Salvage radiotherapy for men with isolated rising PSA or locally palpable recurrence after radical prostatectomy: Do outcomes differ?

O. Kenneth MacDonald, Steven E. Schild, Sujaya Vora, Paul E. Andrews, Robert G. Ferrigni, Donald E. Novicki, Scott K. Swanson, William W. Wong

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Abstract

To compare, in a retrospective analysis, the outcome of salvage external beam radiotherapy (EBRT) for isolated prostate-specific antigen (PSA) elevation or palpable local recurrence after radical prostatectomy (RP). We evaluated 102 men who underwent EBRT from 1993 to 1999, 60 for a rising PSA level alone and 42 for palpable local disease after RP. Biochemical disease-free survival and overall survival were calculated. Prognostic factors were evaluated to determine associations with biochemical disease-free survival. The 5-year rate of biochemical disease-free survival, local control, freedom from distant metastasis, and overall survival for all 102 patients was 38%, 94%, 87%, and 88%, respectively. All palpable disease resolved completely after salvage EBRT. The greatest 5-year rate of biochemical control (69%) was obtained in patients with a pre-EBRT PSA level of 0.5 ng/mL or less. The 5-year overall survival rate was significantly better for those who underwent salvage EBRT for a rising PSA level than for those with palpable recurrence (96% versus 78%, P = 0.02). A low pre-EBRT PSA level and a less than 2-year interval from RP to EBRT were independent predictors of biochemical failure. Five patients (5%) experienced chronic grade 3 or 4 RT-related toxicity. Salvage EBRT provides excellent local control of recurrent disease after RP. Salvage EBRT before the development of palpable local disease may confer a survival benefit and decrease the risk of metastasis, and durable biochemical control was achieved best in those whose pre-EBRT PSA level was 0.5 ng/mL or less. Early referral and careful patient selection is vital for salvage EBRT to be of optimal benefit.

Original languageEnglish (US)
Pages (from-to)760-764
Number of pages5
JournalUrology
Volume64
Issue number4
DOIs
StatePublished - Oct 1 2004

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ASJC Scopus subject areas

  • Urology

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MacDonald, O. K., Schild, S. E., Vora, S., Andrews, P. E., Ferrigni, R. G., Novicki, D. E., Swanson, S. K., & Wong, W. W. (2004). Salvage radiotherapy for men with isolated rising PSA or locally palpable recurrence after radical prostatectomy: Do outcomes differ? Urology, 64(4), 760-764. https://doi.org/10.1016/j.urology.2004.05.016