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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: December 2017 - Volume 40 - Issue 6 - p 612–620
doi: 10.1097/COC.0000000000000207
Original Articles: Genitourinary

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.

Departments of *Radiation Oncology

Clinical Science

§Urology, University of Texas at Southwestern Medical Center, Dallas

Department of Radiation Oncology, Texas Oncology, Waco, TX

Department of Radiation Oncology, University of Chicago, Chicago, IL

J.Y. and C.J.W. contributed equally.

The authors declare no conflicts of interest.

Reprints: D. Nathan Kim, MD, PhD, Department of Radiation Oncology, Texas Oncology, 1700 W. Highway 6, Waco, TX 76712. E-mail: Nathan.Kim@usoncology.com.

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