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Multimodality salvage for patients with persistently elevated postprostatectomy PSA.

R R Allison1, A Schulsinger

  • 1Department of Radiation Oncology, State University of New York at Buffalo, USA.

International Journal of Cancer
|February 17, 2001
PubMed
Summary
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Salvage radiation therapy with hormonal blockade effectively lowers prostate-specific antigen (PSA) in men with persistently elevated postprostatectomy PSA levels below 5.0 ng/ml. Higher PSA levels may necessitate systemic treatments.

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).

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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.