCa) features. Design, setting, and participantsA total of 525 patients received SRT at PSA levels ≤2ng/ml. Outcome measurements and statistical analysesMultivariable Cox regression analyses assessed factors associated with metastasis. We tested the hypothesis that the impact of ADT varied according to the risk of metastasis. An interaction with groups (concomitant ADT vs no ADT) and the probability of distant metastasis according to a newly developed model was tested. A nonparametric curve explored the relationship between the risk of metastasis and 10-yr metastasis rates according to ADT. Results and limitationsMedian PSA and radiotherapy dose were 0.42ng/ml and 66Gy, respectively. Overall, 178 (34%) patients received ADT. At a median follow-up of 104 mo, 71 patients experienced metastasis. Grade group ≥4 (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.01–3.30), pT3b/4 (HR: 2.61; 95% CI: 1.51–4.52), and dose (HR: 0.82; 95% CI: 0.76–0.89) were associated with metastasis. The impact of ADT differed according to the risk of metastasis calculated using a multivariable model (p=0.01). This was confirmed when considering patients treated with early SRT (p=0.046), where ADT was associated with a reduction in the rate of metastasis only in eSRT; patients with more aggressive characteristics (ie, pT3b/4 and grade group ≥4, or pT3b/4 and PSA at eSRT ≥0.4ng/ml). ConclusionsThe beneficial effect of ADT concomitant to eSRT varied significantly according to disease characteristics, such that only men with more aggressive PCa features benefit from ADT in the eSRT setting for BCR after RP. Patient summaryThe oncological benefits of concomitant androgen deprivation therapy (ADT) in patients undergoing salvage radiotherapy (SRT) vary according to pathological characteristics. Only patients with more aggressive disease characteristics seemed to benefit from the use of hormonal manipulation at the time of early SRT. Conversely, the potential side effects of ADT could be spared in patients with low prostate-specific antigen levels and favorable pathological features.

Optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy: is ultra-early salvage radiotherapy beneficial?

BackgroundThe optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy is controversial. In particular, the prognostic significance of salvage radiotherapy delivered before a current definition of biochemical recurrence, i.e. ultra-early salvage radiotherapy, is unclear.MethodsWe reviewed 76 patients with pT2-3N0M0 prostate cancer who underwent salvage radiotherapy for post-prostatectomy biochemical recurrence at the following three timings: ultra-early salvage radiotherapy (n = 20) delivered before meeting a current definition of biochemical recurrence (two consecutive prostate-specific antigen [PSA] values ≥0.2 ng/mL); early salvage radiotherapy (n = 40) delivered after meeting the definition but before PSA reached 0.5 ng/mL; and delayed salvage radiotherapy (n = 16) delivered after PSA reached 0.5 ng/mL. The primary endpoint was failure of salvage radiotherapy, defined as a PSA value ≥0.2 ng/mL. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses, respectively.ResultsDuring the follow-up period (median: 70 months), four of 20 (20 %), nine of 40 (23 %) and seven of 16 (44 %) patients failed biochemically in the ultra-early, early and delayed salvage radiotherapy groups, respectively. On univariate analyses, the outcome of delayed salvage radiotherapy was worse than the others, while there was no significant difference between ultra-early and early groups. Multivariate analysis demonstrated the presence of Gleason pattern 5, perineural invasion and delayed salvage radiotherapy as independent predictors of poorer survival.ConclusionsNo survival benefit of ultra-early salvage radiotherapy was demonstrated, whereas delayed salvage radiotherapy was associated with worse outcome as reported in previous studies. Our results may support the current recommendations that salvage radiotherapy should be undertaken after two consecutive PSA values ≥0.2 ng/mL and before reaching 0.5 ng/mL.

2528 Long-term follow-up of post-prostatectomy salvage radiotherapy for biochemical recurrence

2528 Long-term follow-up of post-prostatectomy salvage radiotherapy for biochemical recurrence

Changes in lower urinary tract symptoms and quality of life after salvage radiotherapy for biochemical recurrence of prostate cancer

Background and purposeThe aim of this study was to evaluate chronologic changes in lower urinary tract symptoms (LUTS), health-related (HR) quality of life (QOL), and disease-specific QOL during the first 12months after salvage radiotherapy (SRT) for biochemical recurrence of prostate cancer in patients who underwent radical prostatectomy. Materials and methodsIn 81 patients who received SRT (70Gy/35fr/7weeks), International Prostate Symptom Score (IPSS), 36-Item Short Form scores, and UCLA-Prostate Cancer Index (UCLA-PCI) were recorded before, during, and immediately after SRT, and 1–12months after the completion of SRT. ResultsThe total IPSS and storage symptom-related sum were significantly increased following initiation of SRT, and returned to the baseline 6months after SRT. For three of eight domains of HRQOL, and the physical component summary score showed transient deterioration in the period between completion of SRT and 1month following SRT. The UCLA-PCI for urinary function/bother and bowel function/bother was affected until 1–6months after SRT. ConclusionsThis is the first report to concurrently evaluate detailed chronologic changes in LUTS and QOL in patients who received SRT. Knowledge of changes in LUTS and QOL outcomes associated with SRT may influence treatment recommendations and enable patients to make better-informed decisions.

422 Predictors of early failure after timely administered salvage radiotherapy for biochemical recurrence after radical prostatectomy

INTRODUCTION AND OBJECTIVES: The oncological safety of robot-assisted (RARP) and open radical prostatectomy (ORP) in patients with more aggressive disease is still debated. We aimed at comparing the biochemical recurrence (BCR) rates of RARP and ORP in patients with intermediate or high-risk prostate cancer (PCa). Additionally, since individuals experiencing early BCR are at increased risk of clinical progression and cancer-specific mortality, we assessed the impact of the surgical approach also on the risk of early BCR. METHODS: Overall, 2,181 patientswith intermediate or high-risk PCa (clinical stage T2b, biopsy Gleason score (GS) 7, and/or preoperative PSA 10ng/ml) treated at a single tertiary referral center between January 2006 and August 2013 were identified. No patient received neo-adjuvant or adjuvant therapies. BCR was defined as the detection of PSA 0.2ng/ml after surgery. Early BCR was defined as the occurrence of BCR within 2 years from surgery. Uniand multivariable (MVA) Cox regression analyses evaluated the association between the surgical approachand the risk of BCRandearly BCR, after accounting for confounders. Covariates consisted of clinical stage, biopsy GS, and preoperative PSA. Subsequently, we evaluated the impact of RARP on the risk of BCR and early BCR after accounting for pathological GS, pathological stage, surgicalmargin status (SM), and adjuvant treatments. RESULTS: Mean patient age was 64.9 years (median: 65). Overall, 1,522 (69.8%) and 659 (30.2%) patients were treated with ORP and RARP, respectively. Overall, the 5-year BCR-free survival rates were 79.8%. The 5-year BCR-free survival rates were 79.8% and 81.9% in patients treated with ORP and RARP, respectively (P1⁄40.7). At univariable Cox regression analysis, RARP was not associated with increased risk of BCR (Odds ratio [OR]: 1.27; 95% confidence interval [CI]: 0.72-1.58; P1⁄40.3) and early BCR (OR: 1.07; 95% CI: 0.78-2.06; P1⁄40.7). This was confirmed at MVA, where RARP was not associated with BCR and early BCR, after accounting both for preoperative (PSA, clinical stage, and biopsy GS) and postoperative (pathological stage, pathological GS, SM, lymph node invasion, and adjuvant treatments) confounders (all P>0.1). CONCLUSIONS: RARP and ORP have comparable 5-year BCR-free survival rates in patients with intermediateand high-risk PCa. Minimally invasive approach leads to comparable oncological outcomes in terms of BCR and early BCR. These results support the oncological safety of RARP in patients with intermediateand high-risk PCa.

The Impact of a Negative 111Indium-Capromab Pendetide Scan Before Salvage Radiotherapy

We determined the prognostic role, if any, of the ProstaScint (111)indium-capromab pendetide scan before salvage radiotherapy for biochemical recurrence after RP for localized prostate cancer. We reviewed the records of 649 patients who underwent a ProstaScint scan from 1998 to 2004. A total of 44 patients were identified who had biochemical recurrence after RP and underwent a ProstaScint scan immediately before salvage radiotherapy. All patients received salvage radiotherapy to the prostatic bed unless pelvic lymph node uptake was identified on the scan, resulting in initial whole pelvic radiotherapy with 45 Gy, followed by a conformal boost to the prostate bed in 6. The median salvage radiotherapy dose to the prostate bed was 72 Gy. Patient demographics, pathological information, PSA values and ProstaScint results were collected retrospectively. The majority of ProstaScint scans were digitally fused with noncontrast pelvic computerized tomography images for interpretation. PSA progression after radiotherapy was defined using American Society for Therapeutic Radiation and Oncology criteria. At a mean followup of 22 months 43 of 44 patients (97%) experienced a PSA decrease after salvage radiotherapy with a mean PSA nadir of 0.16 ng/ml compared to a mean pre-radiotherapy PSA of 1.7 ng/ml. Of the 44 patients 15 (34%) showed post-radiotherapy PSA progression. When the entire cohort was analyzed, patients with negative ProstaScint scans had statistically lower post-radiotherapy PSA progression rates than patients with positive scans (1 of 10 or 10% vs 14 of 34 or 41%, p = 0.026). Patients with negative ProstaScint results were also statistically more likely to have a pre-radiotherapy PSA of less than 1.0 ng/ml (p = 0.005), no seminal vesicle involvement (p = 0.006), a greater mean PSA doubling time (p = 0.008) and received no hormone therapy (p = 0.003). When patients with pre-radiotherapy PSA less than 1.0 ng/ml were analyzed, a negative ProstaScint scan suggested but did not provide a statistically significant advantage over pre-radiotherapy PSA alone for predicting post-radiotherapy PSA progression (1 of 9 or 11% for negative vs 5 of 15 or 33% for positive scans, p = 0.20). Our early experience supports an improved prognosis in patients receiving salvage pelvic radiotherapy for biochemical recurrence after RP who have a negative pre-radiotherapy ProstaScint scan. However, this finding is not necessarily independent of pre-radiotherapy PSA.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy

To evaluate the clinical outcome of salvage radiotherapy (RT) for biochemical recurrence after radical prostatectomy (RP) at our institution. Between March 1999 and January 2004, 37 patients had salvage RT for prostate-specific antigen (PSA) failure after RP, including eight who had had neoadjuvant hormone therapy. After surgery, PSA was measured with ultrasensitive immunoassays. In all patients RT was delivered to the prostatic bed at a total dose of 60 Gy with a four-field box technique. The median (range) PSA level before salvage RT was 0.146 (0.06-3.216) ng/mL and RT was started at a PSA level of <0.5 ng/mL in 34 of the 37 patients (92%). With a median follow-up of 31.9 (0-69.8), months, 11 patients (30%) had disease progression after RT and the 3- and 5-year progression-free probability was 74% and 54%, respectively. Univariate analysis showed that clinical and pathological tumour stages and PSA level before RT (>0.15 vs < or = 0.15 ng/mL) were significant predictors of disease progression. There were no late adverse events related to RT. Salvage RT for biochemical failure after RP at a low PSA level, using ultrasensitive immunoassays for monitoring, is a reasonably effective treatment. A relatively low radiation dose (60 Gy) seems to be effective.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: a study of 62 patients

ObjectivesTo determine the predictive factors of prostate-specific antigen (PSA) recurrence after salvage radiotherapy (RT) for biochemical recurrence following radical prostatectomy (RP) to identify patients who may benefit from this treatment. MethodsFrom June 1992 to January 2002, 62 patients experiencing PSA recurrence after RP were treated with RT at a dose of 65 Gy. No patient received hormonal therapy. PSA recurrence after RT was defined as three consecutive increased PSA measurements. The risk of experiencing PSA recurrence after RT was analyzed according to 10 factors: patient age, pre-RP PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after RP, time to PSA recurrence after RP, pre-RT PSA level, PSA nadir after RT, and length of follow-up after RT. ResultsWith a mean follow-up of 44 months (range 3 to 110), 23 patients (37.1%) experienced PSA recurrence after RT. Using univariate analysis, six factors were found to be predictive of PSA recurrence after RT: the length of follow-up after RT (P <0.0001), PSA nadir after RP (P = 0.0004), time to PSA recurrence after RP (P = 0.003), pre-RP PSA level (P = 0.008), Gleason score (P = 0.011), and pre-RT PSA level (P = 0.028). Using multivariate analysis, only the Gleason score (P = 0.015) and length of follow-up after RT (P = 0.02) were found to be predictive of PSA recurrence after RT. A Gleason score greater than 7 was a significant predictor of PSA recurrence after salvage RT (P = 0.04). ConclusionsIn our experience, the Gleason score and length of follow-up were the sole independent predictors of PSA recurrence after salvage RT. Our findings suggest that patients with a Gleason score of 7 or less are more likely to benefit from salvage RT after RP and that the durability of the PSA response may be only transient.