DELAYED SALVAGE RADIATION-THERAPY IN PATIENTS WITH ELEVATED PROSTATE-SPECIFIC ANTIGEN LEVELS AFTER RADICAL PROSTATECTOMY - A LONG-TERM FOLLOW-UP/

BACKGROUND. In this article the authors report an analysis and long te rm results of delayed/salvage radiation therapy administered to asympt omatic patients who had an elevated prostate specific antigen (PSA) le vel, many months to many years after radical prostatectomy. METHODS. D uring 1987 to 1990, 40 asymptomatic patients were found to have an ele vated PSA level 9 to 96 months after radical prostatectomy. The patien ts underwent transrectal needle aspiration biopsy of the urethrovesicl e junction anastomosis (uvj); 28 patients had a positive biopsy and 12 patients had a negative biopsy. Delayed/salvage radiation therapy was administered to the pelvis (45 Gray [Gy]) and prostate bed (59.5 Gy), including the uvj. RESULTS. Twenty-four of 37 patients (65%) were fre e of clinical disease. In 10 patients (27%), the radiation therapy res ulted in a durable decrease in the elevated PSA level below a detectab le level for a minimum 5-year follow-up. Five patients were alive with clinical disease. Eight died of disease. Three patients were lost to follow-up. CONCLUSIONS. This experience shows that delayed/salvage rad iation therapy to the pelvis (45 Gy) and prostate bed (59.5 Gy), even many years after radical prostatectomy for pathologic stage pB, pC, an d pD1 carcinoma of the prostate, was well tolerated and provided freed om from clinical disease in 24 of 37 patients (65%), and a decrease in elevated PSA level in 10 patients (27%]. Delayed/salvage radiation th erapy appears to be beneficial for patients who had undergone radical prostatectomy only and then developed rising PSA levels during the fol low-up period. (C) 1996 American Cancer Society.