There is exciting news out of the 2008 Genitourinary Cancers Symposium in San Francisco. An abstract (American Society of Clinical Oncology 2008 Genitourinary Cancers Symposium (GCS): Abstract 85) presented at the conference described a retrospective study that strongly suggests that salvage radiotherapy reduced the risk of dying from prostate cancer by more than 60% for men with a rising prostate specific antigen (PSA) level following radical prostatectomy. Even more noteworthy is that the advantages seem to persist even when the therapy is administered up to 2 years after PSA levels began to rise.
According to the lead author of the study, Bruce Trock, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, “These findings are the first to support the effectiveness of salvage radiotherapy for improving survival in men with recurrent prostate cancer,”
Since this study was a retrospective analysis additional follow-up studies are required to confirm its conclusions. Dr. Trock added, “If validated, these results suggest that, for high-risk prostate cancer, radiotherapy should be given promptly when there is evidence of recurrence after radical prostatectomy, as early salvage radiotherapy may improve overall survival.”
In this analysis the researchers compared prostate cancer survival among men who experienced a biochemical recurrence. One hundred sixty (160) men received salvage radiotherapy alone, 78 received radiation plus hormonal therapy, and 397 had no radiation or hormonal therapy.
After 10 years, 86% of men in the salvage radiotherapy group and 82% of men in the radiation with hormonal therapy group had not died from prostate cancer. The prostate cancer survival rate for the men who did not receive salvage therapy was only 62%. What is even more convincing is that after taking into account individual patient characteristics associated with prognosis these results did not change.
The study did note that the more aggressive the disease, the more significant the effect on the survival rate. In the cases where PSA levels doubled in less than 6 months the radiation treatments reduced the risk for prostate cancer death by 86%. When PSA doubling rates were longer then six months the radiation therapy did not significantly reduce the risk for death. This suggests that patients with less aggressive disease may have done as well even without radiation.
If you have experienced a PSA recurrence after surgery, are less then two years from the recurrence and have a PSA doubling time under 6 months you should speak with your oncologist about the possibility of having salvage radiation.
Joel T Nowak MA, MSW