title: Long-term Outcome of Prostate Cancer Patients Who Exhibit Biochemical Failure Despite Salvage Radiation Therapy After Radical Prostatectomy.
abstract: OBJECTIVE
  Salvage radiation therapy (SRT) is an effective treatment for recurrent prostate cancer (PCa) after radical prostatectomy. We report the long-term outcome of men who developed biochemical recurrence (BCR) after SRT and were treated >14 years ago.
  
  
  METHODS
  In total, 61 patients treated with SRT from 1992 to 2000 at our institution were identified. Survival was calculated by Kaplan-Meier method. Log-rank test and Cox regression were used to determine significance of clinical parameters.
  
  
  RESULTS
  The median follow-up was 126 months (interquartile range, 66-167 mo). Thirty-four (56%) had prostate-specific antigen (PSA) failure after SRT. At 10 years, overall survival (OS) was 67%, freedom from PSA failure (FFPF) was 33%, prostate cancer-specific survival (PCSS) was 84%, and distant metastases-free survival (DMFS) was 84%. Pathologic T-stage, Gleason score, seminal vesicle involvement, and pre-SRT PSA were associated with FFPF. For patients who failed SRT, the median time to BCR after SRT was 30 mo. A total of 19 (68%) received androgen deprivation therapy. The median OS was 13.6 years. At 10 years from time of BCR, OS was 59%, PCSS was 73%, DMFS was 75%, and castration-resistant-free survival was 70%. Early SRT failure correlated with significantly decreased DMFS and PCSS. Ten-year DMFS from SRT was 43% (BCR≤1 y) versus 91% (BCR>1 y).
  
  
  CONCLUSIONS
  Extended follow-up demonstrates that despite SRT failure, PCSS remains high in select patients. Early failure (≤1 y after SRT) predicted for significantly worse outcome and may represent a subgroup with more aggressive disease that may be considered for further prospective clinical studies.
authors.affiliation: Departments of Radiation Oncology.
authors.forename: James
authors.initials: J
authors.lastname: Ying
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Chiachien J
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Clinical Science.
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Radiation Oncology, University of Chicago, Chicago, IL.
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Christopher
authors.initials: C
authors.lastname: Straka
authors.affiliation: Departments of Radiation Oncology.
authors.forename: David
authors.initials: D
authors.lastname: Pistenmaa
authors.affiliation: Clinical Science.
authors.forename: Xian-Jin
authors.initials: XJ
authors.lastname: Xie
authors.affiliation: Urology, University of Texas at Southwestern Medical Center, Dallas.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Urology, University of Texas at Southwestern Medical Center, Dallas.
authors.forename: Claus
authors.initials: C
authors.lastname: Roehrborn
authors.affiliation: Department of Radiation Oncology, Texas Oncology, Waco, TX.
authors.forename: D Nathan
authors.initials: DN
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000532:radiotherapy*; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011878:Radiotherapy; D012189:Retrospective Studies; D016879:Salvage Therapy
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen