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A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
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Contemporary salvage post prostatectomy radiotherapy: Early implementation improves biochemical control.
Andrew Kneebone1,2, George Hruby1,2, Georgia Harris1,2
1Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Journal of Medical Imaging and Radiation Oncology
|October 29, 2017
Summary
Higher pre-treatment prostate-specific antigen (PSA) levels before salvage radiotherapy (SRT) correlate with increased risk of biochemical failure (BCF) after prostatectomy. Early SRT is recommended for men with rising PSA to improve outcomes.
Area of Science:
- Urology
- Radiation Oncology
- Oncology
Background:
- The optimal timing for salvage radiotherapy (SRT) following radical prostatectomy for rising prostate-specific antigen (PSA) remains unclear.
- This study investigates the impact of pre-treatment PSA (iPSA) levels on biochemical failure (BCF) rates after SRT.
Purpose of the Study:
- To assess the relationship between index PSA (iPSA) levels before SRT and the rate of biochemical failure (BCF) post-treatment.
- To identify prognostic factors for BCF in patients undergoing SRT.
Main Methods:
- A prospective database of 189 patients receiving SRT for rising PSA post-prostatectomy was analyzed.
- Data collected included baseline demographics, tumor characteristics (pathologic T and N stage, margin status, Gleason score, LVSI), ADT use, and time from surgery to SRT.
- The primary endpoint was time to biochemical failure (BCF).
Main Results:
- Patients with iPSA ≥ 1.0 ng/mL had a 73.7% BCF rate at 5 years, compared to 28.3% for iPSA < 0.2 ng/mL.
- Higher iPSA levels (≥ 0.2 to < 1.0 ng/mL and ≥ 1.0 ng/mL) were significantly associated with increased hazard ratios for BCF (1.73 and 3.1, respectively).
- Multivariate analysis identified iPSA, Gleason score, T stage, PSA nadir, margin status, and ADT use as significant predictors of BCF.
Conclusions:
- Rising pre-treatment PSA levels are a significant predictor of increased biochemical failure risk after SRT.
- Early initiation of salvage radiotherapy post-prostatectomy is recommended, particularly in the context of rising PSA levels.
- Prognostic factors like Gleason score, T stage, and margin status also play a crucial role in predicting outcomes.
