Radiotherapy for PSA recurrence after radical prostatectomy

Objectives: The treatment of patients presenting with an isolated PSA recur rence after radical prostatectomy (RP) remains controversial. The present s tudy aims at assessing the results of salvage radiotherapy (RT), to define prognostic factors and to identify subgroups of patients most suitable for RT with curative intent. Materials and Methods: A retrospective study was performed of 53 patients, diagnosed with a rising PSA after RP, and treated with RT to the prostate b ed, between July 1992 and July 1998. Results: On univariate analysis, significant determinants to obtain and mai ntain a nondetectable PSA (<0.02 ng/ml) were Gleason grade (<less than or e qual to>III vs. greater than or equal to IV), pre-RT PSA, considered as cat egorical or continuous variable, and pathological stage, pT (2 vs. 3). Pre- RP PSA (less than or equal to 10 vs. >10), time interval between surgery an d moment of rising PSA and pathological section margin status were not sign ificant. On multivariate analysis, only Gleason grade and pre-RT PSA remain ed significant. For the patient group with a Gleason grade less than or equ al to III the PSA-free survival at 3 years was 75% (+/- 11%) com pared to 2 7% (+/-9%) for the patients with a Gleason grade greater than or equal to I V (p = 0.002). Pre-RT PSA significantly influenced PSA-free survival in the first group, but not in the latter. Conclusion: From the group of RP patients with rising PSA following a posts urgery PSA-free period, subgroups can be defined with a distinctly differen t probability of obtaining and maintaining nondetectable PSA levels after s alvage RT Copyright (C) 2001 S. Karger AG, Basel.