ADJUVANT AND SALVAGE IRRADIATION FOLLOWING RADICAL PROSTATECTOMY FOR PROSTATE-CANCER

Purpose: We performed a retrospective analysis to assess the durabilit y of benefit derived from irradiation after prostatectomy for pT3NO di sease, and the possibility of cure. Methods and Materials: We studied 88 patients who were irradiated after prostatectomy and had available prostate specific antigen (PSA) data, no known nodal or metastatic dis ease, no hormonal treatment, and follow-up of at least 12 months from surgery, Forty patients received adjuvant therapy for a high risk of l ocal failure with undetectable PSA, Forty-eight patients received salv age therapy for elevated PSA levels, Mean follow up was 44 months from date of surgery and 31 months from irradiation, Biochemical failure w as strictly defined as a confirmed rise in PSA of >10%, or as the abil ity to detect a previously undetectable PSA value. Results: After salv age irradiation, 69% of patients attained an undetectable PSA, Eighty- eight percent of adjuvant patients were biochemically and clinically f ree of disease (bNED) at 3 years from prostatectomy, Sixty-eight perce nt of those receiving salvage irradiation were bNED 3 years after surg ery, On univariate analysis, treatment group (adjuvant or salvage), pr e-operative PSA, and the status of seminal vesicles were significant p rognostic factors, The extent of PSA elevation in the salvage group wa s also significant, We did not demonstrate a significant difference be tween those salvage patients referred for persistently elevated PSA as compared to those with a late rise in PSA, On multivariate analysis, the only significant predictor of outcome was treatment group, with ad juvant irradiation having better outcome than salvage. Conclusion: Mor e than two-thirds of this group of patients remain biochemically disea se free at 3 years following irradiation, attesting to a number of pot ential cures, For patients with stage pT3NO prostate cancer following radical prostatectomy, our data support the use of either routine post operative adjuvant irradiation or close PSA follow-up with early salva ge treatment. (C) 1997 Elsevier Science Inc.