Salvage radiotherapy after prostatectomy – What is the best time to treat?

Siegmann, Alessandra; Bottke, Dirk; Faehndrich, Julia; Brachert, Maike; Lohm, Gunnar; Miller, Kurt; Bartkowiak, Detlef; Hinkelbein, W.; Wiegel, Thomas

doi:10.1016/j.radonc.2011.10.024

Cited by 57 publications

(23 citation statements)

References 31 publications

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“…PSADT after BF following RP is prognostic for clinical outcomes as well as response to SRT [3-18]. Boorjian et al found that a PSADT <6 months strongly correlated with the development of metastatic disease following RP [6].…”

Section: Discussionmentioning

confidence: 99%

“…Stephenson et al identified that a post-RP PSADT <10 months resulted in increased risk for BF following SRT [3,12]. A number of studies have looked at PSADT prior to SRT and associations with BF or metastases with thresholds selected between 3 and 12 months, although, to date, no studies have evaluated an association between PSADT and PCSM following SRT [11-18]. Interestingly, in our analysis using PSADT as a continuous variable, the strongest association as evaluated by c-index was between PSADT and PCSM (c-index 0.721) which was greater than that observed for more commonly reported end-points such as BF (0.623) and DM (0.670).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a short PSADT after RP predicts worse clinical outcomes following SRT, including an increased likelihood of BF and development of distant metastasis [3,11-18]. To our knowledge, a direct association between a short pre-SRT PSADT and increased PCSM following SRT has yet to be reported; however, others have noted an association between a short pre-SRT PSADT and an improved overall benefit of SRT [19,20].…”

Section: Introductionmentioning

confidence: 99%

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A prostate-specific antigen doubling time of <6 months is prognostic for metastasis and prostate cancer-specific death for patients receiving salvage radiation therapy post radical prostatectomy

Jackson

Johnson

et al. 2013

Radiat Oncol

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BackgroundThe ideal prostate-specific antigen (PSA) doubling time (PSADT) threshold for identifying patients at high-risk for poor clinical outcome following salvage radiation therapy (SRT) has not been well established. We sought to assess what PSADT threshold is most clinically prognostic in this setting.Methods575 patients who received SRT at a single institution for biochemical recurrence after radical prostatectomy were retrospectively reviewed. We assessed the impact of pre-SRT PSADT on biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall mortality (OM). Kaplan-Meier methods, hazard ratio (HR) assessment, and Cox Proportional Hazard models were used to assess the discriminatory ability of various PSADT thresholds.ResultsSufficient data to calculate PSADTs were available for 277 patients. PSADT was prognostic for BF, DM, PCSM, and OM on univariate analysis regardless of threshold. HR assessment identified 6 months as a strong threshold. No statistically significant difference was observed in BF, DM, PCSM, or OM between patients with PSADT <3 (n=40) and 3–6 months (n=61) or between 6–10 (n=62) and >10 months (n=114). However significant differences were seen in BF (HR:2.2, [95%CI: 1.4-3.5], p<0.01) and DM (HR:2.2, [95%CI: 1.2-4.3], p=0.02) between a PSADT of 3–6 and 6–10 months. On multivariate analysis a PSADT <6 months predicted BF (HR:2.0, [95%CI: 1.4-2.9], p=0.0001), DM (HR:2.0, [95%CI: 1.2-3.4], p=0.01), and PCSM (HR:2.6, [95%CI: 1.1-5.9], p=0.02).ConclusionsA pre-SRT PSADT <6 months was a strong predictor of outcomes in our data set, including PCSM. The most common nomogram for SRT uses a 10-month PSADT threshold for assigning points used to assess BF following SRT. If validated, our findings suggest that a PSADT threshold of <6 months should be considered for stratification of patients in future clinical trials in this setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A prostate-specific antigen doubling time of <6 months is prognostic for metastasis and prostate cancer-specific death for patients receiving salvage radiation therapy post radical prostatectomy

Jackson

Johnson

et al. 2013

Radiat Oncol

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“…в 2012 г. проанализировали связь уровня ПСА на момент начала СЛТ с результатами терапии у больных с рецидивами РПЖ после РПЭ. Авторы показали, что при величине ПСА на момент начала СЛТ не более 0,28 нг / мл показатели 2-летнего биохимического контроля составили 78 %, при уровне ПСА более 0,28 нг / мл -только 61 % (р = 0,01) [4].…”

Section: материалы и методыunclassified

Prostate-specific antigen is a predictor of the efficacy of salvage radiation therapy in patients with recurrent prostate cancer after radical prostatectomy

et al. 2019

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The study objective is to determine advisability of radiation therapy in patients with recurrent prostate cancer after radical prostatectomy.Materials and methods. In our research 92 patients were treated by salvage radiation therapy after radical prostatectomy. The median of follow up is 48 months.Results. The rates of 1, 2 and 3 years disease-free survival were 96, 91 and 86 %. We received that prostate specific antigen doubling time <6 months and prostate specific antigen >0.5 ng/ml before salvage radiation therapy statistical significance associated with biochemical failure. The results of our study indicate two main negative factors in the prognosis of the efficacy of radiotherapy and combined hormone therapy in patients with biochemical or clinical locoregional recurrence – the period of prostate specific antigen doubling time less than 6 months (p = 0.035) after radical prostatectomy and a higher prostate specific antigen level, especially more than 0.5 ng/ml before salvage radiotherapy (p = 0.037).Conclusion. Taking into account the absence of differences in the results of treatment between groups of patients with clinical and biochemical recurrences, it is not advisable to postpone the implementation of salvage radiotherapy and recommend patients to repeat the study. Repeated studies of these patients, as a rule, are conducted after many months at a higher level of the prostate specific antigen, which is associated with a higher tumor activity and a worse prognosis of the disease.

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“…The functional component as well as the detailed anatomic information obtained from mp-MRI can be used to help differentiate between local recurrence, residual normal prostate tissue, scar/fibrosis, and granulation tissue [44]. Current evidence suggests that for salvage radiation therapy, lower preradiation PSA levels correspond to more durable responses [45]. A recent study of men with biochemical recurrence after radical prostatectomy and PSA ≤0.4 ng/ml reported the sensitivity of mp-MRI to identify local recurrence was 86 % [46].…”

Section: Local Recurrencementioning

confidence: 99%

Optimizing Patient Population for MP-MRI and Fusion Biopsy for Prostate Cancer Detection

2015

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The diagnosis and treatment of prostate cancer continue to evolve with advances in science and technology. The utilization of multiparametric MRI (mp-MRI) to identify lesions in the prostate has given clinicians the ability to visualize malignancy in the prostate with greater confidence. With this new ability came the advancement of fusion biopsy platforms, which allow for direct targeting of these lesions. As with any new technology in medicine, the proper use of these modalities and how they fit into current clinical practice need to be addressed. This review summarizes the current knowledge on how to best optimize which men undergo mp-MRI and fusion biopsies both in the screening and treatment settings.

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Salvage radiotherapy after prostatectomy – What is the best time to treat?

Cited by 57 publications

References 31 publications

A prostate-specific antigen doubling time of <6 months is prognostic for metastasis and prostate cancer-specific death for patients receiving salvage radiation therapy post radical prostatectomy

A prostate-specific antigen doubling time of <6 months is prognostic for metastasis and prostate cancer-specific death for patients receiving salvage radiation therapy post radical prostatectomy

Prostate-specific antigen is a predictor of the efficacy of salvage radiation therapy in patients with recurrent prostate cancer after radical prostatectomy

Optimizing Patient Population for MP-MRI and Fusion Biopsy for Prostate Cancer Detection

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