Salvage radiotherapy for biochemical recurrence after radical prostatectomy: does the outcome depend on the prostate cancer characteristics?

Abstract

Objective: To build a model to evaluate the impact of salvage radiotherapy (SRT) in men with PSA rise or persistent PSA after undergoing radical prostatectomy (RP). Materials and Methods: The study included 107 node-negative patients treated with SRT after RP at a single institution. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP. All patients received local radiation to the prostate / seminal vesicle bed. The primary measured outcome was the biochemical recurrence (BCR) free survival. Multivariable Cox regression analysis was used to develop a risk-stratification group to identify predictive factors associated with the probability of BCR at 5yr. Results: At a median follow-up of 52 months, the BCR free survival rate and overall survival in 5 years was 73% and 94%, respectively. At multivariable analysis, pre-SRT PSA level > 0.35ng / mL (p = 0.023), negative margins (p = 0.038), and seminal vesicles invasion (p = 0.001) were significantly associated with BCR free survival. Three risk groups using regression analysis for SRT administration was built. Low-, intermediate- and the high-risk groups had a BCR free survival in 5-years of 96%, 84%, and 44% (p = 0.0001), respectively. Conclusions: We developed a risk group stratification to show the impact of SRT based on prostate cancer characteristics. SRT showed to be extremely beneficial for patients with low- and intermediate-risk tumors. Moreover, the risk-group built could identify patients classified as high-risk who might benefit from more aggressive treatment for SRT.

The multiparametric prostate resonance imaging with the prostate imaging-reporting and data system (PI-RADS): the state of art of prostate cancer diagnosis

“…Prostate cancer had important modifications in diagnosis, clinical management and surgical treatment in last years (8)(9)(10)(11). Multiparametric magnetic resonance imaging (mpMRI) has become the standard of care and provides useful information for prostate cancer diagnosis (12).…”

The impact of salvage radiotherapy initiation at PSA ≤ 0.5 ng/ml on metastasis‐free survival in patients with relapsed prostate cancer following prostatectomy

“…Conventionally, early SRT has been defined as either intervention at shorter time interval following prostatectomy or as intervention at low initial PSA levels following biochemical relapse. Although multiple series have shown that initiation of SRT at lower PSA levels is associated with improved biochemical relapse‐free survival rates when compared to SRT given at higher PSA levels, less data have confirmed an impact upon more important clinical outcomes such as metastasis‐free or overall survival, thus contributing to uncertainty regard the optimal risk/benefit calculus when determining the timing of SRT 6–13 . Given the documented long natural history of prostate cancer even for patients with biochemical relapse after SRT, questions remain as to the value of early SRT while PSA remains at very low levels, versus initial expectant management followed by later salvage intervention at higher PSA levels.…”