Interval to biochemical failure is prognostic for distant metastases after salvage radiation therapy for prostate cancer

2015 ◽  
Vol 5 (1) ◽  
pp. 79-85
Author(s):  
Nicholas George Zaorsky ◽  
Tianyu Li ◽  
Aruna Turaka ◽  
David Y. T. Chen ◽  
Eric M. Horwitz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Distant Metastases ◽  
Biochemical Failure ◽  
Salvage Radiation Therapy

Natural history of ‘second’ biochemical failure after salvage radiation therapy for prostate cancer: a multi-institution study

2017 ◽  
Vol 121 (3) ◽  
pp. 365-372 ◽  
Author(s):  
Vasu Tumati ◽  
William C. Jackson ◽  
Ahmed E. Abugharib ◽  
Ganesh Raj ◽  
Claus Roehrborn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Natural History ◽  
Biochemical Failure ◽  
Salvage Radiation Therapy ◽  
History Of

Post-prostatectomy salvage radiation therapy in prostate cancer upon identification of biochemical failure.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 127-127
Author(s):  
Suneal Gopal Peddada ◽  
Craig Oliver ◽  
Angela Phelps ◽  
Steven H. Stokes ◽  
Jarrod Bartlett Adkison
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Salvage Radiotherapy ◽  
Failure Rates ◽  
Biochemical Control ◽  
Salvage Radiation Therapy

127 Background: Prostate Specific Antigen (PSA) values post-prostatectomy are used as an indication for salvage radiation therapy. It has been suggested that initiation of therapy at lower PSA values lead to better outcomes. This study investigates outcomes of salvage radiation therapy at specific PSA thresholds. Methods: One hundred two prostate cancer patients were treated with salvage radiotherapy at our institution with curative intent, 19 of whom had Gleason score ≤6, 52 of whom had Gleason 7, and 31 with Gleason ≥8. Median follow-up after radiotherapy was 51 months. The median PSA prior to salvage radiotherapy was 0.33 ng/mL, and the median time from prostatectomy to radiotherapy was 24.6 months. Positive margins were identified in 52 patients, and perineural invasion was positive in 83. The median dose delivered was 64.8 Gy. Results: The 5-year actuarial freedom from biochemical failure rates for NCCN low, intermediate, and high risk groups were 100%, 77%, and 62%, p=0.2449. The 5-year actuarial freedom from biochemical failure rates for Gleason score ≤6, Gleason 7, and Gleason ≥8 patients were 87%, 72%, and 49%, p=0.0187. Patients with pre-radiotherapy PSA ≤0.5 ng/mL had better 5-year biochemical control relative to patients with higher pre-radiotherapy PSA, 76% versus 51%, p=0.0211. The pathological margin status did not predict for biochemical control after salvage radiation across the different Gleason grades. Very few interval biochemical failures are observed after the 5-year point of follow-up. The 5-year overall survival for the entire cohort is 92%, with prostate cancer specific survival of 96%. Conclusions: Salvage radiotherapy demonstrated favorable efficacy with durable PSA control and few failures 5 years post radiation. Initiation of salvage radiotherapy for PSA ≤0.5 ng/mL demonstrated improved biochemical control, supporting the adoption of early referral to radiation oncology once post-prostatectomy biochemical failure is identified. [Table: see text]

Prostate cancer specific mortality and overall survival outcomes for salvage radiation therapy after radical prostatectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 9-9
Author(s):  
Shree Agrawal ◽  
Jason A. Efstathiou ◽  
Jeff M. Michalski ◽  
Thomas Michael Pisansky ◽  
Bridget F. Koontz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Proportional Hazards ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Salvage Radiation Therapy ◽  
Specific Mortality ◽  
Completion Date ◽  
Cancer Specific Mortality

9 Background: Early salvage radiation therapy (SRT) following radical prostatectomy (RP) has been shown to reduce biochemical recurrence and distant metastases. We aim to identify factors predictive of prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) from a consortium database from 10 academic institutions. Methods: 2,454 node-negative patients (pts) with detectable post-prostatectomy PSA ( ≥ 0.01 ng/mL) treated with SRT ± neoadjuvant/concurrent androgen deprivation therapy (N/C ADT) were included. Cumulative incidence and Kaplan-Meier methods were used to estimate rates of PCSM and ACM, respectively. Univariate and multivariable analyses (MVA) were performed by competing risks regression and Cox proportional hazards methods for PCSM and ACM. Results: Median follow-up was 5 years from SRT completion and 8 years from date of RP; 24% had pathologic Gleason score (GS) of ≤ 6, 56% GS 7, and 19% GS ≥ 8; 56% extraprostatic extension (EPE), 18% seminal vesicle invasion (SVI), 58% positive surgical margins, and 16% received N/C ADT. Median age at RP and SRT were 62 years (IQR 56-66) and 64 years (59-69), respectively. Median SRT dose was 66 Gy (IQR 65-68) and median pre-SRT PSA was 0.5 ng/mL (IQR 0.3-1.1). MVA performed from SRT completion date demonstrated higher pre-SRT PSA (HR = 2.1), higher GS (GS 7 vs. ≤ 6: HR 2.0; GS ≥ 8 vs. 6: HR 3.3) , SVI (HR 2.5), year of SRT (2000-2004, 1995-1999, 1985-1994 vs. 2005-2012; HR 2.9, HR 2.5, HR 3.6, respectively) were significantly associated with higher PCSM. These same variables were all significantly associated with higher PCSM and ACM rates calculated from both SRT completion date and date of RP. Conclusions: Initiation of early SRT at lower post-operative PSA levels following RP is associated with reduced risk of PCSM and ACM, even when calculated from RP date to account for lead time bias. Other factors significantly associated with PCSM include higher GS, SVI, and earlier year of SRT. [Table: see text]

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