David Pfister1, Michel Bolla2, Alberto Briganti3, Peter Carroll4, Cesare Cozzarini5, Steven Joniau6, Hein van Poppel6, Mack Roach7, Andrew Stephenson8, Thomas Wiegel9, Michael J Zelefsky10. 1. Department of Urology, RWTH Aachen University, Aachen, Germany. Electronic address: dpfister@ukaachen.de. 2. Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, Grenoble, France. 3. Department of Urology, Università Vita-Salute San Raffaele, Milan, Italy. 4. Department of Urology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. 5. Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy. 6. Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. 7. Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. 8. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 9. Department of Radiation Oncology, University Hospital, Ulm, Germany. 10. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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 Among them, we received previously unpublished patient characteristics and updated outcome data from five retrospective single-centre trials to perform a subgroup analysis for early salvage RT.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.
CONTEXT: Depending on the pathologic tumour stage, up to 60% of prostate cancerpatients 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.
Authors: Henrik Kjölhede; Göran Ahlgren; Helen Almquist; Fredrik Liedberg; Kerstin Lyttkens; Thomas Ohlsson; Ola Bratt Journal: World J Urol Date: 2015-04-01 Impact factor: 4.226
Authors: A Karl; A Buchner; C Tympner; T Kirchner; U Ganswindt; C Belka; R Ganzer; M Burger; F Eder; F Hofstädter; D Schilling; K Sievert; A Stenzl; M Scharpf; F Fend; F Vom Dorp; H Rübben; K Schmid; D Porres-Knoblauch; A Heidenreich; B Hangarter; R Knüchel-Clarke; M Rogenhofer; B Wullich; A Hartmann; E Comploj; A Pycha; E Hanspeter; D Pehrke; G Sauter; M Graefen; C Stief; A Haese Journal: World J Urol Date: 2015-02-15 Impact factor: 4.226
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
Authors: Christina Bluemel; Markus Krebs; Bülent Polat; Fränze Linke; Matthias Eiber; Samuel Samnick; Constantin Lapa; Michael Lassmann; Hubertus Riedmiller; Johannes Czernin; Domenico Rubello; Thorsten Bley; Saskia Kropf; Hans-Juergen Wester; Andreas K Buck; Ken Herrmann Journal: Clin Nucl Med Date: 2016-07 Impact factor: 7.794