Abstract
Introduction: To assess the value of androgen deprivation therapy (ADT) on salvage radiotherapy (RT) in post-prostatectomy recurrent prostate cancer patients, we compared the oncologic outcomes between patients receiving RT + ADT and those receiving RT alone. Materials and Methods: We reviewed the records of patients diagnosed with prostate cancer between 1995 and 2011, including 93 patients who underwent salvage RT and 69 patients who underwent salvage RT + ADT. The ADT-free duration after withdrawal was calculated to verify testosterone recovery. Results: Presalvage prostate serum antigen (PSA) was the only significantly different characteristic between the 2 groups (p < 0.001). The ADT-free duration was greater than 6 months in >80% of patients. Presalvage PSA ≥0.6 ng/mL, pathologic stage ≥T3b, and RT + ADT were significantly associated with biochemical progression after salvage treatment. RT + ADT reduced biochemical progression in patients with seminal vesicle invasion or presalvage PSA ≥0.6 ng/mL (p = 0.001) compared to RT alone; biochemical progression-free probability was unchanged in seminal vesicle noninvasive prostate cancer patients with presalvage PSA <0.6 ng/mL (p = 0.541). Conclusions: RT + ADT reduced the risk of biochemical progression after salvage treatment in patients with seminal vesicle invasion or presalvage PSA ≥0.6 ng/mL, but had no effect in patients with seminal vesicle noninvasive disease and presalvage PSA <0.6 ng/mL.
References
1.
Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC: Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003;169:517-523.
2.
Pierorazio PM, Ross AE, Schaeffer EM, Epstein JI, Han M, Walsh PC, Partin AW: A contemporary analysis of outcomes of adenocarcinoma of the prostate with seminal vesicle invasion (pT3b) after radical prostatectomy. J Urol 2011;185:1691-1697.
3.
Pfister D, Bolla M, Briganti A, Carroll P, Cozzarini C, Joniau S, van Poppel H, Roach M, Stephenson A, Wiegel T, Zelefsky MJ: Early salvage radiotherapy following radical prostatectomy. Eur Urol 2014;65:1034-1043.
4.
Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, Forman JD, Zelefsky MJ, Kestin LL, Roehrborn CG, Catton CN, DeWeese TL, Liauw SL, Valicenti RK, Kuban DA, Pollack A: Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 2007;25:2035-2041.
5.
Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, Bernier J, Kuten A, Sternberg C, Gil T, Collette L, Pierart M: Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Eng J Med 1997;337:295-300.
6.
Pilepich MV, Winter K, John MJ, Mesic JB, Sause W, Rubin P, Lawton C, Machtay M, Grignon D: Phase III radiation therapy oncology group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001;50:1243-1252.
7.
Wo JY, Zietman AL: Why does androgen deprivation enhance the results of radiation therapy? Urol Oncol 2008;26:522-529.
8.
Choo R, Danjoux C, Gardner S, Morton G, Szumacher E, Loblaw DA, Cheung P, Pearse M: Efficacy of salvage radiotherapy plus 2-year androgen suppression for postradical prostatectomy patients with PSA relapse. Int J Radiat Oncol Biol Phys 2009;75:983-989.
9.
Katz MS, Zelefsky MJ, Venkatraman ES, Fuks Z, Hummer A, Leibel SA: Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol 2003;21:483-489.
10.
Soto DE, Passarelli MN, Daignault S, Sandler HM: Concurrent androgen deprivation therapy during salvage prostate radiotherapy improves treatment outcomes in high-risk patients. Int J Radiat Oncol Biol Phys 2012;82:1227-1232.
11.
Nejat RJ, Rashid HH, Bagiella E, Katz AE, Benson MC: A prospective analysis of time to normalization of serum testosterone after withdrawal of androgen deprivation therapy. J Urol 2000;164:1891-1894.
12.
Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, Klein E, Michalski J, Roach M, Sartor O, Wolf JS Jr, Faraday MM: Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol 2013;190:441-449.
13.
Song C, Kim YS, Hong JH, Kim CS, Ahn H: Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs androgen deprivation. BJU Int 2010;106:188-193.
14.
Lawton CA, DeSilvio M, Roach M 3rd, Uhl V, Kirsch R, Seider M, Rotman M, Jones C, Asbell S, Valicenti R, Hahn S, Thomas CR Jr: An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 2007;69:646-655.
15.
Morote J, Orsola A, Planas J, Trilla E, Raventos CX, Cecchini L, Catalan R: Redefining clinically significant castration levels in patients with prostate cancer receiving continuous androgen deprivation therapy. J Urol 2007;178:1290-1295.
16.
Anscher MS, Clough R, Dodge R: Radiotherapy for a rising prostate-specific antigen after radical prostatectomy: the first 10 years. Int J Radiat Oncol Biol Phys 2000;48:369-375.
17.
Pisansky TM, Kozelsky TF, Myers RP, Hillman DW, Blute ML, Buskirk SJ, Cheville JC, Ferrigni RG, Schild SE: Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 2000;163:845-850.
18.
Pagliarulo V, Bracarda S, Eisenberger MA, Mottet N, Schröder FH, Sternberg CN, Studer UE: Contemporary role of androgen deprivation therapy for prostate cancer. Eur Urol 2012;61:11-25.
19.
Murthy V, Norman AR, Shahidi M, Parker CC, Horwich A, Huddart RA, Bange A, Dearnaley DP: Recovery of serum testosterone after neoadjuvant androgen deprivation therapy and radical radiotherapy in localized prostate cancer. BJU Int 2006;97:476-479.
20.
Sengupta S, Christensen CM, Zincke H, Slezak JM, Leibovich BC, Bergstralh EJ, Myers RP, Blute ML: Detectable prostate specific antigen between 60 and 120 days following radical prostatectomy for prostate cancer: natural history and prognostic significance. J Urol 2006;176:559-563.
21.
Audenet F, Seringe E, Drouin SJ, Comperat E, Cussenot O, Bitker MO, Rouprêt M: Persistently elevated prostate-specific antigen at six weeks after radical prostatectomy helps in early identification of patients who are likely to recur. World J Urol 2012;30:239-244.
22.
MacDonald OK, Schild SE, Vora S, Andrews PE, Ferrigni RG, Novicki DE, Swanson SK, Wong WW: Salvage radiotherapy for men with isolated rising PSA or locally palpable recurrence after radical prostatectomy: do outcomes differ? Urology 2004;64:760-764.
23.
King CR: The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys 2012;84:104-111.
24.
King CR, Presti JC Jr, Gill H, Brooks J, Hancock SL: Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? Int J Radiat Oncol Biol Phys 2004;59:341-347.
25.
Kwon O, Kim KB, Lee YI, Byun SS, Kim JS, Lee SE, Hong SK: Salvage radiotherapy after radical prostatectomy: prediction of biochemical outcomes. PLoS One 2014;9:e103574.
26.
Parekh A, Chen MH, Graham P, Mahal BA, Hirsch AE, Nakabayashi M, Evan C, Kantoff PW, Martin NE, Nguyen PL: Role of androgen deprivation therapy in early salvage radiation among patients with prostate-specific antigen level of 0.5 or less. Clin Genitourin Cancer 2015;13:e1-e6.
27.
Milecki P, Antczak A, Martenka P, Kwias Z: What is the possible role of PSA doubling time (PSADT) and PSA velocity (PSAV) in the decision-making process to initiate salvage radiotherapy following radical prostatectomy in patients with prostate cancer? Cent Eur J Urol 2011;64:67-70.
28.
Paller CJ, Olatoye D, Xie S, Zhou X, Denmeade SR, Eisenberger MA, Antonarakis ES, Carducci MA, Rosner GL: The effect of the frequency and duration of PSA measurement on PSA doubling time calculations in men with biochemically recurrent prostate cancer. Prostate Cancer Prostatic Dis 2014;17:28-33.
29.
Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ: Long-term outcomes after high-dose postprostatectomy salvage radiation treatment. Int J Radiat Oncol Biol Phys 2012;84:112-118.
30.
Nguyen PL, Alibhai SM, Basaria S, DʼAmico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR: Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2015;67:825-836.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
