ESOU18: Salvage Radiotherapy for Prostate Cancer

Amsterdam, The Netherlands ( According to the American Urologic Association (AUA) guidelines, biochemical recurrence (BCR) after radical prostatectomy (RP) occurs when there are two consecutive detectable PSA rises  >0.2 ng/ml. Large series have demonstrated that the 5 year BCR free survival rate after surgery for high risk prostate cancer (PC) is approximately 55%. However, there is a difference in cancer specific mortality (CSM) if the BCR occurred within 36 months from surgery  (8.2%) or after 36 months from surgery (1.8%).

The European Association of Urology (EAU) guidelines recommend treating patients with BCR after RP with salvage radiotherapy (RT) (the total dose of RT should be at least 66 Gy and should be given early, when PSA is less than 0.5 ng/ml). Studies have shown even better results can be achieved when salvage RT is given at lower PSA levels (0.01-0.2 ng/ml). It is important to remember that not all rising PSAs are the same. Patient outcomes after salvage RT are dependent on preoperative and postoperative factors (including preoperative PSA, stage, Gleason score, and time to BCR).

There is growing research in genomic classifiers of men with adverse pathology after RP, in an attempt to identify who would gain the most from salvage  RT. Additionally, there is data demonstrating that the addition of short term androgen deprivation therapy (ADT ) to salvage RT increases the patient 5 year recurrence free survival from 62% to 80%.

In summary, postoperative rise of PSA after surgery for high risk PC disease is not uncommon. However, not all rising PSAs after surgery are the same and have a different impact on the CSM. The classical PSA cutoffs after surgery for initiation of salvage RT, such as 0.2 or 0.5 ng/ml, may not be adequate and should probably be lowered. Lastly, a more personalized model should be adopted to fit the therapeutic requirement of each patient.

Speaker: Alberto Bossi, MD Head of Urology and Prostate Brachytherapy Unit Gustave Roussy Villejuif, France

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands