Salvage radiotherapy for PSA failure after radical prostatectomy

Parker, Chris; Warde, Padraig; Catton, Charles

doi:10.1016/s0167-8140(01)00439-x

Cited by 46 publications

(22 citation statements)

References 60 publications

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“…Percutaneous RT seems to offer the sole curative approach as long as there is isolated local tumor growth. An increasing number of papers is being published on RT for patients with PSA elevation out of the undetectable range, or persisting PSA after RP (table 3) [28]. The major topics are: In how many patients can an elevated PSA level after RP be reduced into the undetectable range by RT?…”

Section: Percutaneous Rt For Rising or Persisting Psa After Rpmentioning

confidence: 99%

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

et al. 2002

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Background: Following radical prostatectomy, between 15 and 60% of all patients with pT3 prostate cancer experience persistence or increasing levels of prostate-specific antigen (PSA) as a sign of tumor persistence or progression within 5 years. Retrospective studies have shown a rate of 35–55% of positive biopsies from the vesicourethral anastomosis in this situation. Best treatment for these disease conditions is under debate, current strategies include adjuvant radiotherapy (RT), ‘wait-and-see‘ and salvage RT or hormone therapy for increasing PSA. Results: A number of retrospective studies have shown an increased rate of local control and ‘freedom from treatment failure‘ following adjuvant RT with doses in the range of 50–60 Gy. However, no survival benefit could be demonstrated by now. Results of three major phase III studies are pending. In case of persisting or increasing PSA levels following radical prostatectomy, 30–70% of these patients will reach an undetectable PSA level after conformal RT with total doses of 60–70 Gy, which will stay undetectable or at least stable within the next 2–5 years in about 50% and therefore offering a chance of cure. When starting RT, PSA should be as low as possible (<2 ng/ml). With higher PSA levels the chance of achieving an undetectable PSA again decreases below 35%. High Gleason scores of 8–10, seminal vesicle involvement and a short PSA doubling time are adverse prognostic factors. Severe late side effects of conformal RT are infrequent (<3%). In contrast, hormonal treatment is of palliative nature in the long run, with a median time to development of metastases of 4–7 years, and can be offered to patients with progressive disease after RT. Conclusions: Adjuvant RT following radical prostatectomy for pT3 prostate cancer offers higher local control rates and an increase in ‘freedom from treatment failure‘, but no prolongation of survival has yet been shown. In the situation of increasing PSA levels after radical prostatectomy, salvage RT seems to offer a chance of cure in selected patients, although it is difficult to draw firm conclusions because of generally too short follow-up times.

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Section: Percutaneous Rt For Rising or Persisting Psa After Rpmentioning

confidence: 99%

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

et al. 2002

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“…In addition, and more surprisingly, age was found to be an independent prognostic factor, with patients younger than 69 years having a significantly poorer outcome than those older than 69 years. A recent comprehensive review of the effect of age on the outcome of localised prostate cancer concluded that age at diagnosis is not a significant determinant of outcome for men treated either with radiation alone or with radical prostatectomy (Parker et al, 2001). Our data based on men receiving combined radiation and hormonal therapy generates the hypothesis of a treatment-specific effect of age on outcome.…”

Section: Clinicalmentioning

confidence: 67%

Pre-treatment nomogram for biochemical control after neoadjuvant androgen deprivation and radical radiotherapy for clinically localised prostate cancer

et al. 2002

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Phase III studies have demonstrated the clinical benefit of adding neo-adjuvant androgen deprivation to radical radiotherapy for clinically localised prostate cancer. We have developed a nomogram to describe the probability of PSA control for patients treated in this way. Five hundred and seventeen men with clinically localised prostate cancer were treated with 3 -6 months of neo-adjuvant androgen deprivation and radical radiotherapy (64 Gy in 32#) between 1988 and 1998. Median presenting PSA was 20 ng ml 71 , and 56% of patients had T3/4 disease. Multivariate analysis of pre-treatment factors was performed, and a nomogram developed to describe PSA-failure-free survival probability. At a median follow-up of 44 months, 233 men had developed PSA failure. Presenting PSA, histological grade and clinical T stage were all highly predictive of PSA failure on multivariate analysis. The nomogram score for an individual patient is given by the summation of PSA (510=0, 10 -19=16, 20 -49=44, 550=100), grade (Gleason 2 -4=0, 5 -7=44, 8 -10=81) and T stage (T1/2=0, T3/4=35). For a nomogram score of 0, 50, 100 and 150 points the 2 year PSA control rate was 93, 87, 75 and 54%, and the 5 year PSA control rate was 82, 67, 44 and 18%. These results are comparable to those using surgery or higher doses of radical radiotherapy alone. The nomogram illustrates the results of multivariate analysis in a visually-striking way, and facilitates comparisons with other treatment methods.

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“…Mais recentemente, três estudos demonstraram que a porcentagem do padrão 4 de Gleason nos carcinomas Gleason 7 representa parâmetro importante na determinação da progressão da doença 14,16,17 . A literatura tem demonstrado maiores taxas de sobrevida livre de doença e menos efeitos colaterais em pacientes tratados com radioterapia adjuvante precocemente após a prostatectomia radical, quando os níveis de PSA são ainda indetectáveis 18,19,20 . O consenso do Canadian GU Radiation Oncologist Group propôs a separação de pacientes em três categorias pre-tratamento: baixo risco, risco intermediário e alto risco de progressão da doença, considerando-se o escore de Gleason, os níveis de PSA e o estádio tumoral 21 .…”

Section: Discussionunclassified

O padrão 4 de Gleason e o volume tumoral no prognóstico do carcinoma da próstata

Leite¹,

Srougi²,

Kauffmann³

et al. 2005

Rev. Assoc. Med. Bras.

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RESUMO OBJETIVOS.A introdução de terapia adjuvante pós-prostatectomia radical foi recentemente proposta na literatura na tentativa de se obter melhores taxas de sobrevida em pacientes com câncer de próstata com maior risco de recidiva da doença. Alguns parâmetros anatomopatológicos têm sido considerados bons determinantes dos riscos de recorrência local ou à distância desses tumores. Recentemente o volume tumoral e a presença de padrão terciário de Gleason menos diferenciado foram apresentados como os melhores indicadores do comportamento do carcinoma da próstata. A proposta deste estudo é avaliar a importância da presença e porcentagem do padrão 4 de Gleason e do volume tumoral na evolução de pacientes portadores da adenocarcinoma bem diferenciado de próstata, tratados com prostatectomia radical. MÉTODOS. Setenta e sete pacientes portadores de adenocarcinoma bem diferenciado da próstata, Gleason 6 ou menos, submetidos a prostatectomia radical entre 1995 e 1997 foram estudados. Trinta e sete pacientes sofreram recidiva bioquímica (PSA > 0,4 ng/ml), e 40 pacientes permaneceram livres de doença após seguimento mínimo de cinco anos. A presença e porcentagem do padrão 4 de Gleason, a porcentagem de tumor comprometendo a glândula (considerado como "volume tumoral"), a infiltração capsular e a invasão do tecido extraprostático foram submetidos a análise uni e multivariada para determinação da associação destes parâmetros com a recidiva bioquímica. RESULTADOS. O volume tumoral foi o parâmetro mais importante para determinação da recorrência bioquímica em análises uni e multivariadas. A mediana do volume foi de 25% nos pacientes que sofreram recidiva e 11,5% naqueles que permaneceram livres de doença (p=0,003). A porcentagem de padrão 4 de Gleason foi importante apenas em análise univariada. A mediana da porcentagem de Gleason 4 foi de 7,5% para os pacientes que não sofreram recidiva e de 19% naqueles que recidivaram (p=0,046). CONCLUSÃO. O volume do adenocarcinoma de próstata é um parâmetro objetivo, de fácil avaliação e importante na previsão da recidiva bioquímica no carcinoma bem diferenciado da próstata. Por outro lado, a porcentagem do padrão menos diferenciado de Gleason também serve para prever recidiva à distância. Ambos os parâmetros devem ser incorporados em estudos futuros de terapias adjuvantes para o carcinoma da próstata. UNITERMOS: Neoplasias prostáticas. Prognóstico. Antígeno prostático específico. Patologia. Prostatectomia. Histologia. INTRODUÇÃOAproximadamente 20% dos pacientes inicialmente tratados por adenocarcinoma de próstata com prostatectomia radical, radioterapia ou crioterapia necessitam de uma segunda forma de tratamento no período de três anos após a terapia inicial 1 . A identificação dos casos com alta probabilidade de recidiva da doença, que podem se beneficiar de um tratamento adjuvante, é um desafio discutido atualmente para o melhor manejo do paciente com câncer de próstata. Alguns autores sustentam que a radioterapia de resgate deva ser iniciada nos primeiros sinais de recidiva naquel...

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Salvage radiotherapy for PSA failure after radical prostatectomy

Cited by 46 publications

References 60 publications

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

Pre-treatment nomogram for biochemical control after neoadjuvant androgen deprivation and radical radiotherapy for clinically localised prostate cancer

O padrão 4 de Gleason e o volume tumoral no prognóstico do carcinoma da próstata

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