Salvage Radiotherapy for Rising Prostate-Specific Antigen Levels After Radical Prostatectomy for Prostate Cancer

Dose-Response Analysis

Johnny Ray Bernard, Steven J. Buskirk, Michael G. Heckman, Nancy N. Diehl, Stephen J. Ko, Orlan K. Macdonald, Steven E. Schild, Thomas M. Pisansky

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Purpose: To investigate the association between external beam radiotherapy (EBRT) dose and biochemical failure (BcF) of prostate cancer in patients who received salvage prostate bed EBRT for a rising prostate-specific antigen (PSA) level after radical prostatectomy. Methods and Materials: We evaluated patients with a rising PSA level after prostatectomy who received salvage EBRT between July 1987 and October 2007. Patients receiving pre-EBRT androgen suppression were excluded. Cox proportional hazards models were used to investigate the association between EBRT dose and BcF. Dose was considered as a numeric variable and as a categoric variable (low, <64.8 Gy; moderate, 64.8-66.6 Gy; high, >66.6 Gy). Results: A total of 364 men met study selection criteria and were followed up for a median of 6.0 years (range, 0.1-19.3 years). Median pre-EBRT PSA level was 0.6 ng/mL. The estimated cumulative rate of BcF at 5 years after EBRT was 50% overall and 57%, 46%, and 39% for the low-, moderate-, and high-dose groups, respectively. In multivariable analysis adjusting for potentially confounding variables, there was evidence of a linear trend between dose and BcF, with risk of BcF decreasing as dose increased (relative risk [RR], 0.77 [5.0-Gy increase]; p = 0.05). Compared with the low-dose group, there was evidence of a decreased risk of BcF for the high-dose group (RR, 0.60; p = 0.04), but no difference for the moderate-dose group (RR, 0.85; p = 0.41). Conclusions: Our results suggest a dose response for salvage EBRT. Doses higher than 66.6 Gy result in decreased risk of BcF.

Original languageEnglish (US)
Pages (from-to)735-740
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume76
Issue number3
DOIs
StatePublished - Mar 1 2010

Fingerprint

antigens
Prostate-Specific Antigen
Prostatectomy
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
dosage
Confounding Factors (Epidemiology)
Proportional Hazards Models
Patient Selection
Androgens
Prostate
hazards
beds
adjusting
retarding
trends

Keywords

  • Biochemical failure
  • Dose response
  • Prostate bed
  • Prostate-specific antigen recurrence
  • Salvage

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Salvage Radiotherapy for Rising Prostate-Specific Antigen Levels After Radical Prostatectomy for Prostate Cancer : Dose-Response Analysis. / Bernard, Johnny Ray; Buskirk, Steven J.; Heckman, Michael G.; Diehl, Nancy N.; Ko, Stephen J.; Macdonald, Orlan K.; Schild, Steven E.; Pisansky, Thomas M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 76, No. 3, 01.03.2010, p. 735-740.

Research output: Contribution to journalArticle

Bernard, Johnny Ray ; Buskirk, Steven J. ; Heckman, Michael G. ; Diehl, Nancy N. ; Ko, Stephen J. ; Macdonald, Orlan K. ; Schild, Steven E. ; Pisansky, Thomas M. / Salvage Radiotherapy for Rising Prostate-Specific Antigen Levels After Radical Prostatectomy for Prostate Cancer : Dose-Response Analysis. In: International Journal of Radiation Oncology Biology Physics. 2010 ; Vol. 76, No. 3. pp. 735-740.
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abstract = "Purpose: To investigate the association between external beam radiotherapy (EBRT) dose and biochemical failure (BcF) of prostate cancer in patients who received salvage prostate bed EBRT for a rising prostate-specific antigen (PSA) level after radical prostatectomy. Methods and Materials: We evaluated patients with a rising PSA level after prostatectomy who received salvage EBRT between July 1987 and October 2007. Patients receiving pre-EBRT androgen suppression were excluded. Cox proportional hazards models were used to investigate the association between EBRT dose and BcF. Dose was considered as a numeric variable and as a categoric variable (low, <64.8 Gy; moderate, 64.8-66.6 Gy; high, >66.6 Gy). Results: A total of 364 men met study selection criteria and were followed up for a median of 6.0 years (range, 0.1-19.3 years). Median pre-EBRT PSA level was 0.6 ng/mL. The estimated cumulative rate of BcF at 5 years after EBRT was 50{\%} overall and 57{\%}, 46{\%}, and 39{\%} for the low-, moderate-, and high-dose groups, respectively. In multivariable analysis adjusting for potentially confounding variables, there was evidence of a linear trend between dose and BcF, with risk of BcF decreasing as dose increased (relative risk [RR], 0.77 [5.0-Gy increase]; p = 0.05). Compared with the low-dose group, there was evidence of a decreased risk of BcF for the high-dose group (RR, 0.60; p = 0.04), but no difference for the moderate-dose group (RR, 0.85; p = 0.41). Conclusions: Our results suggest a dose response for salvage EBRT. Doses higher than 66.6 Gy result in decreased risk of BcF.",
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AU - Buskirk, Steven J.

AU - Heckman, Michael G.

AU - Diehl, Nancy N.

AU - Ko, Stephen J.

AU - Macdonald, Orlan K.

AU - Schild, Steven E.

AU - Pisansky, Thomas M.

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KW - Salvage

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