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Radiotherapy after radical prostatectomy for prostate cancer: clinical outcomes and factors influencing biochemical recurrence

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Abstract

Background

Radiotherapy (RT) after radical prostatectomy (RP) includes adjuvant radiotherapy (ART) and salvage radiotherapy (SRT), which can prevent or cure biochemical recurrence.

Aims

To evaluate long-term outcomes of RT after RP and to examine factors affecting biochemical recurrence-free survival (bRFS).

Methods

Sixty-six received ART and 73 received SRT between 2005 and 2012 were included. The clinical outcomes and late toxicities were evaluated. Univariate and multivariate analyses were performed to examine factors affecting bRFS.

Results

Median follow-up from RP was 111 months. Five-year bRFS and 10-year distant metastasis-free survival from RP were 82.8% and 84.5% in ART, and 74.6% and 92.4% in SRT, respectively. The most frequent late toxicity was hematuria, which was higher in ART (p = .01). No recurrence within RT field was occurred. On univariate analysis, pelvic RT was associated with favorable bRFS in ART (p = .048). In SRT, post-RP prostate-specific antigen (PSA) level (< 0.05 ng/mL), PSA nadir after RT (≤ 0.01 ng/mL), and time to PSA nadir (≥ 10 months) were associated with favorable bRFS (p = .03, p < .001, and p = .002, respectively). On multivariate analysis, post-RP PSA level and time to PSA nadir were independent predictive factors for bRFS in SRT (p = .04 and p = .005).

Conclusions

ART and SRT had favorable outcomes with no recurrence within RT field. In SRT, the time to PSA nadir after RT (≥ 10 months) was found to be a new predictor for favorable bRFS and useful in assessing treatment efficacy.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

References

  1. Stephenson AJ, Bolla M, Briganti A et al (2012) Postoperative radiation therapy for pathologically advanced prostate cancer after radical prostatectomy. Eur Urol 61:443–451

    Article  PubMed  Google Scholar 

  2. Vargas C, Kestin LL, Weed DW et al (2005) Improved biochemical outcome with adjuvant radiotherapy after radical prostatectomy for prostate cancer with poor pathologic features. Int J Radiat Oncol Biol Phys 61:714–724

    Article  PubMed  Google Scholar 

  3. Thompson IM, Tangen CM, Paradelo J et al (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

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bolla M, Van Poppel H, Tombal B et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomized controlled trial (EORTC trial 22911). Lancet 380:2018–2027

    Article  PubMed  Google Scholar 

  5. Wiegel T, Bartkowiak D, Bottke D et al (2014) Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96–02/AUO AP 09/95 trial. Eur Urol 66:243–250

    Article  PubMed  Google Scholar 

  6. Briganti A, Karnes RJ, Joniau S et al (2014) Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol 66:479–486

    Article  CAS  PubMed  Google Scholar 

  7. Pfister D, Bolla M, Briganti A et al (2014) Early salvage radiotherapy following radical prostatectomy. Eur Urol 65:1034–1043

    Article  PubMed  Google Scholar 

  8. Stish BJ, Pisansky TM, Harmsen WS et al (2016) Improved metastasis-free and survival outcomes with early salvage radiotherapy in men with detectable prostate-specific antigen after prostatectomy for prostate cancer. J Clin Oncol 34:3864–3871

    Article  PubMed  Google Scholar 

  9. Abugharib A, Jackson WC, Tumati V et al (2017) Exceedingly early salvage radiotherapy improves distant metastasis-free survival. J Urol 197:662–668

    Article  PubMed  Google Scholar 

  10. Parker CC, Clarke NW, Cook AD et al (2020) Timing of radiotherapy after radical prostatectomy (RADICALS-RT): A randomised, controlled phase 3 trial. Lancet 396:1413–1421

    Article  CAS  PubMed  Google Scholar 

  11. Kneebone A, Fraser-Browne C, Duchesne GM et al (2020) Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): A randomised, controlled, phase 3, non-inferiority trial. Lancet Oncol 21:1331–1340

    Article  CAS  PubMed  Google Scholar 

  12. Sargos P, Chabaud S, Latorzeff I et al (2020) Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU-17): A randomised, phase 3 trial. Lancet Oncol 21:1341–1352

    Article  CAS  PubMed  Google Scholar 

  13. Vale CL, Fisher D, Kneebone A et al (2020) Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: A prospectively planned systematic review and meta-analysis of aggregate data. Lancet 396:1422–1431

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Chen RC, Choudhury A (2021) Adjuvant Versus Early Salvage Radiation Therapy After Radical Prostatectomy for Men with Adverse Pathologic Features-The Debate Continues. Int J Radiat Oncol Biol Phys 109:839–843

    Article  PubMed  Google Scholar 

  15. Shimoyachi N, Yoshioka Y, Sasamura K et al (2021) Comparison Between Dose-Escalated Intensity Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy for Salvage Radiation Therapy After Prostatectomy. Adv Radiat Oncol 6:100753

    Article  PubMed  PubMed Central  Google Scholar 

  16. Briganti A, Wiegel T, Joniau S et al (2012) Early Salvage Radiation Therapy Does Not Compromise Cancer Control in Patients with pT3N0 Prostate Cancer After Radical Prostatectomy: Results of a Match-controlled Multi-institutional Analysis. Eur Urol 62:472–487

    Article  PubMed  Google Scholar 

  17. Stephenson AJ, Shariat SF, Zelefsky MJ et al (2004) Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy. JAMA 291:1325–1332

    Article  CAS  PubMed  Google Scholar 

  18. Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041

    Article  PubMed  Google Scholar 

  19. Fossati N, Karnes RJ, Cozzarini C et al (2016) Assessing the optimal timing for early salvage radiation therapy in patients with prostate-specific antigen rise after radical prostatectomy. Eur Urol 69:728–733

    Article  PubMed  Google Scholar 

  20. Spieler B, Goldstein J, Lawrence YR et al (2017) Salvage Radiation Therapy for Biochemical Failure Following Radical Prostatectomy. Isr Med Assoc J 19:19–24

    PubMed  Google Scholar 

  21. Sheets NC, Hendrix LH, Allen IM et al (2013) Trends in the use of postprostatectomy therapies for patients with prostate cancer: A surveillance, epidemiology, and end results Medicare analysis. Cancer 119:3295–3301

    Article  PubMed  Google Scholar 

  22. Maurice MJ, Zhu H, Abouassaly R (2015) Low use of immediate and delayed postoperative radiation for prostate cancer with adverse pathological features. J Urol 194:972–976

    Article  PubMed  Google Scholar 

  23. Freedland SJ, Humphreys EB, Mangold LA et al (2005) Risk of prostate cancer-specific mortality following radical prostatectomy. JAMA 294:433–439

    Article  CAS  PubMed  Google Scholar 

  24. Mir MC, Li J, Klink JC et al (2014) Optimal definition of biochemical recurrence after radical prostatectomy depends on pathologic risk factors: identifying candidates for early salvage therapy. Eur Urol 66:204–210

    Article  PubMed  Google Scholar 

  25. Freedland SJ, Sutter ME, Dorey F et al (2003) Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Urology 61:365–369

    Article  PubMed  Google Scholar 

  26. Pollack A, Karrison TG, Balogh AG et al (2022) The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet 399:1886–1901

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Spiotto MT, Hancock SL, King CR (2007) Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys 69:54–61

    Article  PubMed  Google Scholar 

  28. Ramey SJ, Agrawal S, Abramowitz MC et al (2018) Multi-institutional evaluation of elective nodal irradiation and/or androgen deprivation therapy with postprostatectomy salvage radiotherapy for prostate cancer. Eur Urol 74:99–106

    Article  PubMed  Google Scholar 

  29. Song C, Byun SJ, Kim YS et al (2019) Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. PLoS ONE 14:e0215057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Moghanaki D, Koontz BF, Karlin JD et al (2013) Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy. Cancer 119:52–60

    Article  CAS  PubMed  Google Scholar 

  31. Ray ME, Thames HD, Levy LB et al (2006) PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis. Int J Radiat Oncol Biol Phys 64:1140–1150

    Article  PubMed  Google Scholar 

  32. Tomioka A, Tanaka N, Yoshikawa M et al (2014) Nadir PSA level and time to nadir PSA are prognostic factors in patients with metastatic prostate cancer. BMC Urol 14:33

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kitagawa Y, Ueno S, Izumi K et al (2014) Nadir prostate-specific antigen (PSA) level and time to PSA nadir following primary androgen deprivation therapy as independent prognostic factors in a Japanese large-scale prospective cohort study (J-CaP). Cancer Res Clin Oncol 140:673–679

    Article  CAS  Google Scholar 

  34. Ogawa K, Nakamura K, Sasaki T et al (2009) Postoperative radiotherapy for localized prostate cancer: clinical significance of nadir prostate-specific antigen value within 12 months. Anticancer Res 29:4605–4613

    CAS  PubMed  Google Scholar 

  35. Bartkowiak D, Thamm R, Bottke D et al (2018) Prostate-specific antigen after salvage radiotherapy for postprostatectomy biochemical recurrence predicts long-term outcome including overall survival. Acta Oncol 57:362–367

    Article  CAS  PubMed  Google Scholar 

  36. Fossati N, Karnes RJ, Boorjian SA et al (2017) Long-term Impact of Adjuvant Versus Early Salvage Radiation Therapy in pT3N0 Prostate Cancer Patients Treated with Radical Prostatectomy: Results from a Multi-institutional Series. Eur Urol 71:886–893

    Article  PubMed  Google Scholar 

  37. Pound CR, Partin AW, Eisenberger MA et al (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597

    Article  CAS  PubMed  Google Scholar 

  38. Aizer AA, Yu JB, McKeon AM et al (2009) Whole pelvic radiotherapy versus prostate only radiotherapy in the management of locally advanced or aggressive prostate adenocarcinoma. Int J Radiat Oncol Biol Phys 75:1344–1349

    Article  PubMed  Google Scholar 

  39. Perez CA, Michalski J, Brown KC et al (1996) Nonrandomized evaluation of pelvic lymph node irradiation in localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys 36:573–584

    Article  CAS  PubMed  Google Scholar 

  40. Lawton CA, DeSilvio M, Roach M III et al (2007) An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94–13 with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 69:646–655

    Article  PubMed  PubMed Central  Google Scholar 

  41. Roach M 3rd, DeSilvio M, Valicenti R et al (2006) Whole pelvis, “mini-pelvis”, or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial. Int J Radiat Oncol Biol Phys 66:647–653

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Department of Radiotherapy, The Jikei University Hospital and the Department of Radiology, Tokyo Dental College Ichikawa General Hospital.

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Author notes

  1. Ichiro Fukuda, Manabu Aoki, Takahiro Kimura, and Koshi Ikeda these authors are equally contributed.

Authors and Affiliations

  1. Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Ichiro Fukuda & Manabu Aoki

  2. Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan

    Ichiro Fukuda & Koshi Ikeda

  3. Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Takahiro Kimura

Authors
  1. Ichiro Fukuda
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  4. Koshi Ikeda
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Corresponding author

Correspondence to Ichiro Fukuda.

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Ethical approval

This study was approved by the Institutional Review Board of The Jikei University School of Medicine [approval number 33–251 (10869)], and informed consent was provided by opt-out. All procedures involving human participants in this study were conducted in accordance with the ethical standards of the institutional and/or national research committees and the 1964 Declaration of Helsinki and its subsequent amendments or equivalent ethical standards.

Conflict of interest statement

Takahiro Kimura is a paid consultant/advisor to Astellas, Bayer, Janssen, and Sanofi. The other authors have no conflicts of interest to declare.

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Fukuda, I., Aoki, M., Kimura, T. et al. Radiotherapy after radical prostatectomy for prostate cancer: clinical outcomes and factors influencing biochemical recurrence. Ir J Med Sci 192, 2663–2671 (2023). https://doi.org/10.1007/s11845-023-03356-z

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  • DOI: https://doi.org/10.1007/s11845-023-03356-z

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