scholarly journals Clinical Outcome of Salvage Radiotherapy for Locoregional Clinical Recurrence After Radical Prostatectomy

2021 ◽  
Vol 20 ◽  
pp. 153303382110412
Author(s):  
Sung Uk Lee ◽  
Kwan Ho Cho ◽  
Jin Ho Kim ◽  
Young Seok Kim ◽  
Taek-Keun Nam ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Distant Metastasis ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Salvage Radiotherapy ◽  
Clinical Recurrence ◽  
Free Survival ◽  
Locoregional Failure ◽  
Psa Nadir ◽  
Grade 3

Objectives: To assess the clinical outcomes of prostate cancer patients treated with salvage radiotherapy (SRT) for locoregional clinical recurrence (CR) after radical prostatectomy (RP). Methods: Records of 60 patients with macroscopic locoregional recurrence after prostatectomy and referrals for SRT were retrospectively investigated in the multi-institutional database. The median radiation dose was 70.2 Gy. Biochemical failure was defined as the prostate-specific antigen (PSA) ≥ nadir + 2 or initiation of androgen deprivation therapy (ADT) for increased PSA. Results: Median recurrent tumor size was 1.1 cm and pre-radiotherapy PSA level was 0.4 ng/ml. At a median follow-up of 83.1-month after SRT, 7-year biochemical failure-free survival (BCFFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were 67.0%, 89.7%, 83.6%, and 91.2%, respectively. Higher Gleason's scores were associated with unfavorable BCFFS, DMFS, and OS. Pre-SRT PSA ≥0.5 ng/ml predicted worse BCFFS, LRFFS, and DMFS. In multivariate analyses, a Gleason's score of 8 to 10 was associated with decreased BCFFS (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.11-8.74, P = .031) and OS (HR 17.72, 95% CI 1.75-179.64, P = .015), and combined ADT decreased the risks of distant metastasis (HR 0.18, 95% CI 0.04-0.92, P = .039). Two patients (3.3%) experienced late grade 3 urinary toxicity. Conclusions: SRT for locoregional CR after RP achieved favorable outcomes with acceptable long-term toxicities. Higher Gleason's scores and pre-radiotherapy PSA level were unfavorable prognostic variables. Combined ADT may decrease the risks of metastases.

Prostate brachytherapy as salvage for local failure after external beam radiation.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 125-125 ◽  
Author(s):  
Brian Christopher Baumann ◽  
John Charles Baumann ◽  
John Paul Christodouleas ◽  
Edward M Soffen
Keyword(s):  
Salvage Therapy ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
Prostate Brachytherapy ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Psa Nadir ◽  
Grade 3 ◽  
Disease Free

125 Background: Local failure (LF) after external beam radiation (EBRT) for prostate cancer is a serious problem. Most patients receive non-curative androgen deprivation therapy (ADT), but there is a subset with LF who are still potentially curable. There is limited evidence to suggest that prostate brachytherapy (BT) is an effective, potentially curative salvage therapy with acceptable toxicity. We hypothesize that salvage BT following EBRT can achieve high rates of biochemical control with acceptable toxicity. Methods: We analyzed 39 consecutive patients treated from 1998-2013 with salvage BT at 2 centers. All patients had pathologically confirmed LF following previous EBRT without distant mets & a disease-free interval of ≥ 18-24 mo. Salvage BT to the whole prostate was delivered to 29 patients using low-dose rate I-125 or Pd-103 seed implants (median dose 100 Gy with Pd-103) while 10 received HDR BT (median 30 Gy in 6 fractions). Cases were planned as if de novo but to a lower dose. 33 (85%) received neoadjuvant and/or adjuvant ADT as part of their salvage therapy. Biochemical failure (BF) was defined using the Phoenix criteria. Risk factor analysis was conducted to identify characteristics that predict BF after salvage BT. Results: For the 39 patients, median PSA at diagnosis was 8.4, and 21 (54%) had high-risk disease. Median EBRT dose was 70 Gy with 11 patients (28%) receiving ADT. Median PSA nadir following EBRT was 0.8 (range 0 – 2.6). Median time to recurrence was 53 mo (range 18 – 150), and median pre-salvage PSA was 4.8. Median follow-up after salvage BT was 60.1 mo (range 7 – 150). Biochemical failure-free survival, DMFS and OS at 5 & 7 yrs were 76% & 67%; 91% & 85% and 92% & 84%, respectively. On univariate analysis, PSA nadir after EBRT & pre-salvage PSA were significant predictors of BF (p< 0.01 for both). On multivariate analysis, only pre-salvage PSA was a significant independent predictor of BF (p< 0.01). Freedom from late grade 3 GU toxicity at 3 yrs was 83%. There were no late Grade 3 GI toxicities. Conclusions: This is the largest series reporting on salvage prostate brachytherapy plus ADT for local-only failures after EBRT & suggests that salvage BT with ADT offers selected patients prolonged disease-free survival with acceptable toxicity.

Predictive factors and the important role of detectable prostatic specific antigen for the detection of clinical recurrence following robot-assisted radical prostatectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e567-e567
Author(s):  
Silvia Garcia Barreras ◽  
François Rozet ◽  
Igor Nunes-Silva ◽  
Victor Srougi ◽  
Mohammed Baghdadi ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Predictive Factors ◽  
Specific Antigen ◽  
High Rate ◽  
Close Monitoring ◽  
Robot Assisted ◽  
Clinical Recurrence ◽  
Free Survival ◽  
Factors Associated ◽  
High Risk Prostate Cancer

e567 Background: To evaluate predictive factors associated with detectable prostate-specific antigen (PSA) and clinical recurrence (CR) after robot assisted radical prostatectomy (RARP). Methods: The study included 2500 patients who were treated with RARP between 2000 and 2016. Patients were divided into two groups according to PSA value at 6 weeks after surgery: undetectable PSA (PSA < 0.1 ng/dl) and PSA persistently elevated (PSA ≥ 0.1 ng/dl). Logistic regression analysis was used to evaluate association between covariates and: (1) detectable PSA, (2) CR (positive imaging during follow up) in persistently elevated PSA group. Kaplan-Meier analyses were used to assess CR and cancer-specific mortality (CSM) rates according to PSA persistence after surgery. Results: Overall, 229 patients (9.16%) experienced PSA persistence and from them, 38 (16.5%) had CR. Inside the group of detectable PSA ,146 men (63.75%) received adjuvant treatments and 44 (19.21%) salvage therapies. Gleason ≥ 7, ≥ pT3a, PSA > 10 ng/dl and positive margins were found as significant predictive factors of detectable PSA after surgery (all p < 0.001). Within patients with detectable PSA, stage ≥ pT3a (HR: 2.71; 95% CI, 1.10-6.67; p < 0.029) and to received adjuvant ADT (HR: 13.36; 95% CI, 5.18-34.48; p < 0.001) were associated with CR. CR-free survival in Gleason ≤ 6 at 3-year was 100% vs 60% for Gleason 7(4+3) and 20% for Gleason ≥ 8, (p 0.02). Men aged < 65 years had higher 3-year CR-free survival than older (35% vs 20%, p 0.05). 10-year CSM rates were higher for patients with CR (25% vs 0% no CR; p < 0.001), for men with Gleason ≥ 8 (10% at 10-y; p 0.003) and pathological stage ≥ pT3a (9% at 10-y; p 0.05). CSM rate for patients who received adjuvant ADT+ RT was 20%, 10% for men with ADT and 0% for patients without adjuvant treatment at 10-year (p 0,03). Conclusions: A detectable PSA is clearly affected by factors associated with high risk prostate cancer. Stage pT3 and adjuvant ADT have an important prognostic value in the prediction of CR. Patients with CR , Gleason ≥ 8, pathologic stage ≥ pT3 and those who are treated with adjuvant ADT+ RT must have a close monitoring due to the high rate of mortality.

Tolerability of ongoing phase II study of concomitant radiation and docetaxel followed by docetaxel in prostate cancer patients with a persistent or rising PSA after radical prostatectomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16054-e16054
Author(s):  
A. M. Harris ◽  
T. Y. Eng ◽  
A. B. Karnad ◽  
G. P. Swanson ◽  
C. Jenkins ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Adverse Events ◽  
Standard Dose ◽  
Progression Free Survival ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Secondary Endpoints ◽  
Psa Progression ◽  
Psa Nadir ◽  
Grade 3

e16054 Background: Patients with a detectable PSA after radical prostatectomy (RRP) have persistent disease and inevitably succumb to disease as progression ensues. Radiation has been used in the salvage setting, but has only been found to cure less than half of these patients. SWOG 8794 has recently reported a significant increase in metastasis free survival in 15 years with adjuvant radiation for patients with high risk findings after RRP. It is of particular interest if adjuvant chemoradiation (CRT) can improve the rate of reaching a PSA nadir of zero after RRP in men with persistent or rising PSA. This ongoing IRB approved trial has thus far evaluated the tolerability of CRT utilizing the radiosensitizing agent Docetaxel (DX) for 7 weeks after RRP followed by adjuvant full dose DX (75mg/m2). Methods: Patients: Chemotherapy/hormone naïve, status post RRP, post-op PSA > 0.2 ng/mL on two separate occasions, ECOG ≤ 2; treated with taxane-based chemotherapy (DX 20mg/m2 weekly) concurrent with standard dose radiation for 7 weeks, and post-radiation chemotherapy DX (75mg/ m2) given every 21 days for 4 cycles with premedication intravenous dexamethasone. Primary endpoint: Rate of PSA decline; Number of subjects reaching PSA nadir of zero. Secondary endpoints: Progression Free Survival (PFS) based on PSA progression, toxicity graded via Common Terminology Criteria for Adverse Events Version 3.0 (CTCAE), and overall survival (OS). Results: From 5/07 to 12/08, 16 pts with detectable PSA after RRP were treated; Median age 65 [48–74]; 16/16 completed CRT; 11/16 completed CRT and adjuvant DX; 3/16 dropped out due to adverse events after CRT; Toxicity: 19% (3/16) patients experienced Grade 3 toxicity during CRT and adjuvant DX; 29% (4/14) patients had Grade 3 toxicity during adjuvant DX; no Grade 4 toxicities. See Table . Conclusions: DX in combination with standard radiation appears to be well tolerated in patients with persistent PSA after RRP. [Table: see text] No significant financial relationships to disclose.

Prognostic significance of the PSA nadir after salvage radiotherapy following radical prostatectomy in prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 207-207
Author(s):  
Thomas Wiegel ◽  
Detlef Bartkowiak ◽  
Dirk Bottke ◽  
Alessandra Siegmann ◽  
Volker Budach ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Salvage Radiotherapy ◽  
Long Term Results ◽  
Logrank Test ◽  
Clinical Recurrence ◽  
Psa Nadir

207 Background: Salvage radiotherapy (SRT) is a curative approach in recurrent prostate cancer after radical prostatectomy. The outcome depends on various parameters. We report the long term results of SRT with special respect to the course of PSA after SRT. Methods: Between 1997 and 2007, 307 patients received SRT with 66.6 (N=240) or 70.2 Gy (N=67) using CT-based 3D planning. The median pre-SRT PSA was 0.297 ng/ml. Post-SRT progression was defined as either PSA rising >0.2 ng/ml above nadir, or hormone treatment, or clinical recurrence. Data were analyzed with the Kaplan-Meier method (Logrank-test) and with multivariate Cox regression. Results: Patients were followed up for median 7.2 (max. 14.4) years. Recurrence occurred in median 9.4 months post-RP. In 112 patients, SRT was administered before their PSA reached 0.2 ng/ml, 195 men were above that threshold. After SRT, 222 patients achieved a PSA nadir <0.1 ng/ml, 85 retained higher values. SRT given at a PSA <0.2 ng/ml correlated with achieving a post-SRT nadir <0.1 ng/ml (p<0.0001) and with improved freedom from progression (p=0.0133). Men with a post-SRT nadir <0.1 ng/ml (undetectable range) had significantly less recurrences (p<0.0001) and a better overall survival (p=0.0248). In multivariate analysis of pre-SRT parameters, pT≥3, Gleason Score ≥7, a post-RP PSA nadir ≥0.1 ng/ml and pre-SRT PSA ≥0.2 ng/ml increased the risk of progression. If failing the post-SRT nadir <0.1 ng/ml was included in the model, then this was the strongest risk factor (hazard ratio 7.93). Conclusions: Our data suggest early salvage RT at a PSA level below 0.2 ng/ml to be a favorable treatment option for post-RP PSA recurrence. It increases the chances of achieving a post-SRT PSA-nadir <0.1 ng/ml, which is associated with an improved outcome in terms of PSA progression and overall survival.

scholarly journals Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer

2021 ◽  
Author(s):  
Jost von Hardenberg ◽  
◽  
Hannes Cash ◽  
Daniel Koch ◽  
Angelika Borkowetz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Oncologic Outcome ◽  
Focal Therapy ◽  
Salvage Radiotherapy ◽  
Free Survival ◽  
Cancer Relapse ◽  
Salvage Radical Prostatectomy

Abstract Purpose Due to the tissue preserving approach of focal therapy (FT), local cancer relapse can occur. Uncertainty exists regarding triggers and outcome of salvage strategies. Methods Patients with biopsy-proven prostate cancer (PCa) after FT for localized PCa from 2011 to 2020 at eight tertiary referral hospitals in Germany that underwent salvage radical prostatectomy (S-RP), salvage radiotherapy (S-RT) or active surveillance (AS) were reported. Prostate specific antigen (PSA) changes, suspicious lesions on mpMRI and histopathological findings on biopsy were analyzed. A multivariable regression model was created for adverse pathological findings (APF) at S-RP specimen. Kaplan–Meier curves were generated to determine oncological outcomes. Results A total of 90 men were included. Cancer relapse after FT was detected at a median of 12 months (IQR 9–16). Of 50 men initially under AS 13 received S-RP or S-RT. In total, 44 men underwent S-RP and 13 S-RT. At cancer relapse 17 men (38.6%) in the S-RP group [S-RT n = 4 (30.8%); AS n = 3 (6%)] had ISUP > 2. APF (pT ≥ 3, ISUP ≥ 3, pN + or R1) were observed in 23 men (52.3%). A higher ISUP on biopsy was associated with APF [p = 0.006 (HR 2.32, 97.5% CI 1.35–4.59)] on univariable analysis. Progression-free survival was 80.4% after S-RP and 100% after S-RT at 3 years. Secondary therapy-free survival was 41.7% at 3 years in men undergoing AS. Metastasis-free survival was 80% at 5 years for the whole cohort. Conclusion With early detection of cancer relapse after FT S-RP and S-RT provide sufficient oncologic control at short to intermediate follow-up. After AS, a high secondary-therapy rate was observed.

scholarly journals Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform

2021 ◽  
Vol 10 (8) ◽  
pp. 1563
Author(s):  
Ching-Chia Li ◽  
Tsu-Ming Chien ◽  
Ming-Ru Lee ◽  
Hsiang-Ying Lee ◽  
Hung-Lung Ke ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Da Vinci ◽  
Specific Antigen ◽  
Operation Time ◽  
Setup Time ◽  
Single Site ◽  
University Hospital ◽  
Da Vinci Surgical System ◽  
Free Survival ◽  
The Aesthetic

Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.

scholarly journals Cabazitaxel for Metastatic Castration-Resistant Prostate Cancer: Retrospective Data Analysis from an Indian Centre

2016 ◽  
Vol 9 (2) ◽  
pp. 506-515
Author(s):  
Vanita Noronha ◽  
Amit Joshi ◽  
Vamshi Krishna Muddu ◽  
Vijay Maruti Patil ◽  
Kumar Prabhash
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Progression Free Survival ◽  
Castration Resistant Prostate Cancer ◽  
Free Survival ◽  
Castration Resistant ◽  
Retrospective Data Analysis ◽  
Grade 3 ◽  
Named Patient Programme

Objective: To determine the efficacy and safety of cabazitaxel in metastatic castration-resistant prostate cancer (mCRPC) patients from the named patient programme (NPP) at our centre. Methods: mCRPC patients who progressed on docetaxel were given cabazitaxel intravenously every 3 weeks until disease progression or unacceptable toxicity occurred. Overall survival, progression-free survival, prostate-specific antigen response, quality of life (QOL) changes, and safety were reported. Results: Nine men received cabazitaxel (median: 7 cycles; range: 1–27) under the NPP and were followed until death. Median survival was 14.07 months (1.07–23.80) and progression-free survival was 2.67 months (1.07–20.27). QOL was stable for most patients. Common adverse events (grade ≥3) were neutropenia (n = 8), anaemia (n = 4), and leucopenia (n = 4). Conclusion: These data from 9 patients are consistent with the results reported in the TROPIC study with a manageable safety profile.

Radiotherapy after Prostatectomy

2002 ◽  
Vol 88 (6) ◽  
pp. 445-452 ◽  
Author(s):  
Giuseppe Sanguineti ◽  
Paola Franzone ◽  
Laura Culp ◽  
Michela Marcenaro ◽  
Salvina Barra ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Potential Role ◽  
Specific Antigen ◽  
Salvage Treatment ◽  
Salvage Radiotherapy ◽  
Risk Of Failure

Aims and background The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. Methods The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. Results As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40–50% of patients are rendered bNED with local salvage radiotherapy, but only 10–50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates ≥70% at 5 years. Conclusions Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (>30%) risk of failure.

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