Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: a single institution experience

Between 1990 and 2003, 59 patients underwent RT for PSA recurrence after radical prostatectomy. Patients received a median of 66 Gy to the prostate bed with 3D or 2D RT. The main end point was biochemical failure after salvage RT, defined as an increase of the serum PSA value >0.2 ng/ml confirmed by a second elevation.Median follow-up was 38 months. The 3-year and 5-year bDFS rates were 56.1% and 41.2% respectively. According to multivariate analysis, only preRT PSA ≥1 ng/ml was associated with biochemical relapse.When delivered early, RT is an effective treatment after radical prostatectomy. Only preRT PSA ≥1 ng/ml predicted relapse.In Europe, the estimated incidence of prostate cancer is 238,000 new cases with 85,000 deaths per year [1]. Radical prostatectomy is the most widely used treatment for localized prostate cancer. Unfortunately, local recurrences occur in up to one-third of the patients by 5 years after surgery. It is generally accepted that 30% (27–32%) of all patients by 10 years after surgery suffer biochemical relapse, defined as increasing serum prostate-specific antigen (PSA) levels >0.2 ng/ml [2,3]. PSA relapse exposes to a 34% risk of metastatic disease at 5 years. After metastatic relapse, median survival is 5 years [4]."Salvage" radiotherapy (RT) to the prostate bed for biochemical relapse achieved biochemical control in 10–66% of the patients at 5 years [5,6]. PSA failure after prostatectomy could reflect local relapse or metastatic disease. At present, modern imaging techniques lack the sensitivity to differentiate between these two types of relapse. Identification of the best candidates for RT should be based on factors predictive for local relapse. Numbers of positive margins, low Gleason score and/or long PSA-doubling time have been proposed to select patients for RT, but they are still discussed [7].In this study, we evaluated RT efficacy and determine prognostic factors identifying patients who may benefit from salvage RT.We reviewed the