title: Salvage radiotherapy after prostatectomy - what is the best time to treat?
abstract: OBJECTIVE
  Salvage radiotherapy (SRT) is applied routinely in patients with biochemical relapse after radical prostatectomy (RP). However, only ∼30% of these patients achieve a durable response after 10 years. As a standard, 66 Gy are given, ideally with a PSA below 0.5 ng/ml. We tried to determine more precisely the optimal PSA for starting SRT.
  
  
  METHODS
  In 301 prostate cancer patients without hormonal treatment, we analysed the impact on the biochemical response (bNED) to SRT of two pre-SRT PSA levels, namely below or above the median of 0.28 ng/ml.
  
  
  RESULTS
  The median follow-up time for the entire group was 30 months. In 151 patients, SRT commenced at a PSA ≤ 0.28 ng/ml, in 150 at > 0.28 ng/ml. Eighty-two patients (27%) developed biochemical progression during follow up. The calculated two-year bNED was 74% for the entire group, 78% versus 61% for a PSA ≤ or > 0.28 ng/ml, respectively. In multivariate analysis, pT(3b), resection status, pre-SRT PSA dichotomized at median, PSA post-SRT undetectable, and PSA doubling time were statistically significant independent predictors of progression after SRT.
  
  
  CONCLUSIONS
  Our findings suggest that a PSA of ≤ 0.28 ng/ml improves bNED compared with a PSA before SRT of > 0.28 ng/ml.
authors: Department of Radiation Oncology, Charité Universitätsmedizin, Berlin, Germany.
authors: Alessandra
authors: A
authors: Siegmann
authors: Dirk
authors: D
authors: Bottke
authors: Julia
authors: J
authors: Faehndrich
authors: Maike
authors: M
authors: Brachert
authors: Gunnar
authors: G
authors: Lohm
authors: Kurt
authors: K
authors: Miller
authors: Detlef
authors: D
authors: Bartkowiak
authors: Wolfgang
authors: W
authors: Hinkelbein
authors: Thomas
authors: T
authors: Wiegel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D016879:Salvage Therapy; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen