Outcome After Conformal Salvage Radiotherapy in Patients With Rising Prostate-Specific Antigen Levels After Radical Prostatectomy

• Published in: International journal of radiation oncology, biology, physics Vol. 82; no. 5; pp. 1930 - 1937
• Main Authors: Geinitz, Hans, M.D, Riegel, Martina G., M.D, Thamm, Reinhard, M.D, Astner, Sabrina T., M.D, Lewerenz, Carolin, M.D, Zimmermann, Frank, M.D, Molls, Michael, M.D, Nieder, Carsten, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2012; Elsevier
• Subjects: Adult; Aged; ANTIGENS; Biochemical relapse; Biological and medical sciences; Conformal radiotherapy; FAILURES; Gynecology. Andrology. Obstetrics; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Male; Male genital diseases; Medical sciences; MEN; METASTASES; Middle Aged; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - radiotherapy; NEOPLASMS; Nephrology. Urinary tract diseases; PATIENTS; Prognostic factors; PROSTATE; Prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - mortality; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy, Conformal - methods; Retrospective Studies; Salvage Therapy - methods; Salvage treatment; SURGERY; Survival Rate; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Conformal radiotherapy; Biochemical relapse; Salvage treatment; Prostate cancer; Prognostic factors; Human; Urinary system disease; Prognosis; Prostate disease; Tumoral marker; Malignant tumor; Biochemical recurrence; Prostate specific antigen; Cancerology; Surgery; Prostatectomy; Predictive factor; Male genital diseases; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.03.003

Purpose This study attempts to improve our understanding of the role of salvage radiotherapy (SRT) in patients with prostate-specific antigen (PSA) relapse after radical prostatectomy with regard to biochemical control, rate of distant metastasis, and survival. Methods and Materials We performed a retrospective analysis of 96 men treated with conformal prostate bed SRT (median, 64.8 Gy) at a single institution (median follow-up, 70 months). The majority had intermediate- or high-risk prostate cancer. Fifty-four percent underwent a resection with positive margins (R1 resection). The median time interval between surgery and SRT was 22 months. Results After SRT, 66% of patients reached a PSA nadir of less than 0.2 ng/mL. However, the 5-year biochemical no evidence of disease rate was 35%. Seminal vesicle involvement was predictive for a significantly lower biochemical no evidence of disease rate. All patients with a preoperative PSA level greater than 50 ng/mL relapsed biochemically within 2 years. The 5-year distant metastasis rate was 18%, the 5-year prostate cancer–specific survival rate was 90%, and the 5-year overall survival rate was 88%. Significantly more distant metastases developed in patients with a PSA nadir greater than 0.05 ng/mL after SRT, and they had significantly inferior prostate cancer–specific and overall survival rates. Resection status (R1 vs. R0) was not predictive for any of the endpoints. Conclusions Men with postoperative PSA relapse can undergo salvage treatment by prostate bed radiotherapy, but durable PSA control is maintained only in about one-third of the patients. Despite a high biochemical failure rate after SRT, prostate cancer–specific survival does not decrease rapidly.