Predominant Treatment Failure in Postprostatectomy Patients Is Local: Analysis of Patterns of Treatment Failure in SWOG 8794

Abstract

The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure. Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels. Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy.

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

“…Kahn constructed a modelling of four prognostic groups based on Gleason score, pathologic stage, and surgical margin status for the likelihood of being free from PSA relapse after RP (23). In recent years, the outcomes of three randomized studies (24)(25)(26)(27), comparing observation with post-operative adjuvant radiotherapy for pathologic T3 (pT3) and/or positive surgical margins, have confirmed that extracapsular tumor extension and/or positive surgical margins are associated with a high risk of PSA relapse. In the Southwest Oncology Group 8794 clinical trial, the rate of PSA relapse was 72% at 10 years in 122 patients with pT3 and/or positive surgical resection margins who had initially achieved an undetectable postoperative PSA (≤0.2 ng/mL) (25).…”

“…In recent years, the outcomes of three randomized studies (24)(25)(26)(27), comparing observation with post-operative adjuvant radiotherapy for pathologic T3 (pT3) and/or positive surgical margins, have confirmed that extracapsular tumor extension and/or positive surgical margins are associated with a high risk of PSA relapse. In the Southwest Oncology Group 8794 clinical trial, the rate of PSA relapse was 72% at 10 years in 122 patients with pT3 and/or positive surgical resection margins who had initially achieved an undetectable postoperative PSA (≤0.2 ng/mL) (25). Similarly, in the European Organization for Research and Treatment of Cancer 22911 clinical trial (26) and the German study (27), the risk of PSA relapse was high, 40% and 46% at 5 years, respectively, in those with pT3 and/or positive surgical resection margins even if they had initially attained an undetectable post-operative PSA.…”

Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

“…However, cases with aggressive pathology exhibit high rates of biochemical and clinical disease progression 1. Randomized controlled trials have demonstrated a progression‐free survival benefit for adjuvant radiotherapy (ART) for patients with aggressive pathology after radical prostatectomy, defined by extracapsular extension, seminal vesicle invasion, or a positive surgical margin 2, 3, 4. However, the impact of ART on overall survival is less clear.…”

Impact of 18F-Fluciclovine PET on Target Volume Definition for Postprostatectomy Salvage Radiotherapy: Initial Findings from a Randomized Trial

“…Disease can recur after surgery, and postprostatectomy radiotherapy can be administered either as adjuvant or as salvage treatment (3)(4)(5)(6). Salvage radiotherapy has been used with success, with factors such as pretreatment prostate-specific antigen (PSA), Gleason score, seminal vesicle invasion, and PSA doubling time determining the rate of success (7).…”