Lower PSA Predicts Favorable Salvage Radiotherapy Outcomes – Renal and Urology News

The overall median follow-up was 63.5 months. The 5-year BCR-free survival rate was 58.2% for the cohort overall and 76.2% for the 118 patients 55.7% who had early salvage RT, defined as RT started when the PSA level was 0.5 ng/mL or less, the investigators reported online in PLoS One

via Lower PSA Predicts Favorable Salvage Radiotherapy Outcomes – Renal and Urology News.

When patients have a PSA that rises over 0.1 after robotic prostatectomy, they likely have recurrent prostate cancer somewhere. This study shows that patients treated with salvage XRT (external beam radiotherapy) had better results if the treatment was started below a PSA of 0.5.

Personally, in the patients who are good candidates for salvage XRT, I prefer to start the radiation after the PSA goes higher than 0.2 and sometimes lower.

Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy: Abstract

Source: JAMA
Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy
Bruce J. Trock, PhD; Misop Han, MD; Stephen J. Freedland, MD; Elizabeth B. Humphreys, MS; Theodore L. DeWeese, MD; Alan W. Partin, MD, PhD; Patrick C. Walsh, MD
JAMA. 2008;299(23):2760-2769.

Context Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy, but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival, and if so, the subgroup of men most likely to benefit.
Objectives To quantify the relative improvement in prostate cancer-specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy, and to identify subgroups for whom salvage treatment is most beneficial.
Design, Setting, and Patients Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982-2004, followed up through December 28, 2007, who experienced biochemical and/or local recurrence and received no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78).
Main Outcome Measure Prostate cancer-specific survival defined from time of recurrence until death from disease.
Results With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer-specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival.
Conclusions Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial.

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Salvage radiation after prostate cancer surgery

UroToday – Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer after Radical Prostatectomy

This retrospective study with a large cohort of patients treated with salvage radiotherapy after prostatectomy suggests that up to 50% of patients may remain free of disease 6 years after treatment if it is instituted before their serum PSA rises above 0.5 ng/ml. The nomogram proposed predicts with reasonable accuracy which patients are more likely to exhibit a favorable response to salvage radiotherapy and may aid in clinical decision-making.

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