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The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer
Author(s) -
Bartkowiak Detlef,
Siegmann Alessandra,
Böhmer Dirk,
Budach Volker,
Wiegel Thomas
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14851
Subject(s) - medicine , prostatectomy , prostate cancer , prostate specific antigen , urology , cohort , prostate , radiation therapy , lymph node , proportional hazards model , oncology , cancer
Objective To test whether salvage radiotherapy ( SRT ) in patients with lymph node negative (N0) prostate cancer is equally effective with persistent prostate‐specific antigen (PSA) and PSA rising from the undetectable range (<0.1 ng/mL) after radical prostatectomy ( RP ). Patients and methods We assessed post‐ SRT PSA progression‐free survival ( PFS ) in 555 patients with prostate cancer. The entire cohort was compared with a risk‐adjusted subgroup of 112 patient pairs with matching pre‐ RP PSA level (±10 ng/mL), Gleason score (≤6 vs 7 vs ≥8), and pre‐ SRT PSA level (±0.5 ng/mL). Results The median follow‐up was 6.1 years. After RP , PSA was undetectable in 422 and persistent in 133 patients. PSA persistence and a pre‐ SRT PSA level of ≥0.5 ng/mL reduced Kaplan–Meier rates of PFS significantly. In multivariate analysis of the entire cohort and after risk adjustment, the pre‐ SRT PSA level but not post‐ RP PSA persistence was a significant parameter. In the matched cohort's subgroup with early SRT at a PSA level of <0.5 ng/mL, a trend towards a worse outcome with post‐ RP PSA persistence was observed. Delayed SRT with a PSA level ≥0.5 ng/mL led to a PFS of <30%, irrespective of the post‐ RP PSA level . Conclusion In patients with N0 prostate cancer with post‐ RP PSA persistence, early SRT at a PSA level <0.5 ng/mL seems to be less effective than in recurrent patients with post‐ RP undetectable PSA . They might benefit from intensified therapy, but larger case numbers are required to substantiate this conclusion. In patients with a PSA level ≥0.5 ng/mL and higher‐risk features associated with post‐ RP PSA persistence, SRT alone is unlikely to provide long‐term freedom from further progression.