Salvage prostatic fossa radiation therapy for biochemical failure after radical prostatectomy: the Sheba experience

The role of prostatic fossa radiation as salvage therapy in the setting of a rising prostate-specific antigen following radical prostatectomy is not well defined.

To study the efficacy and safety of pelvic and prostatic fossa radiation therapy following radical prostatectomy for adenocarcinoma.

A retrospective review of the charts of 1,050 patients treated at the Sheba Medical Center for prostate cancer between 1990 and 2002 identified 48 patients who received post-prostatectomy pelvic and prostatic fossa radiotherapy for biochemical failure. Two patients were classified as T1, T2A-9, T2B-19, T3A-7 and T3B-11. Gleason score was 2-4 in 9 patients, 5-6 in 22 patients, 7 in 10 patients and 8-10 in 7 patients. Positive surgical margins were noted in 28 patients (58%) of whom 18 had single and 10 had multiple positive margins. Radiation was delivered with 6 mV photons using a four-field box to the pelvis followed by two lateral arcs to the prostatic fossa.

At a median follow-up of 34.3 months (25th, 75th) (14.7, 51.3) since radiation therapy, 32 patients (66%) are free of disease or biochemical failure. Exploratory analysis revealed that a pre-radiation PSA less than 2 ng/ml was associated with a failure rate of 24% compared with 66% in patients with a pre-radiation PSA greater than 2 ng/ml (chi-square P < 0.006).

For patients with biochemical failure following radical prostatectomy early salvage radiation therapy is an effective and safe treatment option.