A multi-institutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy

Tom Budiharto, Christiaan Perneel, Karin Haustermans, Sara Junius, Bertrand Tombal, Pierre Scalliet, Laurette Renard, Evelyne Lerut, Kris Vekemans, Steven Joniau, Hendrik Van Poppel

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: In men with adverse pathology at the time of radical prostatectomy (RP), the most appropriate timing to administer radiotherapy (RT) remains a subject for debate. To determine whether salvage radiotherapy (SRT) upon early prostate-specific antigen (PSA) relapse is equivalent to immediate adjuvant radiotherapy (ART) post RP. Material and methods: 130 patients receiving ART and 89 receiving SRT were identified. All had an undetectable PSA after RP. Homogeneous subgroups were built based on the status (±) of lymphatic invasion (LVI) and surgical margins (SM), to allow a comparison of ART and SRT. Biochemical disease-free survival (bDFS) was calculated from the date of surgery and from the end of RT. The multivariate analysis was performed using the Cox Proportional hazard model. Results: In the SM-/LVI- and SM+/LVI- groups, SRT was a significant predictor of a decreased bDFS from the date of surgery, while in the SM+/LVI+ group, there was a trend towards significance. From the end of RT, SRT was also a significant predictor of a decreased bDFS in three patient groups: SM-/LVI-, SM+/LVI- and SM+/LVI+. Gleason score >7 showed to be another factor on multivariate analysis associated with decreased bDFS in the SM-/LVI- group, from the date of surgery and end of RT. Preoperative PSA was a significant predictor in the SM-/LVI- group from the date of RP only. Conclusions: Immediate ART post RP for patients with high risk features in the prostatectomy specimen significantly reduces bDFS after RP compared with early SRT upon PSA relapse.

Original languageEnglish
Pages (from-to)474-479
Number of pages6
JournalRadiotherapy and Oncology
Volume97
Issue number3
DOIs
Publication statusPublished - Dec 2010

Keywords

  • Adjuvant
  • High risk
  • Postoperative radiotherapy
  • Prostate cancer
  • Salvage

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