Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate

Purpose: To evaluate the outcome of adjuvant and salvage radiotherapy (RT) after radical prostatectomy (RP) for clinically localized prostate cancer u sing conventional clinical end-points, and the biochemical relapse-free rat e (bRFR). Methods: Between 1987 and 1994, 113 node negative, hormonally naive men rec eived RT 1 month to 12 years after RP. Adjuvant RT was given for positive r esection margins and/or pT3 disease. Salvage RT was given for a persistentl y elevated prostatic specific antigen (PSA), a rising PSA, or palpable recu rrence post RP. Clinical and biochemical endpoints determined outcome. Log- rank testing and the Cox proportional hazards model identified factors pred ictive for biochemical relapse free rate. Results: Median follow-up after RT was 3.7 years (range 0.2-9 years). Five- year clinical local control was 95% for patients with no palpable evidence of disease and 59% for those with palpable recurrence (P < 0.0001). 5-year bRFR was 81% for adjuvant RT, 19% for salvage of biochemical recurrence, 0% for patients with palpable disease (P < 0.0001). Improved bRFR for adjuvan t and salvage RT was predicted by a Gleason score <7 vs. 7 vs. >7 (hazard r atio 1.53; 95% CI 0.99-2.35) and an undetectable pre-RT PSA vs. PSA <2.0 ng /ml vs. PSA >2.0 ng/ml (hazard ratio 3.81; 95% CI 2.47-5.87), Seminal vesic le involvement was not a statistically significant independent predictor of bRFR. Conclusions: The most favourable bRFR was observed for adjuvant therapy. Sa lvage was most successful with a pre-RT PSA <2.0 ng/ml, or Gleason score <7 . Few patients with a pre-RT PSA >2.0 ng/ml were salvaged, and none with pa lpable recurrence. These patients require investigation of alternative salv age strategies. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.