Multimodality salvage for patients with persistently elevated postprostatectomy PSA.
A persistently elevated postprostatectomy prostate-specific antigen (PSA) is a therapeutic dilemma for which optimal management is undefined. We evaluated the salvage efficacy of whole-pelvis radiation with hormonal blockade in a subset of patients with persistently elevated postprostatectomy PSA. Within 180 days after surgery, 14 men with elevated postprostatectomy PSA (0.9-18 ng/ml; mean 4.8) and negative metastatic work-up began whole-pelvis radiation (4500 cGy / 25 fractions), which was directly followed by prostate-bed boost (2000 cGy / 10 fractions). Concomitant with radiation, 6 months of LHRH agonist was prescribed. No patients have been lost to follow-up. Chronic morbidity from radiation and hormone treatment was not noted and all 10 patients whose salvage was initiated when PSA was <5.0 ng/ml remain with undetectable PSA at follow-up (36-56 months; median 44 months). Of the four patients with PSA levels >5.0 ng/ml at salvage initiation, none remain with undetectable follow-up PSA. Postprostatectomy salvage initiated at PSA levels < or =5.0 ng/ml with the combination of whole-pelvis external-beam radiation and hormone blockade offers excellent diminishment of PSA for prolonged follow-up periods. Patients with postprostatectomy PSA of >5 ng/ml likely require salvage regimens with greater emphasis on systemic treatment. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 331-335 (2000).
Allison
R R
RR
Department of Radiation Oncology, State University of New York at Buffalo, USA.
Schulsinger
A
A
D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy
D017430:Prostate-Specific Antigen