Dual-timing PSA as a biomarker for patients with salvage intensity modulated radiation therapy for biochemical failure after radical prostatectomy.
We investigated the outcomes and the associated clinical-pathological factors in patients with prostate cancer (PCa) undergoing salvage intensity modulated radiation therapy (IMRT) for post-radical-prostatectomy (RP) biochemical failure. We report clinical outcomes of post-RP salvage IMRT, and describe chronic toxicity in these patients.Fifty patients with PCa underwent post-RP salvage IMRT. The median dose of IMRT was 70 Gy to the prostatic and seminal vesicle bed. Clinical-pathological and toxicity information were collected. The prostate cancer-specific survival (PCSS), disease-free survival (DFS), and biochemical-failure-free survival (BFFS) were calculated. Prognostic factors were analyzed for their association with disease control.The median follow-up time was 74 months. The 5-year PCSS, DFS, and BFFS after salvage IMRT were 95%, 88%, and 60%, respectively. Two patients (4%) experienced late gastrointestinal toxicity ≥ grade 3, and 5 patients (10%) had late genitourinary toxicity ≥ grade 3. On multivariate analysis, post-RP prostate-specific antigen (PSA) nadir ≤0.1 ng/ml (P=0.018) and PSA ≤0.5 ng/ml at salvage IMRT (P=0.016) were independent factors predicting better BFFS. Patients with both post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT had a 5-year BFFS of 83% as compared with 43% in other patients (P=0.001).In conclusion, with hormonal therapy in most PCa patients, the addition of salvage IMRT for post-RP biochemical failure can achieve a good outcome with low toxicity. Patients with a post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT could benefit the most from salvage IMRT.
Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Yu-Jen
YJ
Wang
Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Chao-Yuan
CY
Huang
Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Wei-Hsien
WH
Hou
Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Chia-Chun
CC
Wang
Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Keng-Hsueh
KH
Lan
Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Hong-Jen
HJ
Yu
Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Ming-Kuen
MK
Lai
Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Shihh-Ping
SP
Liu
Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Yeong-Shau
YS
Pu
Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.|Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Jason Chia-Hsien
JC
Cheng
D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy* / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
biochemical failure; intensity modulated radiation therapy; prostate cancer; radical prostatectomy