Advertisement

Role of Androgen Deprivation Therapy in Early Salvage Radiation Among Patients With Prostate-Specific Antigen Level of 0.5 or Less

      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

      To read this article in full you will need to make a payment

      References

        • Ahove D.A.
        • Hoffman K.E.
        • Hu J.C.
        • Choueiri T.K.
        • D'Amico A.V.
        • Nguyen P.L.
        Which patients with undetectable PSA levels 5 years after radical prostatectomy are still at risk of recurrence?–implications for a risk-adapted follow-up strategy.
        Urology. 2010; 76: 1201-1205
        • Pound C.R.
        • Partin A.W.
        • Eisenberger M.A.
        • Chan D.W.
        • Pearson J.D.
        • Walsh P.C.
        Natural history of progression after PSA elevation following radical prostatectomy.
        JAMA. 1999; 281: 1591-1597
        • Walz J.
        • Chun F.K.
        • Klein E.A.
        • et al.
        Nomogram predicting the probability of early recurrence after radical prostatectomy for prostate cancer.
        J Urol. 2009; 181: 601-608
        • Trock B.J.
        • Han M.
        • Freedland S.J.
        • et al.
        Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy.
        JAMA. 2008; 99: 2760-2769
      1. Shipley WU. Initial report of RTOG 9601, a phase III trial in prostate cancer: effect of anti-androgen therapy (AAT) with bicalutamide during and after radiation therapy (RT) on freedom from progression and incidence of metastatic disease in patients following radical prostatectomy (RP) with pT2-3,N0 disease and elevated PSA levels. 2011 Feb 17 Genitoruinary Cancers Symposium, American Society of Clinical Oncology; Orlando, FL.

        • Saylor P.J.
        • Smith M.R.
        Adverse effects of androgen deprivation therapy: defining the problem and promoting health among men with prostate cancer.
        J Natl Compr Canc Netw. 2010; 8: 211-223
        • Smith M.R.
        • Lee H.
        • Nathan D.M.
        Insulin sensitivity during combined androgen blockade for prostate cancer.
        J Clin Endocrinol Metab. 2006; 91: 1305-1308
        • Stephenson A.J.
        • Shariat S.F.
        • Zelefsky M.J.
        • et al.
        Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy.
        JAMA. 2004; 291: 1325-1332
        • Stephenson A.J.
        • Scardino P.T.
        • Kattan M.W.
        • et al.
        Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy.
        J Clin Oncol. 2007; 25: 2035-2041
        • Wright J.L.
        • Dalkin B.L.
        • True L.D.
        • et al.
        Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality.
        J Urol. 2010; 183: 2213-2218
        • Van der Kwast T.H.
        • Bolla M.
        • Van Poppel H.
        • et al.
        Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911.
        J Clin Oncol. 2007; 25: 4178-4186
        • Cheung R.
        • Kamat A.M.
        • de Crevoisier R.
        • et al.
        Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.
        Int J Radiat Oncol Biol Phys. 2005; 63: 134-140