Radiotherapy for Cancer Recurrence After Radical Prostatectomy Associated With Increased Survival

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Title: Radiotherapy for Cancer Recurrence After Radical Prostatectomy Associated With Increased Survival
URL: http://www.pslgroup.com/dg/223B6A.htm
Doctor's Guide
June 17, 2008

NEW YORK -- June 17, 2008 -- Radiotherapy after prostate cancer recurrence in men who underwent radical prostatectomy increases prostate cancer-related survival, according to preliminary findings published in the June 18 issue of JAMA.

"Nearly 60,000 men will have undergone radical prostatectomy in 2007. Although surgery provides excellent cancer control, approximately 15% to 40% of these men will experience cancer recurrence within 5 years, usually manifested only by elevated prostate-specific antigen [PSA] level," the authors write.

For such men it is unknown whether salvage radiotherapy offers a survival benefit compared with observation alone.

Bruce J. Trock, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues, conducted a study to determine the association between salvage radiotherapy and prostate cancer-specific survival.

The study included 635 men who underwent radical prostatectomy from 1982 to 2004, were followed up through December 2007, and who experienced biochemical recurrence and/or local cancer recurrence. The subjects also received either no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78).

With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy.

The researchers found that salvage radiotherapy, regardless of whether given alone or with hormonal therapy, was associated with a statistically significant decrease in the risk of death of nearly 60% and a 3-fold increase in prostate cancer-specific survival compare with those who received no salvage treatment. Salvage radiotherapy was also associated with a significant increase in overall survival.

The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with PSA-doubling time of less than 6 months. Among 166 men (26%) with PSA-doubling time of less than 6 months, salvage radiotherapy alone and salvage therapy with hormonal treatment were associated with a reduction in risk of prostate cancer-specific death by more than 75%. Salvage radiotherapy was associated with an increase in survival only if given sooner than 2 years after recurrence.

Men whose PSA level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival.

"This study provides provocative evidence that even men with adverse prognostic features such as rapid PSA-doubling time or high Gleason score may benefit from salvage radiotherapy," the authors write.

SOURCE: JAMA

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