title: Early salvage radiotherapy following radical prostatectomy.
abstract: BACKGROUND
  Depending on the pathologic tumour stage, up to 60% of prostate cancer patients who undergo radical prostatectomy will develop biochemical relapse and require further local treatment.
  
  
  OBJECTIVE
  We reviewed the results of early salvage radiation therapy (RT), defined as prostate-specific antigen (PSA) values prior to RT ≤ 0.5 ng/ml in the setting of lymph node-negative disease.
  
  
  METHODS
  Ten retrospective studies, including one multicentre analysis, were used for this analysis. Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT.
  
  
  RESULTS
  Patients treated with early salvage RT have a significantly improved biochemical recurrence-free survival (BRFS) rate compared with those receiving salvage RT initiated after PSA values are >0.5 ng/ml. Similarly, within the cohort of patients with pre-RT PSA values <0.5 ng/ml, improved BRFS rates were noted among those with lower rather higher pre-RT PSA levels. It is possible that higher RT dose levels and the use of adjunctive androgen-deprivation therapy improve biochemical control outcomes in the salvage setting.
  
  
  CONCLUSIONS
  Based on a literature review, improved 5-yr BRFS rates are observed for patients who receive early salvage RT compared with patients treated with salvage RT with a pre-RT PSA value >0.5 ng/ml. Whether the routine application of early salvage RT in patients with initially undetectable PSA levels will be associated with demonstrable clinical benefit awaits the results of ongoing prospective trials.
authors: Department of Urology, RWTH Aachen University, Aachen, Germany. Electronic address: dpfister@ukaachen.de.
authors: David
authors: D
authors: Pfister
authors: Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France.
authors: Michel
authors: M
authors: Bolla
authors: Department of Urology, Università Vita-Salute San Raffaele, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
authors: Peter
authors: P
authors: Carroll
authors: Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.
authors: Cesare
authors: C
authors: Cozzarini
authors: Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors: Steven
authors: S
authors: Joniau
authors: Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors: Hein
authors: H
authors: van Poppel
authors: Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
authors: Mack
authors: M
authors: Roach
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Andrew
authors: A
authors: Stephenson
authors: Department of Radiation Oncology, University Hospital, Ulm, Germany.
authors: Thomas
authors: T
authors: Wiegel
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Michael J
authors: MJ
authors: Zelefsky
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000532:radiotherapy*; 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
keywords: Biochemical recurrence-free survival; Early salvage radiotherapy; Prostate cancer; Radiotherapy