Salvage radiation for a rising PSA following radical prostatectomy

Maier, Jordan; Forman, Jeffrey D.; Tekyi-Mensah, Samuel; Bolton, S.; Patel, Ravi; Pontes, J. Edson

doi:10.1016/j.urolonc.2003.12.001

Cited by 28 publications

(17 citation statements)

References 22 publications

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“…One of consistent variables associated with PSA relapse-free outcome has been PSA levels prior to salvage RT. Multiple studies examined various PSA cut-off levels and showed that the lower the PSA level at the time of salvage RT, the better the treatment outcome (61,(68)(69)(70)72,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84). No specific PSA cut-off level has been identified as being superior to others at predicting treatment outcome.…”

Section: Salvage Radiotherapy For Psa Relapsementioning

confidence: 99%

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

Choo

2010

Cancer Res Treat

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Section: Salvage Radiotherapy For Psa Relapsementioning

confidence: 99%

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

Choo

2010

Cancer Res Treat

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“…The general approach was to record rates of significant (Ն Grade 2) chronic complication rates along the GU, GI, and potency axes. GU toxicity [35][36][37][38][39][40][41][42] includes primarily cystitis, dysuria, or hematuria. A randomized trial of post-RRP RT versus observation demonstrated no difference in incontinence and stricture rates.…”

Section: Complication/utility-adjusted Nnt Resultsmentioning

confidence: 99%

“…43 The range of severe toxicity reported was 0 -10%. GI toxicity [35][36][37][38][39][40][41][42]44 primarily includes proctitis but also may include diarrhea, or, rarely, fecal incontinence. The range of severe GI toxicity varied from 0% to 10%.…”

Section: Complication/utility-adjusted Nnt Resultsmentioning

confidence: 99%

“…A general literature review of major RT complications in the post-RRP setting was undertaken to estimate the incidence of these individual complications. [35][36][37][38][39][40][41][42][43][44][45][46][47][48] This literature review provided a means of estimating H 1 and H 2 in Equation 4. One general assumption is that the incidence of side effects of RT is similar in the adjuvant and salvage settings (i.e., H 1 ϭ H 2 ).…”

Section: Adjustment For Side Effectsmentioning

confidence: 99%

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Postprostatectomy adjuvant versus salvage radiotherapy

Jani

Kao

2005

Cancer

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BACKGROUNDRadiotherapy (RT) has been used with success after radical retropubic prostatectomy (RRP), both in the adjuvant and salvage settings. The purpose of the current investigation was to systematically compare adjuvant versus salvage RT in a manner that incorporates both treatment efficacy and complications.METHODSA literature review was performed of reports of post‐RRP salvage and adjuvant RT, and 12 trials comprising 1060 patients met the appropriate inclusion criteria. The biochemical failure‐free survival in each study/arm was tabulated, and these values were entered into a model to compute an unadjusted number‐needed‐to treat (NNT). RT complications were then considered, accounting for differences in toxicity incidences in the salvage versus adjuvant setting, to compute complication‐adjusted NNTs. In all the trials, the signs and magnitudes of the NNTs obtained were used to compare adjuvant with salvage RT.RESULTSThe absolute NNT analysis showed an advantage of adjuvant compared with salvage RT. After adjustment for RT complications, however, the advantage shifted to salvage RT. This transition point from superiority of adjuvant RT to superiority of salvage RT was sensitive to the estimated incidence and severity of RT side effects.CONCLUSIONSAdjuvant post‐RRP RT was advantageous in comparison to salvage RT if the side effects of RT were estimated to be negligible. However, with moderate incidence/severity of RT side effects, salvage RT was advantageous. The findings herein must be tested in a prospective study in which both health‐related quality of life and cancer control are documented in patients receiving adjuvant versus salvage post‐RRP RT. Further work is needed to better estimate parameters entered into the model to determine the precise transition point between adjuvant and salvage RT with modern RT techniques. Cancer 2005. © 2005 American Cancer Society.

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“…Maier et al (15) have treated 149 patients with a median dose of 68 Gy and 21 patients with a dose of 78 Gy, and reported 19% and 33% gastrointestinal and genitourinary toxicity grade 2, and 3% and 6% of gastrointestinal and genitourinary toxicity grade 3, respectively. Katz et al (11) reported annual actuarial rates in 4 years of late genitourinary toxicity grades 2 and 3 of 9% and 10%, respectively, and late gastrointestinal toxicity grades 2 and 3 of 12% and 0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy

Monti¹,

Nakamura²,

Ferrigno³

et al. 2006

Int. braz j urol.

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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.

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Salvage radiation for a rising PSA following radical prostatectomy

Cited by 28 publications

References 22 publications

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

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

Postprostatectomy adjuvant versus salvage radiotherapy

Salvage conformal radiotherapy for biochemical recurrent prostate cancer after radical prostatectomy

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