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Salvage radiation therapy following radical prostatectomy in Stockholm County in 2008–2016

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

This is a large single-institution report including 714 consecutive prostate cancer patients who received salvage radiation therapy (SRT) between 2008 and 2016 in Stockholm, Sweden. The aim of the study was to determine the PSA outcomes of salvage radiotherapy in a cohort of prostate cancer patients after radical prostatectomy (RP).

Methods

All patients have been treated with 70 Gy during a 7-week period. STHLM-0 database was the source of all PSA test results in Stockholm.

Results

During a median follow-up of 48 months after radiotherapy treatment, 49% of patients had no signs of biochemical failure (BcF), 13% experienced BcF, and 38% never reached PSA nadir and subsequently progressed after SRT. Five-year biochemical free survival (bPFS) was 47%. Low PSA at SRT start as well as low preoperative Gleason score and T-stage were independently associated with favorable 5-year biochemical progression-free survival.

Conclusions

Patients who started SRT at PSA < 0.28 ng/ml had the best 5-year bPFS of 58%. Median pre-SRT PSA was 0.28 ng/l (0.2–0.45) indicating the good standard of salvage radiotherapy process from patient referral to start of radiotherapy in Stockholm County.

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References

  1. Samverkan RCi (2016) Prostatacancer. Årsrapport från Nationella prostatacancerregistret 2015

    Google Scholar 

  2. Bjartell A, Bottai M, Persson J, Bratt O, Damber JE, Stattin P, Akre O (2016) Prediction of clinical progression after radical prostatectomy in a nationwide population-based cohort. Scand J Urol 50(4):255–259. https://doi.org/10.1080/21681805.2016.1183226

    Article  PubMed  Google Scholar 

  3. Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294(4):433–439. https://doi.org/10.1001/jama.294.4.433

    Article  CAS  PubMed  Google Scholar 

  4. Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, Akre O, Carlsson S, Hosseini A, Olsson M, Egevad L, Wiklund F, Steineck G, Wiklund NP (2016) Oncologic outcomes after robot-assisted radical prostatectomy: a large European single-centre cohort with median 10-year follow-up. Eur Urol Focus 4:351–359. https://doi.org/10.1016/j.euf.2016.10.007

    Article  PubMed  Google Scholar 

  5. Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouviere O, Wiegel T, Mottet N (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642. https://doi.org/10.1016/j.eururo.2016.08.002

    Article  PubMed  Google Scholar 

  6. 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(3):956–962. https://doi.org/10.1016/j.juro.2008.11.032

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, Colombel M, van de Beek C, Verhagen P, van den Bergh A, Sternberg C, Gasser T, van Tienhoven G, Scalliet P, Haustermans K, Collette L (2012) European organisation for R, treatment of cancer RO, Genito-urinary G (2012) postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380(9858):2018–2027. https://doi.org/10.1016/S0140-6736(12)61253-7

    Article  PubMed  Google Scholar 

  8. Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, Golz R, Storkel S, Willich N, Semjonow A, Stockle M, Rube C, Rebmann U, Kalble T, Feldmann HJ, Wirth M, Hofmann R, Engenhart-Cabillic R, Hinke A, Hinkelbein W, Miller K (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(2):243–250. https://doi.org/10.1016/j.eururo.2014.03.011

    Article  PubMed  Google Scholar 

  9. Latorzeff I, Sargos P, Loos G, Supiot S, Guerif S, Carrie C (2017) Delineation of the prostate bed: the "invisible target" is still an issue? Front Oncol 7:108. https://doi.org/10.3389/fonc.2017.00108

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chade DC, Eastham J, Graefen M, Hu JC, Karnes RJ, Klotz L, Montorsi F, van Poppel H, Scardino PT, Shariat SF (2012) Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol 61(5):961–971. https://doi.org/10.1016/j.eururo.2012.01.022

    Article  PubMed  Google Scholar 

  11. King CR (2016) The dose-response of salvage radiotherapy following radical prostatectomy: a systematic review and meta-analysis. Radiother Oncol 121(2):199–203. https://doi.org/10.1016/j.radonc.2016.10.026

    Article  PubMed  Google Scholar 

  12. Pfister D, Bolla M, Briganti A, Carroll P, Cozzarini C, Joniau S, van Poppel H, Roach M, Stephenson A, Wiegel T, Zelefsky MJ (2014) Early salvage radiotherapy following radical prostatectomy. Eur Urol 65(6):1034–1043. https://doi.org/10.1016/j.eururo.2013.08.013

    Article  PubMed  Google Scholar 

  13. Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ (2012) Long-term outcomes after high-dose postprostatectomy salvage radiation treatment. Int J Radiat Oncol Biol Phys 84(1):112–118. https://doi.org/10.1016/j.ijrobp.2011.10.077

    Article  PubMed  Google Scholar 

  14. Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, Sartor O, Patel MP, Bahary JP, Zietman AL, Pisansky TM, Zeitzer KL, Lawton CA, Feng FY, Lovett RD, Balogh AG, Souhami L, Rosenthal SA, Kerlin KJ, Dignam JJ, Pugh SL, Sandler HM, RTOG NRGO (2017) Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 376(5):417–428. https://doi.org/10.1056/NEJMoa1607529

    Article  PubMed  PubMed Central  Google Scholar 

  15. Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Latorzeff I, Supiot S, Bosset M, Lagrange JL, Beckendorf V, Lesaunier F, Dubray B, Wagner JP, N'Guyen TD, Suchaud JP, Crehange G, Barbier N, Habibian M, Ferlay C, Fourneret P, Ruffion A, Dussart S (2016) Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol 17(6):747–756. https://doi.org/10.1016/S1470-2045(16)00111-X

    Article  CAS  PubMed  Google Scholar 

  16. Mohler J, Bahnson RR, Boston B, Busby JE, D'Amico A, Eastham JA, Enke CA, George D, Horwitz EM, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Macvicar G, Plimack ER, Pow-Sang JM, Roach M 3rd, Rohren E, Roth BJ, Shrieve DC, Smith MR, Srinivas S, Twardowski P, Walsh PC (2010) NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Cancer Netw 8(2):162–200

    Article  CAS  Google Scholar 

  17. Aly M, Dyrdak R, Nordstrom T, Jalal S, Weibull CE, Giske CG, Gronberg H (2015) Rapid increase in multidrug-resistant enteric bacilli blood stream infection after prostate biopsy - a 10-year population-based cohort study. Prostate 75(9):947–956. https://doi.org/10.1002/pros.22979

    Article  PubMed  Google Scholar 

  18. Nordstrom T, Aly M, Clements MS, Weibull CE, Adolfsson J, Gronberg H (2013) Prostate-specific antigen (PSA) testing is prevalent and increasing in Stockholm County, Sweden, despite no recommendations for PSA screening: results from a population-based study, 2003-2011. Eur Urol 63(3):419–425. https://doi.org/10.1016/j.eururo.2012.10.001

    Article  PubMed  Google Scholar 

  19. Nordstrom T, Bratt O, Ortegren J, Aly M, Adolfsson J, Gronberg H (2016) A population-based study on the association between educational length, prostate-specific antigen testing and use of prostate biopsies. Scand J Urol 50(2):104–109. https://doi.org/10.3109/21681805.2015.1113200

    Article  CAS  PubMed  Google Scholar 

  20. Cortes-Gonzalez JR, Castellanos E, Sandberg K, Eriksson MH, Wiklund P, Carlsson S, Cohn-Cedermark G, Harmenberg U, Gustafsson O, Levitt SH, Lennernas B, Brandberg Y, Marquez M, Kalkner KM, Nilsson S (2013) Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy. Int J Oncol 42(1):109–117. https://doi.org/10.3892/ijo.2012.1694

    Article  PubMed  Google Scholar 

  21. American Society for Therapeutic Radiology and Oncology Consensus Panel (1997) Consensus statement: guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 37(5):1035–1041

  22. Stephenson AJ, Slawin KM (2004) The value of radiotherapy in treating recurrent prostate cancer after radical prostatectomy. Nat Clin Pract Urol 1(2):90–96. https://doi.org/10.1038/ncpuro0056

    Article  PubMed  Google Scholar 

  23. Briganti A, Karnes RJ, Joniau S, Boorjian SA, Cozzarini C, Gandaglia G, Hinkelbein W, Haustermans K, Tombal B, Shariat S, Sun M, Karakiewicz PI, Montorsi F, Van Poppel H, Wiegel T (2014) Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol 66(3):479–486. https://doi.org/10.1016/j.eururo.2013.11.045

    Article  CAS  PubMed  Google Scholar 

  24. Oertel M, Scobioala S, Kroeger K, Baehr A, Stegger L, Haverkamp U, Schafers M, Eich HT (2018) Worth a local treatment? - analysis of modern radiotherapy concepts for oligometastatic prostate cancer. Radiat Oncol 13(1):185. https://doi.org/10.1186/s13014-018-1118-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Henkenberens C, Derlin T, Bengel FM, Ross TL, Wester HJ, Hueper K, Kuczyk MA, Christiansen H, von Klot CA (2018) Patterns of relapse as determined by (68)Ga-PSMA ligand PET/CT after radical prostatectomy : importance for tailoring and individualizing treatment. Strahlenther Onkol 194(4):303–310. https://doi.org/10.1007/s00066-017-1231-9

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors appreciate the kind help of Carina Holmberg, Eva Onjukka, Berit Wennberg, Andreas Pettersson, colleagues from the former urosektionen, Mattias Hedman, professor Sten Nilsson, and professor Henrik Grönberg.

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Authors and Affiliations

  1. Department of Radiation Therapy, Karolinska University Hospital, 171 76, Stockholm, Sweden

    Jens Falk & Alexander Valdman

  2. Department of Urology, Karolinska University Hospital, Stockholm, Sweden

    Markus Aly

  3. Department of Medical Epidemiology and Statistics, Karolinska Institutet, Stockholm, Sweden

    Markus Aly & Tobias Nordström

  4. EpiStat, 75655, Uppsala, Sweden

    Anders Berglund

  5. Department of Urology, Danderyd Hospital, Stockholm, Sweden

    Tobias Nordström

Authors
  1. Jens Falk
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  2. Markus Aly
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  5. Alexander Valdman
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Corresponding author

Correspondence to Tobias Nordström.

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Funding

No funding support is associated with this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human or animal subjects performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical permission to conduct the study has been granted in 2012 (Dnr: 2012/438-31/3) and prolonged in 2018 (Dnr: 201/568-32) [17, 19].

Informed consent

Informed consent regarding all individuals participating in the study is subjected to coverage by the national Swedish ethical permissions (Dnr: 2012/438-31/3) and (Dnr: 201/568-32) obtained specifically for the purposes of this study.

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Falk, J., Aly, M., Berglund, A. et al. Salvage radiation therapy following radical prostatectomy in Stockholm County in 2008–2016. J Radiat Oncol 8, 225–231 (2019). https://doi.org/10.1007/s13566-019-00393-z

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  • DOI: https://doi.org/10.1007/s13566-019-00393-z

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