Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy

Stephenson, Andrew J.; Scardino, Peter T.; Kattan, Michael W.; Pisansky, Thomas M.; Slawin, Kevin M.; Klein, Eric A.; Anscher, Mitchell S.; Michalski, Jeff M.; Sandler, Howard M.; Lin, Daniel W.; Forman, Jeffrey D.; Zeléfsky, Michael J.; Kestin, Larry L.; Roehrborn, Claus G.; Catton, Charles; DeWeese, Theodore L.; Liauw, Stanley L.; Valicenti, Richard K.; Kuban, Deborah A.; Pollack, Alan

doi:10.1200/jco.2006.08.9607

Cited by 830 publications

(631 citation statements)

References 48 publications

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“…As observed in previous studies for SRT [25], our study seems to confirm that lower serum PSA level prior to salvage HIFU is a predictor of favorable response. Similarly, an increased percentage of high-grade RP Gleason scores (4ϩ3 or greater) was observed in the HIFU failure group compared with the success group (12.5% vs. 86%; P ϭ 0.01), suggesting that favorable Gleason Score could be associated with better outcomes.…”

Section: Discussionsupporting

confidence: 91%

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Asimakopoulos

Miano

Virgili

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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Objective: To test high-intensity focused ultrasound (HIFU) as salvage first-line treatment for palpable, TRUS-evidenced, biopsyproven locally recurrent prostate cancer (CaP) after radical prostatectomy (RP). Materials and methods:Nineteen patients with palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP after RP, unwilling to undergo salvage radiotherapy (SRT), underwent HIFU as a single-session procedure. Pre-, intra-, and postoperative data including early and late complications, and oncologic outcomes (PSA nadir, biochemical recurrence (BCR)-free survival, and need of secondary adjuvant treatment) were prospectively evaluated. Success was defined as PSA nadir Յ0.1 ng/ml obtained within 3 months from HIFU. In case of PSA nadir Ͼ0.1 ng/ml or PSA increase Ն1 ng/ml above the PSA nadir, a biopsy of the treated lesion was performed, and if negative, maximum androgen blockade (MAB) was adopted. In case of positive biopsy, RT was performed. Failure was defined as use of secondary adjuvant treatment (MAB or RT).Results: Median follow-up was 48 months. All cases were performed as overnight procedure. No case of urethrorectal fistula or anastomotic stricture was observed. Two cases of acute urinary retention were resolved with prolonged urethral catheterization. Four cases of stress urinary incontinence were observed; 2 (mild incontinence) were resolved after pelvic floor exercises within 6 months, while 2 cases of severe incontinence required surgical minimally invasive treatment;17/19 patients (89,5%) were classified as success. Two patients failed to show a PSA nadir Ͻ0.1 ng/ml. During follow-up, 8/17 patients (47%) were classified as failure, with consequent total rate of failures 10/19 (52.6%). A statistically significant difference was observed in pre-HIFU median PSA (2 vs. 5.45 ng/ml, respectively, P ϭ 0.013) and Gleason score of the RP specimen (P ϭ 0.01) between the success and failure group.Conclusions: Salvage first-line HIFU for palpable, TRUS-evidenced, biopsy-proven local recurrence of CaP is a feasible, minimally invasive day-case procedure, with an acceptable morbidity profile. It seems to have a good cancer control in the short-and mid-term. Patients with lower pre-HIFU PSA level and favorable pathologic Gleason score presented better oncologic outcomes. A prospective randomized trial with an adequate recruitment and follow-up is necessary to confirm our preliminary oncologic results.

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Section: Discussionsupporting

confidence: 91%

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Asimakopoulos

Miano

Virgili

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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“…PSA kinetics can help identify these patients [22] but often involve multiple PSA measurements that can result in a delay of secondary therapy. Risk assessment tools that can accurately predict cancer recurrence and progression would allow a more timely institution of additional treatments that might be beneficial for selected patients [23][24][25]. Among the 109 published prediction tools [3], only 8 take advantage of pathologic information gained from RP, and very few of these tools have been validated.…”

Section: Discussionmentioning

confidence: 99%

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

et al. 2014

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“…Stephenson et al constructed a nomogram to predict the PSA response to salvage RT for BCR after RP [39]. The authors identified PSA levels before salvage RT, prostatectomy Gleason score, PSA DT, surgical margin status, lymph node involvement, and use of ADT with salvage RT as significant variables in the model.…”

Section: Salvage Treatment After Radical Prostatectomymentioning

confidence: 99%

Management of Biochemical Recurrence After Primary Treatment of Prostate Cancer: A Systematic Review of the Literature

et al. 2013

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Context: Despite excellent cancer control with the treatment of localized prostate cancer (PCa), some men will experience a recurrence of disease. The optimal management of recurrent disease remains uncertain. Objective: To systematically review recent literature regarding management of biochemical recurrence after primary treatment for localized PCa. Evidence acquisition: A comprehensive systematic review of the literature was performed from 2000 to 2012 to identify articles pertaining to management after recurrent PCa. Search terms included prostate cancer recurrence, salvage therapy, radiorecurrent prostate cancer, post HIFU, post cryoablation, postradiation, and postprostatectomy salvage. Studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and required to provide a comprehensive description of primary and secondary treatments along with outcomes. Evidence synthesis: The data from 32 original publications were reviewed. The most common option for local salvage therapy after radical prostatectomy (RP) was radiation. Options for local salvage therapy after primary radiation included RP, brachytherapy, and cryotherapy. Different definitions of recurrence and risk profiles among patients make comparative assessment among salvage treatment modalities difficult. Triggers for intervention and factors predicting response to salvage therapy vary. Conclusions: Radiation therapy (RT) after RP can provide durable prostate-specific antigen (PSA) responses in a sizeable percentage of men, especially when given early (ie, PSA <1 ng/ml). Though a few studies suggest improvements in mortality, prospective randomized trials are needed and underway. The role of salvage treatment after RT is less clear.

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Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy

Cited by 830 publications

References 48 publications

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: A pilot study

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

Management of Biochemical Recurrence After Primary Treatment of Prostate Cancer: A Systematic Review of the Literature

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