BACKGROUND AND PURPOSE: In patients with prostate cancer (PC) and biochemical relapse after radical prostatectomy, salvage radiotherapy (SRT) could improve PC-specific survival (PCSS) but the timing for initiation is still under discussion.
We have demonstrated a low rate of biochemical relapses in a patient series with very low pre-SRT PSA levels after a median follow-up of 42 months. Here, we present an update of that study.
PATIENTS AND METHODS: Overall, 151 patients were analyzed. A biochemical relapse after SRT was diagnosed when the PSA exceeded the post-SRT nadir by 0.2 ng/ml with subsequent increase. Parameters with significant impact on biochemical progression-free survival (BPFS), PCSS, and overall survival (OS) in univariate analysis were included in a multiple Cox regression analysis.
RESULTS: After a median follow-up of 82 months, 18 patients (12 %) had died with 10 (6.6 %) deaths being PC-related. A biochemical progression was diagnosed in 83 patients (55 %). Univariate analysis revealed a significant impact of pre-SRT PSA level, Gleason score, and PSA doubling time (PSADT) on BPFS and for initial tumor stage and Gleason score on OS. Multivariate analysis confirmed the impact of pre-SRT PSA level, Gleason score, and PSADT on BPFS and tumor stage on OS.
CONCLUSION: In this update, the rate of biochemical relapses increased compared with our previous data. Compared to similar studies, we found a remarkably low rate of PC-related deaths. Our data support early initiation of SRT. However, this treatment strategy, triggered by very low PSA levels, could carry the risk of overtreatment in at least a subset of patients.
Written by:
Lohm G, Lütcke J, Jamil B, Höcht S, Neumann K, Hinkelbein W, Wiegel T, Bottke D. Are you the author?
Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Campus Benjamin- Franklin Hindenburgdamm 30, 12200, Berlin, Germany.
Reference: Strahlenther Onkol. 2014 Feb 28. Epub ahead of print.
doi: 10.1007/s00066-014-0612-6
PubMed Abstract
PMID: 24577132
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