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Men who have a prostate cancer recurrence after radical prostatectomy may benefit from early salvage radiation therapy, according to results of a retrospective cohort analysis.

Men who have a prostate cancer recurrence after radical prostatectomy may benefit from early salvage radiation therapy, according to results of a retrospective cohort analysis. This strategy is most beneficial to patients with a PSA doubling time of less than six months, Dr. Bruce T. Trock and colleagues report in the Journal of the American Medical Association for June 18.

"Our study provides the first evidence that salvage radiotherapy can improve survival," Dr. Trock said in comments to Reuters Health.

Recent research has raised the question of whether patients with advanced prostate cancer should undergo adjuvant therapy immediately after surgery, or if it should be put off until after relapse to avoid over-treating patients who do not progress.

To answer this question, Dr. Trock of Johns Hopkins School of Medicine in Baltimore and colleagues analyzed the outcome of 635 men who underwent radical prostatectomy for clinically localized prostate cancer between 1982 and 2004 and subsequently relapsed. One hundred sixty men received salvage radiotherapy; 78 received salvage radiotherapy plus hormonal therapy; and 397 were not given any salvage treatment.

Salvage radiotherapy was associated with a three-fold increase in prostate cancer-specific survival compared with those not given salvage therapy (p < 0.001), the authors report. Hormone therapy did not significantly affect outcomes.

The survival advantage was confined to patients treated within two years of relapse and who had a PSA doubling time less than six months. Men whose PSA never dropped below undetectable levels did not benefit from salvage therapy.

"Men with a PSA doubling time of more than six months had a better prognosis already - their survival at ten years was 75 per cent without any salvage treatment - so adding salvage radiation didn't improve their survival much," Dr. Trock explained. However, "men whose PSA never became undetectable after salvage radiation are likely to have had tumor that had already spread to other parts of the body, so radiation did not significantly improve their survival."

"Our results suggest that salvage radiation may be appropriate for those men with rapidly growing tumors who previously may not have been considered for such therapy," he said.
The researcher cautioned, however, that their study was not a randomized trial, so their results need to be considered as provisional. "Physicians need to weigh the pros and cons of salvage radiation, as well as the nature of prostate cancer in each individual patient," he concluded.

JAMA 2008;299:2760-2769