Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer Journal Article

Authors: Katz, M. S.; Zelefsky, M. J.; Venkatraman, E. S.; Fuks, Z.; Hummer, A.; Leibel, S. A.
Article Title: Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer
Abstract: Purpose: To identify predictors of biochemical outcome following radiotherapy in patients with a rising prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer. Patients and Methods: One hundred fifteen patients with a rising PSA after radical prostatectomy received salvage three-dimensional conformal radiotherapy (3D-CRT) alone or with neoadjuvant androgen deprivation. Tumor-related and treatment-related factors were evaluated to identify predictors of subsequent PSA failure. Results: The median follow-up time after 3D-CRT was 42 months. The 4-year actuarial PSA relapse-free survival, distant metastasis-free survival, and overall survival rates were 46%, 83%, and 95%, respectively. Multivariate analysis, which was limited to 70 patients receiving radiation without androgen deprivation therapy, showed that negative/close margins (P = .03), absence of extracapsular extension (P < .01), and presence of seminal vesicle invasion (P < .01) were independent predictors of PSA relapse after radiotherapy. Neoadjuvant androgen deprivation did not improve the 4-year PSA relapse-free survival in patients with positive margins, extracapsular extension, and no seminal vesicle invasion (P = .24). However, neoadjuvant androgen deprivation did improve PSA relapse-free survival when one or more of these variables were absent (P = .03). Conclusions: Salvage 3D-CRT can provide biochemical control in selected patients with a rising PSA after radical prostatectomy. Among patients with positive margins and no poor prognostic features, 77% achieved PSA control after salvage 3D-CRT. Salvage neoadjuvant androgen deprivation therapy may improve short-term biochemical control, but it requires further study. © 2003 by American Society of Clinical Oncology.
Keywords: adult; controlled study; human tissue; aged; disease-free survival; middle aged; major clinical study; overall survival; androgen; clinical feature; clinical trial; histopathology; cancer recurrence; salvage therapy; adjuvant therapy; disease free survival; neoadjuvant therapy; follow up; prostate specific antigen; metastasis; controlled clinical trial; neoplasm recurrence, local; pathology; prostate cancer; cancer invasion; prostate-specific antigen; prostatic neoplasms; prostatectomy; tumor recurrence; prostate tumor; androgen antagonists; neoplasm metastasis; forecasting; neoplasm invasiveness; hormonal therapy; radiotherapy, conformal; antiandrogen; seminal vesicle; computer assisted radiotherapy; humans; prognosis; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 21
Issue: 3
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2003-02-01
Start Page: 483
End Page: 489
Language: English
DOI: 10.1200/jco.2003.12.043
PUBMED: 12560439
PROVIDER: scopus
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    285 Seshan
  2. Amanda J Hummer
    60 Hummer
  3. Zvi Fuks
    291 Fuks
  4. Michael J Zelefsky
    615 Zelefsky
  5. Matthew Katz
    12 Katz
  6. Steven A Leibel
    215 Leibel