Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy

Abstract

Objective: Assess the results of salvage conformal radiotherapy in patients with biochemical failure after radical prostatectomy and identify prognostic factors for biochemical recurrence and toxicity of the treatment. Materials and Methods: From June 1998 to November 2001, 35 patients were submitted to conformal radiotherapy for PSA ≥ 0.2 ng/mL in progression after radical prostatectomy and were retrospectively analyzed. The mean dose of radiation in prostatic bed was of 77.4 Gy (68-81). Variables related to the treatment and to tumor were assessed to identify prognostic factors for biochemical recurrence after salvage radiotherapy. Results: The median follow-up was of 55 months (17-83). The actuarial survival rates free of biochemical recurrence and free of metastasis at a distance of 5 years were 79.7% e 84.7%, respectively. The actuarial global survival rate in 5 years was 96.1%.The actuarial survival rate free of biochemical recurrence in 5 years was 83.3% with PSA pre-radiotherapy ≤ 1, 100% when > 1 and ≤ 2, and 57.1% when > 2 (p = 0.023). Dose > 70 Gy in 30% of the bladder volume implied in more acute urinary toxicity (p = 0.035). The mean time for the development of late urinary toxicity was 21 months (12-51). Dose > 55 Gy in 50% bladder volume implied in more late urinary toxicity (p = 0.018). A patient presented late rectal toxicity of 2nd grade. Conclusions: Conformal radiotherapy showed to be effective for the control of biochemical recurrence after radical prostatectomy. Patients with pre-therapy PSA ≤ 2 ng/mL have more biochemical control.

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 ).…”

“…Of these 204 papers, 196 were finally excluded because they did not meet the inclusion criteria. In addition, four papers were identified from the reference lists 13141516. Finally, a total of 11 papers were eligible for review.…”

“…Four studies891013 evaluated GS: 441 patients were ≥7 and 265 were <7. The overall effect of this meta-analysis was against the patients with GS ≥7 (OR: 3.82; 95% CI: 2.60–5.64).…”

“…Seven studies891011131619 including 1024 patients reported the relationship between pT stage and BCR. When these results were pooled, pT ≥3a was a significant factor predicting BCR after SRT (OR: 1.87; 95% CI: 1.08–3.23).…”

Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy

“…A low pretreatment PSA level is an important factor for sRT to be successful. The borderline value of PSA for excellent results of sRT is 1.5 and 2.0 ng/ml, respectively [29][30][31][32][33][34][35][36][37] . Other prognostic factors for the efficacy of sRT are: PSADT [38][39][40][41][42] , PSA before RP [22,23] , seminal vesicle invasion [23,24,27,43,44] and extracapsular extension [27,43,44] .…”