693 node-negative RP patients who received salvage RT at six centers were included in analysis at a median follow-up of 96 months. Inclusion criteria for salvage RT included a rising PSA post-RP or PSA persistence at >0.09 ng/mL at 1 month post-RP. A risk stratification tool was developed with a study endpoint of cancer progression to metastasis post-salvage RT (M1a, M1b, or M1c). Multivariate analysis adjusted for pathologic t-stage, pathologic Gleason, surgical margins, post-operative undetectable PSA, and PSA level at salvage RT.
Of the 693 patients, 82 (12%) patients progressed to distant metastasis: 18 (2.6%) M1a, 33 (4.8%) M1b, and 9 (1.3%) M1c. Five risk groups were identified with regression tree analysis, of which the cohort was subdivided as follows:
1) very low-risk (42%): undetectable PSA after RP, Gleason sum ≤7, and ≤pT3a
2) low-risk (30%): undetectable PSA after RP, Gleason sum ≤7, and ≥pT3b
3) intermediate-risk (16%): undetectable PSA after RP, and Gleason sum ≥8
4) high-risk (8%): PSA persistence after RP, and Gleason sum ≤7)
5) very high-risk (3%): PSA persistence after RP, and Gleason sum ≥8.
Overall metastasis-free survival at 8 years was 86%, 75%, 74%, 72%, and 60%, respectively (p=0.003), with significant association with PSA level at the time of SRT. Early SRT was associated with treatment control and lower risk of distant metastasis in the low, intermediate, and high-risk patients, although there was no effect in both the very low and very high-risk patients. While further validation is necessary before expansion to the clinical setting, Dr. Fossati and colleagues present a valuable tool for patients experiencing BCR post-RP.
Presented by: Nicola Fossati (MD) from Milan, Italty
Authors: Nicola Fossati, Jeffrey Karnes, Stephen Boorjian, Michele Colicchia, Alberto Bossi, Thomas Seisen, Villejuif, France, Cesare Cozzarini, Claudio Fiorino, Barbara Noris Chiorda, Giorgio Gandaglia, Thomas Wiegel
Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of UroToday.com
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA