Skip to main content

Advertisement

SpringerLink
Log in

Salvage radiotherapy following radical prostatectomy

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Biochemical relapse will occur in 17–64% of men who undergo radical prostatectomy, and up to a third of men with biochemical relapse will progress to develop metastatic disease and ultimately die of prostate cancer. Postoperative salvage radiotherapy (RT) to the prostatic fossa is well-tolerated and potentially curative treatment and should be considered for all men who have biochemical relapse following prostatectomy. Gleason score <8, prostate-specific antigen (PSA) doubling time >10 months and PSA re-emergence >2 years following surgery predict for a low risk of early metastatic failure, but even men with no favourable prognostic factors may have a long-term durable response to RT and should not be excluded from consideration of treatment on the basis of these factors alone. Positive surgical margin status and a positive anastomotic biopsy do not predict response to RT, and routine biopsy is not recommended. PSA level at time of RT is a strong indicator of durable response to RT. No one PSA cutpoint level appears to be more significant, and early RT is likely more effective than late. Contemporary PSA assays can detect biochemical relapse in the 0.01–0.2 range, and this may provide additional therapeutic advantage if treatment can be given when tumour burden is smallest. There is an urgent need for prospective data from randomised trials to optimally select patients for salvage RT, to determine the optimal time to initiate treatment and to determine the role of adjuvant hormone therapy, and all patients should be considered for entry into ongoing and future clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abi-Aad A, Macfarlane M, Stein A, deKernion J (1992) Detection of local recurrence after radical prostatectomy by prostate specific antigen and transrectal ultrasound. J Urol 147:952–955

    CAS  PubMed  Google Scholar 

  2. Amling C, Bergstralh E, Blute M, Slezak J, Zincke H (2001) Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J Urol 165:1146–1151

    Google Scholar 

  3. Anscher M, Clough R, Dodge R (2000) Radiotherapy for a rising prostate-specific antigen after radical prostatectomy: the first 10 years. Int J Radiat Oncol Biol Phys 48:369–375

    Article  CAS  PubMed  Google Scholar 

  4. Bianco F, Grignon D, Sakr W, Shekarriz B, Upadhyay J, Dornelles E, Pontes J (2003) Radical prostatectomy with bladder neck preservation: impact of a positive margin. Eur Urol 43:461–466

    Article  PubMed  Google Scholar 

  5. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, Gil T, Collette L, Pierart M (1997) Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 337:295–300

    Google Scholar 

  6. Caddeddu J, Partin A, DeWeese T, Walsh P (1998) Long-term results of radiation therapy for prostate cancer recurrence following radical prostatectomy. J Urol 159:173–177

    PubMed  Google Scholar 

  7. Catalona W, Smith D (1994) 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol 152:1837–1842

    CAS  PubMed  Google Scholar 

  8. Catton C, Gospodarowicz M, Warde P, Panzarella T, Catton P, McLean M, Milosevic M (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59:51–60

    Article  CAS  PubMed  Google Scholar 

  9. Chawla A, Thakral H, Zietman A, Shipley W (2002) Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: analysis of efficacy and prognostic factors. Urology 59:726–731

    Article  PubMed  Google Scholar 

  10. Cher M, Bianco FJ, Lam J, Davis L, Grignon D, Sakr W, Banerjee M, Pontes J, Wood DJ (1998) Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol 160:1387–1391

    CAS  PubMed  Google Scholar 

  11. Choo R, Hruby G, Hong J, Bahk E, Hong E, Danjoux C, Morton G, DeBoer G (2002) (In)-efficacy of salvage radiotherapy for rising PSA or clinically isolated local recurrence after radical prostatectomy. Int J Radiat Oncol Biol Phys 53:269–276

    Article  PubMed  Google Scholar 

  12. Coetzee L, Hars V, Paulson D (1996) Postoperative prostate-specific antigen as a prognostic indicator in patients with margin positive prostate cancer undergoing adjuvant radiotherapy after radical prostatectomy. Urology 47:232–235

    Article  CAS  PubMed  Google Scholar 

  13. Connolly J, Shinohara K, Presti JJ, Carroll P (1996) Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins. Urology 47:225–231

    Article  CAS  PubMed  Google Scholar 

  14. Cox J, Gallagher M, Hammond E, Kaplan R, Schellhammer P (1997) Consensus statements on radiation therapy of prostate cancer: guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate-specific antigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel. J Clin Ocol 17:1155

    Google Scholar 

  15. Crane C, Rich T, Read P, Sanfilippo M, Gillenwater J, Kelly M (1997) Preirradiation PSA predicts biochemical disease-free survival in patients treated with postprostatectomy external beam irradiation. Int J Radiat Oncol Biol Phys 39:681–686

    Article  CAS  PubMed  Google Scholar 

  16. de la Taille A, Flam T, Thiounn N, Pontvert D, Saighi D, Zerbib M, Debre B (2002) Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy. BJU Int 90:887–892

    Article  PubMed  Google Scholar 

  17. Do T, Parker R, Do C, Tran L, Do L, Dolkar D (1998) Salvage radiotherapy for biochemical and clinical failures following radical prostatectomy. Cancer J Sci Am 4:324–330

    CAS  PubMed  Google Scholar 

  18. Doherty A, Bower M, Smith G, Miano R, Mannion E, Mitchell H, Christmas T (2000) Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival. Br J Cancer 83:1432–1436

    Article  CAS  PubMed  Google Scholar 

  19. Duchesne G, Millar J, Moraga V, Rosenthal M, Royce P, Snow R (2003) What to do for prostate cancer patients with a rising PSA?--a survey of Australian practice. Int J Radiat Oncol Biol Phys 55:986–991

    Article  PubMed  Google Scholar 

  20. Egawa S, Matsumoto K, Suyama K, Soh S, Kuwao S, Iwamura M (1999) Limited suppression of prostate specific antigen after salvage radiotherapy for its isolated elevation after radical prostatectomy. Urology 53:148–154

    Article  CAS  PubMed  Google Scholar 

  21. Elias S, Parker R, Gallardo D, Law J (1997) Adjuvant radiation therapy after radical prostatectomy for carcinoma of the prostate. Am J Clin Oncol 20:120–124

    Google Scholar 

  22. Foster L, Jajodia P, Fournier GJ, Shinohara K, Carroll P, Narayan P (1993) The value of prostate specific antigen and transrectal ultrasound guided biopsy in detecting prostatic fossa recurrences following radical prostatectomy. J Urol 149:1024–1028

    CAS  PubMed  Google Scholar 

  23. Freedland S, Sutter M, Dorey F, Aronson W (2003) Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Urology 61:365–369

    Article  PubMed  Google Scholar 

  24. Garg M, Tekyi-Mensah S, Bolton S, Velasco J, Pontes E, Wood Jr D, Porter A, Forman J (1998) Impact of postprostatectomy prostate-specific antigen nadir on outcomes following salvage radiotherapy. Urology 51:998–1002

    Article  CAS  PubMed  Google Scholar 

  25. Grossfeld G, Chang J, Broering J, Miller D, Yu J, Flanders S, Henning J, Stier D, Carroll P (2000) Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: data from the Capsure database. J Urol 163:1171–1177

    CAS  PubMed  Google Scholar 

  26. Han M, Partin A, Pound C, Epstein J, Walsh P (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am 28:555–565

    CAS  PubMed  Google Scholar 

  27. Hinkle G, Burgers J, Neal C, Texter J, Kahn D, Williams R, Maguire R, Rogers B, Olsen J, Badalament R (1998) Multicenter radioimmunoscintigraphic evaluation of patients with prostate carcinoma using indium-111 capromab pendetide. Cancer 83:739–747

    Article  CAS  PubMed  Google Scholar 

  28. Jhaveri F, Zippe C, Klein E, Kupelian P (1999) Biochemical failure does not predict overall survival after radical prostatectomy for localized prostate cancer: 10-year results. Urology 54:884–890

    Article  CAS  PubMed  Google Scholar 

  29. Kahn D, Williams R, Haseman M, Reed N, Miller S, Gerstbrein J (1998) Radioimmunoscintigraphy with in-111-labeled capromab pendetide predicts prostate cancer response to salvage radiotherapy after failed radical prostatectomy. J Clin Ocol 16:284–289

    CAS  Google Scholar 

  30. Kane C, Amling C, Johnstone P, Pak N, Lance R, Thrasher J, Foley J, Riffenburgh R, Moul J (2003) Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy. Urology 61:607–611

    Article  PubMed  Google Scholar 

  31. Kausik S, Blute M, Sebo T, Leibovich B, Bergstralh E, Slezak J, Zincke H (2002) Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy. Cancer 95:1215–1219

    Article  PubMed  Google Scholar 

  32. Koppie T, Grossfeld G, Nudell D, Weinberg V, Carroll P (2001) Is anastomotic biopsy necessary before radiotherapy after radical prostatectomy? J Urol 166:111–115

    Google Scholar 

  33. Kupelian P, Katcher J, Levin H, Klein E (1997) Stage t1–2 prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Int J Radiat Oncol Biol Phys 37:1043–1052

    Article  CAS  PubMed  Google Scholar 

  34. Lassiter L, Eisenberger M (2002) The dilemma of patients with a rising PSA level after definitive local therapy for prostate cancer. Semin Urol Oncol 20:146–154

    Article  PubMed  Google Scholar 

  35. Lattouf J, Saad F (2003) Digital rectal exam following prostatectomy: is it still necessary with the use of PSA? Eur Urol 43:333–336

    Google Scholar 

  36. Lau W, Bergstralh E, Blute M, Slezak J, Zincke H (2002) Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol 167:117–122

    PubMed  Google Scholar 

  37. Leventis A, Shariat S, Kattan M, Butler E, Wheeler T, Slawin K (2001) Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy. J Clin Ocol 19:1030–1039

    CAS  Google Scholar 

  38. Leventis A, Shariat S, Slawin K (2001) Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings. Radiology 219:432–439

    CAS  PubMed  Google Scholar 

  39. Levesque P, Nieh P, Zinman L, Seldin D, Libertino J (1998) Radiolabeled monoclonal antibody indium 111-labeled cyt-356 localizes extraprostatic recurrent carcinoma after prostatectomy. Urology 51:978–984

    Article  CAS  PubMed  Google Scholar 

  40. Lightner D, Lange P, Reddy P, Moore L (1990) Prostate specific antigen and local recurrence after radical prostatectomy. J Urol 144:921–926

    CAS  PubMed  Google Scholar 

  41. Mathews D, Oz O (2002) Positron emission tomography in prostate and renal cell carcinoma. Curr Opin Urol 12:381–385

    Article  PubMed  Google Scholar 

  42. Morris M, Dallow K, Zietman A, Park J, Althausen A, Heney N, Shipley W (1997) Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 38:731–736

    Article  CAS  PubMed  Google Scholar 

  43. Nudell D, Grossfeld G, Weinberg V, Roach 3rd M, Carroll P (1999) Radiotherapy after radical prostatectomy: treatment outcomes and failure patterns. Urology 54:1049–1057

    Article  CAS  PubMed  Google Scholar 

  44. Ornstein D, Colberg J, Virgo K, Chan D, Johnson E, Oh J, Johnson F (1998) Evaluation and management of men whose radical prostatectomies failed: results of an international survey. Urology 52:1047–1054

    Article  CAS  PubMed  Google Scholar 

  45. Parker C, Warde P, Catton C (2001) Salvage radiotherapy for PSA failure after radical prostatectomy. Radiother Oncol 61:107–116

    Article  CAS  PubMed  Google Scholar 

  46. Partin A, Pearson J, Landis P, Carter H, Pound C, Clemens J, Epstein J, Walsh P (1994) Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Urology 43:649–659

    CAS  PubMed  Google Scholar 

  47. Patel A, Dorey F, Franklin J, deKernion J (1997) Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol 158:1441–1445

    CAS  PubMed  Google Scholar 

  48. Petrovich Z, Lieskovsky G, Langholz B, Bochner B, Formenti S, Streeter O, Skinner D (1999) Adjuvant radiotherapy in patients with pathologic stage c (pT3N0) adenocarcinoma of the prostate. Urology 53:1184–1193

    Article  CAS  PubMed  Google Scholar 

  49. Pisansky T, Kozelsky T, Myers R, Hillman D, Blute M, Buskirk S, Cheville J, Ferrigni R, Schild S (2000) Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 163:845–850

    CAS  PubMed  Google Scholar 

  50. Pollack A, Zagars G, Smith L, Lee J, von Eschenbach A, Antolak J, Starkschall G, Rosen I (2000) Preliminary results of a randomized radiotherapy dose-escalation study comparing 70 Gy with 78 Gy for prostate cancer. J Clin Oncol 18:3904–3911

    CAS  PubMed  Google Scholar 

  51. Pound C, Christens-Barry O, Gurganus R, Partin A, Walsh P (1999) Digital rectal examination and imaging studies are unnecessary in men with undetectable prostate specific antigen following radical prostatectomy. J Urol 162:1337–1340

    CAS  PubMed  Google Scholar 

  52. Pound C, Partin A, Eisenberger M, Chan D, Pearson J, Walsh P (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597

    Article  CAS  PubMed  Google Scholar 

  53. Price D, Coleman R, Liao R, Robertson C, Polascik T, DeGrado TR (2002) Comparison of [18 F]fluorocholine and [18 F]fluorodeoxyglucose for positron emission tomography of androgen dependent and androgen independent prostate cancer. J Urol 168:273–280

    PubMed  Google Scholar 

  54. Ravery V (1999) The significance of recurrent PSA after radical prostatectomy: benign versus malignant sources. Semin Urol Oncol 17:127–129

    CAS  PubMed  Google Scholar 

  55. Salminen E, Hogg A, Binns D, Frydenberg M, Hicks R (2002) Investigations with FDG-PET scanning in prostate cancer show limited value for clinical practice. Acta Oncol 41:41

    Google Scholar 

  56. Scattoni V, Roscigno M, Raber M, Montorsi F, Bertini R, Bua L, Da Pozzo L, Rigatti P (2002) Diagnostic value of ultrasound-guided anastomotic biopsies in patients with high PSA (>or = 0,4 ng/ml) after radical prostatectomy. Arch Ital Urol Androl 74:129–131

    PubMed  Google Scholar 

  57. Scherr D, Swindle P, Scardino P (2003) National comprehensive cancer network guidelines for the management of prostate cancer. Urology 61 [Suppl 1]:14–24

  58. Schild S, Wong W, Grado G, Buskirk S, Robinow J, Frick L, Ferrigini R (1994) Radiotherapy for isolated increases in serum prostate-specific antigen levels after radical prostatectomy. Mayo Clin Proc 69:613–619

    CAS  PubMed  Google Scholar 

  59. Schild S, Wong W, Grado G, Halyard M, Novicki D, Swanson S, Larson T, Ferrigni R (1996) The results of radical retropubic prostatectomy and adjuvant therapy for pathologic stage C prostate cancer. Int J Radiat Oncol Biol Phys 34:535–541

    Article  CAS  PubMed  Google Scholar 

  60. Seltzer M, Barbaric Z, Belldegrun A, Naitoh J, Dorey F, Phelps M, Gambhir S, Hoh C (1999) Comparison of helical computerized tomography, positron emission tomography and monoclonal antibody scans for evaluation of lymph node metastases in patients with prostate specific antigen relapse after treatment for localized prostate cancer. J Urol 162:1322–1328

    CAS  PubMed  Google Scholar 

  61. Shah R, Bassily N, Wei J, Mucci N, Montie J, Sanda M, Rubin M (2002) Benign prostatic glands at surgical margins of radical prostatectomy specimens: frequency and associated risk factors. Urology 56:721–725

    Article  Google Scholar 

  62. Sodee D, Malguria N, Faulhaber P, Resnick M, Albert J, Bakale G (2000) Multicenter Prostascint imaging findings in 2154 patients with prostate cancer. The Prostascint Imaging Centers. Urology 56:988–993

    Article  CAS  PubMed  Google Scholar 

  63. Song D, Thompson T, Ramakrishnan V, Harrison R, Bhavsar N, Onaodowan O, DeWeese T (2002) Salvage radiotherapy for rising or persistent PSA after radical prostatectomy. Urology 60:281–287

    Article  PubMed  Google Scholar 

  64. Syndikus I, Pickles T, Kostashuk E, Sullivan L (1996) Postoperative radiotherapy for stage pT3 carcinoma of the prostate: Improved local control. J Urol 155:1983–1986

    CAS  PubMed  Google Scholar 

  65. Trapasso J, deKernion J, Smith R, Dorey F (1994) The incidence and significance of detectable levels of serum prostate specific antigen after radical prostatectomy. J Urol 152:1821–1825

    CAS  PubMed  Google Scholar 

  66. Connolly J, Shinohara, K, Presti, JC Jr, Carroll, PR (1996) Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins. Urology 47:225–231

    Article  CAS  PubMed  Google Scholar 

  67. Valicenti R, Gomella L, Ismail M, Mulholland S, Petersen R, Corn B (1998) Effect of higher radiation dose on biochemical control after radical prostatectomy for pT3N0 prostate cancer. Int J Radiat Oncol Biol Phys 42:501–506

    Article  CAS  PubMed  Google Scholar 

  68. Vanuytsel L, Janssens G, Van Poppel H, Rijnders A, Baert L (2001) Radiotherapy for PSA recurrence after radical prostatectomy. Eur Urol 39:425–429

    Article  CAS  PubMed  Google Scholar 

  69. Vicini F, Ziaja EL, Kestin LL, Brabbins DS, Stromberg JS, Gonzalez JA, Martinez, AA (1999) Treatment outcome with adjuvant and salvage radiation after radical prostatectomy for prostate cancer. Urology 54:111–117

    Article  CAS  PubMed  Google Scholar 

  70. Wyant G, Murphy G, Horoszewicz J, Neal C, Collier B, Mitchell E, Purnell G, Tyson I, Heal A, Abdel-Nabi, H (1991) Immunoscintigraphy of prostate cancer: preliminary results with111In-labelled monoclonal antibody. Prostate 18:229–241

    PubMed  Google Scholar 

  71. Yu H, Diamandis E, Wong P, Nam R, Trachtenberg J (1997) Detection of prostate cancer relapse with prostate specific antigen monitoring at levels of 0.001 to 0.1 microg./l. J Urol 157:913–918

    CAS  PubMed  Google Scholar 

  72. Zelefsky M, Aschkenasy E, Kelsen S, Leibel S (1997) Tolerance and early outcome of postprostatectomy three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 39:327–333

    Article  CAS  PubMed  Google Scholar 

  73. Zelefsky M, Fuks Z, Hunt M, Yamada Y, Marion C, Ling C, Amols H, Venkatraman E, Leibel S (2002) High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 53:1111–1116

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, 610 University Avenue, Toronto, M5G 2M9, Canada

    Charles Catton & Michael Milosevic

Authors
  1. Charles Catton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Milosevic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Catton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Catton, C., Milosevic, M. Salvage radiotherapy following radical prostatectomy. World J Urol 21, 243–252 (2003). https://doi.org/10.1007/s00345-003-0360-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-003-0360-1

Keywords

Search

Navigation