title: Predicting PSA failure following salvage radiotherapy for a rising PSA post-prostatectomy: from the CaPSURE database.
abstract: BACKGROUND
  The role of radiotherapy (RT) for rising PSA after radical prostatectomy (RP) is debatable. We analyzed a large database of men to evaluate for predictors of prostate-specific antigen (PSA) failure after salvage RT.
  
  
  METHODS
  Data from the Cancer of the Prostate Strategic Urologic Research Endeavor database (CaPSURE) identified 4,563 men with RP between 1989 and 2004; 194 underwent salvage RT > or = 6 months after RP. PSA failure following RT was defined as a PSA >0.2 ng/ml. The association between clinical and pathologic characteristics and PSA failure was examined using a chi-square metric. A multivariable analysis of predictors for time to PSA failure was performed using a Cox proportional hazard regression model.
  
  
  RESULTS
  After a median follow-up of 66 months, 121 (62%) men experienced PSA failure at a median 20 months. Significant associations for PSA failure were found for the clinical T category (P < .01), race/ethnicity (P = 0.04), pT3 disease (P < 0.01), seminal vesicle invasion (P < 0.01), and pre-RT PSA level (P < 0.01). The pre-RT PSA level (P = 0.07) was the only factor to approach significance as an independent predictor of PSA failure on multivariable analysis. Pre-RT PSA doubling time was calculated for 131 men but did not predict for PSA failure on univariate (P = 0.38) or multivariate analyses (P = 0.13) for < or = 12 vs. >12 months.
  
  
  CONCLUSIONS
  Salvage RT provided the greatest benefit in PSA control in men with the lowest pre-RT PSA levels. Post-RP PSA doubling time >12 months trended toward predicting for PSA failure but was not significant likely owing to limited sample size. Together, these findings would suggest that salvage RT is optimal at low pre-RT PSA and long doubling times with favorable pathologic features.
authors.affiliation: Huntsman Cancer Hospital, Salt Lake City, UT 84112, USA. kenny.macdonald@hci.utah.edu
authors.forename: O Kenneth
authors.initials: OK
authors.lastname: Macdonald
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Natalia
authors.initials: N
authors.lastname: Sadetsky
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Shrieve
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000368:Aged; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen