Prostate-Specific Antigen Persistence After Radical Prostatectomy as a Predictive Factor of Clinical Relapse-Free Survival and Overall Survival: 10-Year Data of the ARO 96-02 Trial
- Department of Radiation Oncology, University Hospital Ulm (Germany)
- WiSP, Research Institute Pharma GmbH, Langenfeld (Germany)
- Department of Urology, University Hospital Homburg/Saar (Germany)
- Department of Radiation Oncology, University Hospital Homburg/Saar (Germany)
- Department of Urology, University Hospital Münster (Germany)
- Department of Urology, University Hospital Dresden (Germany)
- Department of Pathology, HELIOS Hospital Wuppertal (Germany)
- Department of Radiation Oncology, University Hospital Giessen-Marburg (Germany)
- Department of Urology, University Hospital Giessen-Marburg (Germany)
- Department of Radiation Oncology, General Hospital Fulda (Germany)
- Department of Urology, General Hospital Fulda (Germany)
- Department of Radiation Oncology, University Hospital Berlin (Germany)
- Department of Urology, University Hospital Berlin (Germany)
Objective: The ARO 96-02 trial primarily compared wait-and-see (WS, arm A) with adjuvant radiation therapy (ART, arm B) in prostate cancer patients who achieved an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP). Here, we report the outcome with up to 12 years of follow-up of patients who retained a post-RP detectable PSA and received salvage radiation therapy (SRT, arm C). Methods and Materials: For the study, 388 patients with pT3-4pN0 prostate cancer with positive or negative surgical margins were recruited. After RP, 307 men achieved an undetectable PSA (arms A + B). In 78 patients the PSA remained above thresholds (median 0.6, range 0.05-5.6 ng/mL). Of the latter, 74 consented to receive 66 Gy to the prostate bed, and SRT was applied at a median of 86 days after RP. Clinical relapse-free survival, metastasis-free survival, and overall survival were determined by the Kaplan-Meier method. Results: Patients with persisting PSA after RP had higher preoperative PSA values, higher tumor stages, higher Gleason scores, and more positive surgical margins than did patients in arms A + B. For the 74 patients, the 10-year clinical relapse-free survival rate was 63%. Forty-three men had hormone therapy; 12 experienced distant metastases; 23 patients died. Compared with men who did achieve an undetectable PSA, the arm-C patients fared significantly worse, with a 10-year metastasis-free survival of 67% versus 83% and overall survival of 68% versus 84%, respectively. In Cox regression analysis, Gleason score ≥8 (hazard ratio [HR] 2.8), pT ≥ 3c (HR 2.4), and extraprostatic extension ≥2 mm (HR 3.6) were unfavorable risk factors of progression. Conclusions: A persisting PSA after prostatectomy seems to be an important prognosticator of clinical progression for pT3 tumors. It correlates with a higher rate of distant metastases and with worse overall survival. A larger prospective study is required to determine which patient subgroups will benefit most from which treatment option.
- OSTI ID:
- 22458594
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 91, Issue 2; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
Similar Records
Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment
Achieving an Undetectable PSA After Radiotherapy for Biochemical Progression After Radical Prostatectomy Is an Independent Predictor of Biochemical Outcome-Results of a Retrospective Study