Early Salvage Radiotherapy for Biochemical Recurrence After Prostatectomy

Summary and Comment |
September 7, 2016

Early Salvage Radiotherapy for Biochemical Recurrence After Prostatectomy

  1. Robert Dreicer, MD, MS, FACP, FASCO

Initiation of SRT at prostate-specific antigen levels of ≤0.5 ng/mL was associated with improved outcomes.

  1. Robert Dreicer, MD, MS, FACP, FASCO

Detectable prostate-specific antigen (PSA) following radical prostatectomy for prostate cancer is seen in 25% to 35% of patients. Such biochemical recurrence represents a clinical dilemma, as it potentially represents either local or local and systemic disease. Prospective evidence supports the use of salvage radiotherapy (SRT) in this setting, but when to administer SRT is unclear.

Now, investigators at a single academic center have assessed outcomes over a 25-year period in 1106 prostate cancer patients who had detectable PSA (≥0.1 ng/mL) after radical prostatectomy and were treated with SRT. Patients were stratified by pre-SRT PSA levels of ≤0.5 and ≥0.5 ng/mL.

At median follow-up of 8.9 years, 54% of patients had experienced biochemical recurrence. Incidences of distant metastases at 5 and 10 years were 10.9% and 19.9%, respectively. Of 280 deaths, 110 (39%) were attributed to prostate cancer. Pre-SRT PSA levels were independently associated with risk for distant metastases: 10-year incidence of distant metastases was significantly lower for patients with pre-SRT PSA values of ≤0.5 versus ≥0.5 ng/mL (13% vs. 25%; P<0.001), although overall survival was similar (83% and 73%, respectively).

Comment

As noted by the authors, although there are data supporting a role for adjuvant RT, significant numbers of men are treated without benefit, and because therapy bears an adverse-effect burden, many clinicians are reluctant to make an RT recommendation. Although retrospective, this series is large, has long-term follow-up, and provides additional evidence that salvage RT in the setting of PSA values ≤0.5 leads to improvement in a number of clinically relevant measures, with potential impact on survival. Data from ongoing prospective studies will be required to make definitive recommendations.

Editor Disclosures at Time of Publication

  • Disclosures for Robert Dreicer, MD, MS, FACP, FASCO at time of publication Consultant / Advisory board Medivation; Genentech/Roche; Ferring; Asana; Churchill Pharma; Tokai Editorial boards Urology; Clinical Genitourinary Cancer; Current Urology Reports Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee); Bladder Cancer Advocacy Network (Member, Scientific Advisory Board)

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