Dennie Meijer1,2, Henk B Luiting3, Pim J van Leeuwen4, Sebastiaan Remmers3, Bernard H E Jansen1,2, Yves J L Bodar1,2, Thelma Witteveen5, Eva E Schaake5, Henk G van der Poel4, Maurits Wondergem6, Martijn B Busstra3, Jakko A Nieuwenhuijzen1,4, Philip Meijnen7, Tessa Brabander8, R Jeroen A van Moorselaar1, N Harry Hendrikse2,9, Daniela E Oprea-Lager2, Monique J Roobol3, André N Vis1,4. 1. Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam, The Netherlands. 2. Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands. 3. Erasmus University Medical Center, Department of Urology, Rotterdam, The Netherlands. 4. The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam, The Netherlands. 5. The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands. 6. Noordwest Ziekenhuisgroep, Department of Nuclear Medicine, Alkmaar, The Netherlands. 7. Amsterdam University Medical Center, VU University, Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands. 8. Erasmus University Medical Center, Department of Radiology & Nuclear Medicine, Rotterdam, The Netherlands. 9. Amsterdam University Medical Center, VU University, Department of Clinical Pharmacology and Pharmacy, Amsterdam, The Netherlands.
Abstract
PURPOSE: We assessed predictors of short-term oncologic outcomes of patients who underwent salvage radiation therapy for biochemical recurrence after robot-assisted laparoscopic radical prostatectomy without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography. MATERIALS AND METHODS: We retrospectively analyzed 194 patients with biochemical recurrence after robot-assisted laparoscopic radical prostatectomy who underwent prostate specific membrane antigen positron emission tomography/computerized tomography prior to salvage radiation therapy. Patients with lymph node or distant metastases on restaging imaging or at the time of extended pelvic lymph node dissection during robot-assisted laparoscopic radical prostatectomy were excluded, as were patients who received androgen deprivation therapy during or prior to salvage radiation therapy. A multivariable logistic regression analysis was performed to assess predictors of treatment response, defined as prostate specific antigen value ≤0.1 ng/ml after salvage radiation therapy. RESULTS: Overall treatment response after salvage radiation therapy was 75% (146/194 patients). On multivariable analysis, prostate specific antigen value at initiation of salvage radiation therapy (OR 0.42, 95% CI 0.27-0.62, p <0.001), pathological T stage (pT3a vs pT2 OR 0.28, 95% CI 0.11-0.69, p=0.006; pT3b vs pT2 OR 0.26, 95% CI 0.09-0.71, p=0.009) and local recurrent disease on imaging (OR 5.53, 95% CI 1.96-18.52, p=0.003) were predictors of treatment response. CONCLUSIONS: Salvage radiation therapy in patients without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography showed a good overall treatment response of 75%. Higher treatment response rates were observed in patients with lower prostate specific antigen values at initiation of salvage radiation therapy, those with local recurrent disease on imaging and those with lower pathological T stage (pT2 vs pT3a/b).
PURPOSE: We assessed predictors of short-term oncologic outcomes of patients who underwent salvage radiation therapy for biochemical recurrence after robot-assisted laparoscopic radical prostatectomy without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography. MATERIALS AND METHODS: We retrospectively analyzed 194 patients with biochemical recurrence after robot-assisted laparoscopic radical prostatectomy who underwent prostate specific membrane antigen positron emission tomography/computerized tomography prior to salvage radiation therapy. Patients with lymph node or distant metastases on restaging imaging or at the time of extended pelvic lymph node dissection during robot-assisted laparoscopic radical prostatectomy were excluded, as were patients who received androgen deprivation therapy during or prior to salvage radiation therapy. A multivariable logistic regression analysis was performed to assess predictors of treatment response, defined as prostate specific antigen value ≤0.1 ng/ml after salvage radiation therapy. RESULTS: Overall treatment response after salvage radiation therapy was 75% (146/194 patients). On multivariable analysis, prostate specific antigen value at initiation of salvage radiation therapy (OR 0.42, 95% CI 0.27-0.62, p <0.001), pathological T stage (pT3a vs pT2 OR 0.28, 95% CI 0.11-0.69, p=0.006; pT3b vs pT2 OR 0.26, 95% CI 0.09-0.71, p=0.009) and local recurrent disease on imaging (OR 5.53, 95% CI 1.96-18.52, p=0.003) were predictors of treatment response. CONCLUSIONS: Salvage radiation therapy in patients without evidence of metastases on prostate specific membrane antigen positron emission tomography/computerized tomography showed a good overall treatment response of 75%. Higher treatment response rates were observed in patients with lower prostate specific antigen values at initiation of salvage radiation therapy, those with local recurrent disease on imaging and those with lower pathological T stage (pT2 vs pT3a/b).
Authors: Henk B Luiting; Sebastiaan Remmers; Dennie Meijer; André N Vis; Maarten Donswijk; Daniela E Oprea-Lager; Louise Emmett; Isabel Rauscher; Henk G Van der Poel; Monique J Roobol; Pim J van Leeuwen Journal: Eur Urol Open Sci Date: 2021-04-29