Abstract
Background
The Radiation Therapy Oncology Group 96-01 randomized trial demonstrated the benefit
of adding androgen deprivation therapy (ADT) to salvage radiotherapy for an increasing
prostate-specific antigen (PSA) after prostatectomy, but it is unknown whether modern
patients followed with ultrasensitive PSA and salvaged at a low PSA (ie, ≤ 0.5) also
benefit from ADT.
Patients and Methods
The cohort comprised 108 patients who received radical prostatectomy (RP), were followed
by ultrasensitive PSA, and received salvage radiotherapy at a PSA of 0.5 or less.
Sixty patients had negative margins, and 48 patients had positive margins at RP. Cox
multivariable regression analysis was performed to identify factors associated with
time to secondary PSA failure and included PSA at salvage, year of treatment, Gleason
score, ADT use, margin status, T stage, and PSA doubling time. Occurrence of distant
metastases was documented.
Results
Median follow-up after radiation was 63.09 months. A total of 24 patients had a distant
metastasis. In all patients, ADT use was associated with a decreased risk of recurrence
(hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.25-0.79; P = .006). On subgroup analysis, ADT was associated with a decreased risk of failure
among patients with negative margins (HR, 0.27; 95% CI, 0.12-0.61; P = .002), but not among men with positive margins (HR, 0.78; 95% CI, 0.29-2.10; P = .63).
Conclusions
Even patients followed with ultrasensitive PSA and salvaged early with a PSA ≤ 0.5
seem to benefit from the addition of ADT to salvage radiation. However, this benefit
seemed to be limited to men with negative margins; thus, men with positive margins
and PSA ≤ 0.5 may be good candidates for salvage radiation alone.
Keywords
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Article info
Publication history
Published online: June 27, 2014
Accepted:
June 20,
2014
Received in revised form:
June 18,
2014
Received:
March 25,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
