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Very Early Salvage Radiotherapy After Radical Prostatectomy Improves Distant Metastasis–Free Survival
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
Early salvage radiotherapy following radical prostatectomy for prostate cancer is commonly advocated in place of adjuvant radiotherapy. We aimed to determine the optimal definition of early salvage radiotherapy.
MATERIALS AND METHODS
We performed a multi-institutional retrospective study of 657 men who underwent salvage radiotherapy between 1986 and 2013. Two comparisons were made to determine the optimal definition of early salvage radiotherapy, including 1) the time from radical prostatectomy to salvage radiotherapy (less than 9, 9 to 21, 22 to 47 or greater than 48 months) and 2) the level of detectable pre-salvage radiotherapy prostate specific antigen (0.01 to 0.2, greater than 0.2 to 0.5 or greater than 0.5 ng/ml). Outcomes included freedom from salvage androgen deprivation therapy, and biochemical relapse-free, distant metastases-free and prostate cancer specific survival.
RESULTS
Median followup was 9.8 years. Time from radical prostatectomy to salvage radiotherapy did not correlate with 10-year biochemical relapse-free survival rates (R(2) = 0.18). Increasing pre-salvage radiotherapy prostate specific antigen strongly correlated with biochemical relapse-free survival (R(2) = 0.91). Increasing detectable pre-salvage radiotherapy prostate specific antigen (0.01 to 0.2, greater than 0.2 to 0.5 and greater than 0.5 ng/ml) predicted worse 10-year biochemical relapse-free survival (62%, 44% and 27%), freedom from salvage androgen deprivation therapy (77%, 66% and 49%), distant metastases-free survival (86%, 79% and 66%, each p <0.001) and prostate cancer specific survival (93%, 89% and 80%, respectively, p = 0.001). On multivariable analysis early salvage radiotherapy (prostate specific antigen greater than 0.2 to 0.5 ng/ml) was associated with a twofold increase in biochemical failure, use of salvage androgen deprivation therapy and distant metastases compared to very early salvage radiotherapy (prostate specific antigen 0.01 to 0.2 ng/ml).
CONCLUSIONS
The duration from radical prostatectomy to salvage radiotherapy is not independently prognostic for outcomes after salvage radiotherapy and it should not be used to define early salvage radiotherapy. Grouping all patients with pre-salvage radiotherapy prostate specific antigen 0.5 ng/ml or less may be inadequate to define early salvage radiotherapy and it has a relevant impact on ongoing and future clinical trials.
Additional Info
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Very Early Salvage Radiotherapy Improves Distant Metastasis-Free Survival
J Urol 2017 Mar 01;197(3 Pt 1)662-668, A Abugharib, WC Jackson, V Tumati, RT Dess, JY Lee, SG Zhao, M Soliman, ZS Zumsteg, R Mehra, FY Feng, TM Morgan, N Desai, DE SprattFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The role of the PSA level as a marker for the initiation of salvage EBRT following prostatectomy is highly controversial and one of the few potentially modifiable factors impacting cancer outcomes. This study by Abugharib et al adds to a growing body of research and specifically addresses a lower PSA threshold of 0.01–0.2 ng/mL.1-3 These studies support the notion that salvage radiation at lower PSA values improves biochemical progression-free survival and stand in stark contrast to the traditional dogma that recommends a value of 0.2 ng/mL.
However, unlike the authors, we are less optimistic about the likelihood that the phase III trials currently underway (RADICALS, RAVES, and GETUG-17) will answer this question because they compare adjuvant EBRT with salvage EBRT at a PSA of 0.1 or 0.2 ng/mL. We believe it is likely that a far more sensitive test might be necessary to rigorously answer the question of true adjuvant versus salvage RT in the post-prostatectomy setting.4
References