Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy

Eur Urol. 2008 Jul;54(1):88-94. doi: 10.1016/j.eururo.2008.03.066. Epub 2008 Apr 1.


Background: Randomized trials have shown an improvement in progression-free survival rates with adjuvant radiation therapy (ART) after radical prostatectomy for patients with a high risk of cancer recurrence. Less is known about the relative advantages and disadvantages of initial observation with delayed salvage radiation therapy (SRT).

Objective: To examine the results of SRT in a large single-surgeon radical prostatectomy series.

Design, setting, and participants: From a radical prostatectomy database, we identified 859 men with positive surgical margins (SM+), extracapsular tumor extension (ECE), or seminal vesicle invasion (SVI) who chose to defer ART. Following a period of initial observation, 192 ultimately received SRT for prostate-specific antigen (PSA) progression.

Measurements: Survival analysis was performed to examine the outcomes of initial observation followed by SRT.

Results and limitations: In patients with SM+/ECE and SVI, the 7-yr PSA progression-free survival rates with observation were 62% and 32%, respectively. Among those who had PSA progression, 56% and 26%, respectively, maintained an undetectable PSA for 5 yr after SRT. The long-term rates of undetectable PSA associated with an SRT strategy were 83% and 50% for men with SM+/ECE and SVI, respectively. In the subset of 716 men who did not receive any hormonal therapy, the corresponding long-term rates of undetectable PSA were 91% and 75%, respectively.

Conclusions: Following radical prostatectomy, initial observation followed by delayed SRT at the time of PSA recurrence is an effective strategy for selected patients with SM+/ECE. Some patients with SVI may also benefit from this strategy. However, additional prospective studies are necessary to further examine the survival outcomes following SRT.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / blood*
  • Humans
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood*
  • Prostatectomy*
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery*
  • Salvage Therapy
  • Survival Analysis
  • Time Factors


  • Biomarkers, Tumor
  • Prostate-Specific Antigen