Assessing the Optimal Timing for Early Salvage Radiation Therapy in Patients with Prostate-specific Antigen Rise After Radical Prostatectomy.

Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience a prostate-specific antigen (PSA) rise after radical prostatectomy (RP); however, the optimal PSA level for eSRT administration is still unclear.

To test the impact of PSA level on cancer control after eSRT according to pathologic tumour characteristics.

The study included 716 node-negative patients with undetectable postoperative PSA who experienced a PSA rise after RP. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at PSA ≤0. 5 ng/ml. Biochemical recurrence (BCR) after eSRT was defined as two consecutive PSA values ≥0. 2 ng/ml.

Multivariable Cox regression analysis tested the association between pre-eSRT PSA level and BCR after eSRT. Covariates consisted of pathologic stage (pT2 vs pT3a vs pT3b or higher), pathologic Gleason score (≤6, 7, or ≥8), and surgical margin status (negative vs positive). We tested an interaction with PSA level and baseline pathologic risk for the hypothesis that BCR-free survival differed by pre-eSRT PSA level. Three pathologic risk factors were identified: pathologic stage pT3b or higher, pathologic Gleason score ≥8, and negative surgical margins.

Median follow-up among patients who did not experience BCR after eSRT was 57 mo (interquartile range: 27-105). At 5 yr after eSRT, BCR-free survival rate was 82% (95% confidence interval [CI], 78-85). At multivariable Cox regression analysis, pre-eSRT PSA level was significantly associated with BCR after eSRT (hazard ratio: 4. 89; 95% CI, 1. 40-22. 9; p

In this retrospective study, cancer control after eSRT greatly depended on pretreatment PSA. The absolute PSA level had a different prognostic value depending on the pathologic characteristics of the tumour. In patients with more adverse pathologic features, eSRT conferred better cancer control when administered at the very first sign of PSA rise. Conversely, the benefit of eSRT was less evident in men with favourable disease at RP.

In this retrospective study, cancer control after early salvage radiation therapy (eSRT) was influenced by pretreatment prostate-specific antigen (PSA) level. This effect was highest in men with at least two of the following pathologic features: pT3b/pT4 disease, pathologic Gleason score ≥8, and negative surgical margins. In these patients, eSRT conferred better cancer control when administered at the very first sign of PSA rise.

European urology. 2015 Oct 20 [Epub ahead of print]

Nicola Fossati, R Jeffrey Karnes, Cesare Cozzarini, Claudio Fiorino, Giorgio Gandaglia, Steven Joniau, Stephen A Boorjian, Gregor Goldner, Wolfgang Hinkelbein, Karin Haustermans, Bertrand Tombal, Shahrokh Shariat, Pierre I Karakiewicz, Francesco Montorsi, Hein Van Poppel, Thomas Wiegel, Alberto Briganti

Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Department of Urology, Mayo Clinic, Rochester, MN, USA. , Department of Radiotherapy, IRCCS Ospedale San Raffaele, Milan, Italy. , Medical Physics, San Raffaele Scientific Institute, Milan, Italy. , Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. , University Hospitals Leuven, Department of Urology, Leuven, Belgium. , Department of Urology, Mayo Clinic, Rochester, MN, USA. , Klinik für Radioonkologie, Medizinische Universität Wien, Vienna, Austria. , Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany. , University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium. , Department of Urology, Université Catholique de Louvain, Brussels, Belgium. , Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. , Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. , Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. , University Hospitals Leuven, Department of Urology, Leuven, Belgium. , Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany. , Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.

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