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Eur Urol. 2014 Jun;65(6):1034-43. doi: 10.1016/j.eururo.2013.08.013. Epub 2013 Aug 15.

Early salvage radiotherapy following radical prostatectomy.

Author information

1
Department of Urology, RWTH Aachen University, Aachen, Germany. Electronic address: dpfister@ukaachen.de.
2
Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France.
3
Department of Urology, Università Vita-Salute San Raffaele, Milan, Italy.
4
Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
5
Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
6
Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
7
Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
8
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
9
Department of Radiation Oncology, University Hospital, Ulm, Germany.
10
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Abstract

CONTEXT:

Depending on the pathologic tumour stage, up to 60% of prostate cancer patients who undergo radical prostatectomy will develop biochemical relapse and require further local treatment.

OBJECTIVES:

We reviewed the results of early salvage radiation therapy (RT), defined as prostate-specific antigen (PSA) values prior to RT ≤ 0.5 ng/ml in the setting of lymph node-negative disease.

EVIDENCE ACQUISITION:

Ten retrospective studies, including one multicentre analysis, were used for this analysis. Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT.

EVIDENCE SYNTHESIS:

Patients treated with early salvage RT have a significantly improved biochemical recurrence-free survival (BRFS) rate compared with those receiving salvage RT initiated after PSA values are >0.5 ng/ml. Similarly, within the cohort of patients with pre-RT PSA values <0.5 ng/ml, improved BRFS rates were noted among those with lower rather higher pre-RT PSA levels. It is possible that higher RT dose levels and the use of adjunctive androgen-deprivation therapy improve biochemical control outcomes in the salvage setting.

CONCLUSIONS:

Based on a literature review, improved 5-yr BRFS rates are observed for patients who receive early salvage RT compared with patients treated with salvage RT with a pre-RT PSA value >0.5 ng/ml. Whether the routine application of early salvage RT in patients with initially undetectable PSA levels will be associated with demonstrable clinical benefit awaits the results of ongoing prospective trials.

KEYWORDS:

Biochemical recurrence-free survival; Early salvage radiotherapy; Prostate cancer; Radiotherapy

PMID:
23972524
DOI:
10.1016/j.eururo.2013.08.013
[Indexed for MEDLINE]
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