Salvage radiotherapy in patients with persistently detectable PSA or PSA rising from an undetectable range after radical prostatectomy gives comparable results

Abstract

Purpose

Salvage radiotherapy (SRT) is applied routinely in patients with a biochemical relapse after radical prostatectomy (RP). Although the detection threshold for relapse after RP has steadily been lowered, only about 30 % of the SRT patients achieve a durable response. We have previously shown the association between a PSA decrease below detectable levels after SRT and biochemical progression-free survival (BPFS). After recalculating our data according to a more recent definition of biochemical failure after SRT, we now show the significance of the post-RP PSA nadir.

Materials and methods

Among 159 prostate cancer patients without hormonal treatment after RP, SRT was given to 72 patients with persistently detectable PSA after RP and to 87 whose PSA increased out of an undetectable range. The median pre-SRT PSA was 0.29 ng/ml for the former group and 0.34 ng/ml for the latter group. A radiation dose of 66.6 Gy was applied to the prostate bed.

Results

The overall median follow-up time was 41.7 months. The probability for BPFS after this period was 52.8 % in 72 patients with persistently detectable PSA after RP and 65.4 % in 87 patients who had a post-RP PSA nadir below detection limit. Univariate and multivariate analyses showed no significant difference in BPFS of both patient groups (p > 0.05).

Conclusion

Our findings suggest that SRT is a viable treatment option for patients with persistently detectable PSA, giving similar results as in patients whose PSA increases out of an undetectable range after RP.

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References

  1. 1.

    Chun FK, Graefen M, Zacharias M, Haese A, Steuber T, Schlomm T, Walz J, Karakiewicz PI, Huland H (2006) Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer. World J Urol 24:273–280

    PubMed  Article  Google Scholar 

  2. 2.

    Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, Slawin K, Scardino PT (2008) Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 179:S47–S51

    PubMed  Article  Google Scholar 

  3. 3.

    Pinto F, Prayer-Galetti T, Gardiman M, Sacco E, Ciaccia M, Fracalanza S, Betto G, Pagano F (2006) Clinical and pathological characteristics of patients presenting with biochemical progression after radical retropubic prostatectomy for pathologically organ-confined prostate cancer. Urol Int 76:202–208

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ (2004) Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910–914

    PubMed  Article  Google Scholar 

  5. 5.

    Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, Marechal JM, Scalliet P, Haustermans K, Pierart M (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366:572–578

    PubMed  Article  Google Scholar 

  6. 6.

    Martin T, Wenz F, Bohmer D, Sedlmayer F, Hinkelbein W, Henkel TO, Miller K, Wiegel T (2010) Radiation therapy for prostate cancer in the new S3 guideline. Part 2: postoperative radiation therapy and brachytherapy. Urologe A 49:216–220

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E, Crawford ED (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181:956–962

    PubMed  Article  Google Scholar 

  8. 8.

    Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S, Willich N, Semjonow A, Souchon R, Stockle M, Rube C, Weissbach L, Althaus P, Rebmann U, Kalble T, Feldmann HJ, Wirth M, Hinke A, Hinkelbein W, Miller K (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96–02/AUO AP 09/95. J Clin Oncol 27:2924–2930

    PubMed  Article  Google Scholar 

  9. 9.

    Shekarriz B, Upadhyay J, Wood DP Jr, Hinman J, Raasch J, Cummings GD, Grignon D, Littrup PJ (1999) Vesicourethral anastomosis biopsy after radical prostatectomy: predictive value of prostate-specific antigen and pathologic stage. Urology 54:1044–1048

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Pisansky TM, Kozelsky TF, Myers RP, Hillman DW, Blute ML, Buskirk SJ, Cheville JC, Ferrigni RG, Schild SE (2000) Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 163:845–850

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Pazona JF, Han M, Hawkins SA, Roehl KA, Catalona WJ (2005) Salvage radiation therapy for prostate specific antigen progression following radical prostatectomy: 10-year outcome estimates. J Urol 174:1282–1286

    PubMed  Article  Google Scholar 

  12. 12.

    Stephenson AJ, Shariat SF, Zelefsky MJ, Kattan MW, Butler EB, Teh BS, Klein EA, Kupelian PA, Roehrborn CG, Pistenmaa DA, Pacholke HD, Liauw SL, Katz MS, Leibel SA, Scardino PT, Slawin KM (2004) Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 291:1325–1332

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Blute ML (2004) Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy. J Urol 172:2244–2248

    PubMed  Article  Google Scholar 

  14. 14.

    Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, Forman JD, Zelefsky MJ, Kestin LL, Roehrborn CG, Catton CN, DeWeese TL, Liauw SL, Valicenti RK, Kuban DA, Pollack A (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041

    PubMed  Article  Google Scholar 

  15. 15.

    Coen JJ, Zietman AL, Thakral H, Shipley WU (2002) Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol 20:3199–3205

    PubMed  Article  Google Scholar 

  16. 16.

    Wiegel T, Lohm G, Bottke D, Hocht S, Miller K, Siegmann A, Schostak M, Neumann K, Hinkelbein W (2009) Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome–results of a retrospective study. Int J Radiat Oncol Biol Phys 73:1009–1016

    PubMed  Article  Google Scholar 

  17. 17.

    Anscher MS, 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

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Schild SE, Buskirk SJ, Wong WW, Halyard MY, Swanson SK, Novicki DE, Ferrigni RG (1996) The use of radiotherapy for patients with isolated elevation of serum prostate specific antigen following radical prostatectomy. J Urol 156:1725–1729

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Coetzee LJ, Hars V, Paulson DF (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

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Cox JD, Gallagher MJ, Hammond EH, Kaplan RS, Schellhammer PF (1999) 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 Oncol 17:1155–1163

    PubMed  CAS  Google Scholar 

  21. 21.

    Siegmann A, Bottke D, Faehndrich J, Lohm G, Miller K, Bartkowiak D, Wiegel T, Hinkelbein W (2011) Dose escalation for patients with decreasing PSA during radiotherapy for elevated PSA after radical prostatectomy improves biochemical progression-free survival : Results of a retrospective study. Strahlenther Onkol 187:467–472

    PubMed  Article  Google Scholar 

  22. 22.

    Parker C, Sydes MR, Catton C, Kynaston H, Logue J, Murphy C, Morgan RC, Mellon K, Morash C, Parulekar W, Parmar MK, Payne H, Savage C, Stansfeld J, Clarke NW (2007) Radiotherapy and androgen deprivation in combination after local surgery (RADICALS): a new Medical Research Council/National Cancer Institute of Canada phase III trial of adjuvant treatment after radical prostatectomy. BJU Int 99:1376–1379

    PubMed  Article  Google Scholar 

  23. 23.

    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Amer Stat Ass 53:457–462

    Article  Google Scholar 

  24. 24.

    Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW, Walsh PC (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299:2760–2769

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Macdonald OK, Schild SE, Vora SA, Andrews PE, Ferrigni RG, Novicki DE, Swanson SK, Wong WW (2003) Radiotherapy for men with isolated increase in serum prostate specific antigen after radical prostatectomy. J Urol 170:1833–1837

    PubMed  Article  Google Scholar 

  26. 26.

    Morris MM, Dallow KC, Zietman AL, Park J, Althausen A, Heney NM, Shipley WU (1997) Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 38:731–736

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    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

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Forman JD, Meetze K, Pontes E, Wood DP Jr, Shamsa F, Rana T, Porter AT (1997) Therapeutic irradiation for patients with an elevated post-prostatectomy prostate specific antigen level. J Urol 158:1436–1439 (discussion 1439–1440)

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Wenz F, Martin T, Bohmer D, Martens S, Sedlmayer F, Wirth M, Miller K, Heidenreich A, Schrader M, Hinkelbein W, Wiegel T (2010) The German S3 guideline prostate cancer: aspects for the radiation oncologist. Strahlenther Onkol 186:531–534

    PubMed  Article  Google Scholar 

  30. 30.

    Siegmann A, Bottke D, Faehndrich J, Brachert M, Lohm G, Miller K, Bartkowiak D, Hinkelbein W, Wiegel T (2011) Salvage radiotherapy after prostatectomy—what is the best time to treat? Radiother Oncol (in press)

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Correspondence to Thomas Wiegel.

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Lohm, G., Bottke, D., Jamil, B. et al. Salvage radiotherapy in patients with persistently detectable PSA or PSA rising from an undetectable range after radical prostatectomy gives comparable results. World J Urol 31, 423–428 (2013). https://doi.org/10.1007/s00345-012-0860-y

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Keywords

  • Prostate cancer
  • Salvage radiotherapy
  • Persistently detectable PSA
  • Increasing PSA
  • Radical prostatectomy