title: Salvage radiotherapy in patients with persistently detectable PSA or PSA rising from an undetectable range after radical prostatectomy gives comparable results.
abstract: OBJECTIVE
  Salvage radiotherapy (SRT) is applied routinely in patients with a biochemical relapse after radical prostatectomy (RP). Although the detection threshold for relapse after RP has steadily been lowered, only about 30% of the SRT patients achieve a durable response. We have previously shown the association between a PSA decrease below detectable levels after SRT and biochemical progression-free survival (BPFS). After recalculating our data according to a more recent definition of biochemical failure after SRT, we now show the significance of the post-RP PSA nadir.
  
  
  METHODS
  Among 159 prostate cancer patients without hormonal treatment after RP, SRT was given to 72 patients with persistently detectable PSA after RP and to 87 whose PSA increased out of an undetectable range. The median pre-SRT PSA was 0.29 ng/ml for the former group and 0.34 ng/ml for the latter group. A radiation dose of 66.6 Gy was applied to the prostate bed.
  
  
  RESULTS
  The overall median follow-up time was 41.7 months. The probability for BPFS after this period was 52.8% in 72 patients with persistently detectable PSA after RP and 65.4% in 87 patients who had a post-RP PSA nadir below detection limit. Univariate and multivariate analyses showed no significant difference in BPFS of both patient groups (p > 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that SRT is a viable treatment option for patients with persistently detectable PSA, giving similar results as in patients whose PSA increases out of an undetectable range after RP.
authors.affiliation: Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin-Franklin, Berlin, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Lohm
authors.forename: Dirk
authors.initials: D
authors.lastname: Bottke
authors.forename: Basil
authors.initials: B
authors.lastname: Jamil
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Konrad
authors.initials: K
authors.lastname: Neumann
authors.forename: Detlef
authors.initials: D
authors.lastname: Bartkowiak
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hinkelbein
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen