Multimodality salvage for patients with persistently elevated postprostatectomy PSA

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Persistently elevated prostate-specific antigen (PSA) after prostatectomy presents a management challenge.
• Optimal salvage strategies for rising PSA post-prostatectomy are not well-defined.

Purpose of the Study:

• To evaluate the efficacy of whole-pelvis radiation therapy combined with hormonal blockade as a salvage treatment for men with persistently elevated postprostatectomy PSA.

Main Methods:

• 14 men with elevated postprostatectomy PSA and negative metastatic work-up received whole-pelvis radiation (4500 cGy/25 fractions) followed by a prostate-bed boost (2000 cGy/10 fractions).
• Hormonal blockade using LHRH agonist was administered for 6 months concurrently with radiation.
• Patients were stratified based on PSA levels at the time of salvage initiation (<5.0 ng/ml vs. >5.0 ng/ml).

Main Results:

• All 10 patients initiated salvage treatment with PSA <5.0 ng/ml achieved undetectable PSA levels at a median follow-up of 44 months (range 36-56 months).
• None of the four patients initiated salvage treatment with PSA >5.0 ng/ml maintained undetectable PSA levels.
• No chronic morbidity from radiation or hormone treatment was reported.

Conclusions:

• Whole-pelvis radiation therapy and hormonal blockade is an effective salvage strategy for postprostatectomy PSA elevation when PSA is less than or equal to 5.0 ng/ml.
• Patients with postprostatectomy PSA levels greater than 5.0 ng/ml may require salvage approaches with a stronger emphasis on systemic therapy.