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Salvage radiotherapy after radical prostatectomy: further insights

Posted Sep 29 2008 4:46pm

Macdonald et al. have reported that, based on an analysis of data from the CaPSURE™ database, salvage radiotherapy (SRT) is optimal for patients with low pre-SRT PSA levels, long PSA doubling times, and favorable pathologic features. Patients who do not meet these criteria may benefit significantly less from SRT, particularly if the potential for complications and side effects is taken into account.

The appropriate role of SRT for patients with a rising PSA after radical prostatectomy (RP) is debatable. The authors analyzed data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database to evaluate potential predictors of PSA failure after SRT.

The database included 4,563 men who underwent RP between 1989 and 2004; 194 underwent SRT ≥ 6 months after RP. PSA failure following SRT was defined as a PSA >0.2 ng/mL. After a median follow-up of 66 months, 121 (62 percent) of these men experienced PSA failure at a median 20 months. Significant association with PSA failure was nioted for the following:

  • clinical T category (P < 0.01)
  • race/ethnicity (P = 0.04)
  • pT3 disease (P < 0.01)
  • seminal vesicle invasion (P < 0.01)
  • pre-RT PSA level (P < 0.01)

However, it appears that the pre-RT PSA level was the only factor to even approach significance (P >0.07) as an independent predictor of PSA failure.

Pre-RT PSA doubling time was calculated for 131 men but did not predict for PSA failure at &le; 12 months compared to > 12 months.

SRT appeared to provide the greatest benefit in controlling the PSA levels of men with the lowest pre-RT PSA levels. Post-RP PSA doubling time >12 months trended toward predicting for PSA failure but was not significant likely owing to limited sample size.

It should be noted that we have only seen the abstract of this paper. A key piece of missing information is what percentage of the men in this study received adjuvant hormone therapy together with the SRT and for how long.

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