Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul 30:11:102.
doi: 10.1186/s13014-016-0671-1.

Optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy: is ultra-early salvage radiotherapy beneficial?

Satoru Taguchi  1 , Kenshiro Shiraishi  2 , Hiroshi Fukuhara  3 , Keiichi Nakagawa  2 , Teppei Morikawa  4 , Akihiro Naito  1 , Shigenori Kakutani  1 , Yuta Takeshima  1 , Hideyo Miyazaki  1 , Tohru Nakagawa  1 , Tetsuya Fujimura  1 , Haruki Kume  1 , Yukio Homma  1
Affiliations

Optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy: is ultra-early salvage radiotherapy beneficial?

Satoru Taguchi et al. Radiat Oncol. .

Abstract

Background: The optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy is controversial. In particular, the prognostic significance of salvage radiotherapy delivered before a current definition of biochemical recurrence, i.e. ultra-early salvage radiotherapy, is unclear.

Methods: We reviewed 76 patients with pT2-3N0M0 prostate cancer who underwent salvage radiotherapy for post-prostatectomy biochemical recurrence at the following three timings: ultra-early salvage radiotherapy (n = 20) delivered before meeting a current definition of biochemical recurrence (two consecutive prostate-specific antigen [PSA] values ≥0.2 ng/mL); early salvage radiotherapy (n = 40) delivered after meeting the definition but before PSA reached 0.5 ng/mL; and delayed salvage radiotherapy (n = 16) delivered after PSA reached 0.5 ng/mL. The primary endpoint was failure of salvage radiotherapy, defined as a PSA value ≥0.2 ng/mL. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses, respectively.

Results: During the follow-up period (median: 70 months), four of 20 (20 %), nine of 40 (23 %) and seven of 16 (44 %) patients failed biochemically in the ultra-early, early and delayed salvage radiotherapy groups, respectively. On univariate analyses, the outcome of delayed salvage radiotherapy was worse than the others, while there was no significant difference between ultra-early and early groups. Multivariate analysis demonstrated the presence of Gleason pattern 5, perineural invasion and delayed salvage radiotherapy as independent predictors of poorer survival.

Conclusions: No survival benefit of ultra-early salvage radiotherapy was demonstrated, whereas delayed salvage radiotherapy was associated with worse outcome as reported in previous studies. Our results may support the current recommendations that salvage radiotherapy should be undertaken after two consecutive PSA values ≥0.2 ng/mL and before reaching 0.5 ng/mL.

Keywords: Biochemical recurrence; Prostate cancer; Prostatectomy; Radiation; Radiotherapy; Salvage.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves depicting failure-free survival according to three timings of SRT (log-rank test: P = 0.0364)
Fig. 2
Fig. 2
Kaplan–Meier curves depicting failure-free survival of ueSRT + eSRT vs dSRT (log-rank test: P = 0.0108)
Fig. 3
Fig. 3
Kaplan–Meier curves depicting failure-free survival of ueSRT vs eSRT + dSRT (log-rank test: P = 0.2991)
See this image and copyright information in PMC

References

    1. Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol. 2002;167:528–534. doi: 10.1016/S0022-5347(01)69079-7. - DOI - PubMed
    1. Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ. Cancer progression and survival rates following anatomical radical retro-pubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004;172:910–914. doi: 10.1097/01.ju.0000134888.22332.bb. - DOI - PubMed
    1. Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS, Jr, Faraday MM. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol. 2013;190:441–449. doi: 10.1016/j.juro.2013.05.032. - DOI - PubMed
    1. Freedland SJ, Rumble RB, Finelli A, Chen RC, Slovin S, Stein MN, Mendelson DS, Wackett C, Sandler HM, American Society of Clinical Oncology Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2014;32:3892–3898. doi: 10.1200/JCO.2014.58.8525. - DOI - PubMed
    1. Mohler JL, Kantoff PW, Armstrong AJ, Bahnson RR, Cohen M, D’Amico AV, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Kane CJ, Kawachi MH, Kuettel M, Kuzel TM, Lee RJ, Malcolm AW, Miller D, Plimack ER, Pow-Sang JM, Raben D, Richey S, Roach M 3rd, Rohren E, Rosenfeld S, Schaeffer E, Small EJ, Sonpavde G, Srinivas S, Stein C, Strope SA, Tward J, Shead DA, Ho M; National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Prostate Cancer Version 2.2014. Fort Washington: National Comprehensive Cancer Network, Inc.; 2014.

Substances