Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer

Morris, Monica; Dallow, K.C.; Zietman, Anthony L.; Park, Jeannine; Althausen, Alex F.; Heney, Niall M.; Shipley, William U.

doi:10.1016/s0360-3016(97)00080-1

Cited by 159 publications

(69 citation statements)

References 21 publications

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“…The serum PSA level before RT has consistently been recognized as a factor associated with biochemical relapse afterward in most of the published reports. This PSA level seems to be a predictive factor (except in the present patients, and [8,9,14,15,17]). To date it seems that when RT is given for postoperative biochemical relapse, it should be instituted as soon as possible rather than assuming that a similar outcome will result in patients with PSA below a certain level (e.g.…”

Section: Discussionsupporting

confidence: 43%

“…as salvage therapy for patients who have a local recurrence confirmed on biopsy or on PSA velocity, or as adjuvant therapy for patients with adverse pathology. In studies with a long follow-up the 3-year biochemical progression-free survival is 24-67% (51% in the present study) and the 5-year biochemical progression-free survival 10-88% (Table 4) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 75%

“…In the present study, pathological stage (marginally significant P = 0.06), Gleason score and nadir PSA after RT were identified on multivariate analysis to be independent predictors of biochemical relapse after RT. Although a consistent association of pathological stage with outcome was not evident in previous studies [6,8], its importance has been suggested by others [16,17,20]. The prognostic significance of Gleason score was established previously.…”

Section: Discussionmentioning

confidence: 79%

“…For patients with presumed local recurrence or persistent prostate cancer based on PSA velocity or adverse pathology, radiation therapy (RT) as an adjuvant or a salvage treatment has been reported as a therapeutic option, with several studies publishing the outcome [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. However, only a few studies tried to identify the predictive factors of biochemical progression in patients with PSA recurrence after RP and treated with RT [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy

Taille¹,

Flam²,

Thiounn³

et al. 2002

BJU International

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Objectives To assess the efficacy of salvage/adjuvant radiation therapy (RT) for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Between 1997 and 2001, 52 patients were treated in our institution with RT for PSA recurrence after RP. The mean (range) delay between RP and RT was 30.5 (0.16-105.6) months. Eighteen patients received no hormonal therapy before RT. The failure of RT was defined as three consecutive increases in PSA levels with intervals of ≥ 6 weeks. Results Within a mean (range) follow-up of 27.7 (6-69) months, 18 patients presented with biochemical progression. The 3-year biochemical progression-free survival was 51%. Using univariate analysis, an age < 65 years ( P = 0.0262), a Gleason score on the RP specimen of ≥ 8 ( P = 0.0024), stage pT3 ( P = 0.02), a detectable nadir PSA after RT ( P < 0.001) and the absence of hormonal therapy ( P = 0.0359) were associated with a lower biochemical progression-free survival. However, only the Gleason score ( P = 0.0395) and nadir serum PSA after RT ( P = 0.028) remained independent predictive factors on multivariate analysis. Conclusion Half of the present patients treated with RT for an isolated high serum PSA level after RP were free of biochemical relapse at 3 years of follow-up. RT may be proposed to selected patients with mild morbidity. However, definitive evidence of the beneficial effect of adjuvant RT for patients with PSA recurrence after RP awaits the conclusion of randomized clinical trials. Patients and methods

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy

Taille¹,

Flam²,

Thiounn³

et al. 2002

BJU International

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“…14 In contrast to other papers that report on XRT after RP, our patients had considerably worsened potency and decreased urinary continence after XRT compared to after RP only (Table 5). [15][16][17][18][19] Many of the patients who received radiation while incontinent remained incontinent (60%) and 22% of patients who received radiation while continent became incontinent or partially incontinent. Many of the patients who were incontinent or partially incontinent pre-XRT were o6 months from the time of RP.…”

Section: Discussionmentioning

confidence: 99%

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Petroski¹,

Warlick

Herring

et al. 2004

Prostate Cancer Prostatic Dis

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Introduction and Objectives: The efficacy of adjuvant and salvage external beam radiation (AXRT þ SXRT) for prostate cancer after radical prostatectomy (RP) has been debated because of the inability to rule out systemic occult metastasis, uncertainty that radiation eradicates residual local disease and the potential of exacerbating impotency and incontinence. To characterize the effectiveness and treatment morbidity a retrospective review was performed. Methods: In all, 38 patients received AXRT and 91 received SXRT. The SXRT group was stratified by PSA level, age, race, pathologic stage, margin status, worst Gleason sum, radiation dose and pelvic field. Complications evaluated were impotence and incontinence. Median follow-up was 60.2 months. Results: The 5-y disease-free survival (DFS) rate was 61.3% for AXRT and 36.3% for SXRT. Multivariate analysis of the SXRT cohort showed Gleason score, pathologic stage and pre-XRT PSA to be predictors of disease recurrence. After XRT 26% had worsened continence. Conclusions: Patients who recur after RP whose pathologic stage is pT2 or pT3c, Gleason score of 8 or higher or pre-XRT PSA is 42.0 ng/dl may have microscopic metastatic disease and a decreased chance of cure with SXRT alone. Continence was further impaired after XRT.

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Use and Timing of Radiotherapy in High-Risk Prostate Cancer

2004

JAMA

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Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer

Cited by 159 publications

References 21 publications

Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy

Predictive factors of radiation therapy for patients with prostate specific antigen recurrence after radical prostatectomy

External beam radiation therapy after radical prostatectomy: efficacy and impact on urinary continence

Use and Timing of Radiotherapy in High-Risk Prostate Cancer

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