Open Access

ARTICLE

Prognostic implications of immediate PSA response to early salvage radiotherapy

Robert M. Turner II¹, Jonathan G. Yabes², Elen Woldemichael¹, Melvin M. Deutsch³, Ryan P. Smith³, Robert S. Werner³, Bruce L. Jacobs¹, Joel B. Nelson¹

Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Department of Radiation Oncology, UPMC Cancer Center, Pittsburgh, Pennsylvania, USA
Address correspondence to Dr. Robert M. Turner II, UPMC Mercy Professional Building, 1350 Locust St., Suite G100A, Pittsburgh, PA15219 USA

Canadian Journal of Urology 2016, 23(6), 8568-8575.

Abstract

Introduction: Up to 25% of men with prostate cancer who undergo radical prostatectomy will recur. In this setting, salvage radiotherapy may cure patients with local recurrence, but is unable to cure those with occult metastatic disease. The objective of this study is to examine how prostate-specific antigen (PSA) response to radiotherapy predicts subsequent disease progression and survival.
Materials and methods: Using a prospectively populated database of 3089 men who underwent open radical prostatectomy, 212 patients (7%) were identified who received early salvage radiotherapy for biochemical recurrence. The main outcome was time to disease progression after salvage radiotherapy. Patients were stratified by PSA response after radiotherapy: 1) PSA <0.1 ng/mL, 2) persistently detectable PSA, and 3) rising PSA.
Results: Patients received salvage radiotherapy at a median PSA of 0.20 ng/mL (IQR 0.10-0.30 ng/mL). At a median follow up of 47.3 months, a total of 52 (25%) patients experienced disease progression. On multivariable analysis, both persistent PSA (HR 5.12; 95% CI 1.98-13.23) and rising PSA (HR 16.55; 95% CI 6.61-41.48) were associated with increased risk of disease progression compared to those with PSA <0.1 ng/mL after adjusting for pre-radiotherapy PSA, Gleason score, margin status, stage, and time to radiotherapy. Only rising PSA was associated with an increased risk of cancer-specific and all-cause mortality.
Conclusions: PSA response is associated with the risk of disease progression following salvage radiotherapy. This information can be used to counsel patients on the potential need for additional therapy and identify those at greatest risk for progression and cancer-related mortality.

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