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Conformal radiotherapy for detectable PSA following radical prostatectomy: efficacy and predictive factors of recurrence.
Can J Urol. 2009 Oct; 16(5):4813-9.CJ

Abstract

INTRODUCTION

Many studies have analyzed outcomes following salvage radiation therapy (RT) after biochemical recurrence--defined as the presence of detectable serum prostate-specific antigen (PSA)--following radical prostatectomy (RP). However, the management of patients with detectable PSA following RP, which is not specific for tumor recurrence, is a matter of debate. This study aimed to evaluate oncological results of three-dimensional conformal RT (3D-CRT) in patients who had biochemical recurrence.

MATERIALS AND METHODS

The study included patients who underwent RP, who had a postoperative PSA level--determined between 2 and 4 months after surgery--that was greater than 0.1 ng/ml, and who subsequently received monotherapy with 3D-CRT on the prostate bed. The patients' clinical, characteristics and the pathological characteristics of their biopsy specimens were recorded. The main endpoint was biochemical failure after 3D-CRT, defined as three consecutive elevated PSA levels.

RESULTS

The tumors in the 46 patients included 4 (9%) pT2a, 7 (15%) pT2b, 14 (30%) pT2c, 10 (22%) pT3a, 10 (22%) pT3b, and 1 (2%) pT4 tumor. The Gleason score was 7 or higher in 37 patients (80%). Positive surgical margins were seen in 37 patients (80%). The patients had a median postoperative PSA level of 0.29 ng/ml (range, 0.1-5.8 ng/ml) and a median PSA doubling time (PSADT) before RT of 6 months (range, 1-53 months). The rate of biochemical recurrence free survival after 3D-RT was 66% at 30 months. Preoperative PSA, PSADT before RT, and D'Amico scores were significantly associated with biochemical failure after 3D-CRT (p < 0.05).

CONCLUSIONS

In cases of persistent PSA following RP for prostate cancer, 3D-CRT can be used as monotherapy with a significant chance of recurrence free survival. Preoperative PSA, PSADT before RT, and D'Amico score are predictive factors of recurrence following RT.

Authors+Show Affiliations

Department of Urology, Cochin Hospital, Descartes University, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19796456

Citation

Delongchamps, Nicolas B., et al. "Conformal Radiotherapy for Detectable PSA Following Radical Prostatectomy: Efficacy and Predictive Factors of Recurrence." The Canadian Journal of Urology, vol. 16, no. 5, 2009, pp. 4813-9.
Delongchamps NB, Zerbib M, Mejean A, et al. Conformal radiotherapy for detectable PSA following radical prostatectomy: efficacy and predictive factors of recurrence. Can J Urol. 2009;16(5):4813-9.
Delongchamps, N. B., Zerbib, M., Mejean, A., Rouach, Y., Debre, B., & Peyromaure, M. (2009). Conformal radiotherapy for detectable PSA following radical prostatectomy: efficacy and predictive factors of recurrence. The Canadian Journal of Urology, 16(5), 4813-9.
Delongchamps NB, et al. Conformal Radiotherapy for Detectable PSA Following Radical Prostatectomy: Efficacy and Predictive Factors of Recurrence. Can J Urol. 2009;16(5):4813-9. PubMed PMID: 19796456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conformal radiotherapy for detectable PSA following radical prostatectomy: efficacy and predictive factors of recurrence. AU - Delongchamps,Nicolas B, AU - Zerbib,Marc, AU - Mejean,Arnaud, AU - Rouach,Yannick, AU - Debre,Bernard, AU - Peyromaure,Michael, PY - 2009/10/3/entrez PY - 2009/10/3/pubmed PY - 2009/12/16/medline SP - 4813 EP - 9 JF - The Canadian journal of urology JO - Can J Urol VL - 16 IS - 5 N2 - INTRODUCTION: Many studies have analyzed outcomes following salvage radiation therapy (RT) after biochemical recurrence--defined as the presence of detectable serum prostate-specific antigen (PSA)--following radical prostatectomy (RP). However, the management of patients with detectable PSA following RP, which is not specific for tumor recurrence, is a matter of debate. This study aimed to evaluate oncological results of three-dimensional conformal RT (3D-CRT) in patients who had biochemical recurrence. MATERIALS AND METHODS: The study included patients who underwent RP, who had a postoperative PSA level--determined between 2 and 4 months after surgery--that was greater than 0.1 ng/ml, and who subsequently received monotherapy with 3D-CRT on the prostate bed. The patients' clinical, characteristics and the pathological characteristics of their biopsy specimens were recorded. The main endpoint was biochemical failure after 3D-CRT, defined as three consecutive elevated PSA levels. RESULTS: The tumors in the 46 patients included 4 (9%) pT2a, 7 (15%) pT2b, 14 (30%) pT2c, 10 (22%) pT3a, 10 (22%) pT3b, and 1 (2%) pT4 tumor. The Gleason score was 7 or higher in 37 patients (80%). Positive surgical margins were seen in 37 patients (80%). The patients had a median postoperative PSA level of 0.29 ng/ml (range, 0.1-5.8 ng/ml) and a median PSA doubling time (PSADT) before RT of 6 months (range, 1-53 months). The rate of biochemical recurrence free survival after 3D-RT was 66% at 30 months. Preoperative PSA, PSADT before RT, and D'Amico scores were significantly associated with biochemical failure after 3D-CRT (p < 0.05). CONCLUSIONS: In cases of persistent PSA following RP for prostate cancer, 3D-CRT can be used as monotherapy with a significant chance of recurrence free survival. Preoperative PSA, PSADT before RT, and D'Amico score are predictive factors of recurrence following RT. SN - 1195-9479 UR - https://www.unboundmedicine.com/medline/citation/19796456/Conformal_radiotherapy_for_detectable_PSA_following_radical_prostatectomy:_efficacy_and_predictive_factors_of_recurrence_ L2 - http://www.canjurol.com/abstract.php?ArticleID=&amp;version=1.0&amp;PMID=19796456 DB - PRIME DP - Unbound Medicine ER -