Temporal trends and predictors of salvage cancer treatment after failure following radical prostatectomy or radiation therapy: An analysis from the CaPSURE registry

Abstract

BACKGROUND Prostate cancer treatment after failure of primary therapy by either radical prostatectomy or radiation therapy can vary greatly. This study sought to determine trends and predictors of salvage treatment after failure of primary treatment in a community cohort over the past 10 years. METHODS From the community‐based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, 6275 patients were identified who initiated a form of primary treatment for prostate cancer; 839 of these were identified as failing treatment by biochemical recurrence or initiation of secondary treatment between 2000 and 2010. Salvage therapy was categorized as either systemic, local, or none. Patient characteristics were tested for association with salvage therapy using analysis of variance, Pearson chi‐square tests, and multinomial logistic regression analysis. RESULTS Of the 839 patients identified as failing therapy, 390 (47%), 146 (17%), and 303 (36%) received systemic, local, or no salvage therapy, respectively. Type of primary treatment received was associated with type of salvage therapy (P < .01). There has been an increasing trend in the use of local salvage therapy over the past 10 years (P = .04). Primary treatment type and biopsy Gleason score were significantly associated with type of salvage therapy. CONCLUSIONS The use of local salvage therapy has increased over the past decade, whereas the use of systemic salvage therapy has declined. Primary treatment is an important factor in determining which type of salvage therapy a patient will receive. Cancer 2014;120:507–512. © 2013 American Cancer Society.

Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort

“…The treatment failure rate found in the current study is in line with or slightly higher than findings of others in comparable patient populations [8,9,10]. Our definition comprises disease progression as measured by PSA levels with a threshold from Dutch guideline [6] (>0.2 ng/ml twice), as well as disease progression according to the urologist solely based on PSA levels, which has been done previously [11]. Most studies however have limited their outcome definition to BCR, although this is ambiguous since the employed threshold of PSA levels is diverse.…”

A Framework for Treatment Decision Making at Prostate Cancer Recurrence

“…The lack of consensus relates to the type of ST—radiation therapy (RT), hormone therapy (HT), or both—to the timing of treatment, and to the selection of cases most likely to benefit. Not all PSA-R patients elect ST: a recent study of the community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database found that approximately 36% of patients received no ST [4]. Further, timing of ST relative to PSA-R varies across patients.…”

Salvage robotic radical prostatectomy

“…[1234] While the overall utilization of potentially curative local salvage therapies after failure of primary therapy has increased in recent years, this trend has been exclusive of salvage radical prostatectomy (SRP), which is still rarely performed despite evidence of improved safety and oncologic efficacy in modern series. [567] Furthermore, it has been shown that a high proportion of patients with radiation failure have clinically localized disease recurrence, which may be amenable to cure by local salvage therapy, although the burden of co-morbid conditions in this patient population combined with the difficulty and morbidity of local salvage therapies like SRP limit the applicability of these findings. [58]…”

“…[567] Furthermore, it has been shown that a high proportion of patients with radiation failure have clinically localized disease recurrence, which may be amenable to cure by local salvage therapy, although the burden of co-morbid conditions in this patient population combined with the difficulty and morbidity of local salvage therapies like SRP limit the applicability of these findings. [58]…”

“…[35] While the often-elderly and co-morbid status of patients with radio-recurrent disease compounded with concerns for the presence of advanced disease certainly impacts the low rates of SRP, the challenging technical aspects of the procedure, poor functional outcomes and risk of major complications likely contribute as well. In historical series, rates of rectal injury approached 15% and rates of anastomotic stricture have been as high as 32%.…”