Risk of biochemical recurrence and timing of radiotherapy in pT3a N0 prostate cancer with positive surgical margin : A single center experience.
BACKGROUND
Despite improved biochemical recurrence-free survival rates by the use of immediate adjuvant radiotherapy (RT) in patients with locally advanced prostate cancer, disagreement about the need and timing of RT remains.


METHODS
From 2005-2009, 94 patients presenting with a stage pT3a N0 and microscopic positive resection margin were retrospectively analyzed after radical prostatectomy. Special attention was given to patients' outcome, the frequency of additive RT, and its efficacy.


RESULTS
Median follow-up was 80 months. A total of 71 patients had a negative postoperative prostate-specific antigen (PSA) level (<0.07 ng/ml). Thirty-six of them did not experience any PSA relapse (subgroup 1). Fourteen of them received additive RT and during follow-up all 36 patients remained PSA negative. Of 71 initially PSA-negative patients, 35 had a biochemical relapse (subgroup 2); 28 patients underwent salvage RT. The median PSA value before salvage RT was 0.24 ng/ml and was subsequently negative (<0.07 ng/ml) in 23 patients after RT. Of the entire cohort, 23 patients had persisting PSA after surgery (subgroup 3). Of these, 18 patients received salvage RT at a median PSA level of 0.4 ng/ml. One patient in subgroup 1, 5 patients in subgroup 2, and 9 patients in subgroup 3 had ongoing androgen deprivation therapy.


CONCLUSIONS
The present study of 94 pT3a N0 R1 prostate cancer patients provides insight into medical care of this patient cohort and underlines the need for additive RT for the majority of patients to achieve long-term biochemical control. Although immediate adjuvant RT was applied with restraint (20 %), during the observation period 60 of 94 patients (63.8 %) received RT - highlighting the need of postoperative treatment.
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
Nina-Sophie
NS
Hegemann
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
Sebastian
S
Morcinek
Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
Alexander
A
Buchner
Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
Alexander
A
Karl
Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
Christian
C
Stief
Department of Pathology, University Hospital RWTH Aachen, Aachen, Germany.
Ruth
R
Knüchel
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
Stefanie
S
Corradini
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
Minglun
M
Li
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
Claus
C
Belka
Department of Radiation Oncology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. ute.ganswindt@med.uni-muenchen.de.
Ute
U
Ganswindt
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D061665:Time-to-Treatment; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
Biochemical relapse; Postoperative radiotherapy; Prostate cancer; Radical prostatectomy; Salvage radiotherapy