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The value of radiotherapy in treating recurrent prostate cancer after radical prostatectomy

Nature Clinical Practice Urology volume 1, pages 90–96 (2004)Cite this article

Abstract

Approximately 25–40% of men who undergo radical retropubic prostatectomy (RRP) for the treatment of clinically localized prostate cancer will experience biochemical recurrence. A rapid prostate-specific antigen (PSA) doubling time or high-grade disease are risk factors for progression to bone metastases and cancer-specific mortality. Salvage external-beam radiotherapy (EBRT) to the prostate fossa is the only curative therapy for patients with biochemical recurrence after RRP, but it is used relatively infrequently to treat recurrent prostate cancer because of a widespread perception that most patients have systemic recurrence, and its reported lack of efficacy for high-risk disease. However, in a large, multicenter study of patients who received salvage EBRT for a rising PSA level after RRP, a substantial proportion of patients with high-grade disease and/or a rapid PSA doubling time were observed to have a favorable outcome after salvage EBRT if it was administered at low PSA values. This suggests that salvage EBRT could provide long-term cancer control for patients at the highest risk of progression to bone metastases and cancer-specific mortality. A nomogram that predicts the 3-year progression-free probability after salvage EBRT has been developed to facilitate the selection of patients for this potentially curative therapy. In the absence of other curative therapies, all patients with recurrent prostate cancer should be considered for salvage EBRT, particularly those with positive surgical margins. To be successful, salvage EBRT should be administered at the earliest evidence of recurrent disease, once a rising PSA trend as been confirmed.

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Figure 1: Pretreatment nomogram to predict probability of 3-years free of disease progression after salvage radiotherapy for patients with disease recurrence after radical prostatectomy.

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Acknowledgements

AJ Stephenson is supported in part by the American Foundation for Urologic Disease, a training grant (T32-82088) from the National Institutes of Health, and a gift from the Tina and Richard V. Carolan Foundation.

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Authors and Affiliations

  1. Memorial Sloan-Kettering Cancer Center, New York, NY

    Andrew J Stephenson & Kevin M Slawin

  2. Baylor Prostate Cancer Center,

    Andrew J Stephenson & Kevin M Slawin

  3. Baylor College of Medicine, Houston, TX

    Andrew J Stephenson & Kevin M Slawin

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  1. Andrew J Stephenson
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  2. Kevin M Slawin
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Correspondence to Andrew J Stephenson.

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Stephenson, A., Slawin, K. The value of radiotherapy in treating recurrent prostate cancer after radical prostatectomy. Nat Rev Urol 1, 90–96 (2004). https://doi.org/10.1038/ncpuro0056

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