Radiotherapy for men with isolated increase in serum prostate specific antigen after radical prostatectomy.
OBJECTIVE
In this retrospective study we determined the results of salvage external beam radiation therapy (RT) to the prostate bed for isolated increase of serum prostate specific antigen (PSA) after radical prostatectomy.


METHODS
A total of 60 patients underwent RT for PSA failure after radical prostatectomy from 1993 to 1999. Median followup was 51 months. Biochemical disease-free survival (bDFS) with a serum PSA of 0.3 ng/ml or less was estimated using the Kaplan-Meier method. Potential prognostic factors were evaluated for significant associations with bDFS.


RESULTS
Median PSA before RT was 0.69 ng/ml. Median radiation dose was 64.8 Gy. The 5-year actuarial bDFS was 45%. There were 32 patients with a minimum followup of 4 years (median 73 months) who experienced a 5-year bDFS rate of 43%. PSA before RT (p = 0.016), RT dose (p = 0.026), surgical margin involvement (p = 0.017) and Gleason score (p = 0.018) were identified as prognostic factors for bDFS. A significant association with bDFS was present at 5 years of 65%, 34% and 0% for PSA before RT less than 0.6, 0.6 to 1.2, and greater than 1.2 ng/ml, respectively (p = 0.036). Patients with PSA before RT less than 0.6 ng/ml and total RT dose greater than 64.8 Gy had improved bDFS at 5 years compared to all others (77% vs 32%, p = 0.04). Of 60 patients 3 (5%) experienced chronic grade 3 toxicity.


CONCLUSIONS
Optimal benefit from salvage RT was achieved in patients with a PSA less than 0.6 ng/ml and doses of RT greater than 64.8 Gy. Early treatment with a sufficiently high dose of RT maximizes the potential for salvage.
Macdonald
O Kenneth
OK
Department of Radiation Oncology, Section of Urology, Mayo Clinic Scottsdale, 13400 E. Shea Boulevard, Scottsdale, AZ 85259, USA.
Schild
Steven E
SE
Vora
Sujay A
SA
Andrews
Paul E
PE
Ferrigni
Robert G
RG
Novicki
Donald E
DE
Swanson
Scott K
SK
Wong
William W
WW
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen