title: Salvage radiation in men after prostate-specific antigen failure and the risk of death.
abstract: BACKGROUND
  A survival benefit has been observed with salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure after radical prostatectomy (RP) in men with rapid rises in PSA doubling time (DT, < 6 months). Whether such a benefit exits in men with a protracted PSA rise in DT (≥ 6 months) is unclear and was examined in the current study.
  
  
  METHODS
  Of 4036 men who underwent RP at Duke University between 1988 and 2008, 519 experienced a PSA failure, had complete data, and were the subjects of this study. Univariate and multivariate Cox regression analyses were performed to evaluate whether salvage RT in men with either a rapid (< 6 months) or a protracted (≥ 6 months) PSA DT was associated with the risk of all-cause mortality adjusting for age at the time of PSA failure, known prostate cancer prognostic factors, and cardiac comorbidity.
  
  
  RESULTS
  After a median follow-up of 11.3 years after PSA failure, 195 men died. Salvage RT was associated with a significant reduction in all-cause mortality for men with either a PSA DT of < 6 months (adjusted hazard ratio [AHR], 0.53; P = .02) or a PSA DT of ≥ 6 months (AHR, 0.52; P = .003). In a subset of patients with comorbidity data at the time of PSA failure, salvage RT remained associated with a significant reduction in all-cause mortality for both men with a PSA DT of < 6 months (AHR, 0.35; P = .042) or a PSA DT of ≥ 6 months (AHR, 0.60; P = .04).
  
  
  CONCLUSIONS
  Salvage RT for PSA DTs less than or in excess of 6 months is associated with a decreased risk in all-cause mortality.
authors: Harvard Radiation Oncology Program, Brigham & Women's Hospital-Dana-Farber Cancer Institute, Boston, Massachusetts, USA. scotter@partners.org
authors: Shane E
authors: SE
authors: Cotter
authors: Ming Hui
authors: MH
authors: Chen
authors: Judd W
authors: JW
authors: Moul
authors: W Robert
authors: WR
authors: Lee
authors: Bridget F
authors: BF
authors: Koontz
authors: Mitchell S
authors: MS
authors: Anscher
authors: Cary N
authors: CN
authors: Robertson
authors: Philip J
authors: PJ
authors: Walther
authors: Thomas J
authors: TJ
authors: Polascik
authors: Anthony V
authors: AV
authors: D'Amico
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D002423:Cause of Death; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000150:complications / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen