Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy

Fossati, Nicola; Karnes, R. Jeffrey; Colicchia, Michele; Boorjian, Stephen A.; Bossi, Alberto; Seisen, Thomas; Muzio, N. Di; Cozzarini, C.; Chiorda, B. Noris; Fiorino, Claudio; Gandaglia, Giorgio; Dell’Oglio, Paolo; Shariat, Shahrokh F.; Goldner, Gregor; Joniau, Steven; Battaglia, Antonino; Haustermans, Karin; Meerleer, Gert De; Fonteyne, Valérie; Ost, Piet; Poppel, Hendrik Van; Wiegel, Thomas; Montorsi, Francesco; Briganti, Alberto

doi:10.1016/j.eururo.2017.07.026

Cited by 69 publications

(59 citation statements)

References 33 publications

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“…The Gleason score, pT stage, and the post-RP PSA level were used to define five risk groups, whose 8-year probability of freedom from metastasis ranged from 62% to 98%. PSA persistence was a shared characteristic in the two most unfavourable groups [14].…”

Section: Discussionmentioning

confidence: 96%

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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Objective To test whether salvage radiotherapy (SRT) in patients with lymph node negative (N0) prostate cancer is equally effective with persistent prostate‐specific antigen (PSA) and PSA rising from the undetectable range (<0.1 ng/mL) after radical prostatectomy (RP). Patients and methods We assessed post‐SRT PSA progression‐free survival (PFS) in 555 patients with prostate cancer. The entire cohort was compared with a risk‐adjusted subgroup of 112 patient pairs with matching pre‐RP PSA level (±10 ng/mL), Gleason score (≤6 vs 7 vs ≥8), and pre‐SRT PSA level (±0.5 ng/mL). Results The median follow‐up was 6.1 years. After RP, PSA was undetectable in 422 and persistent in 133 patients. PSA persistence and a pre‐SRT PSA level of ≥0.5 ng/mL reduced Kaplan–Meier rates of PFS significantly. In multivariate analysis of the entire cohort and after risk adjustment, the pre‐SRT PSA level but not post‐RP PSA persistence was a significant parameter. In the matched cohort's subgroup with early SRT at a PSA level of <0.5 ng/mL, a trend towards a worse outcome with post‐RP PSA persistence was observed. Delayed SRT with a PSA level ≥0.5 ng/mL led to a PFS of <30%, irrespective of the post‐RP PSA level. Conclusion In patients with N0 prostate cancer with post‐RP PSA persistence, early SRT at a PSA level <0.5 ng/mL seems to be less effective than in recurrent patients with post‐RP undetectable PSA. They might benefit from intensified therapy, but larger case numbers are required to substantiate this conclusion. In patients with a PSA level ≥0.5 ng/mL and higher‐risk features associated with post‐RP PSA persistence, SRT alone is unlikely to provide long‐term freedom from further progression.

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Section: Discussionmentioning

confidence: 96%

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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“…Prostate cancer is the most common noncutaneous cancer in men, with 1,212,653 case excepted in 2019 in China alone. Treatment of localized prostate cancer has been proven by clinical trial including hypo-fractionation RT dose escalation with ENI and ADT combined with RT [1][2][3][4][5]. With the development of radiotherapy IMRT, it has been generally used in prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Radiation therapy related toxicities is associated with high total RT dose, short recovery time, and the volume of neighboring OAR normal tissues (rectum, bowel and bladder) ever in prostate-only RT 6,7 .In recent years, with the development of radiotherapy technology, IMRT has replaced 3-dimensional conformal radiation therapy as the most common method of radiation therapy for prostate cancer for its conformable dose distributions which can reduce normal tissue toxicity [1,3]. The most common method for IMRT delivery for prostate cancer involves [5][6][7][8][9], fixed gantry positions with computergenerated, sliding-window multi-leaf collimator positions to modulate dose to the prostate [8][9][10]. A more recent IMRT technique named as VMAT, involves gantry rotation around the prostate with 1 to 4 arcs while the x-ray beam is on.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of fixed field dynamic IMRT and VMAT techniques in simultaneous integrated boost radiotherapy of Prostate Cancer

Sun

Liu

Chen

et al. 2020

Preprint

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Background: As the high risk prostate cancer can be benefited from the combination of hypo-fractionated radiotherapy and pelvic conventional fraction radiotherapy, the comparison between fixed field dynamic IMRT and VMAT techniques can provide suggestion for clinical treatment. Methods: We selected 10 patients with high risk prostate cancer who received radiotherapy at Sun Yat-sen University Cancer Center from 2013 January to 2013 December. The target including the prostate, seminal vesicle and pelvic lymph nodes. With the same prescription and optimized parameters, 9 field IMRT, single arc and double arc VMAT treatment plans were designed, which are expressed by 9F, 1ARC and 2ARC respectively. The dose distribution of the targets, organs at risk (OAR), monitor units (MUs), treatment time and gamma pass ratios of dose verification were compared. Results: The D2%(69.37±0.89)Gy,D50%(66.92±0.63)Gy, HI(0.09±0.02) and CI(0.83±0.05) of PTV1 in 9F were slightly better than those of 1ARC which were (71.13±1.21) Gy, (68.50±0.76)Gy, (0.12±0.02), (0.74±0.07), except D98% , the difference were significant(p<0.05). All dosimetric indices of PTV1 in 9F and 2ARC were close and has no significant differences (p>0.05). The V95 %(99.45±0.78)% of PTV2 in 9F was slightly better than that in 1ARC (99.35±1.28)%, the difference was significant (p<0.05). All dosimetric indices of PTV2in 9F and 2ARC were close and the difference were no significant (p>0.05). The Dmean of bladder and the V67.5Gyof rectum between all three plans were similarity The Dmean of left and right femoral in 1ARC and 2ARC were lower than that in 9F, and the difference was significant (p<0.05). Other dosimetric indices of OARs in 9F were lower than those in 1ARC and 2ARC, and much lower than 1ARC, the difference were significant (p<0.05). The mean monitor units in 1ARC and 2ARC were fewer by 70.0% and 67.2% in comparison with 9F. The treatment mean time in 1ARC and 2ARC were shorter by 81.7% and 61% in comparison with 9F. The verification pass ratios of γ(3%/3mm)were 97.8% (9F), 98.9% (1ARC) and 99.4% (2ARC) respectively, the difference were significant(p<0.05). Conclusion: Compared with IMRT, VMAT improved delivery efficiency noticeably. Two arcs provided comparable tumor dosimetric coverage, but performed worse in dose sparing for bladder, rectum and small bowel. IMRT plan was better than VMAT in prostate cancer simultaneous integrated boost radiotherapy.

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“…Even patients with persisting PSA serum concentrations after undergoing RP exhibit a heterogeneous clinical course of the disease, therefore, a risk‐adapted, personalized approach stratifying biologically aggressive from less aggressive prostate cancer should be adopted. In a retrospective study in 925 patients who underwent sRT, PSA persistence was associated with a significantly lower 8‐year metastasis‐free survival rate when compared to patients with PSA relapse following undetectbale postoperative PSA serum concentrations . Furthermore, it was shown that PSA persistence and a Gleason score ≥8 were independent, statistically significant predictors for systemic metastases, with a hazard ratio of 4.64 (95% CI 3.06–7.02; P < 0.001) and 8.37 (95% CI 4.15–16.88; P < 0.001), respectively.…”

mentioning

confidence: 99%

“…PSA persistence is associated with an increased risk of metastases and impaired cancer‐specific survival as compared to undetectable PSA levels after RP for patients with negative and positive lymph nodes . In fact, the majority of patients with persisting PSA serum levels postoperatively have locally advanced prostate cancer, positive lymph nodes, positive surgical margins and high Gleason scores.…”

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confidence: 99%

PSA persistence after radical prostatectomy needs more than standard therapeutic options to improve outcomes

Heidenreich

Pfister

2019

BJU International

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Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy

Cited by 69 publications

References 33 publications

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

Dosimetric comparison of fixed field dynamic IMRT and VMAT techniques in simultaneous integrated boost radiotherapy of Prostate Cancer

PSA persistence after radical prostatectomy needs more than standard therapeutic options to improve outcomes

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