The European Association of Urology (EAU) has proposed a risk stratification for patients harboring biochemical recurrence (BCR) after radical prostatectomy (RP).
To assess whether this risk stratification helps in choosing patients for salvage radiotherapy (SRT).
Analyses of 2379 patients who developed BCR after RP (1989-2020), within ten European high-volume centers, were conducted. Early and late SRT were defined as SRT delivered at prostate-specific antigen values <0.5 and ≥0.5 ng/ml, respectively.
Multivariable Cox models tested the effect of SRT versus no SRT on death and cancer-specific death. The Simon-Makuch method tested for survival differences within each risk group.
Overall, 805 and 1574 patients were classified as having EAU low- and high-risk BCR. The median follow-up was 54 mo after BCR for survivors. For low-risk BCR, 12-yr overall survival was 87% versus 78% (p = 0.2) and cancer-specific survival was 100% versus 96% (p = 0.2) for early versus no SRT. For high-risk BCR, 12-yr overall survival was 81% versus 66% (p < 0.001) and cancer-specific survival was 98% versus 82% (p < 0.001) for early versus no SRT. In multivariable analyses, early SRT decreased the risk for death (hazard ratio [HR]: 0.55, p < 0.01) and cancer-specific death (HR: 0.08, p < 0.001). Late SRT was a predictor of cancer-specific death (HR: 0.17, p < 0.01) but not death (p = 0.1).
Improved survival was recorded within the high-risk BCR group for patients treated with early SRT compared with those under observation. Our results suggest recommending early SRT for high-risk BCR men. Conversely, surveillance might be suitable for low-risk BCR, since only nine patients with low-risk BCR died from prostate cancer during follow-up.
The impact of salvage radiotherapy (SRT) on cancer-specific outcomes stratified according to the European Association of Urology biochemical recurrence (BCR) risk classification was assessed. While men with high-risk BCR should be offered SRT, surveillance might be a suitable option for those with low-risk BCR.
European urology. 2023 Jun 22 [Epub ahead of print]
Felix Preisser, Raisa S Abrams-Pompe, Piter Jan Stelwagen, Dirk Böhmer, Fabio Zattoni, Alessandro Magli, Juan Gómez Rivas, Roser Vives Dilme, Matteo Sepulcri, Aritz Eguibar, Isabel Heidegger, Christoph Arnold, Christian D Fankhauser, Felix K-H Chun, Henk van der Poel, Giorgio Gandaglia, Thomas Wiegel, Roderick C N van den Bergh, Derya Tilki, EAU-YAU Prostate Cancer Working Group
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Radiation Oncology, Charité University Hospital, Berlin, Germany., Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padova, Italy., Department of Radiation Oncology, University Hospital of Udine, ASUIUD, Udine, Italy; Department of Radiation Oncology, Hospital San Martino, Belluno, Italy., Department of Urology, Clinico San Carlos Hospital, Madrid, Spain., Radiation Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy., Department of Urology, La Paz University Hospital, Madrid, Spain., Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Department of Therapeutic Radiology and Oncology, Medical University Innsbruck, Innsbruck, Austria., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, University Zurich, Zurich, Switzerland., Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy., Department of Radiotherapy and Radiooncology, University Hospital Ulm, Ulm, Germany., Department of Urology, Antonius Hospital, Utrecht, The Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey. Electronic address: .