Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy

Purpose An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence. Patients and Methods Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients. Results The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69. Conclusion Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.

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Prostate-specific antigen is a predictor of the efficacy of salvage radiation therapy in patients with recurrent prostate cancer after radical prostatectomy

Cancer Urology ◽

10.17650/1726-9776-2019-15-2-66-72 ◽

2019 ◽

Vol 15 (2) ◽

pp. 66-72

Author(s):

Р. V. Bulychkin ◽

S. I. Tkachev ◽

V. B. Matveev ◽

A. V. Nazarenko

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Doubling Time ◽

Specific Antigen ◽

Salvage Radiotherapy ◽

Recurrent Prostate Cancer ◽

Study Objective ◽

Salvage Radiation Therapy

The study objective is to determine advisability of radiation therapy in patients with recurrent prostate cancer after radical prostatectomy.Materials and methods. In our research 92 patients were treated by salvage radiation therapy after radical prostatectomy. The median of follow up is 48 months.Results. The rates of 1, 2 and 3 years disease-free survival were 96, 91 and 86 %. We received that prostate specific antigen doubling time <6 months and prostate specific antigen >0.5 ng/ml before salvage radiation therapy statistical significance associated with biochemical failure. The results of our study indicate two main negative factors in the prognosis of the efficacy of radiotherapy and combined hormone therapy in patients with biochemical or clinical locoregional recurrence – the period of prostate specific antigen doubling time less than 6 months (p = 0.035) after radical prostatectomy and a higher prostate specific antigen level, especially more than 0.5 ng/ml before salvage radiotherapy (p = 0.037).Conclusion. Taking into account the absence of differences in the results of treatment between groups of patients with clinical and biochemical recurrences, it is not advisable to postpone the implementation of salvage radiotherapy and recommend patients to repeat the study. Repeated studies of these patients, as a rule, are conducted after many months at a higher level of the prostate specific antigen, which is associated with a higher tumor activity and a worse prognosis of the disease.

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When should salvage radiation therapy be associated with concomitant hormonal therapy in patients affected by prostate cancer? The key role of PSA doubling time

European Urology Supplements ◽

10.1016/s1569-9056(18)33345-1 ◽

2018 ◽

Vol 17 (8) ◽

pp. 333-334

Author(s):

A. Briganti ◽

N. Fossati ◽

J. Karnes ◽

M. Soligo ◽

S. Boorjian ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Hormonal Therapy ◽

Doubling Time ◽

Salvage Radiation Therapy ◽

Psa Doubling Time

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Prediction of Response to Salvage Radiation Therapy in Patients With Prostate Cancer Recurrence After Radical Prostatectomy

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.4.1030 ◽

2001 ◽

Vol 19 (4) ◽

pp. 1030-1039 ◽

Cited By ~ 157

Author(s):

Angelos K. Leventis ◽

Shahrokh F. Shariat ◽

Michael W. Kattan ◽

E. Brian Butler ◽

Thomas M. Wheeler ◽

...

Keyword(s):

Multivariate Analysis ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Doubling Time ◽

Salvage Radiation Therapy ◽

Psa Relapse ◽

Psa Doubling Time ◽

Prostatic Fossa ◽

Biopsy Confirmation

PURPOSE: To identify factors predictive of local recurrence as defined by a complete response to salvage radiation therapy in patients whose disease recurs after radical prostatectomy. PATIENTS AND METHODS: Ninety-five patients with recurrence after radical prostatectomy who were evaluated by prostatic fossa biopsies, and a subset of 49 of these patients treated with radiation for control of presumed or biopsy-proven local recurrence, were studied. RESULTS: Biopsies were positive in 40 (42%) of the 95 biopsied patients. Multivariate analysis revealed that prebiopsy prostate-specific antigen (PSA) level, postrecurrence PSA doubling time, and positive digital rectal examination (DRE) of the prostatic fossa were all statistically significant predictors of a positive biopsy. For the 49 patients subsequently treated with salvage radiation therapy, the overall actuarial 3- and 5-year PSA relapse-free probabilities were 43% and 24%, respectively. Univariate analysis showed no differences in the PSA relapse-free probabilities associated with any pathologic features of the radical prostatectomy specimen, biopsy confirmation of local recurrence, or DRE of the prostatic fossa. In multivariate analysis, controlling for all other variables, preradiation PSA and postrecurrence PSA doubling time measured before radiation were the only statistically significant predictors of outcome. CONCLUSION: DRE of the prostatic fossa, prebiopsy PSA, and postrecurrence PSA doubling time predict which patients will have biopsy-proven local recurrence. However, response to salvage radiation therapy is associated with postrecurrence PSA doubling time and with preradiation PSA level only. DRE of the prostatic fossa and biopsy confirmation of local recurrence are not associated with salvage radiation outcome.

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