title: Proposed salvage treatment strategy for biochemical failure after radical prostatectomy in patients with prostate cancer: a retrospective study.
abstract: BACKGROUND
  Treatment options for patients with recurrent disease after radical prostatectomy include salvage radiotherapy of the prostatic bed and/or androgen deprivation therapy. To establish an effective treatment strategy for recurrent disease after radical prostatectomy, we retrospectively analyzed the outcome of salvage radiation monotherapy in such cases.
  
  
  METHODS
  Data from 61 men who had undergone salvage radiation monotherapy for biochemical recurrent disease after radical prostatectomy were retrospectively reviewed. In all patients, salvage radiotherapy consisted of iraradiation to the prostatic bed (70 Gy) using three-dimensional conformal radiotherapy techniques. Treatment outcome was analyzed to identify predictive factors of salvage radiotherapy.
  
  
  RESULTS
  The biochemical recurrence-free survival after salvage radiation monotherapy at 2 and 5 years was 55% and 38%, respectively. Cox proportional regression models revealed that the independent predictive factors for biochemical recurrence were Gleason Score ≥ 8, negative surgical margin, and PSA velocity ≥ 0.38 ng/mL/year. Negative surgical margin and PSA velocity ≥ 0.8 ng/mL/year were significantly associated with poor response in the serum PSA levels after salvage radiotherapy.
  
  
  CONCLUSIONS
  Based on our findings, we propose a treatment strategy for biochemical recurrent disease after radical prostatectomy. Patients with Gleason score ≤ 7, positive surgical margin, and PSA velocity < 0.38 ng/mL/year are categorized the most favorable group, so that eradication by salvage radiation monotherapy could be expected. Other patients could be divided to two groups depending on surgical margin status and PSA velocity: 1) patients who might require combination of SRT and short-term androgen deprivation therapy and 2) patients who should be treated by androgen deprivation monotherapy.
authors.forename: Makito
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Nara 634-8522, Japan. sendo@naramed-u.ac.jp.
authors.forename: Nobumichi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Isao
authors.initials: I
authors.lastname: Asakawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Morizawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Anai
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Torimoto
authors.forename: Katsuya
authors.initials: K
authors.lastname: Aoki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yoneda
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Noboru
authors.initials: N
authors.lastname: Konishi
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology / Q000532:radiotherapy; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen