Salvage radiotherapy after prostatectomy for prostate cancer – pro

Approximately 30 000 men annually in the United States will have recurrence of prostate cancer after radical prostatectomy. Initially, for most of these patients the only evidence of recurrent disease is an increasing serum prostate-specific antigen (PSA) level without radiographic or physical evidence of disease. An estimated 65% of these men will develop bone metastases within 10 years in the absence of salvage therapy.2 A rapid PSA doubling time (PSADT), high-grade disease, and a short disease-free interval after radical prostatectomy are prognostic factors associated with the development of metastases in untreated patients with an increasing PSA level.
In contrast with the results of primary radiotherapy for localized prostate cancer,8-9 the reported success rates of salvage radiotherapy range between 10% and 50%, suggesting that the majority of unselected patients with an increasing PSA level have occult metastases and do not benefit from salvage radiotherapy; however, it remains the standard of care after aoccult distant mets have been ruled out. As such, raditoherapy for salvage is medically necessary.

Andrew J. Stephenson, MD; Shahrokh F. Shariat, MD; Michael J. Zelefsky, MD; Michael W. Kattan, PhD; E. Brian Butler, MD; Bin S. Teh, MD; Eric A. Klein, MD; Patrick A. Kupelian, MD; Claus G. Roehrborn, MD; David A. Pistenmaa, MD; Heather D. Pacholke, MD; Stanley L. Liauw, MD; Matthew S. Katz, MD; Steven A. Leibel, MD; Peter T. Scardino, MD; Kevin M. Slawin, MD
Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy
JAMA. 2004;291:1325-1332.

Mitchell S. Anscher Salvage Radiotherapy for Recurrent Prostate Cancer: The Earlier the Better
JAMA. 2004;291(11):1380-1382., prostate cancer

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