title: Clinical outcomes after salvage radiotherapy without androgen deprivation therapy in patients with persistently detectable PSA after radical prostatectomy: results from a national multicentre study.
abstract: OBJECTIVE
  To assess oncologic outcomes after salvage radiotherapy (SRT) without androgen deprivation therapy (ADT) in patients with persistently detectable PSA after radical prostatectomy (RT).
  
  
  METHODS
  Two hundred and one patients who failed to achieve an undetectable PSA received SRT without ADT. The primary endpoint was failure to SRT that was defined by clinical progression or use of second-line ADT. Clinicopathological parameters, 6-week PSA level, PSAV and pre-SRT PSA levels were assessed using time-dependent analyses.
  
  
  RESULTS
  Median postoperative 6-week PSA and pre-SRT PSA levels were 0.25 and 0.48 ng/mL, respectively. Median time between surgery and SRT was 7 months. Failure to SRT was reported in 42.8 % of cases with the need for second-line ADT in 26.9 % of cases. Pre-SRT PSA was strongly correlated with postoperative 6-week PSA (p < 0.001) but not with PSAV. The risk of SRT failure was increased by threefold in case of Gleason score 8-10 (p = 0.036) or pT3b cancer (p = 0.006). Risk group classification based on these prognostic factors improved SRT failure prediction. Survival curves confirmed that 5-year ADT-free survival rates were significantly influenced by PSAV (p = 0.002) and pre-SRT PSA (p = 0.030).
  
  
  CONCLUSIONS
  In patients with persistently detectable PSA after RP and selected for local salvage treatment, SRT offers good oncologic clinical outcomes. The most powerful pathologic predictive factors of SRT failure include a pT3b stage, a Gleason score 8 or more cancer and high PSAV and pre-SRT PSA levels. Patients having a high PSAV >0.04 ng/mL/mo would be potentially better candidates for a systemic therapy due to a high SRT failure rate.
authors.affiliation: Department of Urology, Henri Mondor Academic Hospital, Creteil, France, g.ploussard@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Frédéric
authors.initials: F
authors.lastname: Staerman
authors.forename: Jean
authors.initials: J
authors.lastname: Pierrevelcin
authors.forename: Sébastien
authors.initials: S
authors.lastname: Larue
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Cyrille
authors.initials: C
authors.lastname: Bastide
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaschignard
authors.forename: François
authors.initials: F
authors.lastname: Buge
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.forename: Romain
authors.initials: R
authors.lastname: Bonniol
authors.forename: Xavier
authors.initials: X
authors.lastname: Rebillard
authors.forename: Saad
authors.initials: S
authors.lastname: Fadli
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
authors.forename: Fabien
authors.initials: F
authors.lastname: Saint
authors.forename: Rodrigue
authors.initials: R
authors.lastname: Saad
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Mickaël
authors.initials: M
authors.lastname: Peyromaure
authors.forename: Nicolas Barry
authors.initials: NB
authors.lastname: Delongchamps
authors.forename: Sébastien
authors.initials: S
authors.lastname: Vincendeau
authors.forename: Tarek
authors.initials: T
authors.lastname: Fardoun
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen