Ahmed Abugharib1, William C Jackson1, Vasu Tumati2, Robert T Dess1, Jae Y Lee1, Shuang G Zhao1, Moaaz Soliman1, Zachary S Zumsteg3, Rohit Mehra4, Felix Y Feng5, Todd M Morgan6, Neil Desai2, Daniel E Spratt7. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 2. Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas. 3. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California. 4. Department of Pathology, University of Michigan, Ann Arbor, Michigan. 5. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, University of California-San Francisco, San Francisco, California. 6. Department of Urology, University of Michigan, Ann Arbor, Michigan. 7. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: sprattda@med.umich.edu.
Abstract
PURPOSE: 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 (R2 = 0.18). Increasing pre-salvage radiotherapy prostate specific antigen strongly correlated with biochemical relapse-free survival (R2 = 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.
PURPOSE: 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 (R2 = 0.18). Increasing pre-salvage radiotherapy prostate specific antigen strongly correlated with biochemical relapse-free survival (R2 = 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.
Authors: Robert T Dess; Todd M Morgan; Paul L Nguyen; Rohit Mehra; Howard M Sandler; Felix Y Feng; Daniel E Spratt Journal: Curr Urol Rep Date: 2017-07 Impact factor: 3.092
Authors: F Casas; I Valduvieco; G Oses; L Izquierdo; I Archila; M Costa; K S Cortes; T Barreto; F Ferrer Journal: Clin Transl Oncol Date: 2018-08-20 Impact factor: 3.405
Authors: William L Hwang; Rahul D Tendulkar; Andrzej Niemierko; Shree Agrawal; Kevin L Stephans; Daniel E Spratt; Jason W Hearn; Bridget F Koontz; W Robert Lee; Jeff M Michalski; Thomas M Pisansky; Stanley L Liauw; Matthew C Abramowitz; Alan Pollack; Drew Moghanaki; Mitchell S Anscher; Robert B Den; Anthony L Zietman; Andrew J Stephenson; Jason A Efstathiou Journal: JAMA Oncol Date: 2018-05-10 Impact factor: 31.777
Authors: Khaled Ajib; Marc Zanaty; Mansour Alnazari; Emad Rajih; Pierre-Alain Hueber; Mila Mansour; Roger Valdivieso; Cristina Negrean; Pierre I Karakiewicz; Daniel Taussky; Guila Delouya; Assaad El-Hakim; Kevin C Zorn Journal: Can Urol Assoc J Date: 2017-12-01 Impact factor: 1.862
Authors: Felipe Couñago; Ana Aurora Díaz Gavela; Gemma Sancho; Irene Ortiz; Francisco José Marcos; Manuel Recio; Julio Fernández; Raquel Cano; Mar Jiménez; Israel J Thuissard; David Sanz-Rosa; Juan Castro Nováis; Eduardo Pardo; Yolanda Molina; Hugo Pérez García; Elia Del Cerro Journal: Rep Pract Oncol Radiother Date: 2019-08-08
Authors: Nina-Sophie Schmidt-Hegemann; Christian Stief; Tak-Hyun Kim; Chukwuka Eze; Simon Kirste; Iosif Strouthos; Minglun Li; Wolfgang Schultze-Seemann; Harun Ilhan; Wolfgang Peter Fendler; Peter Bartenstein; Anca-Ligia Grosu; Ute Ganswindt; Claus Belka; Philipp T Meyer; Constantinos Zamboglou Journal: J Nucl Med Date: 2018-07-12 Impact factor: 10.057
Authors: Robert T Dess; Yilun Sun; William C Jackson; Neil K Jairath; Amar U Kishan; David G Wallington; Brandon A Mahal; Bradley J Stish; Zachery S Zumsteg; Robert B Den; William A Hall; Laila A Gharzai; Elizabeth M Jaworski; Zachary R Reichert; Todd M Morgan; Rohit Mehra; Edward M Schaeffer; Oliver Sartor; Paul L Nguyen; William Robert Lee; Seth A Rosenthal; Jeff M Michalski; Matthew J Schipper; James J Dignam; Thomas M Pisansky; Anthony L Zietman; Howard M Sandler; Jason A Efstathiou; Felix Y Feng; William U Shipley; Daniel E Spratt Journal: JAMA Oncol Date: 2020-05-01 Impact factor: 31.777