Impact of pathological tumor stage for salvage radiotherapy after radical prostatectomy in patients with prostate-specific antigen < 1.0 ng/ml

Abstract

BackgroundTo evaluate prognostic factors in salvage radiotherapy (RT) for patients with pre-RT prostate-specific antigen (PSA) < 1.0 ng/ml.MethodsBetween January 2000 and December 2009, 102 patients underwent salvage RT for biochemical failure after radical prostatectomy (RP). Re-failure of PSA after salvage RT was defined as a serum PSA value of 0.2 ng/ml or more above the postradiotherapy nadir followed by another higher value, a continued rise in serum PSA despite salvage RT, or initiation of systemic therapy after completion of salvage RT. Biochemical relapse-free survival (bRFS) was estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model.ResultsThe median follow-up period was 44 months (range, 11-103 months). Forty-three patients experienced PSA re-failure after salvage RT. The 4-year bRFS was 50.9% (95% confidence interval [95% CI]: 39.4-62.5%). In the log-rank test, pT3-4 (p < 0.001) and preoperative PSA (p = 0.037) were selected as significant factors. In multivariate analysis, only pT3-4 was a prognostic factor (hazard ratio: 3.512 [95% CI: 1.535-8.037], p = 0.001). The 4-year bRFS rates for pT1-2 and pT3-4 were 79.2% (95% CI: 66.0-92.3%) and 31.7% (95% CI: 17.0-46.4%), respectively.ConclusionsIn patients who have received salvage RT after RP with PSA < 1.0 ng/ml, pT stage and preoperative PSA were prognostic factors of bRFS. In particular, pT3-4 had a high risk for biochemical recurrence after salvage RT.

Importance of the site of positive surgical margin in salvage external beam radiation therapy for biochemical recurrence of prostate cancer after radical prostatectomy

“…Approximately one-third of patients with BRec after RP will have distant metastases, and the median time to the development of distant metastases following BRec is 8 years [3]. Salvage radiation therapy (SRT) has been reported as an effective treatment for BRec after RP [4][5][6][7][8][9][10][11][12][13][14][15][16]. Reports have varied regarding prognostic factors for biochemical control after SRT.…”

Factors influencing biochemical recurrence in patients who have received salvage radiotherapy after radical prostatectomy: a systematic review and meta-analysis

“…In this meta-analysis, eight studies evaluated the surgical margins910131416171920 However, the overall effect showed no significant association between surgical margins and BCR (OR: 1.09; 95% CI: 0.83–1.43). The fixed-effects model was reported here because there was no evidence of heterogeneity ( I 2 = 30%) ( Figure 5 ).…”

“…In this meta-analysis, we evaluated three studies including 264 patients that evaluated radiation dose 141519. Pooling of data from these studies showed a significant effect of radiation dose ≥64 Gy versus the controls (OR: 0.35; 95% CI: 0.19–0.64).…”

“…reported that a positive surgical margin may be a risk factor of BCR after SRT. Meanwhile, a study conducted by Umezawa et al 19. showed that the status of the surgical margin did not affect BCR after SRT.…”

“…Trock7 reported that patients with PSADT <6 months may experience significantly improved prostate cancer-specific survival. However, Umezawa et al 19. and Stephenson et al 21.…”