title: Delayed/salvage radiation therapy in patients with elevated prostate specific antigen levels after radical prostatectomy. A long term follow-up.
abstract: BACKGROUND
  In this article the authors report an analysis and long term results of delayed/salvage radiation therapy administered to asymptomatic patients who had an elevated prostate specific antigen (PSA) level, many months to many years after radical prostatectomy.
  
  
  METHODS
  During 1987 to 1990, 40 asymptomatic patients were found to have an elevated PSA level 9 to 96 months after radical prostatectomy. The patients underwent transrectal needle aspiration biopsy of the urethrovesicle junction anastomosis (uvj); 28 patients had a positive biopsy and 12 patients had a negative biopsy. Delayed/salvage radiation therapy was administered to the pelvis (45 Gray [Gy]) and prostate bed (59.5 Gy), including the uvj.
  
  
  RESULTS
  Twenty-four of 37 patients (65%) were free of clinical disease. In 10 patients (27%), the radiation therapy resulted in a durable decrease in the elevated PSA level below a detectable level for a minimum 5-year follow-up. Five patients were alive with clinical disease. Eight died of disease. Three patients were lost to follow-up.
  
  
  CONCLUSIONS
  This experience shows that delayed/salvage radiation therapy to the pelvis (45 Gy) and prostate bed (59.5 Gy), even many years after radical prostatectomy for pathologic stage pB, pC, and pD1 carcinoma of the prostate, was well tolerated and provided freedom from clinical disease in 24 of 37 patients (65%), and a decrease in elevated PSA level in 10 patients (27%). Delayed/salvage radiation therapy appears to be beneficial for patients who had undergone radical prostatectomy only and then developed rising PSA levels during the follow-up period.
authors.affiliation: Department of Therapeutic Radiology, Veterans Administration Medical Center, Minneapolis, Minnesota 55417, USA.
authors.forename: E
authors.initials: E
authors.lastname: Medini
authors.forename: I
authors.initials: I
authors.lastname: Medini
authors.forename: P K
authors.initials: PK
authors.lastname: Reddy
authors.forename: S H
authors.initials: SH
authors.lastname: Levitt
mesh_terms: D000714:Anastomosis, Surgical; D001707:Biopsy, Needle; D002277:Carcinoma / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009367:Neoplasm Staging; D010388:Pelvis / Q000528:radiation effects; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D012669:Seminal Vesicles / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D015996:Survival Rate; D014521:Urethra / Q000473:pathology / Q000528:radiation effects / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen