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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

Eine Dosiseskalation bei Patienten mit PSA-Abfall unter einer Salvage-Strahlentherapie nach radikaler Prostatektomie verbessert das biochemisch progressionsfreie Überleben – Ergebnisse einer retrospektiven Untersuchung

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Abstract

Purpose:

The optimal dose for salvage radiotherapy (SRT) after radical prostatectomy (RP) is still not defined. It should be at least 66 Gy. In the present study, the suitability of PSA regression as a selection criterion for an SRT dose escalation to 70.2 Gy was examined.

Patients and Methods:

Between 1997 and 2007, 301 prostate cancer patients received SRT after RP at the Charité – University Medicine Berlin, Campus Benjamin Franklin. None of the patients had antihormone therapy prior to SRT. A total of 234 patients received 66.6 Gy. From 2002 on, 67 patients with a PSA decrease during SRT were irradiated with 70.2 Gy. The influence of this selection and dose escalation on freedom from biochemical progression (bNED) was analyzed.

Results:

The median follow-up of the whole group was 30 months, the median pre-SRT PSA was 0.28 ng/ml. Of the patients, 27% (82/301) developed biochemical progression, 31% from the 66.6 Gy cohort (73/292) and 13% from the 70.2 Gy cohort (9/67) (p = 0.01). The calculated 2-years bNED was 74% for the whole group, 88% vs. 71% after 70.2 Gy and 66.6 Gy, respectively (p = 0.01). In a multivariate analysis, the total dose (p = 0.017), the re-achievement of an undetectable PSA after SRT (p = 0.005), and the infiltration of the seminal vesicles (p = 0.049) were independent parameters of bNED.

Conclusion:

Our analysis suggests that patient selection during SRT for a dose escalation to 70.2 Gy can improve the freedom from biochemical progression in patients with SRT after RP.

Zusammenfassung

Ziel:

Die optimale Dosis der Salvage-Strahlentherapie (SRT) nach radikaler Prostatektomie (RP) ist derzeit nicht definiert. Sie sollte mindestens 66 Gy betragen. In der vorliegenden Arbeit wird die Bedeutung des PSA-Abfalls unter laufender SRT als Selektionskriterium für eine Dosiserhöhung auf 70,2 Gy untersucht.

Patienten und Methode:

Zwischen 1997 und 2007 wurden 301 Patienten mit Prostatakarzinom nach radikaler Prostatektomie an der Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, einer SRT unterzogen. Kein Patient hatte eine antihormo-nelle Therapie vor der SRT. 234 Patienten erhielten eine SRT-Dosis von 66,6 Gy. Seit 2002 wurden 67 Patienten mit einem PSA-Abfall unter SRT mit einer erhöhten Gesamtdosis von 70,2 Gy bestrahlt. Der Einfluss dieser Selektion mit der erhöhten Gesamtdosis auf die biochemische Progressionsfreiheit (bNED) nach SRT wird analysiert.

Ergebnisse:

Die mediane Nachbeobachtungszeit für die Gesamtgruppe war 30 Monate, der mediane Prä-SRT-PSA war 0,28 ng/ml. 27% (82/301) der Patienten entwickelten eine biochemische Progression, 31% in der Behandlungsgruppe mit 66,6 Gy (73/292) und 13% in der Gruppe mit 70,2 Gy (9/67), (p = 0,01). Die berechnete bNED nach 2 Jahren war 74% für die Gesamtgruppe und 88% vs. 71% bei 70,2 Gy bzw. 66.6 Gy (p = 0,01). In der multivariaten Analyse zeigten sich die Gesamtdosis (p = 0,017) das Wiedererreichen des PSA-Null-Bereichs nach SRT (p = 0,005) und die Samenblaseninfiltration (p = 0,049) als unabhängige Einflussfaktoren auf die bNED.

Schlussfolgerung:

Unsere Untersuchungen weisen darauf hin, dass eine Patientenselektion unter SRT in Verbindung mit einer Dosiseskalation auf 70,2 Gy die biochemische Progressionsfreiheit von Patienten mit SRT nach RP verbessern kann.

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Authors and Affiliations

  1. Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin-Franklin, Berlin, Germany

    Alessandra Siegmann, Julia Faehndrich, Gunnar Lohm & Wolfgang Hinkelbein

  2. Department of Radiation Oncology, University Hospital, Ulm, Germany

    Dirk Bottke, Detlef Bartkowiak &  Thomas Wiegel

  3. Department of Urology, Charité Universitätsmedizin, Campus Benjamin-Franklin, Berlin, Germany

    Kurt Miller

  4. Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Thomas Wiegel

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  1. Alessandra Siegmann
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  8. Wolfgang Hinkelbein
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Correspondence to Thomas Wiegel.

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*Both authors contributed equally to the manuscript

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Siegmann, A., Bottke, D., Faehndrich, J. et al. Dose Escalation for Patients with Decreasing PSA during Radiotherapy for Elevated PSA after Radical Prostatectomy Improves Biochemical Progression-Free Survival. Strahlenther Onkol 187, 467–472 (2011). https://doi.org/10.1007/s00066-011-2229-3

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  • DOI: https://doi.org/10.1007/s00066-011-2229-3

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