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Author Wiegel, Thomas ♦ Bartkowiak, Detlef ♦ Bottke, Dirk ♦ Thamm, Reinhard ♦ Hinke, Axel ♦ Stöckle, Michael ♦ Rübe, Christian ♦ Semjonow, Axel ♦ Wirth, Manfred ♦ Störkel, Stephan ♦ Golz, Reinhard ♦ Engenhart-Cabillic, Rita ♦ Hofmann, Rainer ♦ Feldmann, Horst-Jürgen ♦ Kälble, Tilman ♦ Siegmann, Alessandra ♦ Hinkelbein, Wolfgang ♦ Steiner, Ursula ♦ Miller, Kurt
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ ANTIGENS ♦ COMPARATIVE EVALUATIONS ♦ HAZARDS ♦ HORMONES ♦ METASTASES ♦ NEOPLASMS ♦ PATIENTS ♦ PROSTATE ♦ RADIOTHERAPY ♦ REGRESSION ANALYSIS ♦ SURGERY
Abstract Objective: The ARO 96-02 trial primarily compared wait-and-see (WS, arm A) with adjuvant radiation therapy (ART, arm B) in prostate cancer patients who achieved an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP). Here, we report the outcome with up to 12 years of follow-up of patients who retained a post-RP detectable PSA and received salvage radiation therapy (SRT, arm C). Methods and Materials: For the study, 388 patients with pT3-4pN0 prostate cancer with positive or negative surgical margins were recruited. After RP, 307 men achieved an undetectable PSA (arms A + B). In 78 patients the PSA remained above thresholds (median 0.6, range 0.05-5.6 ng/mL). Of the latter, 74 consented to receive 66 Gy to the prostate bed, and SRT was applied at a median of 86 days after RP. Clinical relapse-free survival, metastasis-free survival, and overall survival were determined by the Kaplan-Meier method. Results: Patients with persisting PSA after RP had higher preoperative PSA values, higher tumor stages, higher Gleason scores, and more positive surgical margins than did patients in arms A + B. For the 74 patients, the 10-year clinical relapse-free survival rate was 63%. Forty-three men had hormone therapy; 12 experienced distant metastases; 23 patients died. Compared with men who did achieve an undetectable PSA, the arm-C patients fared significantly worse, with a 10-year metastasis-free survival of 67% versus 83% and overall survival of 68% versus 84%, respectively. In Cox regression analysis, Gleason score ≥8 (hazard ratio [HR] 2.8), pT ≥ 3c (HR 2.4), and extraprostatic extension ≥2 mm (HR 3.6) were unfavorable risk factors of progression. Conclusions: A persisting PSA after prostatectomy seems to be an important prognosticator of clinical progression for pT3 tumors. It correlates with a higher rate of distant metastases and with worse overall survival. A larger prospective study is required to determine which patient subgroups will benefit most from which treatment option.
ISSN 03603016
Educational Use Research
Learning Resource Type Article
Publisher Date 2015-02-01
Publisher Place United States
Journal International Journal of Radiation Oncology, Biology and Physics
Volume Number 91
Issue Number 2


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