Limited efficacy of salvage radiotherapy for biopsy confirmed or clinically palpable local recurrence of prostate carcinoma after surgery.

Abstract

To assess the efficacy of salvage radiotherapy (RT) for biopsy confirmed or clinically palpable local recurrence of prostate adenocarcinoma after radical prostatectomy (RP). We retrospectively analyzed 44 patients treated with salvage RT for biopsy confirmed or clinically palpable local recurrence between 1991 and 2000. Thirty-six had positive biopsy for local recurrence and the rest without histological confirmation had clinically palpable disease. All had rising PSA at the time of RT (median: 3.7). Median interval from RP to RT was 2.6 years. Thirty-six received salvage RT alone, while eight had a short course (<4 months) of androgen ablation prior to RT. RT doses were 60-66Gy in 30-33 fractions. Freedom from PSA failure was defined as the maintenance of PSA<or=0.2. Median follow-ups from RP and salvage RT were 8.7 and 5.5 years, respectively. All but one achieved local control clinically. The actuarial PSA relapse-free and survival rate at 5 years were 11 and 87%, respectively. On Cox regression analysis, significant predictors for relapse were PSA level prior to salvage RT, and Gleason score. The efficacy of salvage RT alone for local recurrence was limited. This study suggests a need to explore other strategies incorporating systemic therapy, and the importance of timely referral for consideration of salvage RT in patients with rising PSA after surgery.