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Risk factors predicting the outcome of salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy
Author(s) -
Kinoshita Hidefumi,
Shimizu Yosuke,
Mizowaki Takashi,
Takayama Kenji,
Norihisa Yoshiki,
Kamoto Toshiyuki,
Kamba Tomomi,
Hayashino Yasuaki,
Hiraoka Masahiro,
Ogawa Osamu
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12049
Subject(s) - medicine , prostatectomy , biochemical recurrence , outcome (game theory) , radiation therapy , salvage therapy , urology , surgery , prostate cancer , cancer , chemotherapy , mathematics , mathematical economics
Objectives Salvage radiotherapy is the only curative treatment for patients with prostate cancer showing biochemical progression after radical prostatectomy. In this study, we evaluated the clinicopathological parameters that influence the outcome of salvage radiotherapy. Methods Medical records of 49 patients who underwent salvage radiotherapy after radical prostatectomy from 1997 to 2008 at the Graduate School of Medicine, Kyoto University, were retrospectively reviewed. Radiotherapy was carried out with 66 G y on the prostatic bed. Results Biochemical progression‐free survival after salvage radiotherapy at 2, 5 and 7 years was 51.0%, 42.2% and 42.2%, respectively. Significant parameters predicting biochemical progression after salvage radiotherapy by C ox regression analysis were prostatectomy G leason score sum ≥8 (hazard ratio 0.08; 95% confidence interval 0.03–0.22; P = 0.001), prostate‐specific antigen nadir after radical prostatectomy ≥0.04 ng/ mL (hazard ratio 0.30; 95% confidence interval 0.13–0.69; P = 0.005) and negative surgical margin (hazard ratio 0.28; 95% confidence interval 0.12–0.70; P = 0.006). When the patients were subgrouped by these risk factors, the 5‐year progression‐free survival rates after salvage radiotherapy were 77.8%, 50.0% and 6.7% in patients with 0, 1 and ≥2 predictors, respectively. Conclusion In order to discriminate favorable candidates for salvage radiotherapy, Gleason score of prostatectomy, prostate‐specific antigen nadir after prostatectomy and positive surgical margin represent independent predictors. Thus, progression‐free survival might be more precisely predicted according to the presence/absence of these risk factors. The significance of this risk classification should be confirmed by large prospective studies.