Outcome, morbidity, and prognostic factors in post-prostatectomy radiotherapy: an Australian multicenter study.
OBJECTIVE
To report the outcome and morbidity data for patients treated with post-prostatectomy radiotherapy (PPRT) in a multicenter collaboration.


METHODS
The case records of all patients treated with PPRT from 1996 to 1998 were reviewed. Survival was calculated using Kaplan-Meier methods. Potential prognostic factors were evaluated using the Cox proportional hazards regression model. Prostate-specific antigen (PSA) remission was defined as a PSA level of 0.2 ng/mL or less. Acute and late morbidities were documented.


RESULTS
We reviewed the data of 115 patients, with a median follow-up from the start of PPRT of 28.7 months. Patients were treated with adjuvant intent (n = 23), for local recurrence (n = 27), or for a detectable PSA level (n = 65). The overall and cause-specific survival rate at 5 years was 73.7% and 81.4%, respectively. The biochemical disease-free survival rate was 69.6% at 2 years and 50% at 5 years. Factors predicting for subsequent relapse on multivariate analysis were pre-PPRT PSA (P = 0.013) and post-PPRT nadir (P <0.0001). Patients with a PSA greater than 1 ng/mL fared significantly worse than those with lower levels (P <0.0001). For patients with a pretreatment PSA of less than 1 ng/mL and an operative Gleason score of 7 or less, the 5-year projected biochemical disease-free survival rate was 71%. One case of grade 3 late proctitis was recorded, and 4 patients had continued grade 3 late urinary incontinence.


CONCLUSIONS
Early use of PPRT is effective and well tolerated in patients at risk of, or with proven, local recurrence.
Duchesne
Gillian M
GM
Division of Radiation Oncology, Alfred Hospital, Melbourne, Australia.
Dowling
Caroline
C
Frydenberg
Mark
M
Joseph
David
D
Gogna
N Kumar
NK
Neerhut
Greg
G
Roberts
Sydney
S
Spry
Nigel
N
Turner
Sandra
S
Woo
Henry
H
D000368:Aged; D001315:Australia; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000532:radiotherapy*; D011183:Postoperative Complications / Q000453:epidemiology / Q000532:radiotherapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000532:radiotherapy; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen