title: Salvage radiotherapy in patients with prostate cancer and biochemical relapse after radical prostatectomy : Long-term follow-up of a single-center survey.
abstract: OBJECTIVE
  In patients with prostate cancer (PC) and biochemical relapse after radical prostatectomy, salvage radiotherapy (SRT) could improve PC-specific survival (PCSS) but the timing for initiation is still under discussion. We have demonstrated a low rate of biochemical relapses in a patient series with very low pre-SRT PSA levels after a median follow-up of 42 months. Here, we present an update of that study.
  
  
  METHODS
  Overall, 151 patients were analyzed. A biochemical relapse after SRT was diagnosed when the PSA exceeded the post-SRT nadir by 0.2 ng/ml with subsequent increase. Parameters with significant impact on biochemical progression-free survival (BPFS), PCSS, and overall survival (OS) in univariate analysis were included in a multiple Cox regression analysis.
  
  
  RESULTS
  After a median follow-up of 82 months, 18 patients (12%) had died with 10 (6.6%) deaths being PC-related. A biochemical progression was diagnosed in 83 patients (55%). Univariate analysis revealed a significant impact of pre-SRT PSA level, Gleason score, and PSA doubling time (PSADT) on BPFS and for initial tumor stage and Gleason score on OS. Multivariate analysis confirmed the impact of pre-SRT PSA level, Gleason score, and PSADT on BPFS and tumor stage on OS.
  
  
  CONCLUSIONS
  In this update, the rate of biochemical relapses increased compared with our previous data. Compared to similar studies, we found a remarkably low rate of PC-related deaths. Our data support early initiation of SRT. However, this treatment strategy, triggered by very low PSA levels, could carry the risk of overtreatment in at least a subset of patients.
authors.affiliation: Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Campus Benjamin- Franklin Hindenburgdamm 30, 12200, Berlin, Germany, gunnar.lohm@charite.de.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Lohm
authors.forename: Jörg
authors.initials: J
authors.lastname: Lütcke
authors.forename: Basil
authors.initials: B
authors.lastname: Jamil
authors.forename: Stefan
authors.initials: S
authors.lastname: Höcht
authors.forename: Konrad
authors.initials: K
authors.lastname: Neumann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hinkelbein
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.forename: Dirk
authors.initials: D
authors.lastname: Bottke
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen