Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy

Abstract

Objectives To assess the efficacy of salvage/adjuvant radiation therapy (RT) for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Between 1997 and 2001, 52 patients were treated in our institution with RT for PSA recurrence after RP. The mean (range) delay between RP and RT was 30.5 (0.16-105.6) months. Eighteen patients received no hormonal therapy before RT. The failure of RT was defined as three consecutive increases in PSA levels with intervals of ≥ 6 weeks. Results Within a mean (range) follow-up of 27.7 (6-69) months, 18 patients presented with biochemical progression. The 3-year biochemical progression-free survival was 51%. Using univariate analysis, an age < 65 years ( P = 0.0262), a Gleason score on the RP specimen of ≥ 8 ( P = 0.0024), stage pT3 ( P = 0.02), a detectable nadir PSA after RT ( P < 0.001) and the absence of hormonal therapy ( P = 0.0359) were associated with a lower biochemical progression-free survival. However, only the Gleason score ( P = 0.0395) and nadir serum PSA after RT ( P = 0.028) remained independent predictive factors on multivariate analysis. Conclusion Half of the present patients treated with RT for an isolated high serum PSA level after RP were free of biochemical relapse at 3 years of follow-up. RT may be proposed to selected patients with mild morbidity. However, definitive evidence of the beneficial effect of adjuvant RT for patients with PSA recurrence after RP awaits the conclusion of randomized clinical trials. Patients and methods

Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: a single institution experience

“…Gleason score and high grade prostate cancer was associated with poor biochemical outcome in previous reported studies [ 19 - 30 ]. However, we did not find any significant bDFS difference for patients with a low (≤6) or high (≥7) Gleason scores.…”

Outcomes of pathologically localized high-grade prostate cancer treated with radical prostatectomy

“…[14] Conversely, Taille et al evaluated ART failure in patients with BCR after RP and showed that GS ( P = .0395) was an independent predictive factor. [31]…”

“…[10–12] Whether adjuvant therapy is necessary when RP GS is high (8–10) remains controversial. [13–15] Several studies analyzed predictors of biochemical recurrence (BCR) after adjuvant therapy to identify patients who might benefit from radiotherapy; nonetheless, the predictive impact of high RP GS was not consistent.…”

The Dilemma of a Rising Prostate-Specific Antigen Level After Local Therapy: What Are Our Options?

“…124 Intermittent ADT is currently only recommended for men 470 years of age with GS r7. 125 Thus, there are a number of uncertainties about the use of ADT in the setting of BR, and there is no consensus on who should receive therapy. Medical practitioners should take into consideration their suspicion that the rising PSA is related to metastatic disease, patient comorbidities, the quality of life of the patient with a known rising PSA (ie, "PSA anxiety"), and the quality of life of the patient while on ADT when making recommendations for the therapy.…”