Early Salvage Radiotherapy Following Radical Prostatectomy

Pfister, David; Bolla, M.; Briganti, Alberto; Carroll, Peter R.; Cozzarini, C.; Joniau, Steven; Poppel, Hein Van; Roach, Mack; Stephenson, Andrew J.; Wiegel, Thomas; Zeléfsky, Michael J.

doi:10.1016/j.eururo.2013.08.013

Cited by 186 publications

(109 citation statements)

References 44 publications

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“…For this purpose, MR imaging recently showed better results (8). Prostatic bed relapse without evidence of locoregional LN involvement or distant metastases is usually suitable for salvage radiotherapy (S-RT) (9). It has been established that the outcome of the patient who received S-RT is optimized when PSA level is as low as reasonably possible (10,11), and there is a direct relation between patient outcome and PSA or PSA kinetics values at the moment of S-RT (10).…”

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confidence: 99%

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?

et al. 2014

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The aim of the study was to assess which factors may influence 11 C-choline PET/CT detection rate in a population of recurrent prostate cancer (PCa) patients listed for salvage radiation therapy (S-RT) in an early phase of biochemical relapse, to select which patients could obtain the most benefit by performing restaging 11 C-choline PET/CT before S-RT. Methods: The study comprised 605 patients, treated with radical prostatectomy (RP) with curative intent for PCa who showed rising PSA levels after primary therapy and listed for S-RT. Prostate-specific antigen (PSA) values were .0.2 ng/mL and ,2 ng/mL (mean, 1.05 ng/mL; median, 1.07 ng/mL; range, 0.2-2 ng/m; SD, ±0.59). All patients were classified as N0 after RP. Seventeen of 605 patients received adjuvant RT together with RP, whereas 148 of 605 patients received androgen-deprivation therapy (ADT) at the time of PET/CT. PSA, PSA kinetics, Gleason score, age, time to biochemical relapse, ADT, and initial tumor stage were statistically analyzed to assess which factor could influence PET/CT positivity and the detection of local versus distant relapse. Results: 11 C-choline PET/CT was positive in 28.4% of patients (172/605). Eighty-three of 605 patients were positive in the pelvis (group A), distant metastasis (group B) were detected in 72 of 605 patients, and local and distant sites of relapse were detected in 17 of 605 patients (group C). At multivariate analysis, PSA, PSA doubling time (PSAdt), and ongoing ADT were significant predictors for positive scan results, whereas PSA and PSAdt were significantly related to distant relapse detection (P , 0.05). At the receiver-operatingcharacteristic analysis, a PSA value of 1.05 ng/mL and PSAdt of 5.95 mo were determined to be the optimal cutoff values in the prediction of a positive 11 C-choline PET/CT scan, with an area under the curve (AUC) of 0.625 for PSA and 0.677 for PSAdt. Conclusion: 11 Ccholine PET/CT may be suggested before S-RT during the early phase of biochemical relapse, to select patients who may benefit from this aggressive treatment. Particularly, patients showing fast PSA kinetics or PSA increasing levels despite ongoing ADT should be studied with 11 C-choline PET/CT before S-RT, considering the higher probability to detect positive findings outside the pelvis.

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confidence: 99%

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?

et al. 2014

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“…14 The early administration of salvage RT to patients with BCR after RP has a good long-term outcome. 15 A pooled analysis published in the European Urology…”

Section: Discussionmentioning

confidence: 99%

Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

Ajib

Zanaty

Alnazari

et al. 2017

CUAJ

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Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP). Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (PSA) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status. Results: Men who underwent SRT had a mean age, prostate-specific antigen (PSA), and time from radical prostatectomy (RP) to RT of 61.8 years (60.1-63.6), 0.5 ng/ml (0.2-0.8), and 458 days (307-747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL was observed in 89%, 93%, and 81% at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months were 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3

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“…Dr King in a review article concluded on adjuvant and salvage RT techniques from 2013 that early SRT was a favorable alternative strategy to ART. Pfister et al reported findings from a systematic review of 10 retrospective studies assessing early SRT defined as pre-RT PSA levels 0.5 ng/ml or less among patients with lymph node negative disease [36]. A pooled analysis of 886 patients yielded a mean 5-year bPFS of 71% (range: 48-81.8%) which is comparable to results from ART therapy studies.…”

Section: Who and When To Offer Early Srt?mentioning

confidence: 94%

Adjuvant versus salvage radiotherapy following radical prostatectomy: do the AUA/ASTRO guidelines have all the answers?

Kneebone

Woo

2014

Expert Review of Anticancer Therapy

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Early Salvage Radiotherapy Following Radical Prostatectomy

Cited by 186 publications

References 44 publications

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

Adjuvant versus salvage radiotherapy following radical prostatectomy: do the AUA/ASTRO guidelines have all the answers?

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Early Salvage Radiotherapy Following Radical Prostatectomy

Cited by 186 publications

References 44 publications

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging11C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging11C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

Adjuvant versus salvage radiotherapy following radical prostatectomy: do the AUA/ASTRO guidelines have all the answers?

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Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging¹¹C-Choline PET/CT Scan Before Salvage Radiation Therapy?