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Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy

Prolongation of prostate-specific antigen doubling time in patients with subsequent biochemical progression

Salvage-Radiotherapie bei Prostatakarzinompatienten mit biochemischem Rezidiv nach radikaler Prostatektomie

Verlängerung der Verdopplungszeit des prostataspezifischen Antigens bei Patienten mit anschließendem biochemischem Progress

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Abstract

Background

In patients with prostate cancer (PCa) and biochemical progression (BP) after radical prostatectomy (RP), salvage radiotherapy (sRT) improves prostate cancer-specific survival (PCSS), but this evidence is based only on retrospective data.

Patients and methods

In addition to our previous study of 151 patients with PCa and BP after RP, we performed univariate analyses of prostate-specific antigen (PSA) kinetics during sRT. In 11 patients with BP or initiation of hormonal treatment (HT) within 180 days after sRT, risk factors were assessed using Mann–Whitney U tests. PSA doubling times (PSADT) before and after sRT in 82 patients with BP after sRT were compared by a Wilcoxon test.

Results

After a median follow-up of 82 months, analysis of PSA kinetics during sRT did not show a statistically significant impact on a subsequent BP, PCSS, or overall survival at an administered dose of 30 or 45 Gy. The subgroup analysis of patients with early BP or early HT revealed higher Gleason scores (p = 0.008) and preoperative PSA values (p = 0.005), shorter PSADT prior to sRT (p < 0.0005), and longer time intervals from RP until the start of sRT (p = 0.005) compared to all other patients. In patients with subsequent BP, PSADTs were significantly prolonged after sRT (median PSADT 4.5 months before and 9.9 months after sRT, p < 0.0005).

Conclusion

PSA monitoring during sRT did not predict the therapeutic success. Subgroup analysis suggests a lower probability of benefit for patients with the abovenamed risk factors . However, the prolonged PSADT after sRT reflects a benefit of sRT for the vast majority of patients.

Zusammenfassung

Hintergrund

Bei Patienten mit Prostatakarzinom (PCa) und biochemischer Progression (BP) nach radikaler Prostatektomie (RP) verbessert eine Salvage-Strahlentherapie (sRT) das prostatakrebsspezifische Überleben (PCSS), wobei die Evidenz hierfür lediglich auf retrospektiven Daten basiert.

Patienten und Methoden

Mit dem Datensatz unserer bereits veröffentlichten Studie zur sRT von 151 Patienten mit BP nach RP führten wir zusätzliche Analysen zum Verlauf des prostataspezifischen Antigens (PSA) während der sRT durch. Insgesamt 11 Patienten mit BP oder Beginn einer Hormontherapie (HT) innerhalb von 180 Tagen nach sRT wurden mittels Mann-Whitney-U-Tests auf Risikofaktoren untersucht. Mit dem Wilcoxon-Test wurden die PSA-Verdopplungszeiten (PSADT) vor und nach sRT bei 82 Patienten mit erneutem BP nach sRT verglichen.

Ergebnisse

Nach einer medianen Nachbeobachtungszeit von 82 Monaten ergab die Analyse des PSA-Verlaufs während sRT nach Strahlendosen von 30 bzw. 45 Gy keinen statistisch signifikanten Einfluss, weder auf einen weiteren BP, noch auf das PCSS bzw. das Gesamtüberleben. Patienten mit frühem BP oder HT-Beginn hatten im Vergleich zu den übrigen Patienten signifikant höhere Gleason-Scores (p = 0,008), höhere PSA-Werte vor RP (p = 0,005), kürzere PSADT vor Beginn der sRT (p < 0,0005) und längere Zeitintervalle von RP bis zum sRT-Beginn (p = 0,005). Bei Patienten mit erneutem BP war die PSADT nach sRT signifikant verlängert (mediane PSADT 4,5 Monate vor und 9,9 Monate nach sRT; p < 0,0005).

Schlussfolgerung

Der weitere Krankheitsverlauf ließ sich durch PSA-Monitoring während der sRT nicht vorhersagen. Weniger erfolgsversprechend erscheint die sRT für Patienten mit den Risikofaktoren, die in der Subgruppenanalyse gefunden wurden. Die verlängerte PSADT nach sRT zeigt hingegen einen Vorteil dieser Behandlung für die überwältigende Mehrheit der Patienten an.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Charité Universitätsmedizin, Berlin, Germany

    Gunnar Lohm, Volker Budach & Johannes Gollrad

  2. Department of Biometry and Clinical Epidemiology, Charité Universitätsmedizin, Berlin, Germany

    Konrad Neumann

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

    Thomas Wiegel

  4. Xcare Praxis für Strahlentherapie, Saarlouis, Germany

    Stefan Hoecht

Authors
  1. Gunnar Lohm
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  2. Konrad Neumann
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  3. Volker Budach
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  4. Thomas Wiegel
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  5. Stefan Hoecht
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  6. Johannes Gollrad
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Corresponding author

Correspondence to Gunnar Lohm.

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Conflict of interest

G. Lohm, K. Neumann, V. Budach, T. Wiegel, S. Hoecht, and J. Gollrad declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

This publication is dedicated to Wolfgang Hinkelbein, our inspiring colleague, co-author of the previous publications of this patient series and mentor of the first and the last authors of this publication, who passed away in 2015, much too early at an age of 67 years.

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Lohm, G., Neumann, K., Budach, V. et al. Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy. Strahlenther Onkol 194, 325–332 (2018). https://doi.org/10.1007/s00066-017-1247-1

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  • DOI: https://doi.org/10.1007/s00066-017-1247-1

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