Salvage radiotherapy for men with isolated rising PSA or locally palpable recurrence after radical prostatectomy: do outcomes differ?
OBJECTIVE
To compare, in a retrospective analysis, the outcome of salvage external beam radiotherapy (EBRT) for isolated prostate-specific antigen (PSA) elevation or palpable local recurrence after radical prostatectomy (RP).


METHODS
We evaluated 102 men who underwent EBRT from 1993 to 1999, 60 for a rising PSA level alone and 42 for palpable local disease after RP. Biochemical disease-free survival and overall survival were calculated. Prognostic factors were evaluated to determine associations with biochemical disease-free survival.


RESULTS
The 5-year rate of biochemical disease-free survival, local control, freedom from distant metastasis, and overall survival for all 102 patients was 38%, 94%, 87%, and 88%, respectively. All palpable disease resolved completely after salvage EBRT. The greatest 5-year rate of biochemical control (69%) was obtained in patients with a pre-EBRT PSA level of 0.5 ng/mL or less. The 5-year overall survival rate was significantly better for those who underwent salvage EBRT for a rising PSA level than for those with palpable recurrence (96% versus 78%, P = 0.02). A low pre-EBRT PSA level and a less than 2-year interval from RP to EBRT were independent predictors of biochemical failure. Five patients (5%) experienced chronic grade 3 or 4 RT-related toxicity.


CONCLUSIONS
Salvage EBRT provides excellent local control of recurrent disease after RP. Salvage EBRT before the development of palpable local disease may confer a survival benefit and decrease the risk of metastasis, and durable biochemical control was achieved best in those whose pre-EBRT PSA level was 0.5 ng/mL or less. Early referral and careful patient selection is vital for salvage EBRT to be of optimal benefit.
MacDonald
O Kenneth
OK
Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
Schild
Steven E
SE
Vora
Sujaya
S
Andrews
Paul E
PE
Ferrigni
Robert G
RG
Novicki
Donald E
DE
Swanson
Scott K
SK
Wong
William W
WW
D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000556:secondary; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D011184:Postoperative Period; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012074:Remission Induction; D016879:Salvage Therapy; D016019:Survival Analysis; D001743:Urinary Bladder / Q000528:radiation effects
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D017430:Prostate-Specific Antigen