The clinical course in patients with prostate cancer (PCa) after biochemical failure (BF) has received limited attention. This study analyzes survival time from recurrence, patterns of progression, and the efficacy of salvage therapies in patients treated with radical or postoperative radiotherapy (RT).
This is a multicenter retrospective comparative study of 1135 patients diagnosed with BF and treated with either radical (882) or postoperative (253) RT. Data correspond to the RECAP database. Clinical, tumor, and therapeutic characteristics were collected. Descriptive statistics, survival estimates, and comparisons of survival rates were calculated.
Time to BF from initial treatment (RT or surgery) was higher in irradiated patients (51 vs 37 months). At a median follow-up of 102 months (14-254), the 8-year cause-specific survival (CSS) was 80.5%, without significant differences between the radical (80.1%) and postoperative (83.4%) RT groups. The 8-year metastasis-free survival rate was 57%. 173 patients (15%) died of PCa and 29 (2.5%) of a second cancer. No salvage therapy was given in 15% of pts. Only 5.5% of pts who underwent radical RT had local salvage treatment and 71% received androgen deprivation (AD) ± chemotherapy. The worst outcomes were in patients who developed metastases after BF (302 pts; 26.5%) and in cases with a Gleason > 7.
In PCa treated with radiotherapy, median survival after BF is relatively long. In this sample, no differences in survival rates at 8-years have been found, regardless of the time of radiotherapy administered. AD was the most common treatment after BF. Metastases and high Gleason score are adverse variables. To our knowledge, this is the first study to compare outcomes after BF among patients treated with primary RT vs. those treated with postoperative RT and to evaluate recurrence patterns, treatments administered, and causes of death. The results allow avoiding overtreatment, improving quality of life, without negatively affecting survival.
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2019 Jan 07 [Epub ahead of print]
C González-San Segundo, J Jové, A Zapatero, J Pastor-Peidro, M L Vázquez, M Casaña, J L Mengual, A Gómez-Caamaño, A Gómez-Iturriaga, C Vallejo, I Henríquez, J L Muñoz-García, J Clemente, M Porras, E Collado, G Ossola, E Villafranca, M A Cabeza, J López-Torrecilla
HGU Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain. ., Hospital Universitario Germans Trias i Pujol, Badalona, Spain., HU de la Princesa, Madrid, Spain., Consorcio Hospital General Universitario de Valencia, Valencia, Spain., Hospital Meixoeiro, Vigo, Spain., Fundación Instituto Valenciano de Oncología, Valencia, Spain., Hospital Clínico Universitario, Santiago de Compostela, Spain., Hospital Universitario Cruces, Baracaldo, Spain., Hospital Universitario Ramón y Cajal, Madrid, Spain., Hospital Universitario San Joan, Reus, Spain., Hospital Infanta Cristina, Badajoz, Spain., Fundación Instituto Valenciano de Oncologia, Alcoy, Spain., Hospital Universitario Virgen de la Arrixaca, Murcia, Spain., Hospital Universitario La Fé, Valencia, Spain., Fundación Rioja Salud, La Rioja, Spain., Hospital de Navarra, Pamplona, Spain., Hospital Universitario 12 de Octubre, Madrid, Spain.