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• W2897988981 abstract "Salvage radiotherapy (SRT) is a standard curative approach for prostate cancer (PCa) patients with biochemical recurrence after radical prostatectomy (RP). In most cases, RP enables a regression of prostate-specific antigen below detection limits (PSA <0.1 ng/ml), but some patients retain a detectable PSA. We analysed the impact of post-RP PSA persistence on progression-free survival (PFS) after SRT. The 555 patients of this retrospective study were irradiated between 1997 and 2012. All had CT-planned 3D-conformal SRT. Men who received androgen depletion therapy (ADT) between RP and SRT were excluded from the analysis. Events in terms of PFS were defined as a rising post-SRT PSA 0.2 ng/ml above the nadir, the application of second salvage treatment (usually ADT), clinical progression, or death for any reason, whatever happened first. We assessed PFS with the Kaplan-Meier (KM) method / logrank test and with Cox regression analysis. To compensate for systematic differences in the risk factors of men with post-RP undetectable vs. persistent PSA, we analysed 112 pairs of patients with matching combinations of pre-RP PSA (±10 ng/ml), Gleason score (GLS ≤6 vs 7 vs ≥8) and pre-SRT PSA (±0.5 ng/ml). The median follow-up in the overall cohort was 6.1 years. There were 422 men with post-RP undetectable and 133 with persistent PSA. After SRT, PSA progression was documented in 209, ADT in 156, and clinical recurrence in 47 patients; 45 men died. PSA persistence and a pre-SRT PSA ≥0.5 ng/ml had a significant negative impact on the KM rates of PFS. However, in a Cox regression model that also included pT stage and GLS, post-RP PSA persistence failed the significance criterion. The matching procedure caused a shift towards higher-risk profiles in the group with a post-RP undetectable PSA. After risk adjustment, the post-RP PSA level had no significant influence on KM-curves, while the pre-SRT PSA did so, and it did so, too, in the Cox regression. Yet, in the matched cohort’s sub-group with early SRT, there was still a trend (p=0.12) to worse outcome with post-RP PSA persistence. In the matched cohort with its higher-risk profile, delayed SRT at PSA ≥0.5 ng/ml yielded <30% PFS at the median follow-up in both post-RP PSA groups. In PCa patients who retain a detectable PSA after RP, early SRT seems to be less efficient than in patients with a post-RP PSA <0.1 ng/ml. They might benefit from intensified therapy, but larger case numbers are required to validate the evidence. In cases of advanced biochemical progression (PSA ≥0.5 ng/ml) and a higher-risk profile associated with post-RP PSA persistence, sole SRT is unlikely to provide long-term freedom from second progression. More aggressive treatment should be considered." @default.
• W2897988981 created "2018-10-26" @default.
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• W2897988981 date "2018-11-01" @default.
• W2897988981 modified "2023-10-02" @default.
• W2897988981 title "The Impact of Post-RP Persisting PSA on SRT Efficiency – A Matched Pair Analysis" @default.
• W2897988981 doi "https://doi.org/10.1016/j.ijrobp.2018.07.288" @default.
• W2897988981 hasPublicationYear "2018" @default.
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