SAN DIEGO, CA USA (UroToday.com) - Many believe starting salvage radiation therapy at the earliest possible time will result in better outcomes than upfront adjuvant radiation therapy in men with high-risk features, as this approach will result in overtreatment with increase in resultant urinary and erectile side effects.
Muller and colleagues identified 288 men from the SEARCH database who started salvage radiotherapy (SRT) at least 6 months following radical prostatectomy and were not treated with adjuvant androgen deprivation therapy. Men predominantly had Gleason score of 7 (59%) at final pathology with only 12% comprising high-risk disease (Gleason 8-10). 26.6% of men failed SRT at a mean of 48.6 months. On multivariable analysis, less SRT failure occurred for men with pre-SRT PSA < 1 compared with those > 1.01. However, within PSA levels ≤ 1.0 ng/ml, there were no differences in SRT failure.
The authors conclude that if there is any potential benefit of starting SRT earlier in men with PSA levels ≤ 1.0 ng/ml, the advantages are minimal. As the field moves forward, these data will need to be reconciled with two prospective randomized trials demonstrating advantages of adjuvant XRT vs salvage therapy and a number of other retrospective analyses suggesting benefits at lower PSA thresholds.
Presented by Roberto Muller, Daniel Moreira, William Aronson, Martha Terris, Christopher Kane, Christopher Amling, Joseph Presti Jr, and Stephen Freedland at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Anthony T. Corcoran, MD