There was a recent Norwegian study which reviewed the impact of salvage external beam radiotherapy (EBRT) on post-prostatectomy patients. They evaluated long-term follow-up on biochemical-free recurrence (PSA only recurrence) (BFR) and metastatic-free survival. He study also described the pathological and clinical predictors of outcome.

The study was conducted between 1987–2010. It included 76 men with failed surgery and with biochemical and clinical recurrence who received salvage EBRT.

The men were treated with conformal EBRT with 68 (90%) receiving a dose of 70 Gy; eight me (10%) received a dose of 60–64 Gy. None of the men received adjuvant or neoadjuvant androgen deprivation therapy (ADT) in conjunction with salvage EBRT.

The median follow-up time after salvage EBRT was 82 months (range 5–192 months). Seventeen men (22%) developed biochemical recurrence subsequent to post-prostatectomy salvage EBRT during the observation time, and the overall 50 and 75 month actuarial BFR rates after salvage EBRT were 84% and 79%, respectively. Seven men (9%) developed metastatic disease and two men died of prostate cancer.

The researchers found that the independent predictors of biochemical recurrence were seminal vesicle invasion (SVI) in the prostatectomy specimen and prostate-specific antigen doubling time (PSADT) of 6 months or less before having the salvage EBRT.

The study concluded that salvage EBRT does provide effective long-term biochemical free recurrence and metastatic-free survival in a selected group of men with detectable, rising prostate-specific antigen values following radical prostatectomy. SVI and PSADT are good prognostic variables for a non-durable response to salvage EBRT and thus predictors of high-risk prostate cancer in patients in whom neo-adjuvant and adjuvant androgen deprivation therapy should be considered.

Translation: If you have a PSA doubling time longer than 6 months and if you did not have seminal vesicle invasion at the time of surgery you might wish to consider salvage EBRT. Men with a PSA doubling time less than 6 months or having had seminal vesicle invasion at surgery are not a good candidates for salvage EBRT.

Einar Servoll, Thorstein Saeter, Ljiljana Vlatkovic, Jan M. Nesland, Gudmund Waaler, and Karol Axcrona

Joel T Nowak, M.A., M.S.W.