Salvage radiotherapy after radical prostatectomy: prediction of biochemical outcomes

• Published in: PloS one 2014-07, Vol.9 (7), p.e103574-e103574
• Main Authors: Kwon, Ohseong, Kim, Ki Bom, Lee, Young Ik, Byun, Seok-Soo, Kim, Jae-Sung, Lee, Sang Eun, Hong, Sung Kyu
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Analysis; Androgens; Antigens; Biochemistry; Cancer therapies; Deprivation; Disease-Free Survival; Follow-Up Studies; Gamma Rays; Humans; Kaplan-Meier Estimate; Male; Medical prognosis; Medicine and Health Sciences; Metastasis; Middle Aged; Mortality; Multivariate analysis; Parameters; Patients; Proportional Hazards Models; Prostate; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radiation therapy; Radiotherapy; Recurrence; Regression analysis; Regression models; Retrospective Studies; Salvage; Salvage Therapy; Surgery; Survival; Urological surgery; Urology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0103574

A significant proportion of patients undergoing salvage radiotherapy (RT) for biochemical recurrence (BCR) following radical prostatectomy (RP) may again experience BCR after salvage RT. Thus, we evaluated the clinical significances of different parameters on the biochemical outcome of RT in salvage setting. We reviewed the records of 212 patients who underwent salvage RT between November 2003 and December 2012 for BCR following primary RP. BCR-free survivals after salvage RT were estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to evaluate the impacts of clinicopathologic parameters on BCR following salvage RT. The overall median follow-up duration was 63.5 months. The BCR-free survival rate after salvage RT was 58.2% at 5 years. Multivariate analysis showed that a pre-RT prostate-specific antigen (PSA) level of ≤0.5 ng/mL, a pre-RT PSA doubling time (PSADT) of >4.5 months, concomitant androgen deprivation therapy (ADT) with salvage RT, and a positive surgical margin were independent predictors of favorable biochemical outcomes after salvage RT (hazard ratios [HR] = 3.012, 1.132, 2.000, and 1.805, respectively, p = less than 0.001, 0.013, 0.005, and 0.036, respectively). In the early (pre-RT PSA ≤0.5 ng/mL) salvage RT setting, concomitant ADT administration was also shown to be significantly associated with higher risk of BCR-free survival following salvage RT (HR = 2.611, p = 0.038). Lower pre-RT PSA value, longer PSADT before salvage RT, concomitant ADT administration, and a positive surgical margin were significant predictors of favorable biochemical outcomes following salvage RT performed for BCR after primary RP.