Original Paper

Journal of Cancer Research and Clinical Oncology

, Volume 139, Issue 1, pp 147-157

Adjuvant and salvage radiotherapy after prostatectomy: outcome analysis of 307 patients with prostate cancer

  • Beatrice DettiAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi Email author 
  • , Silvia ScocciantiAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
  • , Sara CassaniAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
  • , Samantha CipressiAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
  • , Donata VillariAffiliated withClinica Urologica II, University of Florence
  • , Alberto LapiniAffiliated withClinica Urologica I, University of Florence
  • , Calogero SaievaAffiliated withMolecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute)
  • , Tommaso CaiAffiliated withDepartment of Urology, Santa Chiara Hospital
  • , Maurizio PerticiAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
    • , Irene GiacomelliAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
    • , Lorenzo LiviAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi
    • , Marco CerotiAffiliated withMolecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute)
    • , Giulio NicitaAffiliated withClinica Urologica II, University of Florence
    • , Marco CariniAffiliated withClinica Urologica I, University of Florence
    • , Giampaolo BitiAffiliated withRadioterapia, Azienda Ospedaliero-Universitaria di Careggi

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Abstract

Aim

In men with adverse pathology after radical prostatectomy, the most appropriate timing to administer radiotherapy (RT) remains a topic of debate. We analyzed in terms of efficacy, prognostic factors and toxicity the two therapeutic strategies: immediate postoperative radiotherapy (PORT) and salvage radiotherapy (SART).

Materials and methods

Between January 1995 and November 2010, 307 patients underwent adjuvant or salvage radiotherapy, after prostatectomy.

Results

In the PORT group, 42 patients (20.7 %) had biochemical failure, with a median time to biochemical failure of 1.8 years; two parameters (age at diagnosis and PSA pre-RT) resulted to be significant at the survival analysis for overall survival (p = 0.003 and p = 0.046, respectively). In the SART group, 33 patients (31.7 %) had biochemical relapse; sixteen patients died of prostate cancer; postoperative hormones therapy, conformal radiotherapy and level of PSA pre-RT >1.0 ng/ml resulted to be significant at the survival analysis, p = 0.009, p = 0.039 and p = 0.002, respectively.

Conclusion

Our study is limited by its retrospective and nonrandomized design. As such, decisions to treat with adjuvant or salvage radiotherapy and the time to initiate therapy were based on patient preference and physician counseling. Our recommendation is to suggest adjuvant radiotherapy for all patients with adverse prognostic factors and to reserve salvage radiotherapy for low-risk patients, when the biochemical recurrence occurs.

Keywords

Prostate cancer Adjuvant radiotherapy Salvage radiotherapy Prostatectomy