Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy

Lohm, Gunnar; Neumann, Konrad; Budach, Volker; Wiegel, Thomas; Hoecht, Stefan; Gollrad, Johannes

doi:10.1007/s00066-017-1247-1

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…In addition, patients in whom PSA levels transiently increased relatively early after the initiation of RT experienced BR. These results indicate that the impact on PSADT may have resulted in PSA elevation, as reported by Lohm [ 9 ]. However, because the PSA elevation due to irradiation of normal prostate tissues reportedly peaks in 2 to 4 weeks [ 22 , 23 ], it may be important to perform high-quality pretreatment tests that can determine the presence or absence of residual prostate tissues and other factors.…”

Section: Discussionsupporting

confidence: 82%

“…Despite salvage RT being a widely adopted strategy, our literature search yielded only 9 articles [ 5 – 13 ] and one review [ 20 ] on changes in PSA levels during RT. All but one of these articles showed that such changes might be a factor impacting biochemical or clinical recurrence [ 5 – 8 , 10 – 13 ], while the other article described changes in PSA levels as not being a factor associated with recurrence [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been 9 studies examining changes in prostate-specific antigen (PSA) levels during salvage RT [ 5 – 13 ]. All but one of these studies, showed that such changes are factors possibly associated with biochemical or clinical recurrence [ 5 – 8 , 10 – 13 ], while the one study found that such changes were not linked to recurrence [ 9 ]. This study was thus designed to retrospectively examine patients with changes in PSA levels during RT after prostate cancer surgery, focusing on the detailed pathological findings.…”

Section: Introductionmentioning

confidence: 99%

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Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery

Aizawa,

Maebayashi,

Ishibashi

et al. 2023

BMC Urol

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Background Administration of adjuvant or salvage radiotherapy (RT) after prostate cancer (PCa) surgery is supported by clinical evidence and is a widely adopted strategy. On occasion, we detect changes in prostate-specific antigen (PSA) levels, such as a transient elevation or decline, during RT. Thus, we retrospectively investigated the frequency of changes in PSA levels, their associations with histopathological parameters, PSA doubling time (PSADT), and biochemical recurrence (BR) of PCa. Methods This study included 23 consecutive patients who underwent surgery for PCa between 2012 and 2019, received salvage RT without hormone therapy, and exhibited changes in PSA levels during RT. The prostatic bed was irradiated with a total dose of 64 to 66 Gy. BR was defined as consecutive PSA levels exceeding 0.2 ng/mL or having to start hormone therapy because of PSA elevation after salvage RT. Results During salvage RT after PCa surgery, PSA levels transiently increased in 11 patients (47.8%) and decreased in 12 (52.2%). When factors associated with BR were examined in patients with transient PSA elevation, seminal vesicle invasion and preoperative PSA values were identified as being statistically significant. When factors for BR were examined in patients with a decline in PSA levels, the Gleason score and PSADT were identified as being significant. Among the cases of a decline in PSA levels during salvage RT, those who received a radiation dose of less than 36 Gy did not experience BR. Similarly, patients who exhibited changes in PSA levels during salvage RT and did not have perineural invasion did not experience BR. Conclusion This is the first study to examine the histopathological factors possibly affecting BR in patients undergoing salvage RT after PCa surgery. The results indicate that in patients with transient PSA elevation, seminal vesicle invasion is a significant risk factor. On the other hand, in patients with a decline in PSA levels during irradiation, the Gleason score and perineural invasion were found to be potential risk factors for BR. These findings suggest that a thorough examination of postoperative histopathological results may be necessary for the optimal management of patients with PCa.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery

Aizawa,

Maebayashi,

Ishibashi

et al. 2023

BMC Urol

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“…For comparisons with the literature data, we created a table of patient characteristics for our cohort and patient characteristics from three larger, previously published studies [4,14,17]. In particular, we performed Cox regression analysis of OS, with pre-SRT PSA dichotomized at 0.7 ng/mL and pre-SRT PSADT calculated only with PSA values above the limit of detection, for comparison with previously published data [4,8,18].…”

Section: Methodsmentioning

confidence: 99%

Salvage Radiotherapy for Relapsed Prostate Cancer after Radical Prostatectomy Is Associated with Normal Life Expectancy

Lohm,

Knörnschild,

Neumann

et al. 2024

Cancers

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In patients with prostate cancer (PCa), salvage radiotherapy (SRT) for biochemical progression (BP) after radical prostatectomy (RP) improves PCa-specific survival. However, no prospective randomized trials have compared the effect of SRT with untreated patients. In this analysis of 151 patients who received SRT for post-RP BP, we compared their overall survival (OS) with virtual, age-matched controls (n = 151,000) retrieved from government life tables. We also investigated the risk factors associated with BP and OS and compared the prostate-specific antigen (PSA) doubling times (DTs) before and after SRT for patients with BP. The median follow-up was 9.3 years for BP and 17.4 years for OS. The risk factors significantly affecting BP were Gleason score (p < 0.001), pre-SRT PSA (p = 0.003), and negative surgical margins (p = 0.003). None of these risk factors were associated with OS. In 93 patients with BP after SRT, the median PSADT was significantly prolonged compared with pre-SRT values (3.7 vs. 8.3 months, p < 0.001). The OS did not differ between patients and controls (p = 0.112), and life expectancy was similar, likely due to the survival benefit of SRT. The prolonged PSADT after SRT further supports the beneficial role of SRT in this patient population. However, subsequent treatments were not systematically recorded, which may have affected the results.

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Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

et al. 2018

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Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy

Abstract: PSA monitoring during sRT did not predict the therapeutic success. Subgroup analysis suggests a lower probability of benefit for patients with the abovenamed risk factors . However, the prolonged PSADT after sRT reflects a benefit of sRT for the vast majority of patients.

Cited by 5 publications

References 26 publications

Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery

Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery

Salvage Radiotherapy for Relapsed Prostate Cancer after Radical Prostatectomy Is Associated with Normal Life Expectancy

Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

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