ORIGINAL
PAPER
Salvage radiotherapy following radical prostatectomy: Long term oncological and functional outcomes (median 96 months) in 108 patients Pietro Pepe 1, Marinella Tamburo 2, Michele Pennisi 1, Dario Marletta 2, Francesco Marletta 2. 1 2
Azienda Ospedaliera Cannizzaro, Urology Unit; Azienda Ospedaliera Cannizzaro, Radiotherapy Unit.
Introduction. To evaluate oncological and functional outcomes in men submitted to salvage radiotherapy (sRT) following radical retropubic prostatectomy (RRP). Materials and Methods. In the years 2003-2020, 108 patients received sRT because biochemical recurrence (BCR) defined as 2 consecutive prostate specific antigen (PSA) values than 0.2 ng/ml and rising after RRP (median 49 months). All patients have been treated up to 66.0-70.4 Gy with single dose of 1.8-2.0 Gy fractions. Predictive factors were analyzed to evaluate prostate specific antigen (PSA) and clinical response to radiotherapy. Results. Median follow-up after sRT was 96 months (12-204 months); 54/108 (54.7%) men had PSA response (PSA value < 0.2 ng/ml), conversely 49/108 (45.3%) demonstrated BCR during follow up. Clinical stage (pT2 vs > pT3), pathological ISUP Grading Group (GG < 3 vs GG > 4), pre-radiotherapy median PSA value (0.55 vs 1.83 ng/ml) and pathological node-involvement were highly predictive for BCR (p < 0.05). Clinical complications following sRT were characterized by late gastrointestinal (GI) and genitourinary toxicity (GU) in 9 (9.5%) and 12 cases (11.8%), respectively. Conclusions. Salvage RT following RP constitutes a curative therapy in about 50% of the cases with a low rate of GI (9.5%) and GU (11.8%) late complications. The oncological outcome is correlated with pathological stage, ISUP Grade Group, node-involvement and pre-sRT PSA value.
SUMMARY
KEY WORDS: Prostate cancer; salvage radiotherapy and prostate cancer; oncological outcome and radical prostatectomy.
INTRODUCTION Salvage radiation therapy (sRT) is considered the most common treatment option employed in case of biochemical recurrence (BCR) after radical prostatectomy (RP) and its effectiveness dependent on the PSA level at the time of treatment (1, 2). Many studies have shown that early sRT at a PSA level < 0.5 ng/ml (2) has been associated with improved BCR, metastasis-free survival, and cancer-specific survival (3). The potential benefit of sRT must be weighed against the potential deleterious effect on functional outcomes, particularly, erectile function, urinary continence (4), and bowel disease; in fact sRT affect long term continence and toxicity irrespective of time of initiation for RT (5, 6). Additionally, a considerable proportion of patients treated with post-surgery radiotherapy may experience early and late high-grade toxicity (7). The impact of sRT on the biochemical control varies according to the clinical and pathological features of patients; moreover, in the presence of unfavorable risk factors multimodal treatment is highly recommended (8).
In this study, we report long term functional and oncological outocomes in men submitted to sRT following radical retropubic prostatectomy (RRP).
MATERIALS
AND METHODS
In the years 2003-2020, 108 patients received sRT following RRP (9-11) because BCR defined as 2 consecutive PSA values than 0.2 ng/ml and rising (1). Nobody had suspicious rectal examination, in addition median number of nodes removed by surgery was equal to 12 (range: 3-27 nodes). Overall, median PSA value before starting sRT was 0.68 ng/ml (range: 0.17-4.2 ng/ml). All the patients with PSA value > 1 ng/ml underwent diagnostic imaging (lungabdominal CT or, in the last five years, choline PET-CT scan); none of the patients showed any clinical evidence of distant metastases before they received sRT. On the contrary, in the presence of PSA value below 1 ng/ml the patients underwent sRT without any imaging evaluation. Advances in Urological Diagnosis and Imaging - 2021; 4,1
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