Early salvage radiotherapy following radical prostatectomy

Eur Urol. 2014 Jun;65(6):1034-43. doi: 10.1016/j.eururo.2013.08.013. Epub 2013 Aug 15.

Abstract

Context: Depending on the pathologic tumour stage, up to 60% of prostate cancer patients who undergo radical prostatectomy will develop biochemical relapse and require further local treatment.

Objectives: We reviewed the results of early salvage radiation therapy (RT), defined as prostate-specific antigen (PSA) values prior to RT ≤ 0.5 ng/ml in the setting of lymph node-negative disease.

Evidence acquisition: Ten retrospective studies, including one multicentre analysis, were used for this analysis. Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT.

Evidence synthesis: Patients treated with early salvage RT have a significantly improved biochemical recurrence-free survival (BRFS) rate compared with those receiving salvage RT initiated after PSA values are >0.5 ng/ml. Similarly, within the cohort of patients with pre-RT PSA values <0.5 ng/ml, improved BRFS rates were noted among those with lower rather higher pre-RT PSA levels. It is possible that higher RT dose levels and the use of adjunctive androgen-deprivation therapy improve biochemical control outcomes in the salvage setting.

Conclusions: Based on a literature review, improved 5-yr BRFS rates are observed for patients who receive early salvage RT compared with patients treated with salvage RT with a pre-RT PSA value >0.5 ng/ml. Whether the routine application of early salvage RT in patients with initially undetectable PSA levels will be associated with demonstrable clinical benefit awaits the results of ongoing prospective trials.

Keywords: Biochemical recurrence-free survival; Early salvage radiotherapy; Prostate cancer; Radiotherapy.

Publication types

  • Review

MeSH terms

  • Disease-Free Survival
  • Humans
  • Male
  • Neoplasm Recurrence, Local / blood*
  • Neoplasm Recurrence, Local / radiotherapy*
  • Prostate-Specific Antigen / blood*
  • Prostatectomy
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery
  • Salvage Therapy*
  • Time Factors

Substances

  • Prostate-Specific Antigen