title: Prognostic implications of immediate PSA response to early salvage radiotherapy.
abstract: BACKGROUND
  Up to 25% of men with prostate cancer who undergo radical prostatectomy will recur. In this setting, salvage radiotherapy may cure patients with local recurrence, but is unable to cure those with occult metastatic disease. The objective of this study is to examine how prostate-specific antigen (PSA) response to radiotherapy predicts subsequent disease progression and survival.
  
  
  METHODS
  Using a prospectively populated database of 3089 men who underwent open radical prostatectomy, 212 patients (7%) were identified who received early salvage radiotherapy for biochemical recurrence. The main outcome was time to disease progression after salvage radiotherapy. Patients were stratified by PSA response after radiotherapy: 1) PSA < 0.1 ng/mL, 2) persistently detectable PSA, and 3) rising PSA.
  
  
  RESULTS
  Patients received salvage radiotherapy at a median PSA of 0.20 ng/mL (IQR 0.10-0.30 ng/mL). At a median follow up of 47.3 months, a total of 52 (25%) patients experienced disease progression. On multivariable analysis, both persistent PSA (HR 5.12; 95% CI 1.98-13.23) and rising PSA (HR 16.55; 95% CI 6.61-41.48) were associated with increased risk of disease progression compared to those with PSA < 0.1 ng/mL after adjusting for pre-radiotherapy PSA, Gleason score, margin status, stage, and time to radiotherapy. Only rising PSA was associated with an increased risk of cancer-specific and all-cause mortality.
  
  
  CONCLUSIONS
  PSA response is associated with the risk of disease progression following salvage radiotherapy. This information can be used to counsel patients on the potential need for additional therapy and identify those at greatest risk for progression and cancer-related mortality.
authors.affiliation: Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Turner I I
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Yabes
authors.forename: Elen
authors.initials: E
authors.lastname: Woldemichael
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Deutsch
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.forename: Robert S
authors.initials: RS
authors.lastname: Werner
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Joel B
authors.initials: JB
authors.lastname: Nelson
mesh_terms: D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen