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Risk of biochemical recurrence and timing of radiotherapy in pT3a N0 prostate cancer with positive surgical margin

A single center experience

Risiko für ein biochemisches Rezidiv und Zeitpunkt der Strahlentherapie bei pT3a N0 Prostatakarzinom mit positivem Schnittrand

Eine monozentrische Analyse

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Abstract

Background

Despite improved biochemical recurrence-free survival rates by the use of immediate adjuvant radiotherapy (RT) in patients with locally advanced prostate cancer, disagreement about the need and timing of RT remains.

Patients and methods

From 2005–2009, 94 patients presenting with a stage pT3a N0 and microscopic positive resection margin were retrospectively analyzed after radical prostatectomy. Special attention was given to patients’ outcome, the frequency of additive RT, and its efficacy.

Results

Median follow-up was 80 months. A total of 71 patients had a negative postoperative prostate-specific antigen (PSA) level (<0.07 ng/ml). Thirty-six of them did not experience any PSA relapse (subgroup 1). Fourteen of them received additive RT and during follow-up all 36 patients remained PSA negative. Of 71 initially PSA-negative patients, 35 had a biochemical relapse (subgroup 2); 28 patients underwent salvage RT. The median PSA value before salvage RT was 0.24 ng/ml and was subsequently negative (<0.07 ng/ml) in 23 patients after RT. Of the entire cohort, 23 patients had persisting PSA after surgery (subgroup 3). Of these, 18 patients received salvage RT at a median PSA level of 0.4 ng/ml. One patient in subgroup 1, 5 patients in subgroup 2, and 9 patients in subgroup 3 had ongoing androgen deprivation therapy.

Conclusion

The present study of 94 pT3a N0 R1 prostate cancer patients provides insight into medical care of this patient cohort and underlines the need for additive RT for the majority of patients to achieve long-term biochemical control. Although immediate adjuvant RT was applied with restraint (20 %), during the observation period 60 of 94 patients (63.8 %) received RT – highlighting the need of postoperative treatment.

Zusammenfassung

Hintergrund

Trotz der nachweislich verbesserten biochemischen Kontrolle besteht Uneinigkeit hinsichtlich Notwendigkeit und Zeitpunkt einer adjuvanten Radiotherapie (RT) bei lokal fortgeschrittenem Prostatakarzinom.

Patienten und Methoden

Vierundneunzig Prostatakarzinompatienten (pT3a N0 R1), die zwischen 2005 und 2009 radikal operiert worden waren, wurden retrospektiv ausgewertet. Untersucht wurden – neben dem Endpunkt biochemische Rezidivfreiheit – Häufigkeit, Zeitpunkt und Effektivität einer additiven RT.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 80 Monate. Postoperativ waren 71 Patienten PSA (prostataspezifisches Antigen)-negativ (<0.07 ng/ml); von diesen blieben während des gesamten Follow-up 36 PSA-negativ (Gruppe 1), 14 von ihnen erhielten eine adjuvante RT. Bei 35 der postoperativ PSA-negativen Patienten trat ein biochemisches Rezidiv auf, von diesen erhielten 28 eine Salvage-Bestrahlung (Gruppe 2). Der PSA vor Salvage-Bestrahlung lag bei median 0,24 ng/ml, nach der Bestrahlung hatten 23 einen medianen PSA < 0.07 ng/ml. Postoperativ wiesen 23 Patienten einen persistierenden positiven PSA-Wert auf (Gruppe 3). Von diesen erhielten 18 Patienten eine Salvage-Bestrahlung bei einem medianen PSA vor RT von 0,4 ng/ml. Ein Patient in Gruppe 1, 5 Patienten in Gruppe 2 und 9 in Gruppe 3 standen bis zum letzten Follow-up unter antiandrogener Therapie.

Schlussfolgerung

Das vorgestellte Kollektiv zeigt repräsentativ die Versorgungsrealität und die Notwendigkeit einer postoperativen Behandlung für die Mehrheit der Patienten, um eine langfristige biochemische Kontrolle zu erreichen. Bei unmittelbar postoperativ eher zurückhaltendem Einsatz einer adjuvanten RT (20 %) wurden im Verlauf letztlich 60 von 94 Patienten (63,8 %) einer RT zugeführt.

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Authors and Affiliations

  1. Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Nina-Sophie Hegemann,  Sebastian Morcinek,  Stefanie Corradini,  Minglun Li,  Claus Belka &  Ute Ganswindt

  2. Department of Urology, Ludwig-Maximilians-University, Munich, Germany

    Alexander Buchner,  Alexander Karl &  Christian Stief

  3. Department of Pathology, University Hospital RWTH Aachen, Aachen, Germany

    Ruth Knüchel

Authors
  1. Nina-Sophie Hegemann
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  2. Sebastian Morcinek
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  3. Alexander Buchner
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  4. Alexander Karl
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  7. Stefanie Corradini
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  8. Minglun Li
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  10. Ute Ganswindt
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Corresponding author

Correspondence to Ute Ganswindt.

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Conflict of interest

N.-S. Hegemann, S. Morcinek, A. Buchner, A. Karl, C. Stief, R. Knüchel, S. Corradini, M. Li, C. Belka, and U. Ganswindt state that there are no conflicts of interest.

This retrospective study was exempt from requiring ethics approval. The Bavarian hospital law (Bayerisches Krankenhausgesetz), §27 Data protection (Datenschutz), allows the retrospective use of patient data for research, provided that any person’s related data remain anonymously. German radiation protection laws request a regular analysis of outcomes for quality control. Thus in the case of purely retrospective studies no additional ethical approval was needed.

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Hegemann, NS., Morcinek, S., Buchner, A. et al. Risk of biochemical recurrence and timing of radiotherapy in pT3a N0 prostate cancer with positive surgical margin. Strahlenther Onkol 192, 440–448 (2016). https://doi.org/10.1007/s00066-016-0990-z

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  • DOI: https://doi.org/10.1007/s00066-016-0990-z

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