Improved Metastasis-Free and Survival Outcomes With Early Salvage Radiotherapy in Men With Detectable Prostate-Specific Antigen After Prostatectomy for Prostate Cancer

Stish, Bradley J.; Pisansky, Thomas M.; Harmsen, William S.; Davis, Brian J.; Tzou, Katherine S.; Choo, Richard; Buskirk, Steven J.

doi:10.1200/jco.2016.68.3425

Cited by 186 publications

(142 citation statements)

References 35 publications

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“…In fact, various endpoints have been used to measure biochemical control after salvage treatments: a PSA level increase of 0.2–0.5 ng/mL above the nadir was the threshold for Group d'Étude des Tumeurs Urogénitales‐Association Francaise d'Urologie (GETUG‐AFU) and Radiation Therapy and Oncology Group (RTOG) 9601 trials , also Bartkowiak et al defined BCR after SRT using similar parameters. Conversely, other authors chose different definitions, i.e., a post‐SRT PSA level of >0.2 ng/mL . However, BCRFS time in the present population ranged between 24 and 36 months depending on the PSA threshold used to define BCR (BCRFS1 or BCRFS2).…”

Section: Discussionmentioning

confidence: 88%

Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series

et al. 2019

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Objective To assess the safety and effectiveness of stereotactic salvage radiotherapy (SSRT) in RT‐naïve patients affected by macroscopic prostate bed recurrence. Patients and methods Consecutive patients treated for prostate bed macroscopic recurrence in three different Italian institutes were reviewed. Patients were treated with SSRT, with a total dose of 30–40 Gy in five fractions, the mean pre‐SSRT PSA level was 2.3 ng/mL. Two different PSA thresholds were defined and biochemical recurrence‐free survival (BCRFS) was reported, in order to better express outcome: BCRFS1 (a PSA level increase of >10% compared to the pre‐SSRT value) and BCRFS2 (a PSA level increase of >0.2 ng/mL for patients with a PSA nadir of <0.2 ng/mL or two consecutive PSA level increases of >25% compared to nadir in patients with a PSA nadir of <0.2 ng/mL). Results In all, 90 patients were treated, with a mean (range) follow‐up of 21.2 (2–64) months, and 17 of these patients (19%) had concomitant androgen‐deprivation therapy (ADT) during SSRT. Complete biochemical response, defined as a PSA nadir of <0.2 ng/mL, was obtained in 39 of the 90 patients (43.3%). Considering BCRFS1, 25 patients (27.8%) had BCR, with an actuarial median BCRFS1 time of 36.4 months. For BCRFS2, BCR was reported in 32 patients (35.5%), with an actuarial median BCRFS2 time of 24.3 months. There was no Grade >2 toxicity. Conclusions SSRT was found to yield significant biochemical control and allowed ADT delay despite adverse features.

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Section: Discussionmentioning

confidence: 88%

Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series

et al. 2019

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“…Post-prostatectomy radiotherapy (RT), given as either adjuvant therapy for adverse pathologic features or as salvage for a rising prostate-specific antigen (PSA), has been shown to improve oncologic outcomes in select patients with prostate cancer (CaP) (1-5). However, between 26-68% of patients who undergo post-prostatectomy RT will suffer biochemical failure within 5 to 6 years of treatment (1, 2, 6).…”

Section: Introductionmentioning

confidence: 99%

Patterns of Recurrence After Postprostatectomy Fossa Radiation Therapy Identified by C-11 Choline Positron Emission Tomography/Computed Tomography

Parker

Evans

Stish

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose To evaluate C-11 choline PET/CT (CholPET) in staging and determining patterns of recurrence in prostate cancer patients with rising PSA post prostatectomy radiotherapy (RT). Materials and Methods The study includes patients with biochemical failure following post-prostatectomy RT who underwent CholPET between 2008 and 2015. Patient and disease characteristics were examined in relation to sites of recurrence. All RT dosimetry records were reviewed, and recurrences were mapped on a representative CT dataset with their relationship relative to the irradiated fossa field as out-of-field (OOF), edge-of-field (EOF; recurrence within <45Gy isodose lines), or in-field (IF; recurrence within ≥45 Gy isodose lines). Results Forty-one patients were identified with 121 sites of recurrence (median 2 sites; IQR 1-4). The median PSA at CholPET was 3.1 (IQR 1.9-5.6) ng/mL. Median interval from RT to biochemical failure was 24 (IQR: 10-46) months, with recurrence identified on CholPET at a median of 15 (IQR 7-28) months from biochemical failure. Histologic confirmation of recurrence was obtained in 20 (49%) patients; with the remainder confirmed by treatment response. Five patients (12%) had IF recurrences, 10 patients (24%) had EOF recurrences (median dose 10 Gy; IQR 5-30 Gy), and 36 patients (88%) had OOF recurrences. Ten patients had combination failures: 6 (15%) EOF/OOF and 4 (10%) IF/OOF. Fifty-seven (47%) of recurrences were pelvic nodal sites inferior to the L5-S1 interspace of which 52 (43%) are within a pelvic RT field. Eighty-one (67%) of recurrences were nodal and inferior to the aortic bifurcation. Conclusions Using CholPET, we found that the majority of patients evaluated for biochemical failure recurred outside of the post-prostatectomy RT field. Furthermore, most recurrence sites were nodal and inferior to the aortic bifurcation. These results provide data which may be useful for examining strategies that include elective lymph node irradiation in post-prostatectomy patients.

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“…Considering the toxicity of any additional local treatment after prostatectomy (increased risk of urinary, sexual, and bowel problems) (9); up to 58% 3-year incontinence after SRT (10), and the paucity of data on an overall survival benefit, a 68Ga-PSMA-PET scan should be strongly considered in all men with a rising PSA after prostatectomy. This is supported by the recent retrospective observation that despite local salvage radiotherapy 43% of men with Gleason 9–10 cancers develop metastases and 54% of men have biochemical recurrence overall (11). …”

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confidence: 72%

Early or delayed radiotherapy after prostatectomy—who really benefits?

Poel

Stam

2017

Transl. Androl. Urol.

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Improved Metastasis-Free and Survival Outcomes With Early Salvage Radiotherapy in Men With Detectable Prostate-Specific Antigen After Prostatectomy for Prostate Cancer

Cited by 186 publications

References 35 publications

Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series

Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series

Patterns of Recurrence After Postprostatectomy Fossa Radiation Therapy Identified by C-11 Choline Positron Emission Tomography/Computed Tomography

Early or delayed radiotherapy after prostatectomy—who really benefits?

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