Dual-timing PSA as a biomarker for patients with salvage intensity modulated radiation therapy for biochemical failure after radical prostatectomy
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Yu-Jen Wang1, Chao-Yuan Huang3, Wei-Hsien Hou2, Chia-Chun Wang2, Keng-Hsueh Lan2, Hong-Jen Yu3, Ming-Kuen Lai3, Shihh-Ping Liu3, Yeong-Shau Pu3 Jason Chia-Hsien Cheng2,4,5
1Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
2Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
3Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
4Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
5Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
Jason Chia-Hsien Cheng, email: firstname.lastname@example.org
Yeong-Shau Pu, email: email@example.com
Keywords: prostate cancer, radical prostatectomy, biochemical failure, intensity modulated radiation therapy
Received: December 24, 2015 Accepted: May 04, 2016 Published: June 14, 2016
We investigated the outcomes and the associated clinical-pathological factors in patients with prostate cancer (PCa) undergoing salvage intensity modulated radiation therapy (IMRT) for post-radical-prostatectomy (RP) biochemical failure. We report clinical outcomes of post-RP salvage IMRT, and describe chronic toxicity in these patients.
Fifty patients with PCa underwent post-RP salvage IMRT. The median dose of IMRT was 70 Gy to the prostatic and seminal vesicle bed. Clinical-pathological and toxicity information were collected. The prostate cancer-specific survival (PCSS), disease-free survival (DFS), and biochemical-failure-free survival (BFFS) were calculated. Prognostic factors were analyzed for their association with disease control.
The median follow-up time was 74 months. The 5-year PCSS, DFS, and BFFS after salvage IMRT were 95%, 88%, and 60%, respectively. Two patients (4%) experienced late gastrointestinal toxicity ≥ grade 3, and 5 patients (10%) had late genitourinary toxicity ≥ grade 3. On multivariate analysis, post-RP prostate-specific antigen (PSA) nadir ≤0.1 ng/ml (P=0.018) and PSA ≤0.5 ng/ml at salvage IMRT (P=0.016) were independent factors predicting better BFFS. Patients with both post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT had a 5-year BFFS of 83% as compared with 43% in other patients (P=0.001).
In conclusion, with hormonal therapy in most PCa patients, the addition of salvage IMRT for post-RP biochemical failure can achieve a good outcome with low toxicity. Patients with a post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT could benefit the most from salvage IMRT.
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