title: The PSA-response to salvage radiotherapy after radical prostatectomy correlates with freedom from progression and overall survival.
abstract: OBJECTIVE
  In a retrospective analysis, we examined factors influencing the outcome of prostate cancer (PCa) patients receiving salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy (RP).
  
  
  METHODS
  306 patients received 3D-conformal SRT at a median pre-SRT PSA of 0.298 ng/ml. Post-SRT progression was defined as PSA ⩾0.2 ng/ml above nadir and rising further, or hormone treatment, or clinical recurrence. Data were analyzed with the Kaplan-Meier method and multivariable Cox regression.
  
  
  RESULTS
  Application of SRT at a PSA <0.2 ng/ml correlated significantly with achieving a post-SRT PSA nadir <0.1 ng/ml and with improved freedom from progression (median follow-up 7.2 years). The post-SRT nadir <0.1 ng/ml correlated significantly with less recurrences and with better overall survival. In multivariable Cox analysis restricted to pre-SRT parameters, a pre-SRT PSA ⩾0.2 ng/ml had the strongest impact (hazard ratio 2.4) on progression. If the post-SRT PSA nadir was included in the model, then failing the nadir was the most important risk factor (hazard ratio 8.1).
  
  
  CONCLUSIONS
  Early SRT at a PSA <0.2 ng/ml is a favorable treatment option for post-RP biochemical recurrence. It correlated with a post-SRT PSA-nadir <0.1 ng/ml which was associated with improved freedom from progression and overall survival.
authors.affiliation: University Hospital Ulm, Department of Radiation Oncology, Ulm, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Bartkowiak
authors.affiliation: University Hospital Ulm, Department of Radiation Oncology, Ulm, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bottke
authors.affiliation: University Hospital Ulm, Department of Radiation Oncology, Ulm, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Thamm
authors.affiliation: Charité University Hospital, Department of Radiation Oncology, Berlin, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Siegmann
authors.affiliation: Charité University Hospital, Department of Radiation Oncology, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hinkelbein
authors.affiliation: University Hospital Ulm, Department of Radiation Oncology, Ulm, Germany. Electronic address: thomas.wiegel@uniklinik-ulm.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biochemical recurrence; Prognosis; Prostate cancer; Radical prostatectomy; Salvage radiotherapy