title: Outcome after conformal salvage radiotherapy in patients with rising prostate-specific antigen levels after radical prostatectomy.
abstract: OBJECTIVE
  This study attempts to improve our understanding of the role of salvage radiotherapy (SRT) in patients with prostate-specific antigen (PSA) relapse after radical prostatectomy with regard to biochemical control, rate of distant metastasis, and survival.
  
  
  METHODS
  We performed a retrospective analysis of 96 men treated with conformal prostate bed SRT (median, 64.8 Gy) at a single institution (median follow-up, 70 months). The majority had intermediate- or high-risk prostate cancer. Fifty-four percent underwent a resection with positive margins (R1 resection). The median time interval between surgery and SRT was 22 months.
  
  
  RESULTS
  After SRT, 66% of patients reached a PSA nadir of less than 0.2 ng/mL. However, the 5-year biochemical no evidence of disease rate was 35%. Seminal vesicle involvement was predictive for a significantly lower biochemical no evidence of disease rate. All patients with a preoperative PSA level greater than 50 ng/mL relapsed biochemically within 2 years. The 5-year distant metastasis rate was 18%, the 5-year prostate cancer-specific survival rate was 90%, and the 5-year overall survival rate was 88%. Significantly more distant metastases developed in patients with a PSA nadir greater than 0.05 ng/mL after SRT, and they had significantly inferior prostate cancer-specific and overall survival rates. Resection status (R1 vs. R0) was not predictive for any of the endpoints.
  
  
  CONCLUSIONS
  Men with postoperative PSA relapse can undergo salvage treatment by prostate bed radiotherapy, but durable PSA control is maintained only in about one-third of the patients. Despite a high biochemical failure rate after SRT, prostate cancer-specific survival does not decrease rapidly.
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. hans.geinitz@lrz.tumuenchen.de
authors.forename: Hans
authors.initials: H
authors.lastname: Geinitz
authors.forename: Martina G
authors.initials: MG
authors.lastname: Riegel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Thamm
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Astner
authors.forename: Carolin
authors.initials: C
authors.lastname: Lewerenz
authors.forename: Frank
authors.initials: F
authors.lastname: Zimmermann
authors.forename: Michael
authors.initials: M
authors.lastname: Molls
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen