Journal of Urology. 174(6):2204-2208, December 2005.
BROOKS, JOSEPH P.; ALBERT, PAUL S.; WILDER, RICHARD B.; GANT, DEAN A.;
McLEOD, DAVID G. *; POGGI, MATTHEW M. +
Abstract:
Purpose: We assessed the efficacy of salvage radiotherapy (SRT) and
analyzed predictors of biochemical progression-free survival (bPFS) and
distant metastasis-free survival in patients with clinically localized
disease recurrence after radical prostatectomy.

Materials and Methods: The records of 114 patients treated with SRT at
2 institutions between 1991 and 2001 were retrospectively reviewed.
Time to biochemical recurrence and to distant metastases was analyzed
using the Kaplan-Meier estimation. Candidate predictors of bPFS and
distant metastasis-free survival were analyzed using the log rank test
and Cox regression. Acute and late complications were scored using
Radiation Therapy Oncology Group/European Organization for Research and
Treatment of Cancer criteria.

Results: At a median followup of 6.3 years (range 1.9 to 13.3) for SRT
4 and 6-year bPFS was 50% (95% CI 42% to 61%) and 33% (95% CI 24% to
43%), respectively. The 6-year actuarial probability of distant
metastases after SRT was 14%. Multivariate analysis demonstrated an
independent association of increasing Gleason score, lymphovascular
invasion and lack of a complete response to SRT with decreased 5-year
bDFS. These factors were associated with significantly less 5-year
distant metastasis-free survival. Pre-RT prostate specific antigen
greater than 2.0 ng/ml was associated with significantly decreased
5-year bDFS and distant metastasis-free survival, although it was not
maintained on multivariate analysis.

Conclusions: SRT results in durable prostate specific antigen control
in select patients. It is well tolerated with few severe late effects.
Increasing Gleason score, lymphovascular invasion and lack of a
complete response to SRT are significant risks for disease progression
requiring additional management.

Copyright (C) 2005 by American Urological Association, Inc.