Salvage prostatic fossa radiation therapy for biochemical failure after radical prostatectomy: the Sheba experience.
BACKGROUND
The role of prostatic fossa radiation as salvage therapy in the setting of a rising prostate-specific antigen following radical prostatectomy is not well defined.


OBJECTIVE
To study the efficacy and safety of pelvic and prostatic fossa radiation therapy following radical prostatectomy for adenocarcinoma.


METHODS
A retrospective review of the charts of 1,050 patients treated at the Sheba Medical Center for prostate cancer between 1990 and 2002 identified 48 patients who received post-prostatectomy pelvic and prostatic fossa radiotherapy for biochemical failure. Two patients were classified as T1, T2A-9, T2B-19, T3A-7 and T3B-11. Gleason score was 2-4 in 9 patients, 5-6 in 22 patients, 7 in 10 patients and 8-10 in 7 patients. Positive surgical margins were noted in 28 patients (58%) of whom 18 had single and 10 had multiple positive margins. Radiation was delivered with 6 mV photons using a four-field box to the pelvis followed by two lateral arcs to the prostatic fossa.


RESULTS
At a median follow-up of 34.3 months (25th, 75th) (14.7, 51.3) since radiation therapy, 32 patients (66%) are free of disease or biochemical failure. Exploratory analysis revealed that a pre-radiation PSA less than 2 ng/ml was associated with a failure rate of 24% compared with 66% in patients with a pre-radiation PSA greater than 2 ng/ml (chi-square P < 0.006).


CONCLUSIONS
For patients with biochemical failure following radical prostatectomy early salvage radiation therapy is an effective and safe treatment option.
Kundel
Yulia
Y
Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel.
Pfeffer
Raphael
R
Lauffer
Menachem
M
Ramon
Jacob
J
Catane
Raphael
R
Symon
Zvi
Z
D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen