title: Underutilization of local salvage therapy after radiation therapy for prostate cancer.
abstract: OBJECTIVE
  To evaluate the rates at which patients are offered and receive local salvage therapy (LST) after failure of primary radiotherapy for localized prostate cancer, as it is the only potentially curative treatment for localized recurrence but appears to be underutilized when compared with androgen-deprivation therapy (ADT) or observation.
  
  
  METHODS
  Patients with localized prostate cancer who received primary radiotherapy with curative intent between 1999 and 2000 were identified in the British Columbia Tumour Registry. Exclusion criteria included patient age >72 years, prostate-specific antigen>40 ng/ml, and clinical stage T4 at diagnosis. Data on clinicopathologic features, primary therapy, prostate-specific antigen kinetics, and salvage therapy were collected retrospectively. Radiation failure was defined as biochemical recurrence according to the Phoenix criteria or by initiation of salvage therapy.
  
  
  RESULTS
  Of 1,782 patients treated in the study period, 1,067 met inclusion criteria. Of these, 257 failed radiation therapy. Radiation therapy failure was managed with observation (>12 mo) in 126 patients and ADT in 119. Of the observed patients, 66 subsequently received ADT. Five patients (1.8%) received LST (3 radical prostatectomy and 2 brachytherapy).
  
  
  CONCLUSIONS
  Only 2% of patients relapsing after radiation therapy for localized prostate cancer received LST. Although the benefits of LST are unproven, these findings reveal a possible underutilization of LST and indicate a need for enhanced collaboration between specialties to optimize care of this challenging cohort.
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Tran
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Kwok
authors.affiliation: Department of Radiation Oncology, Vancouver Cancer Center, BC Cancer Agency, Vancouver, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Pickles
authors.affiliation: Department of Radiation Oncology, Vancouver Cancer Center, BC Cancer Agency, Vancouver, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. Electronic address: pblack@mail.ubc.ca.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000706:statistics & numerical data; D001955:British Columbia; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000628:therapy*; D011878:Radiotherapy / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Cryotherapy; Prostatic neoplasms; Radiotherapy; Salvage brachytherapy; Salvage radical prostatectomy; Salvage therapy