Radiation for Cancer Recurrence after Radical
Prostatectomy Shows Increased Survival
Provocative evidence that even men with adverse
prognostic features may benefit from salvage radiotherapy
June 17, 2008 - Preliminary findings indicate that
for men who underwent radical prostatectomy, radiation treatment after
prostate cancer recurrence was associated with an increase in prostate
cancer-related survival, according to a study in the June 18 issue of
the Journal of the American Medical Association.
“Nearly 60,000 men (27% of newly diagnosed cases)
will have undergone radical prostatectomy in 2007. Although surgery
provides excellent cancer control, approximately 15 percent to 40
percent of these men will experience cancer recurrence within 5 years,
usually manifested only by elevated prostate-specific antigen (PSA)
level,” the authors note.
For such men there has been a question whether
salvage radiotherapy (radiation treatment given after recurrence of
cancer) offers a survival benefit compared with observation alone.
A study to determine the association between
salvage radiotherapy and prostate cancer–specific survival was conducted
by Bruce J. Trock, Ph.D., of the Johns Hopkins University School of
Medicine, Baltimore, and colleagues.
The study included 635 men who underwent radical
prostatectomy from 1982-2004, were followed up through December 2007,
and who experienced biochemical recurrence (increased PSA levels) and/or
local cancer recurrence and received either no salvage treatment (397
men), salvage radiotherapy alone (160 men), or salvage radiotherapy
combined with hormonal therapy (78 men).
With a median (midpoint) follow-up of 6 years after
recurrence and 9 years after prostatectomy, 116 men (18 percent) died
from prostate cancer, including
● 89 (22 percent) who received no salvage treatment,
● 18 (11 percent) who received salvage radiotherapy alone, and
● 9 (12 percent) who received salvage radiotherapy and hormonal
therapy.
The researchers found that salvage radiotherapy,
regardless of whether given alone or with hormonal therapy, was
associated with a statistically significant decrease in the risk of
death of nearly 60 percent and a 3-fold increase in prostate
cancer–specific survival relative to those who received no salvage
treatment.
Salvage radiotherapy was also associated with a
significant increase in overall survival.
The increase in prostate cancer–specific survival
associated with salvage radiotherapy was limited to men with PSA
doubling time (a measurement of how aggressive the disease is) of less
than 6 months.
Among 166 men (26%) with PSA doubling time of less
than 6 months, salvage radiotherapy alone and salvage therapy with
hormonal treatment were associated with a reduction in risk of prostate
cancer–specific death by more than 75 percent.
Salvage radiotherapy was associated with an
increase in survival only if given sooner than 2 years after recurrence.
Men whose PSA level never became undetectable after
salvage radiotherapy did not experience a significant increase in
prostate cancer–specific survival.
“This study provides provocative evidence that even
men with adverse prognostic features such as rapid PSA doubling time or
high Gleason score [a grading system for prostate cancer] may benefit
from salvage radiotherapy,” the authors write.
“...our data provide the first evidence (albeit
retrospective and hence, provisional) that early salvage radiotherapy is
associated with improved prostate cancer–specific survival, and the
magnitude of the survival benefit is similar to that observed in
adjuvant [supplemental] radiotherapy trials.
"These data suggest that men for whom salvage
radiotherapy is most beneficial are those with a PSA doubling time of
less than 6 months, who also undergo treatment within 2 years of an
increase in PSA level. If validated in other settings, these results
could motivate a clinical trial comparing adjuvant with salvage
radiotherapy, with prostate cancer–specific survival and overall
survival as the primary end points.”
Links to more SeniorJournal.com reports on
Prostate Cancer:
June 17, 2008 - Preliminary findings indicate that
for men who underwent radical prostatectomy, radiation treatment after
prostate cancer recurrence was associated with an increase in prostate
cancer-related survival, according to a study in the June 18 issue of
the Journal of the American Medical Association. 