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Contemporary salvage post prostatectomy radiotherapy: Early implementation improves biochemical control
Author(s) -
Kneebone Andrew,
Hruby George,
Harris Georgia,
Rasiah Kris,
Vass Justin,
Whalley Deborah,
McCloud Philip,
Louw Sandra,
Guo Linxin,
Eade Thomas
Publication year - 2018
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12684
Subject(s) - medicine , prostatectomy , radiation therapy , urology , univariate analysis , salvage therapy , androgen deprivation therapy , hazard ratio , surgery , prostate cancer , multivariate analysis , confidence interval , cancer , chemotherapy
The optimal time to commence salvage radiotherapy ( SRT ) for a rising PSA post radical prostatectomy is not known. We wished to assess the impact of index PSA ( iPSA ) level prior to SRT on rates of biochemical failure ( BCF ) post treatment. Methods Patients referred to our institution for SRT for a rising PSA post surgery were accrued onto a prospective database. Baseline demographic data, tumour and treatment factors were collected including pathologic T and N stage, margin status, Gleason score ( GS ), lymphovascular space invasion ( LVSI ), use of androgen deprivation therapy ( ADT ) and time from surgery to salvage radiotherapy. Our endpoint was time to BCF . Results Between January 2008 and December 2013, 189 patients received SRT to a mean dose of 69.8 Gy in 34 fractions using Intensity Modulated Radiotherapy ( IMRT ). Median follow‐up was 50 months. For patients with an iPSA of <0.2 ng/ mL ( n = 92), iPSA ≥ 0.2 to <1.0 ng/ mL ( n = 75) and ≥ 1.0 ng/ mL ( n = 22), rates of BCF at 5 years were 28.3%, 44.3% and 73.7% respectively. Compared to the iPSA <0.2 ng/ mL group, the hazard ratios for time to BCF for an iPSA ≥ 0.2 to <1.0 ng/ mL was 1.73 ( P = 0.05) and >1.0 ng/ mL was 3.1 ( P = 0.002). Factors predicting time to BCF on univariate analysis included iPSA , GS , T stage, PSA nadir post surgery and LVSI . On multivariate analysis, GS , iPSA , use of ADT , T stage, PSA post surgery nadir and margin status remained significant. Conclusion Rising iPSA levels are associated with an increasing risk of biochemical failure after adjusting for known prognostic factors and early salvage post prostatectomy radiotherapy is recommended.