Main Session
Sep
30
PQA 07 - Genitourinary Cancer, Patient Safety, Nursing/Supportive Care
3354 - Comparison of Patients with Early Salvage Radiotherapy and Low PSA Levels (Pre-SRT-PSA = 0.3 ng/ml) - A Retrospective Analysis of Patients with Persisting or Increasing PSA after Radical Prostatectomy for Prostate Cancer
Presenter(s)
Thomas Wiegel, MD - University Hospital Ulm, Ulm, Baden-Wuerttembe
R. Thamm1, S. Scharl1, L. Gartner1, D. Böhmer2, A. Siegmann2, D. Zips2, C. Horsch3, B. Mayer3, and T. Wiegel1; 1Ulm University Hospital, Clinic for Radiotherapy and Radiooncology, Ulm, Germany, 2Charité University Hospital, Department of Radiation Oncology and Radiotherapy, Berlin, Germany, 3Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
Purpose/Objective(s):
The European Association of Urology EAU guidelines give a “weak” recommendation to add hormonal therapy (ADT) to Salvage Radiotherapy (SRT) to improve the prognosis for all patients with persisting PSA Values after radical prostatectomy (RP) for prostate cancer (PCa). This work focuses on oncological outcome parameters of patients with low pre-SRT-PSA Values = 0.3 ng/ml. It retrospectively compares subgroups with persistent PSA and PSA recurrences after RP.Materials/Methods:
In a retrospective cohort of 698 patients with SRT (median dose 70.2 Gy, IQR 66.6 - 72.2) to the prostate bed without ADT, 243 patients with PSA increase from undetectable levels (post-OP-PSA = 0.05 ng/ml and pre-SRT-PSA = 0.3 ng/ml) and 110 patients with persisting PSA after RP (post-OP-PSA > 0.05 ng/ml and pre-SRT-PSA = 0.3 ng/ml) were identified. Primary endpoints were biochemical (BPFS) or clinical progression-free survival (PFS), metastases-free survival (MFS), and overall survival (OS). Statistical methods were the log-rank test (Kaplan-Meier) for survival analysis and Cox proportional hazards regression for uni- and multivariate analysis.Results:
With a median follow-up of 60 months (IQR 27 - 94 months), the BPFS of the patients with low persistent and recurrent PSA was 66.4% and 71.6% (p=0.253), respectively. There was a trend to lower PFS in patients with PSA persistence (72.0% vs. 79.4%, p=0.099). No significant difference was seen in MFS (98.8% vs. 96.6%, p=0.319) and OS (96.9% vs. 97.5%, p=0.505). In the univariate and multivariate analysis, T-Status (T3a, b, T4) and Gleason Grade (GG 4-5) predicted biochemical progression. The T-Status, R-Status (R1,2), and Gleason Grade influenced PFS. MFS and OS were predicted only by Gleason Grade and T-Status, respectively. In the multivariate analysis, PSA persistence was not a predictor for BPFS (p=0.486), PFS (p=0.641), MFS (p=0.237), or OS (p=0.278).Conclusion:
To our best knowledge, this is the first evaluation to show that patients with low values of persisting PSA (post-RP-PSA > 0,05 ng/ml) seem to have a comparable good prognosis as patients with PSA increase out of the undetectable level when the pre-SRT-PSA is = 0.3 ng/ml. Prospective trials are needed to confirm these results.