Open Access

ARTICLE

Conformal radiotherapy for detectable PSA following radical prostatectomy: effi cacy and predictive factors of recurrence

Nicolas B. Delongchamps¹, Marc Zerbib¹, Arnaud Méjean², Yannick Rouach², Bernard Debré¹, Michaël Peyromaure^1,2

1 Department of Urology, Cochin Hospital, Descartes University, Paris, France
2 Department of Urology, Necker Hospital, Descartes University, Paris, France
Address correspondence to Dr. Nicolas Barry Delongchamps, Service d’Urologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques 75679 Paris

Canadian Journal of Urology 2009, 16(5), 4813-4819.

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.

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