Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

Abstract

Purpose To investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy. Methods Data from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared. Results Data from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26–0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL. Conclusions These data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.

68Ga-PSMA-PET screening and transponder-guided salvage radiotherapy to the prostate bed alone for biochemical recurrence following prostatectomy: interim outcomes of a phase II trial

“…SRT to the prostate bed alone, with no ADT, has historically been associated with 3–5-year rates of biochemical progression-free survival (bPFS) in the order of 50% [ 24 , 25 ]. The 5-year interim results of the recent NRG Oncology/RTOG 0534 SPPORT trial report higher rates of bPFS (71%), however, the threshold for biochemical failure was 2 ng/mL above the post-SRT [ 26 ] nadir compared to 0.2 ng/mL in the present study.…”

Dosimetric evaluation of whole-pelvis radiation therapy of prostate cancers: clinical experience

“…According to Lawton et al, 22 whole-pelvis radiotherapy provides significant benefit to patients with regard to progression-free survival when delivered with neoadjuvant and concurrent hormonal therapy. Several other studies 10,18,32,35,36 have also demonstrated the benefit of whole pelvis radiotherapy in terms of biochemical-free survival. Aizer et al 16 conducted a study on whole-pelvis radiotherapy versus prostate-only radiotherapy in the management of locally advanced or aggressive prostate adenocarcinoma.…”

“…A study by Song et al investigated biochemical relapse-free survival in patients receiving whole-pelvis radiation therapy and reported a biochemical-free survival rate of 65.9% and concluded that patients undergoing radiation therapy after prostatectomy with whole-pelvis radiation therapy will have better biochemical relapse-free survival rates compared to prostate bed-only radiation therapy. 35 Poelaert et al 18 studied the outcome of whole-pelvis radiation therapy in patients with positive pelvic lymph nodes and reported an estimated biochemical relapse-free survival of 67%, a cancer progression-free survival of 71% and a cancer-specific survival of 96%. Furthermore, they reported that patients treated with whole-pelvis radiation therapy, along with androgen deprivation therapy, show a promising cancer-specific survival.…”

“…This usually involves a two-phase approach: Phase 1 will involve whole-pelvis radiation therapy (WPRT) to cover the prostate and seminal vesicles or prostate bed post prostatectomy and the pelvic lymph nodes followed by a phase 2 which delivers a boost dose to the prostate and seminal vesicles or prostate bed. 15,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Radiation therapy is also an effective salvage therapy for biochemical recurrence following prostatectomy.…”

Efficacy and Toxicity of Whole Pelvic Radiotherapy Versus Prostate-Only Radiotherapy in Localized Prostate Cancer: A Systematic Review and Meta-Analysis

“…A total of 4,680 publications and 52 registered clinical studies were identified from the literature search, and 16 studies that met the eligibility criteria were finally selected, including 6 randomized controlled trials (RCTs) (7)(8)(9)(10)(11)(12) and 10 cohort studies (CRS) (23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Four studies that met the inclusion criteria were excluded because of no hazard ratio available for survival (33)(34)(35)(36).…”