PURPOSE: We performed a retrospective analysis to assess the durability of benefit derived from irradiation after prostatectomy for pT3N0 disease, and the possibility of cure. METHODS AND MATERIALS: We studied 88 patients who were irradiated after prostatectomy and had available prostate specific antigen (PSA) data, no known nodal or metastatic disease, no hormonal treatment, and follow-up of at least 12 months from surgery. Forty patients received adjuvant therapy for a high risk of local failure with undetectable PSA. Forty-eight patients received salvage therapy for elevated PSA levels. Mean follow up was 44 months from date of surgery and 31 months from irradiation. Biochemical failure was strictly defined as a confirmed rise in PSA of >10%, or as the ability to detect a previously undetectable PSA value. RESULTS: After salvage irradiation, 69% of patients attained an undetectable PSA. Eighty-eight percent of adjuvant patients were biochemically and clinically free of disease (bNED) at 3 years from prostatectomy. Sixty-eight percent of those receiving salvage irradiation were bNED 3 years after surgery. On univariate analysis, treatment group (adjuvant or salvage), pre-operative PSA, and the status of seminal vesicles were significant prognostic factors. The extent of PSA elevation in the salvage group was also significant. We did not demonstrate a significant difference between those salvage patients referred for persistently elevated PSA as compared to those with a late rise in PSA. On multivariate analysis, the only significant predictor of outcome was treatment group, with adjuvant irradiation having better outcome than salvage. CONCLUSION: More than two-thirds of this group of patients remain biochemically disease free at 3 years following irradiation, attesting to a number of potential cures. For patients with stage pT3N0 prostate cancer following radical prostatectomy, our data support the use of either routine postoperative adjuvant irradiation or close PSA follow-up with early salvage treatment.
PURPOSE: We performed a retrospective analysis to assess the durability of benefit derived from irradiation after prostatectomy for pT3N0 disease, and the possibility of cure. METHODS AND MATERIALS: We studied 88 patients who were irradiated after prostatectomy and had available prostate specific antigen (PSA) data, no known nodal or metastatic disease, no hormonal treatment, and follow-up of at least 12 months from surgery. Forty patients received adjuvant therapy for a high risk of local failure with undetectable PSA. Forty-eight patients received salvage therapy for elevated PSA levels. Mean follow up was 44 months from date of surgery and 31 months from irradiation. Biochemical failure was strictly defined as a confirmed rise in PSA of >10%, or as the ability to detect a previously undetectable PSA value. RESULTS: After salvage irradiation, 69% of patients attained an undetectable PSA. Eighty-eight percent of adjuvant patients were biochemically and clinically free of disease (bNED) at 3 years from prostatectomy. Sixty-eight percent of those receiving salvage irradiation were bNED 3 years after surgery. On univariate analysis, treatment group (adjuvant or salvage), pre-operative PSA, and the status of seminal vesicles were significant prognostic factors. The extent of PSA elevation in the salvage group was also significant. We did not demonstrate a significant difference between those salvage patients referred for persistently elevated PSA as compared to those with a late rise in PSA. On multivariate analysis, the only significant predictor of outcome was treatment group, with adjuvant irradiation having better outcome than salvage. CONCLUSION: More than two-thirds of this group of patients remain biochemically disease free at 3 years following irradiation, attesting to a number of potential cures. For patients with stage pT3N0 prostate cancer following radical prostatectomy, our data support the use of either routine postoperative adjuvant irradiation or close PSA follow-up with early salvage treatment.
Authors: Tavish Nanda; Andrew Yaeh; Cheng-Chia Wu; Ashish Jani; Shumaila Saad; Yasir H Qureshi; Keith A Cauley; Jeraldine Lesser; Simon K Cheng; Steven R Isaacson; Michael B Sisti; Jeffrey N Bruce; Guy M McKhann; Sameer A Sheth; Andrew B Lassman; Tony J C Wang Journal: J Neurooncol Date: 2017-11-23 Impact factor: 4.130
Authors: Gunnar Lohm; Dirk Bottke; Basil Jamil; Kurt Miller; Konrad Neumann; Detlef Bartkowiak; Wolfgang Hinkelbein; Thomas Wiegel Journal: World J Urol Date: 2012-03-30 Impact factor: 4.226
Authors: Edouard J Trabulsi; Richard K Valicenti; Alexandra L Hanlon; Thomas M Pisansky; Howard M Sandler; Deborah A Kuban; Charles N Catton; Jeff M Michalski; Michael J Zelefsky; Patrick A Kupelian; Daniel W Lin; Mitchell S Anscher; Kevin M Slawin; Claus G Roehrborn; Jeffrey D Forman; Stanley L Liauw; Larry L Kestin; Theodore L DeWeese; Peter T Scardino; Andrew J Stephenson; Alan Pollack Journal: Urology Date: 2008-07-30 Impact factor: 2.649