Use of androgen deprivation and salvage radiation therapy for patients with prostate cancer and biochemical recurrence after prostatectomy

Ghadjar, Pirus; Aebersold, Daniel M.; Albrecht, Clemens; Böhmer, Dirk; Flentje, Michael; Ganswindt, Ute; Höcht, Stefan; Hölscher, Tobias; Sedlmayer, Felix; Wenz, Frederik; Zips, Daniel; Wiegel, Thomas

doi:10.1007/s00066-018-1269-3

Cited by 27 publications

(23 citation statements)

References 28 publications

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“…Although our present patient numbers in the subgroups are too small for unequivocal conclusions, the observation of poor outcome in post‐RP PSA‐persistent patients with delayed SRT alone is consistent with a recent systematic review that reported that ADT combined with SRT improved OS in patients with a pre‐SRT PSA level of ≥0.7 ng/mL . The prospective randomised GETUG‐AFU 22 phase‐II trial () addresses the effect of 6 months ADT concomitant with SRT vs SRT alone in 125 patients with a ‘persistent’ PSA level after RP of ≥0.2 and ≤2 ng/mL at randomisation.…”

Section: Discussionsupporting

confidence: 85%

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The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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Objective To test whether salvage radiotherapy (SRT) in patients with lymph node negative (N0) prostate cancer is equally effective with persistent prostate‐specific antigen (PSA) and PSA rising from the undetectable range (<0.1 ng/mL) after radical prostatectomy (RP). Patients and methods We assessed post‐SRT PSA progression‐free survival (PFS) in 555 patients with prostate cancer. The entire cohort was compared with a risk‐adjusted subgroup of 112 patient pairs with matching pre‐RP PSA level (±10 ng/mL), Gleason score (≤6 vs 7 vs ≥8), and pre‐SRT PSA level (±0.5 ng/mL). Results The median follow‐up was 6.1 years. After RP, PSA was undetectable in 422 and persistent in 133 patients. PSA persistence and a pre‐SRT PSA level of ≥0.5 ng/mL reduced Kaplan–Meier rates of PFS significantly. In multivariate analysis of the entire cohort and after risk adjustment, the pre‐SRT PSA level but not post‐RP PSA persistence was a significant parameter. In the matched cohort's subgroup with early SRT at a PSA level of <0.5 ng/mL, a trend towards a worse outcome with post‐RP PSA persistence was observed. Delayed SRT with a PSA level ≥0.5 ng/mL led to a PFS of <30%, irrespective of the post‐RP PSA level. Conclusion In patients with N0 prostate cancer with post‐RP PSA persistence, early SRT at a PSA level <0.5 ng/mL seems to be less effective than in recurrent patients with post‐RP undetectable PSA. They might benefit from intensified therapy, but larger case numbers are required to substantiate this conclusion. In patients with a PSA level ≥0.5 ng/mL and higher‐risk features associated with post‐RP PSA persistence, SRT alone is unlikely to provide long‐term freedom from further progression.

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Section: Discussionsupporting

confidence: 85%

“…Although our present patient numbers in the subgroups are too small for unequivocal conclusions, the observation of poor outcome in post-RP PSA-persistent patients with delayed SRT alone is consistent with a recent systematic review that reported that ADT combined with SRT improved OS in patients with a pre-SRT PSA level of ≥0.7 ng/mL [21].…”

Section: Variablesupporting

confidence: 90%

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

et al. 2019

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“…For patients with high risk disease shorter delays of 2-4 months but with ADT are recommended as a safe and pragmatic approach. Data also appears to support the use of ADT to delay radiotherapy in a post-prostatectomy salvage situation [33] Dose escalation studies in the definitive treatment of prostate cancer have failed to show overall survival benefit which in this scenario provides further comfort in using lower dose schedules [34]. When radiotherapy is required then, just as with breast, there is data to support both modest hypofractionation over 20 fractions (60Gy) or ultra hypo-fractionated regimens (42·7Gy in seven fractions, 3 days per week for 2·5 weeks) [35] or 36Gy in 6weeks [36].…”

Section: Prostate Cancermentioning

confidence: 87%

COVID-19: Global radiation oncology’s targeted response for pandemic preparedness

Simcock

Thomas

Estes

et al. 2020

Clinical and Translational Radiation Oncology

215

257

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“…In total, there were 4 patients with a Clavien Grade II (2 × paralytic ileus, 2 × lymphorrhea) and 2 patients with a Clavien Grade IIIa (2 × pulmonary artery embolism) complication ( Table 2). ADT was recommended to all patients with SLNRT due to the evidence of PET-positive lymph nodes for 2 years [20,21]. Consequently, 59/67 (88%) patients were started on ADT before initiation of SLNRT, 42/67 patients (63%) discontinued after a median time of 7 (2-41) months due to patients' preferences.…”

Section: Management Of Pet-positive Lymph Nodes and Toxicitymentioning

confidence: 99%

PSMA-positive nodal recurrence in prostate cancer

et al. 2020

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Purpose This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68 Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE). Methods A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA <0.2 ng/mL) were calculated according to Kaplan-Meier and survival curves were compared using the log rank test. For multivariable analysis, binary logistic regression analysis was performed (p < 0.05). Results Median follow-up was 17 months (range, 6-53 months) in SLND patients and 31 months (range, 3-56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2-year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789-9.878; p = 0.001). Conclusion Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE.

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Use of androgen deprivation and salvage radiation therapy for patients with prostate cancer and biochemical recurrence after prostatectomy

Cited by 27 publications

References 28 publications

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

COVID-19: Global radiation oncology’s targeted response for pandemic preparedness

PSMA-positive nodal recurrence in prostate cancer

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