CONTEXT: Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy, but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival, and if so, the subgroup of men most likely to benefit. OBJECTIVES: To quantify the relative improvement in prostate cancer-specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy, and to identify subgroups for whom salvage treatment is most beneficial. DESIGN, SETTING, AND PATIENTS: Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982-2004, followed up through December 28, 2007, who experienced biochemical and/or local recurrence and received no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78). MAIN OUTCOME MEASURE: Prostate cancer-specific survival defined from time of recurrence until death from disease. RESULTS: With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer-specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival. CONCLUSIONS: Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial.
CONTEXT: Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy, but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival, and if so, the subgroup of men most likely to benefit. OBJECTIVES: To quantify the relative improvement in prostate cancer-specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy, and to identify subgroups for whom salvage treatment is most beneficial. DESIGN, SETTING, AND PATIENTS: Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982-2004, followed up through December 28, 2007, who experienced biochemical and/or local recurrence and received no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78). MAIN OUTCOME MEASURE: Prostate cancer-specific survival defined from time of recurrence until death from disease. RESULTS: With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer-specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival. CONCLUSIONS: Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial.
Authors: Andrew J Stephenson; Peter T Scardino; Michael W Kattan; Thomas M Pisansky; Kevin M Slawin; Eric A Klein; Mitchell S Anscher; Jeff M Michalski; Howard M Sandler; Daniel W Lin; Jeffrey D Forman; Michael J Zelefsky; Larry L Kestin; Claus G Roehrborn; Charles N Catton; Theodore L DeWeese; Stanley L Liauw; Richard K Valicenti; Deborah A Kuban; Alan Pollack Journal: J Clin Oncol Date: 2007-05-20 Impact factor: 44.544
Authors: Matthew S Katz; Michael J Zelefsky; Ennapadam S Venkatraman; Zvi Fuks; Amanda Hummer; Steven A Leibel Journal: J Clin Oncol Date: 2003-02-01 Impact factor: 44.544
Authors: A W Partin; J D Pearson; P K Landis; H B Carter; C R Pound; J Q Clemens; J I Epstein; P C Walsh Journal: Urology Date: 1994-05 Impact factor: 2.649
Authors: Andrew J Stephenson; Shahrokh F Shariat; Michael J Zelefsky; Michael W Kattan; E Brian Butler; Bin S Teh; Eric A Klein; Patrick A Kupelian; Claus G Roehrborn; David A Pistenmaa; Heather D Pacholke; Stanley L Liauw; Matthew S Katz; Steven A Leibel; Peter T Scardino; Kevin M Slawin Journal: JAMA Date: 2004-03-17 Impact factor: 56.272
Authors: David M Schuster; Bital Savir-Baruch; Peter T Nieh; Viraj A Master; Raghuveer K Halkar; Peter J Rossi; Melinda M Lewis; Jonathon A Nye; Weiping Yu; F DuBois Bowman; Mark M Goodman Journal: Radiology Date: 2011-04-14 Impact factor: 11.105
Authors: William U Shipley; Wendy Seiferheld; Himanshu R Lukka; Pierre P Major; Niall M Heney; David J Grignon; Oliver Sartor; Maltibehn P Patel; Jean-Paul Bahary; Anthony L Zietman; Thomas M Pisansky; Kenneth L Zeitzer; Colleen A F Lawton; Felix Y Feng; Richard D Lovett; Alexander G Balogh; Luis Souhami; Seth A Rosenthal; Kevin J Kerlin; James J Dignam; Stephanie L Pugh; Howard M Sandler Journal: N Engl J Med Date: 2017-02-02 Impact factor: 91.245
Authors: Emmanuel S Antonarakis; Yongmei Chen; Sally I Elsamanoudi; Stephen A Brassell; Mario V Da Rocha; Mario A Eisenberger; David G McLeod Journal: BJU Int Date: 2010-11-23 Impact factor: 5.588
Authors: T M Morgan; S R Hawken; K R Ghani; D C Miller; F Y Feng; S M Linsell; J A Salisz; Y Gao; J E Montie; M L Cher Journal: Prostate Cancer Prostatic Dis Date: 2016-03-08 Impact factor: 5.554