Prostate Cancer–Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy | Cancer Biomarkers | JAMA | JAMA Network
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1.
Penson DF, Chan JM. Prostate cancer.  J Urol. 2007;177(6):2020-202917509282PubMedGoogle ScholarCrossref
2.
Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy: the 15-year Johns Hopkins experience.  Urol Clin North Am. 2001;28(3):555-56511590814PubMedGoogle ScholarCrossref
3.
Ward JF, Moul JW. Rising prostate-specific antigen after primary prostate cancer therapy.  Nat Clin Pract Urol. 2005;2(4):174-18216474760PubMedGoogle ScholarCrossref
4.
Pound CR, Partin AW, Eisenberger MA,  et al.  Natural history of progression after PSA elevation following radical prostatectomy.  JAMA. 1999;281(17):1591-159710235151PubMedGoogle ScholarCrossref
5.
Bolla M, van Poppel H, Collette L,  et al; European Organization for Research and Treatment of Cancer.  Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911).  Lancet. 2005;366(9485):572-57816099293PubMedGoogle ScholarCrossref
6.
Thompson IM, Tangen CM, Paradelo J,  et al.  Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial.  JAMA. 2006;296(19):2329-233517105795PubMedGoogle ScholarCrossref
7.
Choo R, Kawakami J, Siemens R,  et al.  Two different perspectives in the management of pT3 and/or margin-positive prostate cancer after radical prostatectomy.  BJU Int. 2006;98(4):773-77616978271PubMedGoogle ScholarCrossref
8.
Boccon-Gibod L. pT3 prostate cancer: the case for salvage (as opposed to adjuvant) radiation therapy.  Eur Urol Suppl. 2007;6(8):521-524Google ScholarCrossref
9.
Harrell FE Jr. Regression Modeling Strategies With Applications to Linear Models, Logistic Regression and Survival Analysis. New York, NY: Springer Verlag; 2001
10.
Maffezzini M, Bossi A, Collette L. Implications of prostate-specific antigen doubling time as indicator of failure after surgery or radiation therapy for prostate cancer.  Eur Urol. 2007;51(3):605-61317113217PubMedGoogle ScholarCrossref
11.
Leventis AK, Shariat SF, Kattan MW,  et al.  Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy.  J Clin Oncol. 2001;19(4):1030-103911181666PubMedGoogle Scholar
12.
Stephenson AJ, Shariat SF, Zelefsky MJ,  et al.  Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy.  JAMA. 2004;291(11):1325-133215026399PubMedGoogle ScholarCrossref
13.
Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Blute ML. Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy.  J Urol. 2004;172(6 pt 1):2244-224815538240PubMedGoogle ScholarCrossref
14.
Stephenson AJ, Scardino PT, Kattan MW,  et al.  Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy.  J Clin Oncol. 2007;25(15):2035-204117513807PubMedGoogle ScholarCrossref
15.
Anscher MS, Clough R, Dodge R. Radiotherapy for a rising prostate-specific antigen after radical prostatectomy: the first 10 years.  Int J Radiat Oncol Biol Phys. 2000;48(2):369-37510974449PubMedGoogle ScholarCrossref
16.
Song DY, Thompson TL, Ramakrishnan V,  et al.  Salvage radiotherapy for rising or persistent PSA after radical prostatectomy.  Urology. 2002;60(2):281-28712137827PubMedGoogle ScholarCrossref
17.
Chawla AK, Thakral HK, Zietman AL, Shipley WU. Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: analysis of efficacy and prognostic factors.  Urology. 2002;59(5):726-73111992848PubMedGoogle ScholarCrossref
18.
Katz MS, Zelefsky MJ, Venkatraman ES,  et al.  Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer.  J Clin Oncol. 2003;21(3):483-48912560439PubMedGoogle ScholarCrossref
19.
Liauw SL, Webster WS, Pistenmaa DA, Roehrborn CG. Salvage radiotherapy for biochemical failure of radical prostatectomy: a single-institution experience.  Urology. 2003;61(6):1204-121012809898PubMedGoogle ScholarCrossref
20.
Buskirk SJ, Pisansky TM, Schild SE,  et al.  Salvage radiotherapy for isolated prostate specific antigen increase after radical prostatectomy: evaluation of prognostic factors and creation of a prognostic scoring system.  J Urol. 2006;176(3):985-99016890677PubMedGoogle ScholarCrossref
21.
Overgaard M, Hansen PS, Overgaard J,  et al.  Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial.  N Engl J Med. 1997;337(14):949-9559395428PubMedGoogle ScholarCrossref
22.
Overgaard M, Jensen MB, Overgaard J,  et al.  Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial.  Lancet. 1999;353(9165):1641-164810335782PubMedGoogle ScholarCrossref
23.
Ragaz J, Olivotto IA, Spinelli JJ,  et al.  Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial.  J Natl Cancer Inst. 2005;97(2):116-12615657341PubMedGoogle ScholarCrossref
24.
Clarke M, Collins R, Darby S,  et al; Early Breast Cancer Trialists' Collaborative Group.  Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials.  Lancet. 2005;366(9503):2087-210616360786PubMedGoogle Scholar
25.
Partin AW, Pearson JD, Landis PK,  et al.  Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases.  Urology. 1994;43(5):649-6597513108PubMedGoogle ScholarCrossref
Preliminary Communication
June 18, 2008

Prostate Cancer–Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy

Author Affiliations

Author Affiliations: Brady Urological Institute (Drs Trock, Han, Partin, and Walsh and Ms Humphreys) and Department of Radiation Oncology and Molecular Radiation Sciences (Dr DeWeese), Johns Hopkins University School of Medicine, Baltimore, Maryland; Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina (Dr Freedland); and Duke Prostate Center, Departments of Surgery and Pathology, Duke University School of Medicine, Durham, North Carolinia (Dr Freedland).

JAMA. 2008;299(23):2760-2769. doi:10.1001/jama.299.23.2760
Abstract

Context Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy, but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival, and if so, the subgroup of men most likely to benefit.

Objectives To quantify the relative improvement in prostate cancer–specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy, and to identify subgroups for whom salvage treatment is most beneficial.

Design, Setting, and Patients Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982-2004, followed up through December 28, 2007, who experienced biochemical and/or local recurrence and received no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78).

Main Outcome Measure Prostate cancer–specific survival defined from time of recurrence until death from disease.

Results With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer–specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer–specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer–specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer–specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer–specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival.

Conclusions Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer–specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial.

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