title: Risk factors predicting the outcome of salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy.
abstract: OBJECTIVE
  Salvage radiotherapy is the only curative treatment for patients with prostate cancer showing biochemical progression after radical prostatectomy. In this study, we evaluated the clinicopathological parameters that influence the outcome of salvage radiotherapy.
  
  
  METHODS
  Medical records of 49 patients who underwent salvage radiotherapy after radical prostatectomy from 1997 to 2008 at the Graduate School of Medicine, Kyoto University, were retrospectively reviewed. Radiotherapy was carried out with 66 Gy on the prostatic bed.
  
  
  RESULTS
  Biochemical progression-free survival after salvage radiotherapy at 2, 5 and 7 years was 51.0%, 42.2% and 42.2%, respectively. Significant parameters predicting biochemical progression after salvage radiotherapy by Cox regression analysis were prostatectomy Gleason score sum ≥ 8 (hazard ratio 0.08; 95% confidence interval 0.03-0.22; P=0.001), prostate-specific antigen nadir after radical prostatectomy ≥ 0.04 ng/mL (hazard ratio 0.30; 95% confidence interval 0.13-0.69; P=0.005) and negative surgical margin (hazard ratio 0.28; 95% confidence interval 0.12-0.70; P=0.006). When the patients were subgrouped by these risk factors, the 5-year progression-free survival rates after salvage radiotherapy were 77.8%, 50.0% and 6.7% in patients with 0, 1 and ≥ 2 predictors, respectively.
  
  
  CONCLUSIONS
  In order to discriminate favorable candidates for salvage radiotherapy, Gleason score of prostatectomy, prostate-specific antigen nadir after prostatectomy and positive surgical margin represent independent predictors. Thus, progression-free survival might be more precisely predicted according to the presence/absence of these risk factors. The significance of this risk classification should be confirmed by large prospective studies.
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan. kinoshih@hirakata.kmu.ac.jp
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizowaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Takayama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Norihisa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kamoto
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kamba
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hayashino
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiraoka
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*
keywords: biochemical progression; prostate cancer; prostatectomy; risk factor; salvage radiotherapy