Clinical factors predicting the outcome of salvage radiotherapy for patients with biochemical recurrence after radical prostatectomy

Int J Clin Oncol. 2024 Sep;29(9):1326-1333. doi: 10.1007/s10147-024-02571-7. Epub 2024 Jun 17.

Abstract

Background: It remains unclear which patients with biochemical recurrence after prostatectomy are most suitable for salvage radiotherapy. We evaluated the parameters related to outcomes.

Methods: We retrospectively evaluated patients who underwent salvage therapy for biochemical recurrence after prostatectomy between 2005 and 2019. This study aimed to evaluate biochemical recurrence-free survival (bRFS) after salvage radiotherapy and elucidate the parameters associated with bRFS. The bRFS rate was calculated using the Kaplan-Meier method, and the parameters associated with bRFS were evaluated using Cox regression analysis.

Results: This study included 67 patients treated with salvage radiotherapy with a median age of 67 years at salvage radiotherapy. The median follow-up period after salvage radiotherapy was 7.3 years. The 5-year bRFS rate following salvage radiotherapy was 47.1%. Univariate analysis showed that PSA doubling time < 6 months, positive surgical margin, and pathological Gleason score ≥ 8 were significantly associated with shorter bRFS (p < 0.001, p = 0.036, p = 0.047, respectively). Multivariable analysis showed that a PSA doubling time < 6 months and positive surgical margins were significantly associated with shorter bRFS (p = 0.001 and p = 0.018, respectively). No serious adverse events were observed.

Conclusions: In our hospital, approximately half of the patients are under long-term control with salvage radiotherapy. A PSA doubling time of < 6 months and positive surgical margins were suggested to be associated with poor outcomes of salvage radiotherapy.

Keywords: PSA doubling time; Salvage radiotherapy; Surgical margin.

MeSH terms

  • Aged
  • Disease-Free Survival
  • Humans
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local* / radiotherapy
  • Prostate-Specific Antigen* / blood
  • Prostatectomy* / methods
  • Prostatic Neoplasms* / blood
  • Prostatic Neoplasms* / pathology
  • Prostatic Neoplasms* / radiotherapy
  • Prostatic Neoplasms* / surgery
  • Retrospective Studies
  • Salvage Therapy* / methods

Substances

  • Prostate-Specific Antigen