Early radiation therapy in men with recurrent prostate cancer after surgery

The authors aimed to determine patients who would benefit from early salvage radiation therapy (SRT) after prostate surgery.

The authors concluded that early SRT is only beneficial for selected patients who experience cancer recurrence after prostate surgery. 

Prostate surgery is a common prostate cancer treatment. This involves surgical removal of the prostate gland. Following prostate surgery, there is a risk that the cancer can come back (recurrence). A biochemical recurrence refers to a rise in prostate specific antigen (PSA) level. PSA is a protein elevated in the blood in the presence of prostate cancer.

Radiation therapy is another form of prostate cancer treatment. It involves targeting beams of radiation at the tumor site to kill cancer cells. SRT is recommended in men with increased PSA levels after prostate surgery. It is the only treatment that can provide a definitive cure for prostate cancer recurrence, however, this is dependent on the PSA level at the time of treatment.

Studies have shown that early SRT has been associated with increases in biochemical-free survival (time after treatment where there is no increase in PSA). It has also been shown to improve metastasis-free survival (time from treatment where there was no cancer progression) and cancer-specific survival (patients who did not die from cancer following treatment). However, it is not clear whether SRT is beneficial for all patients.

The aim of this study was to determine the benefit of early SRT after prostate surgery.

925 men were included in this study. All participants were treated with SRT either due to biochemical recurrence or to continuing PSA after prostate surgery. The average follow-up time was 8 years.

Metastasis-free survival was 86% at 8 years. PSA level at SRT was a significant predictor of distant tumors after SRT.

There was a significant decrease in metastasis-free survival by PSA level in low, intermediate and high-risk prostate cancer groups. Low-risk was identified as undetectable PSA after surgery, stage 3 disease, and a Gleason score (measure of cancer aggressiveness) of 7 or less. High-risk was identified as PSA persistence after surgery and a Gleason score of 7 or less. In all three groups, early SRT was associated with improved cancer control. Early SRT was not associated with improvments in men with very low or very high risk disease.

The authors concluded that early SRT is only beneficial for selected patients who experience cancer recurrence after prostate surgery.