Outcome after conformal salvage radiotherapy in patients with rising prostate-specific antigen levels after radical prostatectomy

Hans Geinitz, Martina G. Riegel, Reinhard Thamm, Sabrina T. Astner, Carolin Lewerenz, Frank Zimmermann, Michael Molls, Carsten Nieder

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31 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1930-1937
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
StatePublished - 1 Apr 2012

Keywords

  • Biochemical relapse
  • Conformal radiotherapy
  • Prognostic factors
  • Prostate cancer
  • Salvage treatment

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