The Effect of Salvage Radiotherapy on Survival, Functional Outcomes and Quality of Life in Men with Persistent PSA After Robot-assisted Radical Prostatectomy; Which Patient Benefits More?

The aim of this study was (a) to evaluate the effect of salvage radiotherapy(sRT) on survival, functional outcomes and quality of life in men with persistent prostate-specific antigen(PSA>0.1ng/ml) after robot-assisted radical prostatectomy(RARP), and (b) to reveal subgroups which benefit more from sRT.

Data of 3409 patients who underwent RARP were retrieved from a high-volume institute database and 313 patients with persistent PSA were included in the further analyses. Patients who received sRT and those who did not were compared after propensity score matching. Progression-free(PFS), metastasis-free(MFS), androgen deprivation therapy(ADT)-free, cancer-specific(CSS), and overall survival(OS), patient-reported outcomes were the endpoints. Multivariable Cox regression models were developed to reveal treatment effect sizes for subgroups.

Overall persistent PSA rate was 9.2%. Median follow-up time after RARP was 4.5 years (IQR: 2.7-7.9). sRT was associated with improved PFS (HR 0.29; p<0.001), ADT-free survival (HR 0.34; p<0.001), MFS (HR 0.39; p=0.001), CSS (HR 0.34; p=0.03), and OS (HR 0.24; p=0.001). Positive surgical margins (HR 0.26; p<0.001 for ADT-free survival), advanced pT (HR 0.24; p<0.001 for PFS) and pN (HR 0.15; p=0.001 for MFS) and lower Gleason score (HR 0.15; p=0.001 for PFS) were associated with marked survival benefits of sRT. Bowel symptoms were observed more frequently in sRT+ patients than sRT- patients (34.3% versus 19.2%, p=0.01). Early sRT (<6 months postoperatively) was associated with bothering incontinence (p<0.001) and bowel symptoms (p=0.03).

Persistent PSA after RP is still a common challenge in the robotic surgery era. sRT provides clear survival benefits for all endpoints, especially in unfavourable loco-regional factors but low Gleason score.

Practical radiation oncology. 2022 Jul 14 [Epub ahead of print]

Oktay Özman, Anne-Claire Berrens, Floris Pos, Pim J van Leeuwen, Henk van der Poel

Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. Electronic address: ., Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Department of Radiation Oncology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands., Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Prostate Cancer Network the Netherlands., Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Prostate Cancer Network the Netherlands; Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

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