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Long-term Outcome of Prostate Cancer Patients Who Exhibit Biochemical Failure Despite Salvage Radiation Therapy After Radical Prostatectomy.

Ying, James BS; Wang, Chiachien J. MD, PhD; Yan, Jingsheng PhD; Liauw, Stanley L. MD; Straka, Christopher MD; Pistenmaa, David MD; Xie, Xian-Jin PhD; Lotan, Yair MD; Roehrborn, Claus MD; Kim, D. Nathan MD, PhD
American Journal of Clinical Oncology: Post Author Corrections: July 9, 2015
doi: 10.1097/COC.0000000000000207
Original Article: PDF Only

Objectives: Salvage radiation therapy (SRT) is an effective treatment for recurrent prostate cancer (PCa) after radical prostatectomy. We report the long-term outcome of men who developed biochemical recurrence (BCR) after SRT and were treated >14 years ago.

Methods: In total, 61 patients treated with SRT from 1992 to 2000 at our institution were identified. Survival was calculated by Kaplan-Meier method. Log-rank test and Cox regression were used to determine significance of clinical parameters.

Results: The median follow-up was 126 months (interquartile range, 66-167 mo). Thirty-four (56%) had prostate-specific antigen (PSA) failure after SRT. At 10 years, overall survival (OS) was 67%, freedom from PSA failure (FFPF) was 33%, prostate cancer-specific survival (PCSS) was 84%, and distant metastases-free survival (DMFS) was 84%. Pathologic T-stage, Gleason score, seminal vesicle involvement, and pre-SRT PSA were associated with FFPF. For patients who failed SRT, the median time to BCR after SRT was 30 mo. A total of 19 (68%) received androgen deprivation therapy. The median OS was 13.6 years. At 10 years from time of BCR, OS was 59%, PCSS was 73%, DMFS was 75%, and castration-resistant-free survival was 70%. Early SRT failure correlated with significantly decreased DMFS and PCSS. Ten-year DMFS from SRT was 43% (BCR<=1 y) versus 91% (BCR>1 y).

Conclusions: Extended follow-up demonstrates that despite SRT failure, PCSS remains high in select patients. Early failure (<=1 y after SRT) predicted for significantly worse outcome and may represent a subgroup with more aggressive disease that may be considered for further prospective clinical studies.

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