title: Anatomical patterns of recurrence following biochemical relapse after post-prostatectomy salvage radiation therapy: a multi-institutional study.
abstract: To characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT).
  
  
  
  A multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months.
  
  
  
  The median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively.
  
  
  
  We demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Jackson
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Desai
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Abugharib
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Vasu
authors.identifier: 0000-0003-3908-6166
authors.initials: V
authors.lastname: Tumati
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Dess
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Shuang G
authors.initials: SG
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Moaaz
authors.initials: M
authors.lastname: Soliman
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Folkert
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Laine
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Raquibul
authors.initials: R
authors.lastname: Hannan
authors.affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Zumsteg
authors.affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Sandler
authors.affiliation: The Texas Center for Proton Therapy, Irving, TX, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hamstra
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Mike A
authors.initials: MA
authors.lastname: Kozminski
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Hearn
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Palapattu
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Tomlins
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Mehra
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.|Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Daniel E
authors.identifier: 0000-0002-5973-4741
authors.initials: DE
authors.lastname: Spratt
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure
chemical_list: D017430:Prostate-Specific Antigen
keywords: #PCSM; #ProstateCancer; patterns of failure; radical prostatectomy; salvage radiotherapy