International Journal of Radiation Oncology*Biology*Physics
Poster Viewing AbstractThe Timing of Salvage Postprostatectomy Radiation Therapy: Waiting for the PSA to Climb Above 0.2 May Compromise Outcome
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Purpose/Objective(s)
Recent American Society for Radiation Oncology/American Urological Association guidelines state that the effectiveness of salvage postprostatectomy radiation therapy (SRT) is greatest when administered at lower levels of prostate-specific antigen (PSA) with a recommendation to start before PSA exceeds 1.0. However no guidelines are given as to what level this should be, and with ultrasensitive assays men are aware of a rising PSA at levels below 0.1. The aim of this study was to review the time
Materials/Methods
Patients referred to our institution for consideration of SRT for a rising PSA following surgery were accrued into a prospective database. Baseline demographic data and tumor and treatment factors were collected including patient age, pathologic T and N stage, margin status, Gleason score, LVSI, ECE, PSA nadir postsurgery, use of androgen deprivation therapy (ADT), months from surgery to SRT, and iPSA prior to commencement of SRT. Study endpoint was time to biochemical failure (defined as post
Results
One hundred ninety-four patients received salvage intensity modulated radiation therapy to a mean dose of 69.7 Gy between January 2008 and December 2013 given in 34 fractions. At analysis, median follow-up was 32 months. For patients with an iPSA of <0.1 (n=34), ≥0.1 to <0.2 (n=63), and ≥0.2 (n=97), rates of biochemical failure at 5 years were 22.4%, 33.4%, and 49.7%, respectively. Compared to the iPSA <0.1 group, the hazard ratios for biochemical failure at 5 years for an iPSA ≥0.1 to <0.2 was
Conclusion
Increasing iPSA levels are associated with an increasing risk of biochemical failure even after adjusting for known prognostic factors. Waiting for a PSA to rise above 0.2 may significantly compromise biochemical control.
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Author Disclosure:G. Harris: None. A. Kneebone: None. D.M. Whalley: None. P. McCloud: None. S.Thompson: None. L. Guo: None. T. Eade: None.