title: Salvage radiotherapy for isolated prostate specific antigen increase after radical prostatectomy: evaluation of prognostic factors and creation of a prognostic scoring system.
abstract: OBJECTIVE
  This study was performed to evaluate the results and prognostic factors associated with radiotherapy for a detectable serum prostate specific antigen level after radical prostatectomy.
  
  
  METHODS
  From July 1987 through July 2003, 368 patients received radiotherapy for a detectable prostate specific antigen level (biochemical relapse) as the sole evidence of recurrence after radical prostatectomy for node negative prostate cancer. Estimated survival and relapse-free probabilities were obtained via Kaplan-Meier estimation. Associations of patient factors with survival and biochemical relapse were investigated using Cox proportional hazards models.
  
  
  RESULTS
  With a median followup of 5 years the 5 and 8-year freedom from biochemical relapse were an estimated 46% (95% CI 41%-53%) and 35% (95% CI 29%-43%) while survival was 92% (95% CI 89%-95%) and 80% (95% CI 74%-87%), respectively. Patient and treatment variables showing evidence of association with biochemical relapse on multivariate analysis included pathological stage T3a or less vs T3b (seminal vesicle involvement, p = 0.029), pathological Gleason score 7 or less vs 8 or greater (p <0.001) and pre-radiotherapy prostate specific antigen (p <0.001). Four biochemical failure risk groups were created by assigning seminal vesicle involvement, Gleason score and pre-radiotherapy prostate specific antigen each a score of 0 to 2. These individual scores were summed. The freedom from biochemical failure at 5 years for each risk group was 0 to 1-69%, 2-53%, 3-26% and 4 to 5-6%.
  
  
  CONCLUSIONS
  The presence of seminal vesicle involvement and high Gleason score in the radical prostatectomy specimen are inherent predictors of adverse outcome. Early referral for salvage radiotherapy can decrease subsequent biochemical relapse.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA. buskirk.steven@mayo.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Buskirk
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: O Kenneth
authors.initials: OK
authors.lastname: Macdonald
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wehle
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Kozelsky
authors.forename: A Craig
authors.initials: AC
authors.lastname: Collie
authors.forename: Robert G
authors.initials: RG
authors.lastname: Ferrigni
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Karin A
authors.initials: KA
authors.lastname: Prussak
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Julia E
authors.initials: JE
authors.lastname: Crook
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Parker
authors.forename: Todd C
authors.initials: TC
authors.lastname: Igel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000532:radiotherapy*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy* / Q000601:surgery; D016879:Salvage Therapy
chemical_list: D017430:Prostate-Specific Antigen