Evaluating the effectiveness and safety of salvage radiotherapy combined with hormone therapy in patients with biochemical recurrence of prostate cancer after prostate surgery.

This study evaluated the effectiveness and safety of salvage radiotherapy (RT) combined with hormone therapy in patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP; prostate removal surgery). This study found that salvage RT combined with hormone therapy was more effective than salvage RT alone, with manageable side effects, in these patients.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiotherapy (RT), and/or hormone therapy. Men with PCa usually have high levels of prostate-specific antigen (PSA). PSA is a protein made by the cells of the prostate gland. PSA levels usually go down after successful treatment for PCa. Another treatment option is hormone therapy such as androgen deprivation therapy (ADT). ADT reduces the production of androgens (male sex hormones such as testosterone). Reducing these androgens prevents cancer cell growth.

Radical prostatectomy (RP) surgically removes the prostate and the surrounding tissues in patients with PCa. Almost 15-40% of men who undergo RP as a treatment for PCa experience biochemical recurrence (BCR). BCR means an increase of 0.2 ng/ml from the lowest value of the PSA after treatment with surgery. Salvage RT is usually performed after RP to prevent BCR. Whether adding hormone therapy to salvage RT in patients after RP is safe and effective in preventing BCR is still unknown. 

This study analyzed 4 other studies and involved 2731 patients with BCR of PCa after RP. Patients were divided into two groups. Group 1 included 1374 patients who were treated with salvage RT plus hormone therapy. Group 2 included 1357 patients who were treated with salvage RT alone.

Patients in group 1 were 17% more likely to have a better overall survival than patients in group 2. This difference was not considered to be statistically significant.

Patients in group 1 were 48% more likely to survive without BCR or cancer worsening than patients in group 2. This difference was statistically significant.

Patients in group 1 were 25% more likely to survive without metastasis (cancer spread to other organs) than patients in group 2. This difference was statistically significant.

At early follow-up, the risk of early serious side effects was similar in the two groups. At later follow-up, the risk of late serious side effects was higher in group 1 (by 33%) than patients in group 2.

This study concluded that salvage RT combined with hormone therapy was more effective than salvage RT alone with manageable side effects in patients with BCR of PCa after RP.

This study looked back in time at medical records. The number of studies analyzed was very small. The follow-up period in these studies was too short. There were some differences in the definitions of BCR before and after treatment in the studies analyzed.