PSA based review of adjuvant and salvage radiation therapy vs. observationin postoperative prostate cancer patients

Because of the uncertainties regarding the efficacy of postoperative radiat ion therapy for early prostate cancer, treatment strategies following radic al prostatectomy include: (1) observation alone in high-risk patients, (2) adjuvant radiation therapy (PSA undetectable) in high-risk patients, or (3) salvage radiation therapy for biochemical and clinical recurrence. Fifty-t wo patients treated with postoperative radiation therapy in either an adjuv ant setting (13) or for salvage (39) were retrospectively reviewed. The act uarial biochemical disease-free survival (bNED) rates following radiation t herapy were calculated using the life-table method. Univariate and multi va riate analyses were used to define the clinical factors that predict bioche mical failure following postoperative radiation therapy. In addition, the b NED survival rate for 36 high-risk surgery patients who were simply observe d following prostatectomy was determined. The 3-year bNED survival rate for the adjuvant radiation group was 85% compared with 27% for salvage radiati on and 43% for the observation group. These results are statistically signi ficant. Factors that predict biochemical failure following postoperative ra diation therapy include preoperative PSA level, pre-radiation therapy PSA l evel, and seminal vesicle involvement. At our institutions, adjuvant radiat ion therapy was a superior strategy compared with either observation alone or salvage radiation therapy for high-risk postoperative prostate cancer pa tients. (C) 2000 Wiley-Liss, Inc.