Background
Methods
Patient selection
Definitions and data acquisition
Statistical analyses
Results
Patient characteristics
All patients (n = 227) | Patients with post-radiotherapy BCR (n = 81) | |||||
---|---|---|---|---|---|---|
No concomitant ADT | Concurrent ADT | p-valuea | No salvage ADT | Salvage ADT | p-valuea | |
Number of patients | 132 | 95 | – | 31 | 50 | – |
Patients characteristics | ||||||
Age (years) | 64.0 (59.3–68.0) | 64.0 (59.0–70.0) | 0.500 | 65.0 (61.0–70.0) | 61.0 (58.0–65.0) | 0.012 |
Pre-operative PSA (ng/mL) | 12.60 (7.00–22.90) | 9.90 (6.90–18.90) | 0.690 | 16.33 (6.40–28.00) | 11.00 (6.55–25.20) | 0.711 |
Pathology-related factors | ||||||
Gleason score | 7 (7–9) | 7 (7–9) | 0.385 | 8 (7–9) | 7 (7–9) | 0.411 |
Pathologic T stage ≥3a | 89 (67.4%) | 56 (58.9%) | 0.190 | 19 (61.3%) | 36 (72.0%) | 0.316 |
Pathologic N stage ≥1 | 4 (3.0%) | 12 (12.6%) | 0.005 | 2 (6.5%) | 1 (2.0%) | 0.302 |
Tumor volume (%) | 10.0 (1.0–20.0) | 9.0 (1.0–17.0) | 0.504 | 9.0 (1.0–20.0) | 2.0 (1.0–16.0) | 0.110 |
Positive surgical margin | 81 (61.4%) | 59 (62.1%) | 0.910 | 19 (61.3%) | 27 (54.0%) | 0.520 |
ADT-related factors | ||||||
Concomitant ADT duration (months) | – | 17.0 (12.0–21.0) | – | – | – | – |
Salvage ADT duration (months) | – | – | – | – | 16.0 (3.8–51.3) | – |
Initial regimen | ||||||
Complete androgen blockage | – | 43 (45.3%) | – | – | 8 (16.0%) | |
LHRH agonist | – | 31 (32.6%) | – | 32 (64.0%) | ||
Antiandrogen | – | 21 (22.1%) | – | 10 (20.0%) | ||
Radiotherapy-related factors | – | |||||
Pre-radiotherapy PSA (ng/mL) | 0.39 (0.25–0.60) | 0.72 (0.50–1.10) | < 0.001 | 0.42 (0.32–0.75) | 0.71 (0.39–1.63) | 0.007 |
Radiotherapy dose (Gy) | 66.0 (66.0–70.0) | 66.0 (66.0–66.0) | 0.117 | 66.0 (66.0–70.0) | 66.0 (66.0–70.0) | 0.607 |
Effect of concurrent ADT on BCR
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (years) | 0.974 (0.944–1.005) | 0.099 | 0.978 (0.943–1.014) | 0.228 |
BMI (kg/m2) | 0.942 (0.871–1.018) | 0.131 | ||
Pre-operative PSA (ng/mL) | ||||
< 20.00 | (reference) | (reference) | ||
≥ 20.00 | 1.640 (1.032–2.608) | 0.036 | 1.112 (0.625–1.976) | 0.719 |
Pre-radiotherapy PSA (ng/mL) | ||||
< 1.00 | (reference) | (reference) | ||
≥ 1.00 | 2.122 (1.288–3.497) | 0.003 | 4.383 (1.797–10.688) | 0.001 |
Pathologic Gleason score | ||||
≤ 7 | (reference) | |||
≥ 8 | 1.393 (0.897–2.163) | 0.140 | ||
Pathologic T stage | ||||
≤ pT2 | (reference) | |||
≥ pT3 | 1.272 (0.798–2.029) | 0.312 | ||
Pathologic N stage | ||||
pN0 or pNx | (reference) | |||
pN1 | 0.498 (0.157–1.579) | 0.236 | ||
Tumor volume (%) | ||||
< 10.0 | (reference) | |||
≥ 10.0 | 0.939 (0.600–1.469) | 0.783 | ||
Surgical margin tumor involvement | ||||
Negative | (reference) | |||
Positive | 0.815 (0.525–1.266) | 0.363 | ||
Radiation dose (Gy) | ||||
< 66.0 | (reference) | |||
≥ 66.0 | 0.770 (0.406–1.461) | 0.424 | ||
Testosterone nadir after RP (ng/mL) | 1.088 (0.948–1.248) | 0.229 | ||
Duration of unrecovered testosterone level (months) | 0.984 (0.970–0.998) | 0.031 | 0.991 (0.971–1.011) | 0.361 |
Concurrent ADT | ||||
No | (reference) | (reference) | ||
Yes | 0.564 (0.352–0.905) | 0.018 | 0.381 (0.157–0.927) | 0.034 |
Effect of salvage ADT on radiographic progression
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (years) | 1.035 (0.978–1.096) | 0.231 | ||
BMI (kg/m2) | 0.913 (0.773–1.078) | 0.282 | ||
Pre-operative PSA (ng/mL) | ||||
< 20.00 | (reference) | |||
≥ 20.00 | 1.111 (0.551–2.241) | 0.768 | ||
Pre-radiotherapy PSA (ng/mL) | ||||
< 1.00 | (reference) | |||
≥ 1.00 | 0.906 (0.427–1.923) | 0.796 | ||
Pathologic Gleason score | ||||
≤ 7 | (reference) | (reference) | ||
≥ 8 | 2.438 (1.169–5.084) | 0.017 | 1.288 (0.636–2.609) | 0.482 |
Pathologic T stage | ||||
≤ pT2 | (reference) | |||
≥ pT3 | 1.262 (0.599–2.659) | 0.540 | ||
Pathologic N stage | ||||
pN0, or pNx | (reference) | (reference) | ||
pN1 | 6.096 (1.316–28.234) | 0.021 | 16.457 (3.358–80.652) | 0.001 |
Tumor volume (%) | ||||
< 10.0 | (reference) | (reference) | ||
≥ 10.0 | 3.888 (1.923–7.862) | < 0.001 | 4.137 (1.999–8.562) | < 0.001 |
Surgical margin tumor involvement | ||||
Negative | (reference) | |||
Positive | 1.678 (0.819–3.437) | 0.157 | ||
Radiation dose (Gy) | ||||
< 66.0 | (reference) | |||
≥ 66.0 | 1.564 (0.619–3.951) | 0.344 | ||
Testosterone nadir after RP (ng/mL) | 1.170 (0.834–1.643) | 0.363 | ||
Duration of unrecovered testosterone level (months) | 1.002 (0.989–1.015) | 0.802 | ||
Concurrent ADT | ||||
No | (reference) | |||
Yes | 1.134 (0.563–2.287) | 0.725 | ||
Salvage ADT | ||||
No | (reference) | (reference) | ||
Yes | 0.344 (0.171–0.692) | 0.003 | 0.306 (0.150–0.627) | 0.001 |